Varun Gopinath contributed the following reflection on his experience working with underserved populations as a second-year College of Medicine student in the Northeast Ohio Medical University-Cleveland State University Partnership for Urban Health.
The Partnership is an urban primary care pathway that immerses students in a multidisciplinary approach to medical education. One of the programmatic features is to experientially learn through the HomeHealth clinic, which allows first- and second-year medicine students to directly work with underserved populations prior to their clinical years.
HomeHealth allowed me to participate in patient health care delivery while being directed by a primary care physician in real-life settings. Instead of being in a sanitized clinic with white walls and fluorescent lighting, I found myself in people’s homes or within the crammed hallways of a homeless center. No white coats are allowed, and students truly meet patients where they are. The program gives students a chance to leave their ivory towers and walk with some of our most vulnerable fellow community members.
On one memorable HomeHealth visit, I saw many men and some women heading towards the nearby homeless center. It was early on a winter morning, and my intuition told me that many these unhoused people had recently been sent out from other shelters, so now they were moving on to this one for a warm place to stay during the day. [Note: I use the term “unhoused” instead of the often-used “homeless” as a way to give back agency to those that currently do not have a home. Those that are unhoused still have a home in the greater community we all reside in, while those that are homeless are looked down upon and are viewed as less.] Possibly they would also have access to other resources, like SNAP benefits, medical care and job placement.
I realized then that by participating in the student HomeHealth clinic, I played a part in delivering one of those fundamental resources.
In total, I saw three patients during our time at the center – two male and one female. I tried to talk with them on their own terms and see how I could help. As I am only a medical student, I knew that the best thing I could do was be someone who could hear them out rather than try to make a diagnosis. Hearing how difficult their lives are, I tried to be a listening ear more than anything else.
One patient was worried about how her current poor nutrition (related to losing her home) could affect her health. I checked her vital signs and made sure there wasn’t anything out of the ordinary when conducting her physical. Most important, I probed to why she was at the center and how she had gotten to be in front of me that day. I genuinely wanted to hear her story and make sure she felt an authentic connection instead of feeling like another case.
While the experience gave me an opportunity to utilize my medical knowledge with patients, it was above all an opportunity to renew my commitment to those in need. Too often in medical school, I find myself getting lost in studying for exams and forgetting why I even decided to go into medicine. When talking to patients, I realize that I’m studying and working hard for them – and to be someone that listens and walks with them. It is this aspect of medicine that I am most drawn to. The patient is the reason I continue on this long and arduous path.
The experiential learning opportunity of HomeHealth allowed me to observe some semblance of the inequalities that are seen in society. By working with those that are unhoused, you see the world in a new paradigm.
Why do some people have nothing while others have more than they will ever need?
What sort of systemic issues does a homeless population expose about what we as Americans value in society? This social justice aspect of medicine is something I value as an opportunity to keep my eyes open to the world around me. Medicine and health do not exist in a vacuum. They are inextricably intertwined with the socioeconomic factors and environment.
Rather than being the white coat that divides us from our patients, the HomeHealth program allows students like me to shed a symbolic barrier within healthcare. If we can experience our patients’ humanity, we are one step closer to achieving health equity.