In this episode of the Purpose in Practice podcast, ACU’s Jennifer Dix speaks with Chandler Hinson, a third-year medical student at the Frederick P. Whiddon College of Medicine at the University of South Alabama (USA) and President Emeritus of this student-run free clinic in Mobile, AL. Listen as they discuss the unique role that student-run free clinics play in the healthcare of underserved communities, USA SRFC’s comprehensive approach to patient care, resources and suggestions for starting or supporting these types of clinics, and more.

Full Transcript

Jennifer Dix: I’m here today with Chandler Hinson from the University of South Alabama’s Student-Run Free Clinic. Thanks so much for being here today, Chandler.

Chandler Hinson: Awesome. Thank you for the invite and happy to talk about our discussion today.

Dix: So let’s just dive in, and I wondered if you would mind just telling us a little bit about yourself and maybe why you wanted to get into the medical field.

Hinson: Yes, so currently I’m a third-year medical student at the Frederick P. Whiddon College of Medicine at the University of South Alabama. A little bit just about my background is I actually started first within the global health public health space, my undergraduate at Georgetown University focusing on global health pursuit of master’s for control infectious diseases. So it kind of seemed the route I was initially planning to take was kind of more in that public health space. I ended up actually after spending time in London doing research on patient safety, shifted into the healthcare consulting space, more focused here in the U.S. and through that experience I was very happy. I always knew I wanted people to be healthy; health is happy, and so working at that population level space, I recognized that through that experience I really enjoyed that one-on-one connection I think you get between a patient and a provider. And so after spending a little bit of time doing that, I decided I really wanted to pursue medicine. I felt within medicine I can still work kind of that public health population health space while also providing one-on-one to a patient. And so after a hard consideration because it is quite a, you have to make a commitment, both financially and personally, I decided to pursue medicine and I have not regretted it since. Even until today, I’m still able to work both at that population level and at that individual level.

Dix: That’s so great. I’m always really fascinated and interested in folks’ stories when they talk about why they ended up in the career that they did. So thanks for sharing that. For those who might not be as familiar, could you just define for us what is a student-run free clinic?

Hinson: Yeah, so a student-run free clinic is basically a clinic model that is often volunteers or students or it’s even run by a student executive board. And the goal of student-run free clinics are to basically provide assistance at no cost to those in society, in the community that may not otherwise be able to afford such services. So usually these are staffed by volunteers. A lot of times they’re seeking opportunities to provide assistance to this population. A lot of clinic models really focus on healthcare alone as there are actually many other student run free clinics out there that focus on other aspects as well, including legal, social services and those types of things. So I think kind of the misconception is a student-run free clinic, it’s just a bunch of medical students that get together on a certain day and they go and they practice doing history and physical exams.

Hinson: But I really think the embodiment of a good student-run free clinic expands that. And a lot of clinics that I’m aware of that I’ve spoken with over my years being involved with our clinic here is a lot of students are doing more than that. Most of them are usually focusing kind of on the uninsured and homeless patient population and really trying to build a deeper connection with them and not just on a diagnostic perspective, but also to an enriching perspective about health, education, social empowerment and those types of things. And so currently I was kind of looking last week and it looks like there are roughly 386 student-run free clinics around the United States. There are quite a few and many of them are in a lot of metropolitan communities.

Dix: As far as where you are specifically at the University of South Alabama, could you tell us a little bit maybe about how that clinic is structured, maybe some about the staffing and the services that you provide?

Hinson: Yeah, so we are a student-led initiative, so we technically fall under a student organization at the University of South Alabama. And currently we’re actually going through a little bit of transition. We have a partner pharmacy school with Auburn Pharmacy, they have a satellite campus here. So for a bit we were kind of run under the Auburn Pharmacy. We transitioned to the college of nursing and then we’re actually taking the next step and we’ll be within probably, hopefully this next year actually transitioning to a department specifically to internal medicine family medicine. So we kind of are housed under a certain college or a certain department. We are a student-led initiative. We really focus on enhancing wellness amongst underserved. We started within Mobile, Alabama, but we’ve really kind of expanded to the greater Mobile area, so including rural populations or populations that don’t live strictly within the metropolitan area.

Hinson: And what’s really unique about our clinic as well is that we have a student leadership board that’s multidisciplinary. We include pharmacy students, we have nursing students, we have occupational therapy, physical therapy students, we have audiology students. We have actually an individual who is getting his undergrad in marketing who helps us be able to market and actually reach certain vulnerable populations. So it’s a multidisciplinary approach in how we run our clinic. But also too when it comes to the actual clinic itself is when a patient sees one of our clinic teams, it’s not just three individuals from one discipline, it’s actually a multidisciplinary team that is seeing and interacting with the patients, which I find really unique and also too, a great learning experience for us as students working in that multidisciplinary team. Obviously we have a regular clinic format, but what I think is really interesting, I’m happy to share is that we actually have an education model with it. With every clinic that we run an hour before said clinic, we have strictly a patient education session where we sit down in a big conference room and we go over certain topics that are one, either of interest to the patients that we serve or two that we find really important to talk about. And so some common themes being about hypertension, diabetes, exercising, healthy living, and how that connects to better management of chronic health conditions. And so we try to really push on health education and improving those health behaviors and it’s really great because I feel like it’s going back to focusing on the patient as a whole and not solely just as a clinical interaction. And on top of that we have above the student level is we have a multidisciplinary faculty board, we include pharmacy professor, we include audiology, professors, OT, PT. And so a lot of times too, and something that we try to improve on every day is we try to interact with these professors and say, this is what we’re seeing. Here’s some ideas that we have. What are your thoughts as a subject matter expert in the field?

Dix: What’s your patient population? What does that look like?

Hinson: Yes, so mostly it is individuals who currently are uninsured, mostly individuals who are houseless or mostly group homes. So specifically we kind of have two clinics going on with the third clinic that we are actually planning on bringing on board this upcoming year. We’re still currently in the planning phases, but we have one main clinic that is based at the Salvation Army of the Greater Gulf Coast. At this Salvation Army, they have two main patient populations, one being individuals who are currently houseless living in the greater Mobile area. They come evenings to stay and we actually have our clinic structured to be at that time when they’re coming to the Salvation Army to stay in. Additionally, the Salvation Army has some federal and state programs, so for individuals who are recovering from drug and rehabilitation as well as court ordered, we serve those patients as well. Our physical main clinic is built within the Salvation Army. We have one outreach clinic that’s based at a women’s shelter and another part of Mobile that we serve as well. And so this is another group housed a patient population, but while the ones at Salvation Army are all strictly men, this one is all strictly women. And so it’s really great because we have partnered and we work a lot with our obstetrics and gynecology department and to build specific programs for the women.

Dix: I was reading on your website, and I know healthcare services obviously is the first thing you think of, but you are also addressing patient’s overall wellness in that more holistic level. I was noticing something about health literacy being a focus as well. Could you talk a little bit about that?

Hinson: Yeah, so it’s actually really interesting talking about health literacy and one thing that we are doing as a program, it’s called Food is Medicine, and we have students who are with our institution have a nutrition interest group. They’re coming in and we’re running a program and sitting down and teaching patients how to read a food label. And on top of that, not even just allowing them bringing food labels to patient education sessions and letting them read the can, we actually have taken them to local grocery stores. We have experiential programs where we run around the shelves and pick up items and we say, oh, what are your thoughts on this? And we see that actually having hands-on experiences, these individuals learn how to actually read a food label. And as many of us know that nutrition is a fundamental pillar to our overall health. And so, it’s great that we feel that not only are we teaching, but we’re also kind of practicing how to do that. In addition to those in the grocery store experiential experiences, we have a teaching kitchen and we actually take those patients to that kitchen and work with them hands-on making a healthy meal and talking about what are ways that you can keep it healthy, balance all your macro micronutrients, how to make it so that you have leftovers and you can eat over the time. And so, I think that is what we really strive for. There’s teaching about these topics, but also there’s that practicing and kind of holding the hand of your patient and really engaging them to learn on those topics. And so that’s why I feel very passionate, very strong about what we do is that is ingrained in how we serve our patients.

Dix: I love that. I love that it’s really a look at the whole person and their health.

Hinson: Absolutely fundamental if you want to serve this patient population is you got to think of the patient as the whole 360.

Hinson: So something that we’re working on this year as a student group and something I’m very passionate about is that we’re going to be hopefully in the near future expanding to doing a monthly clinic at a Native American reservation that’s within the Mobile county and actually building a monthly clinic. So it’ll be multidisciplinary including trauma medicine, family medicine, obstetrics and gynecology and pediatrics. And every month going and doing that same model that we do with these other clinics is doing that at the Native American reservation. So we are really excited because this was a patient population that was brought to us as being socially vulnerable and they had a recent needs assessment saying, hey, this is something that we want as a community and based off their needs, we realized that’s something that we feel like we have worked on building and perfecting here in Mobile and we are planning on taking that model and bringing it to them to hopefully meet the needs that they would like to have addressed.

Dix: That’s great. And it sounds like you guys are definitely open to growth and when you see a need and being able to fill that, if resources allow.

Hinson: Yes, definitely. I would definitely say is, and one thing I’m so proud of us as an organization as a board is that we are not afraid to jump in and help when we see a need. Sometimes there’s growing pains and sometimes we have to pull back to readdress and implement, but what I love is the dedication and that drive from students who really do want to make an impact and help and build these partnerships with these patients. And so that is why I feel very strongly about this role of the student-run free clinic and targeting these vulnerable populations. We talk about all the time about patient advocacy and so that’s why I feel like when we see problems in our community here, I feel like we’re one of the first ones to try to be proactive in addressing whatever need that may be.

Dix: You did touch on this a little bit as far as community partnerships go. We know that community partnerships are so important in the healthcare space and in the health center space. Is there other partnerships that you have experienced at your time at the clinic that you could tell us about?

Hinson: Oh yes. And so I would have to say from a student-run free clinic model, partnerships are absolutely integral to succeed. And also I think more importantly to be sustainable over the years because very similar to a student organization is you have a lot of rollover. You have medical students who go on to be residents and they graduate and same with all the other disciplines. And so it’s important to really build on those partnerships and so you keep them as you move forward over time. But some big partners that we heavily rely on is so obviously one being the Salvation Army that we have our clinic in and they are one of the main patient populations that we address, the female shelter that we care for. We partner with their executive board and we talk to their executive director on multiple occasions about the program we want to do and such.

Hinson: Additionally, some other ones that I want to give a shout out to and absolutely thank is the Center for Healthy Communities, so it’s an institution within University of South Alabama. So it’s a little bit separate from us, but we realize our missions overlap and that Center for Healthy Communities, they actually have community health workers that now work through our clinic to address those individuals that maybe were not being able to address or who are not coming to our clinic and spreading awareness about what we can provide. And so it’s great because we see it as them being the experts of being able to refer for social services. We’ve had patients come in, we talk about nutrition, whatever, and we find out they don’t have any running electricity or water. We have a community health worker that works with us through the Center of Healthy Communities who can get you in contact with services that may be able to help you get that electricity and water. That partnership is absolutely fundamental. And also too, it’s an institution that has a slightly different expertise than what us students can do, but together when we work synergistically, it empowers that 360 approach to the patient. We actually partner with other clinics as well that also target the same population. And so a big one is we have a clinic here called Healthcare for the Homeless. One thing that’s great about them is that they have some more ability to do more diagnostic workup than what we can do. And so for example, if we see a patient that comes in and something that has a board that we feel that we either don’t have the necessary equipment or we don’t have the necessary referral strength to be able to get this patient to get where they need to get to have their problem addressed is that we can actually reach out to Healthcare for the Homeless. And they’ve been absolutely wonderful and seeing this patient, getting them in the more appropriate referral pattern than what we can do. And it’s great because we work hand in hand with Healthcare for the Homeless, seeing either the same patients or the same kind of patient type. And so I think it’s integral that any clinic or any student-run free clinic look at the community and see who’s out there targeting that same patient population that you want to serve and partner with them, talk to them on the phone, talk about how you can align services or how for example, your services are overlapping and how you can strengthen how this service should be offered here versus there. And we can focus on X, Y, or Z. Many partnerships are integral and I think to succeed long-term you have to build those partnerships with those fellow organizations.

Dix: That’s some really, really great advice. So what is unique about the role of student-run free clinics in caring for underserved populations?

Hinson: We have a lot of driven students who one want to be there, two want to grow what we’re doing and three want to improve how we’re doing it. And so one thing that is really great about the clinic is after we actually have clinic, we have a huddle after we have completed our clinic and we literally go around the room as students and we say what went well, what didn’t go well, what could we be doing better? What are things that we’re lacking on? And the time that sometimes we spend during that huddle in the ideas we get are just absolutely incredible. Kind of going back to the reason I keep pointing towards and bringing up multidisciplinary models is because just some other disciplines like say, oh yeah, we saw this patient today, we talked about it from a medicine perspective, but we can do that from our field or our side of things. And it’s like, great, let’s do it. So I think having that young, driven student is something great for us to be able to be a clinic that can continue to serve. But also too, I think as well as our patients actually notice that. And so we actually recently did a study, we wrote up a manuscript and it’s currently in prep to be published, but we actually looked at the role of a student provider and how it improves the perception and possible long-term health of that patient. And we saw that within the data we did. It was a qualitative study where our patient said that they enjoy working with student providers, they feel that the student provider is engaged and cares about their health. And three that moving forward based off their experiences so far working with a student provider that they’re willing or more likely to actually seek future healthcare services maybe after they’ve left the group house or when they get insurance, they go in, they’re able to see another provider.

Hinson: And so I think that kind of also data wise plays into this kind of pointing claim is student providers are energetic and wanting to help and also they are very strong about building these relationships. And so I’ve been working at this clinic for two and a half, three years and there’s some patients that I’ve seen over that time and now I have a strong relationship with and they know that when they see me in the clinic that I have their best interest at heart. I think that’s something that is invaluable especially to these vulnerable populations that have sort of distrust in the healthcare system or feel that they’re being taken advantage of. And I think that’s a way that we can maybe us as providers, we’ve done well at breaking down those boundaries to hopefully improve their long-term healthcare seeking behavior in their decisions and whatnot.

Dix: You are building relationships with patients and that kind of thing and they come to you for help. They know they can trust you. Are there any sort of interesting experiences or insights or maybe any patient interactions that have stood out to you that you’ve had while you’ve been working there that you might be able to share with us?

Hinson: Yeah, so I think one thing that I recognized kind of going back to this multidisciplinary approach is we deal with patients who were currently in drug rehabilitation. They’re working on themselves. A lot of them as a step down measure have switched from doing those types of activities and now regularly smoke. But one thing that has been really interesting is the importance of cognitive behavior therapy and just actually sitting down and talking things through with the patient when it comes to these health seeking behaviors. I talk a lot about smoking. That was kind of a light for me when I was actually talking to one of my patients. You don’t need any more medicine. I just think you need to sit down and talk with someone and write down how you’re feeling and understanding what are your triggers coming up with, how can we focus on staying away from those triggers or if you do have a trigger, how do you deal with it in a more appropriate approach versus just smoking a cigarette. We see that also too in other aspects when it comes to, for example, nutrition is I’m stressed out in life and my go-to is to Taco Bell and a two-liter Coke. Well, are there other things that you enjoy equally that kind of gives you that fulfillment without having to down a soda and eat fast food? And so I’ve recognized as I’ve spent more time with these patients and moving on is that the role of maybe psychology and just actually having dedicated time to sit down and talk and journal and go through those things can be really integral. And so one thing that I’ve been working on is actually building up just a talk clinic and that talk clinic really being just sitting down and gone and going through those things and obviously relating it to their overall health but focusing on that from a cognitive behavior therapy standpoint versus strictly medicines and clinical and those types of things.

Dix: Turning a little bit to another kind of topic, what advice do you have for other medical students when it comes to volunteering at a clinic like the one that you’re working at?

Hinson: I think one thing is recognizing that so one, this is a real patient and more importantly it’s your patient and it may be your patient for a while in the sense if you regularly volunteer is that’s someone that you can build the rapport with and really take ownership and take advocacy for them. So I think it’s important to recognize that as integral when you’re initially seeing a patient. Also too, I think it’s a great opportunity to practice how you want to be a provider in the future that plays across all the disciplines there is. I think it’s a great opportunity to envision yourself and practice. How are you going to be when you’re that professional? I think it’s great, great ways to actually continue practice. And I recognize too, while I’m on my clinical rotations now as a third year, that the way I talk to my patients when I interact with them is kind of built off my experiences when I was working a lot in the free clinic. And then also too, I think some advice is please don’t forget all the things outside the clinical diagnosis and management. Take a social history, talk about those lifestyle behavior things. Talk about that 360 approach and making sure that that is a part of your workup and assessment of the patient. Take the time to sit down and talk with them because sometimes this may be the only time that they really do get that it’s absolutely integral important not only for treatment but also prevention moving forward.

Dix: This is kind of a big overarching concept and question, but in your opinion, what can healthcare providers do to advance health equity?

Hinson: Being culturally competent and by culturally is obviously we can look at different cultures that we see around the world, but also to understanding that specific individual and where they sit in society. I noticed too is talking to someone who may come from a more educated, wealthy, socially powerful background. The way I try to interact and work with them may be different than someone who may be less educated and may be more socially vulnerable or may have these other kinds of disadvantages. And also too, I think another important thing when it comes to healthcare is being inclusive and accessible. And that’s kind of one thing I feel like I have witnessed in this really kind of this busy world where doctors are trying to see many patients they’re trying to help, but sometimes you have to recognize that if you’re trying to serve a patient population that works all day, maybe having your clinic from one to five may not be beneficial because they have to take off work, maybe they have to get transportation or such things. So I think keeping that in mind is really important. So that’s why at our clinic we try to actually have it tiered so it’s partially during the workday and also when the workday is done so we can have availability for those patients that need to work all day because they have bills to pay. And I think lastly too, another important point when it comes to advancing health equity is community engagement is partnerships with organizations that can empower the patient. Seeing who’s working with those patients and engaging with them, seeing how you can work together to create that safety net across these patients is important because each organization has a skillset that another may not be as strong. In having organizations working together, I think you can fulfill the mission better versus just working alone. And so I think healthcare providers, having a contact with a community health worker or having contact with the social support service is a great initial start because if you ever have a clinic or a patient that comes through those doors, at least you know how to start the conversation and where to get the engagement for that.

Dix: Excellent. Yes, I think cultural competence is so, so important. So those are some really great tips. Do you have any resources that you would like to share for medical students and or university staff who might be interested in starting a student-run free clinic at their school?

Hinson: Yes. So there’s a Society of Student-Run Free Clinics. You can just Google them. It’s a national organization that we as a student-run free clinic are a part of. We go to their national meetings, but they actually have really great resources on their website. I believe it’s like 25 steps to opening a student free clinic. And so I think for any student or university who wants to open it, I think that’s a great starting point to being able to see what are some my checkboxes I need to check off. And also too as well, they have a lot of great resources about not only starting but also growing a student-run free clinic. And so they actually have a connected journal with them and they kind of talk about some research or some programming that other clients are doing. And so it’s great to be able to actually see what other clients are doing and kind of collaborating and sharing ideas. And that’s actually a journal that we refer to a lot and we actually look and see like, oh, we see this student-run free clinic in Florida has been doing this as a program; that would be fantastic for our program here. And actually maybe just implementing that point. So I think starting with that Society of Student-Run Free Clinics is a really great initial point to any students or university that wants to start building a student-run free clinic.

Dix: Great. I’ll definitely make sure that we include that in our show notes for this. So that does sound like a really good resource. As far as your goals for the future, are you planning to stay in serving underserved communities or what are your plans?

Hinson: Absolutely. I want to really focus on individuals who are socially vulnerable in the future and making sure that once again, they’re being advocated for and they have a healthcare provider that is rooting for them and being their advocate to say the least. But yes, I think myself and I think as well my student board obviously speaking on behalf of them, but we are all wanting to continue to serve these populations moving forward as we move from student to resident to an attending.

Dix: I’m real happy to hear that; what you all are doing is so important. In the last couple of minutes here, do you have anything else that you would like to add? Did we miss anything or anything you want to share?

Hinson: I think so. One, if you’re a healthcare provider listening to this, I think first off is look and see if there’s a student-run free clinic around you or in your area and please reach out to them and by reaching out, I think that can either be, if you have time to volunteer, that’s great, but also too, I think just as well dropping a note saying, hey, I think you’re doing great work. Motivating them. I know for example, we’ve had physicians around our area email us and say, you’re doing a great job, keep up the good work. And that’s been actually even those very minute things have been really meaningful to us and kind of empowering us to continue move our mission forward. And also too, for the students out there who continue to volunteer at student-run free clinics, I want to give a shout out to them and to keep up that amazing work. And don’t forget to keep on advocating for your patients currently and then also moving forward and take those lessons and take those experiences that you’ve gained from it and make sure that it’s kind of a part of who you are as a future healthcare provider. I do that here and I think it’s important for all those volunteers out there to do that as well.

Dix: Thanks so much for sharing that. Well, I think we’re about out of time, so thanks so much again, Chandler for talking with us and this has really been a great conversation. I know that I’ve learned a lot and I’m sure our listeners will as well. And we just really, really appreciate the work that you’re doing there.

Hinson: Awesome. Well, thank you so much for allowing me to come on and talk about this. This topic is very meaningful to me. I would love to see other student-run free clinics out there equally succeed and continue to grow to really empower and focus on the populations that we serve.

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