San Antonio Current

San Antonio Current February 17-23, 2005

House Call

BY SUSAN PAGANI Rolling down East Mulberry Street towards Highway 281, one is more likely to notice Trinity Baptist Church than the light brown, craftsman-style house that sits nearby. It belongs to Alpha Home, a residential and outpatient chemical dependency program that serves more than 325 women a year. Last month, students from the University of Texas Health Science Center at San Antonio started a free clinic at the site, providing well-woman exams, screenings for sexually transmitted diseases, and other health-care services for residents of Alpha’s Mulberry and Camden Street locations.

Many Alpha Home patients enter treatment with health and dental issues. Some have been victims of violence or sexual abuse; for others, health care has taken a backseat to poverty and addiction.

“By the time they get here, they have severe, chronic addiction,” says Melanie Lane, residential program director at Alpha Home. “They have no money, job or home. They’re indigent and this is the end of the line.”

UTHSC medical students specially trained for the clinic, residents, and clinic cofounder Dr. Richard Usatine, a UTHSC faculty member, see the patients.

In the first five weeks of the program, medical students at the Alpha Home clinic have seen serious ailments: a staph infection, a stab wound, a prolapsed bladder, and chronically draining breast cysts.

On a recent Saturday, there were only three patients when the students arrived at 8:30a.m., but by 10 o’clock, several more had shown up. The medical staff for the day, three students and a resident, split into two make-shift exam rooms, while Dr. Usatine moved between them, overseeing the patient care and writing prescriptions when necessary.

“Things are working best when I can watch the students do their thing, and just be there to help and advise,” says Usatine. “I want the students to have a sense that they started something, not that I started it for them. And it’s working.”

In one room, students saw a patient complaining of sharp abdominal pain, another was experiencing restless sleep, and a third had a mild case of ringworm, which likely came from a turtleneck she bought at Salvation Army the previous day. Each visit was organized, the students were competent, interested, and empathetic, and the patients appeared open and confident. It seemed to be a remarkable smooth day for a clinic that has only been open for five weeks.

The clinic was started by Dr. Usatine and Amy Cantor, a second-year medical student at the university. Usatine, a relative newcomer to UTHSC, was awarded the prestigious Association of American Medical Colleges Humanism in Medicine Award in 2000 for his work helping UCLA medical students create clinics providing free health-care to the homeless. His students were no only successful in establishing three clinics serving different homeless populations, but also in making the clinics a permanent part of the school’s curriculum.

After hearing Usatine lecture, Cantor, who has a background in public health, was inspired to create a similar program at UTHSC. Usatine put her in touch with Alpha Home.

Established in 1939, Alpha Home is the only women-specific drug treatment program in Bexar County and draws clients from all over the state. Clients are referred to Alpha Home from various community agencies, including hospitals, detox facilities, and homeless shelters.

The women are not qualified to receive Carelink, which provides medical care for Bexar County residents who do not have health insurance, because Alpha Home is recognized as a temporary residence. In addition, the women rarely have valid identification or a social security card. In most cases, sick Alpha Home patients end up in the emergency room.

“These women are vulnerable and sick [from drug withdrawal], so it is difficult to take them to the ER, where they sit for 20 hours,” says Lane. “And, even if they see a doctor and get a prescription, where do they get the money to pay for it?”

The clinic also has to find money to pay for its services. With no initial grant money for basic medical supplies, Cantor has turned to the medical community and received donations of everything from gloves and tongue depressors to an examination table and medical-record system software and training. Serendipitously, the Alpha Home received a health-care grant from the St. Luke’s Foundation in December, which, while not specifically directed at the clinic will be used to help purchase medication.

In addition, the students are applying for a $30,000 AAMC community outreach grant that will allow them to purchase expensive items such as ophthalmoscopes, scales, and mounted blood pressure cuffs, as well as supplies, hospital gowns and paper for the exam table, and limited medication.

“If the grants don’t come through, we will continue doing what we are doing,” says Usatine. “What makes this work is students, faculty, and community doctors who are willing to give of their time.”

For the students, especially those in their first and second year who would generally have to wait until their third to get clinical experience, Alpha Home provides a rare opportunity to practice their skills. “In a private office, the students are often shadowing the doctor, observing,” says Dr. Usatine. “Here they can be active participants in the health-care delivery, and they can do it in a setting where they are needed.”

Cantor hopes Alpha Home is not just another clinical experience, and that students learn from the women. “In our clinical years I’m not sure we learn from patients,” says Cantor. “At Alpha Home, we have the time to talk to them, and listen to what’s bothering them. They trust us as young doctors-in -training, and are willing to discuss their addiction.”

“The women are overwhelmed by the attention they receive from the students; no doctor has ever treated them that well,” adds Lane. “And, by doing what basically amounts to a house call, they are providing them a service that goes beyond health care, helping their recovery and confidence, and changing their interaction with the medical system.”