Friday, March 31, 2017

At a health screening held at a homeless shelter on a recent Wednesday evening in March, a Virginia Commonwealth University medical student measures Doris Ann Powell’s blood pressure at 124/83 mmHG.

“That’s pretty good!” Powell exclaims.

Four months earlier, the 51-year-old had had a stroke while visiting her boyfriend, who has cancer, at VCU Medical Center. That night her systolic blood pressure measured more than 208 mmHg.

“I had come straight from work and when they were getting ready to take him to his room I fell,” Powell said. “I was drained. I was stressed.”

Powell spent two weeks at VCU Medical Center and 30 days at a nursing home after the stroke. She lost her job at McDonald’s during that time and when she was discharged from the nursing home, she found herself suddenly homeless.

“I was working until I had the stroke,” Powell said. “I didn’t get fired or quit, I got sick.”

“I was working until I had the stroke.”

The recent Wednesday evening in March was Powell’s first night staying at CARITAS. The congregation-based emergency homeless shelter provides food, shelter and showers for people in Richmond who are experiencing homelessness. The mobile shelter is housed at more than 150 faith communities in Richmond that open their facilities for one week increments throughout the year. 

VCU students have hosted health screenings at the shelters since 2003. During the clinics, students from the schools of Medicine, Pharmacy and Dentistry provide services such as pulmonary function testing, blood pressure checks, cholesterol and glucose measurements and oral cancer screenings. Faculty from the three schools attend the clinics as well to offer expertise if students encounter anything they are not equipped to treat. If the patient requires follow-up care, they are referred to The Daily Planet for no-cost or low-cost health care.

“The health screenings help demystify the homeless population for our students,” said Susan Digiovanni, M.D., professor of internal medicine and interim senior associate dean for medical education at VCU School of Medicine. “They are a way of building bridges with this community and letting them know that there are people out there who care.”

‘A different kind of meeting ground’

As with Powell, most CARITAS residents are new to homelessness.

“People are generally only homeless for about two weeks of their life, so we see them at their lowest points,” said third-year pharmacy student Lily Jia. “Everyone goes through difficult periods and hopefully we can help them during those low points so they can get out of the system and improve their situation.”

The 23-year-old Jia has been volunteering at CARITAS since her first year of pharmacy school at VCU. She says the screenings have been more than just an opportunity to practice what she is learning in school.

“Getting practice with how to do things like blood pressure checks is important, but I think more important is learning how to interact with people who come from backgrounds that are different from me,” Jia said.

Jia felt awkward at the first few screenings she attended and says she didn’t know how to interact with patients.

“Usually when I first meet someone I ask them what they do or if they have siblings, but here it is hard to ask what people do or how their family is,” she said. “Just learning how to empathize with people and how to make them feel comfortable has been important.”

Students dress casually at the clinics, where medical and pharmacy students work side-by-side at each screening station. As they check vital signs, students talk with homeless shelter residents about their day. Sometimes shelter residents share with students the story of what led them to homelessness.

“It is a different kind of meeting ground,” said Mary Lee Magee, assistant professor in the Department of Family Medicine and Population Health at VCU School of Medicine and faculty advisor for the CARITAS health screenings since 2009. “Rather than asking shelter guests to come to us, we are going to them in the community where we are a little more on their turf.”  

Lending an ear

The screenings were initiated by Gaynel Olsen, Ph.D., former assistant professor and family medicine educational coordinator at VCU School of Medicine. The School of Pharmacy partnered with the School of Medicine in 2010 to facilitate pharmacy and medical student collaboration. Dentistry and dental hygiene students joined in 2011.

In addition to providing health sciences students with an opportunity to engage with the local community, the clinics are an opportunity for them to practice alongside students from other health disciplines.

“Interdisciplinary practice is going to be our lives as soon as we are done with medical school,” said first-year medical student Justin Riederer, who was working at the body mass index station on Wednesday. “Getting experience with people from other health sciences disciplines is important in helping to inform our future careers.”

While they practice their skills together, students take time to get to know the residents’ medical histories and to interpret the results of the screenings.

First-year medical student Madhur Batra recalls doing a glucose check while volunteering at a CARITAS screening in October and noticing the measurement was high.

“That was a point in the semester when we were learning about glucose levels and what they could indicate,” Batra said. “I was able to explain to the patient what her reading meant and how to control it. I liked being able to use the knowledge I was getting from school directly for the patient’s benefit. It made what I was learning a little more real.”

The slower pace benefits CARITAS shelter residents such as Fabienne Ismael, whose medical conditions include Type 2 diabetes, asthma and arthritis.

“I feel that since the students are learning, they are more patient than people who have been doing it for a while,” Ismael said. “The students are trying to learn, so they listen to everything you say. It is good to be heard sometimes.”

Changed conceptions

Before each health screening, students join shelter residents for dinner. “The dinners are an incredible way to get to know someone as more than a patient,” said CARITAS program manager Allie Cornell. “Changing the misconceptions around homelessness is huge, and hopefully the students carry that into their medical practice.”

At the screening in March, Powell arrived in a red McDonald’s T-shirt and cap. She recently started working again, doing food preparation at a McDonald’s in Richmond’s South Side in January. The $7.25 she is paid an hour isn’t enough for her to afford rent yet, but she is grateful for the opportunity to start working her way out of homelessness.

“Homelessness doesn’t define who people are.”

“God is good for me to able to be working again,” Powell said.

For Batra, the meals are a valuable time to get to know the patients he serves at the clinic. He recalls having dinner one evening with a man who told him it was his first night at the shelter and he didn’t plan to stay there more than one night.

“Homelessness doesn’t define who people are,” Batra said. “Sometimes people just have a stroke of bad luck. Volunteering at CARITAS has put into perspective for me that these are people who have the same basic needs as me. They are not homeless people. They are people who are homeless tonight.”

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