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Health care for the poor

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On a Thursday evening in December 2010, two dozen medicine, nursing and pharmacy students decide to meet up. Their destination is less than obvious, though. They aren’t hunkering down behind library stacks or studying in a coffee shop nook or celebrating another semester closer to graduation. Rather, they’re staffing MedZou, a student-run clinic that provides free care for uninsured Boone County residents.

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Since opening in October 2008, MedZou volunteers have served more than 400 patients. David Atashroo, BS ’06, MD ’10, of Lexington, Ky., pushed for a student clinic after he and his classmates found that 53 percent of Columbia’s emergency room patients had difficulties obtaining medical care, largely because of costs. On top of that, the city’s Family Health Center, which serves low-income families, had a four-month waiting list.

MedZou helps bridge that gap by providing primary care to about 10 to 15 patients each Thursday. Although licensed physicians advise volunteers and provide final diagnoses, students take care of everything else. Each year, four first-year medical students take the lead as clinic directors. They handle the scheduling, finances, volunteers, fundraising and community partnerships.

“I have learned so much about the health care system that I would not have been exposed to at a typical clinic,” says Whitney Beck, BS, BA ’07, of Ballwin, Mo., who was serving as a clinic co-director in December. “It’s really been eye-opening to see that such a disparity really exists in Columbia.”

Before appointments begin at 5 p.m., students convert donated space in the Central Missouri Community Action facility, 800 N. Providence Road, into a makeshift clinic. Hallways become patient waiting areas. Storage closets morph into exam rooms. A printer sits atop a mini-fridge, and a paper MedZou sign is taped to the reception desk.

In the hall, James Shells waits patiently. A St. Louis native, he worked for the Salvation Army in Newton, Iowa, before he “fell down on his luck” and returned to old drinking habits. In August 2010, he moved to Columbia to enroll in Phoenix Programs, a substance-abuse recovery facility. After treatment, Shells found himself unemployed and uninsured in an unfamiliar city.

“They care about people, or they wouldn’t be here. They still treat us top of the line, as if we are somebody.”

“Right now I’m just taking it one day at a time and trying to stay clean,” says Shells, who has started building a support system by attending Woodcrest church.

From his backpack, he pulls out an issue of Preaching Magazine, which helps him pass the time; on average, patients spend two hours at MedZou.

But Shells knows the drill and doesn’t mind the wait. He speaks with a pharmacy student about the medication he’s taking. Two medical students interview him about his medical history and conduct his physical examination. The students meet privately with a physician and propose a diagnosis and treatment plan. The physician makes the final decisions, while advising the students, and together they meet with Shells. It’s a lot of shuffling, but Shells thinks MedZou sets itself apart by offering compassionate care.

“When people show you love, that makes a difference,” he says. “When people herd you in like cattle and don’t know who you are …” His voice trails.

Each week, MedZou relies on volunteers in medicine, health professions, pharmacy, nursing and social work. Nursing students take vital signs, and pharmacy majors advise patients on their prescribed medications, many of which MedZou provides for free thanks to grants and donations. Volunteers host monthly specialty clinic nights, such as the ongoing program for diabetic patients and the dermatology services offered on the third Monday of each month. Other students are working to secure donated taxi vouchers and bus tickets for patients who can’t afford transportation. Social work majors counsel patients on healthy lifestyle choices and connect them with community resources and organizations.

On an earlier visit, Shells adamantly refused to talk to a social worker. Then in December, realizing he can’t do it alone, he brings a wish list to discuss with a MedZou volunteer: a coat and warm winter clothing, an eye exam, an affordable dentist.

“Until I get my things together, I plan to keep coming to MedZou,” Shells says. “They care about people, or they wouldn’t be here. They still treat us top of the line, as if we are somebody.”

But Beck says she wishes they could do more. Currently, the clinic provides few diagnostic services. The co-directors are hoping to win grant money to fund ultrasounds, X-rays, EKGs and other potentially lifesaving procedures for high-risk patients.

For example, one man visited the MedZou clinic a few months ago after noticing blood in his stool. He was anemic, and the MedZou staff expressed concerns that he might have colon cancer. Ordering a colonoscopy would be routine in most clinics, but the patient couldn’t afford the procedure. Then, he began having chest pains, leading them to worry about his cardiovascular health.

“We all root for him but don’t feel like we can do enough,” Beck says.

The clinic has allocated funds to help the patient secure the costly prescriptions he needs and is helping him fill out the paperwork for disability benefits, including insurance. It is not the optimal treatment plan, but it is an important lesson in the difficulties of providing individualized care to poor patients. 

“We’re not solving his problem,” Beck says, “but we’re helping him get through another day.”

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