by Sarah Marucci, MD

On the hospital wards, Internal Medicine residents frequently take care of uninsured and underserved patients, but we rarely get exposed to how these vulnerable patients live and obtain access to healthcare outside the hospital after discharge. Through multiple different outreach efforts, residents now have opportunities to interact and better understand the daily challenges and health inequities facing the medically underserved of the greater Birmingham area, as well as develop camaraderie amongst other residents while serving.

A patient in the UAB PATH ClinicMy first day at the UAB PATH (Providing Access to Healthcare) clinic, which provides care to uninsured patients throughout Birmingham with poorly controlled diabetes, I saw firsthand the stark realities of limited access to health care and the trials patients face in securing medications that often keep them alive. Connecting abundance with need through grant money and generous pharmaceutical donations, the PATH Clinic has gained success as a referral site for discharged UAB Hospital and Children’s of Alabama diabetic patients. My first patient at the PATH Clinic was a middle-aged man recently discharged from the hospital where he had presented with DKA and was given new diagnoses of diabetes and hypertension. He was discharged with prescriptions for insulin 70/30 and lisinopril. However, he was unable to afford his insulin and filled only his less expensive antihypertensive medication. Thankfully, I was able to provide him with basal-bolus insulin through the Patient Assistance Program as well as prescriptions for medications that he could receive at free or reduced prices at local pharmacies or charitable medication distributors such as the Dispensary of Hope located at St. Vincent’s Hospital.

Internal Medicine residents such as myself can get involved in the PATH Clinic through the Health Disparities Track, which was developed as a two-year curriculum of lecture and primary care experience for PGY2 and PGY3 residents to better understand health inequality and the social determinants of health. Residents learn how to provide culturally competent, high quality care for low income patients in the setting of limited resources in the transition from inpatient to outpatient care. This year, PGY1 residents are able to get exposure to the PATH clinic during their Ambulatory Block rotation, and opportunities for service will continue to expand with the addition of a second half-day per week for residents to cover. This expansion was made possible with the continued focus on interdisciplinary healthcare in close connection with a passionate team of nurse practitioners and social workers. Through the Health Disparities Track, I have been humbled by the challenges patients take on in seeking medical care and have been encouraged to overcome bias to become a public advocate for addressing health inequality in my daily care of patients.

Other opportunities for community service have been organized by the Resident Wellness Committee. In the Fall of 2016, residents prepared and shared a meal with the families at the American Cancer Society’s Hope Lodge, which provides free housing on a first-come, first-served basis to cancer patients and their families from the surrounding rural area during the course of their treatment. Over a dinner of spaghetti, salad, and cake, residents were able to sit down and have meaningful conversations with these vulnerable patients temporarily displaced from home, many of whom they had taken care of on the wards in the hospital. Dr. Jeremey Walker, PGY3, remembers the experience of sharing a meal with patients in the midst of a major life event as “rejuvenating as [he] had recently finished Oncology wards where [he] had seen many examples of the complications and adverse events that can occur during chemotherapy.” Being able to connect with patients on a personal level outside of the hospital allowed for insight into the real emotions, fears, and hopes of these cancer patients.

Another community service activity organized by the Wellness Committee included preparing and delivering food baskets from the East Lake Farmers Market, a weekly food co-op that provides fresh fruit and vegetables for older and disabled adults with limited access to fresh and affordable food who live in subsidized housing communities in the East Lake Neighborhood. In addition to exposing residents to the complexity of day-to-day life challenges these adults face, Dr. Walker says that “the relationships formed with my fellow residents as we packed 300 bags into a small bus...were as important for my health and wellness as my improved understanding of the community with which we so often work.” At the Avondale School Fair, residents were able to connect once again over food with the local population by providing eager parents with information on heart-healthy Southern soulfood recipes and explain common health problems such as hypertension, diabetes, and depression.

Equal Access Birmingham is UAB’s student-run free clinic that serves the uninsured and underinsured of Birmingham and provides active service-learning for UAB medical, pharmacy, and physical and occupational therapy students. Many patients have a difficult time establishing primary care at UAB or Cooper Green, so EAB provides an avenue for care during this transitional time. This year, Internal Medicine residents have the opportunity to partner with the attending to help teach students and oversee patient care at the clinic. Dr. Jonathan Kalehoff, PGY2, has been leading the initiative to have residents become more involved at EAB. As a volunteer, he appreciates the “fantastic opportunity...to provide care to those in need, while at the same time guiding medical students as they practically exercise their growing skills...and prepare for 3rd year clinical rotations.” As the patient population who attend the EAB clinic continues to suffer from lack of access to care, there is hope that continued donations from the medical school as well as residents’ involvement and awareness of the clinic can play a role in helping to grow and expand the clinic to help meet the needs of the underserved in Birmingham.