Model Prenatal Program of Rush Medical College at St. Basil's Free Peoples Clinic, Chicago
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Model Prenatal Program of Rush Medical College at St. Basil's Free Peoples Clinic, Chicago MICHELLE A. BARDACK comprehensive prenatal care to poor and disadvan- SUSAN H. THOMPSON taged women; (b) providing a learning environment in which medical students are taught to be humane, Miss Bardack and Miss Thompson are fourth-year students at culturally sensitive, and competent physicians Rush Medical College, Chicago, IL. Their proposal won third through active involvement in patient management; prize in the contest for the 1992 Secretary's Award for Innova- and (c) creating an experience that reinforces the tions in Health Promotion and Disease Prevention. The contest student's self-motivation to practice community- is sponsored by the Department of Health and Human Services and administered by the Health Resources and Services Admin- oriented primary care. istration, in cooperation with the Federation of Associations of Schools of the Health Professions. At the clinic 24 medical students, working in Tearsheet requests to Miss Bardack, 1 South 215 Pine Lane, teams supervised by the three program physicians, Lombard, IL 60148; telephone (708) 627-6507 or to Miss maintain continuity of excellent prenatal care that Thompson, 2822 Forrest Lane, Decatur, IL 62521; telephone follows the expectant mother from pregnancy (217) 422-8765. through delivery and beyond. The Rush Prenatal Program, which has been initiated, organized, and Synopsis.................................... managed by medical students, has evolved into a model of education and service that can be emu- The lack of adequate prenatal and gynecological lated at other institutions. care for indigent women has reached crisis propor- tions. The situation is aggravated by the diminish- All participants in the program-students, fac- ing supply of primary care physicians who are ulty, patients, and community representatives-are willing to practice obstetrics in community settings. being followed longitudinally as a method of as- Added to this condition is the rapidly declining sessing program efficacy. This collaborative effort number of medical students seeking careers in the between an academic medical center and a neigh- primary care field. The Rush Prenatal Program at borhood clinic demonstrates that such a partner- St. Basil's Free Peoples Clinic on Chicago's south ship is not only feasible but potentially cost effec- side addresses these problems by (a) delivering tive and socially responsible. OF ALL THE GROUPS in our society that are or physical disabilities that could have been affected by the lack of health care, indigent women avoided if their mothers had received better and children suffer most acutely (1-4). This prob- medical and social support during their preg- lem is reflected in the 1989 high infant mortality nancies. rate-9.8 per 1,000 live births (5,6). The rate of 18.6 deaths per 1,000 live births for blacks puts us It is simplistic to assume that financial barriers behind some 30 nations. The situation is worse in are the only obstacle to adequate prenatal care for Chicago, where in 1989 the infant mortality rate the population at risk (1-3,6). Other factors include was 11.7 overall and 22.6 for nonwhites-compara- a lack of neighborhood clinics with convenient ble to many Third World countries (5). In fact, the hours, a shortage of primary care obstetricians and problem is even more severe than the infant mor- gynecologists, and a scarcity of physicians who are tality rates indicate. Low birth weight is a signifi- willing to accept patients who are on public aid. cant factor in neonatal mortality and morbidity Some women who need adequate prenatal care are (6-8). Abraham states in the Chicago Reporter (9): unaware of their need and the potential benefits of this care (10,11). For each of the nearly 1,000 Chicago babies The problem is further intensified as the needs of who die each year, public health officials esti- this underserved population grow, and the supply mate that three others are born with mental of primary care physicians diminishes (12-15). A Mrch-April 193, Vol. 108, No. 2 161 weight baby (28). It is estimated that one of these babies can cost as much as $40,000 in hospital care; up to 16 percent of these infants carry lifelong handicaps requiring additional care at costs ranging from $6,000 to $37,000 for each year of life (29). The number of primary care physicians and students prepared to fill these positions has dropped far below the critical level. Only about one-third of today's practicing physicians describe themselves as generalists, and the numbers who are significant factor is in the scant opportunity avail- preparing for this career are declining rapidly (30). able during traditional medical school curricula (a) to train physicians in the special knowledge and Project Objectives skills required for community-based ambulatory care, (b) to make them aware of the particular In 1989, Rush's medical students, recognizing the health needs of these women and children, and (c) need to expand existing community-based health to teach them to deal sensitively and understand- care delivery to Chicago's inner-city disadvantaged ingly with the special problems of disadvantaged population, established the primary care clinics patients from different cultural and ethnic back- project. This project was centered at St. Basil's grounds. Free Peoples Clinic, located in the basement of the In sum, the inadequacy of prenatal care for the church rectory on the south side of Chicago. St. disadvantaged is partially the result of the lack of Basil's patient population consists mainly of the committed physicians to provide the care. unemployed poor and the working poor; it is about Community-based clinics are needed to give quality 80 percent black and 20 percent Hispanic. The care and also to function as training grounds for prenatal program was initiated, organized, and run future primary care physicians. The Rush Prenatal by medical students from Rush Medical College. Program at St. Basil's Free Peoples Clinic is such a The program objectives are place. 1. to develop and reinforce among medical stu- Literature Summary dents, early in their education, the ability to become humane, culturally sensitive, and compe- Numerous proposals incorporate ways of im- tent physicians through practical, hands-on experi- proving access to health care, teaching health ences in a community clinic; promotion and disease prevention at the commu- 2. to provide free, high-quality gynecological nity level, and addressing the appropriateness of care to all female patients and the same quality contemporary medical education in preparing more prenatal care to expectant mothers, including nutri- humane and culturally responsive physicians tion education, awareness about the consequences (16-20). Community-oriented primary care repre- of smoking, the effects of alcohol and drugs, and sents one approach (21-23). Recognizing the special information about sexually transmitted diseases; problems facing women and children, some pro- 3. to create a clinical setting that allows students grams focus on the delivery of preventive health to work closely with physicians in an environment care for this population (24-26). that promotes personal, one-to-one training that It has been demonstrated that the lack of health facilitates the students' personal learning and devel- insurance makes it unlikely that a woman will opment and stimulates their interest in a career in receive appropriate prenatal care (1). A 1985 study primary care. showed that 26 percent of women of reproductive age did not have insurance to cover maternity care Methodology (27). Access to prenatal care and outcome of pregnancy have been directly correlated, that is, The Rush Prenatal Program is staffed by 24 comprehensive, quality prenatal care results in medical students (first-year through fourth-year fewer complications and better deliveries for both students) and three physicians, and it operates mother and child (6-8,25,26,28). every other Tuesday night. First-year medical stu- In 1988, about 1 in 14 live births was a low birth dents are informed about the program in small 162 Public H"ah Reports group discussions during orientation. More stu- program administration, select and distribute in- dents apply than can be accommodated, and there structional materials to patients, and obtain medi- is always a waiting list. cal equipment for the clinic. Participation is voluntary and students receive no academic credit. Each student commits 3 to 4 hours Significance of Project a night twice a month. One junior and one senior medical student form a team which is supervised by A number of women and children from Chi- a physician. (To qualify as a senior, the student must cago's inner-city are receiving much needed health have finished the obstetrical-gynecological rotation.) care. Most are the working uninsured for whom a The responsibility of the student teams is to long wait at the county hospital means losing a explain to the patient their role as student- day's pay. The program offers these patients physicians, take the patient's history, perform the evening hours and a comfortable waiting room that physical, present the findings to the physician, and is also safe for children. Moreover, women are actively participate in the patient's education. Stu- scheduled to see a physician with minimum waiting dents also learn technical skills such as drawing time. blood and doing a Papanicolaou's (Pap) test. This prenatal clinic also enhances the health of In the event that the patient needs additional the community since patients encourage friends to tests, students arrange for them at our home insti- come. Many return because they value the personal tution, Rush Presbyterian St. Luke's Medical Cen- attention they receive. The students see patients ter, and if possible, attend the procedure. The stu- outside the sterile hospital room.