{"id":11961,"date":"2017-09-12T10:18:57","date_gmt":"2017-09-12T16:18:57","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=11961"},"modified":"2022-08-01T11:52:12","modified_gmt":"2022-08-01T17:52:12","slug":"dawn-clinic-brings-care-to-those-who-need-it-most","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/dawn-clinic-brings-care-to-those-who-need-it-most\/","title":{"rendered":"DAWN Clinic brings care to those who need it most"},"content":{"rendered":"
<\/div>
\"A
Pancho Bustamante of Aurora awaits his medical exam during a DAWN Clinic visit Aug. 15. The clinic has helped Bustamante recover from life-threatening liver disease.<\/figcaption><\/figure>\n

In health care, as in all professions, there are many ways to learn. Students in medicine, nursing, pharmacy, physical therapy and other areas spend plenty of time burying their heads in books, scribbling lecture notes and asking questions of their instructors well before they put their acquired skills to the test with a patient encounter or a clinical test.<\/p>\n

Rarer is the opportunity to take on the challenges of delivering health care in a bustling clinic while juggling schedules, triaging patients and collaborating with colleagues in different professions. Rarer still is the chance to serve patients with the greatest need for medical care and assistance overcoming barriers to meeting that need: the uninsured.<\/p>\n

But that\u2019s exactly what happens each Tuesday night in a brick storefront facility in downtown Aurora. There, dozens of students from the University of Colorado health sciences schools volunteer their time for the DAWN (Dedicated to Aurora\u2019s Wellness and Needs) Clinic<\/a>. Opened two years ago<\/a> with support from the health sciences schools and UCHealth University of Colorado Hospital<\/a>, the clinic has expanded its capacity while continuing to see patients with diabetes, hypertension, acid reflux, chronic pain and a wide variety of other issues, many of them on a regular basis.<\/p>\n

Both the university and UCH remain committed to supporting and contributing to the clinic\u2019s fundraising efforts. Preceptors from the university \u2013 licensed health professionals with faculty or clinical appointments \u2013 offer guidance to the students with patient care, and the hospital provides additional clinical support. Jeff Thompson, vice president of government and corporate affairs for UCHealth, serves on the clinic\u2019s executive steering committee.<\/p>\n

\u201cWe have a close relationship and partnership with the DAWN Clinic,\u201d said Keith Peterson, director of Community Benefit for UCHealth. The clinic\u2019s work helps the hospital to build stronger ties to the community, Peterson noted. In addition, the students provide basic services that help prevent unnecessary emergency department visits and hospitalizations. The clinic also serves as a referral source for the hospital for patients who lack insurance coverage.<\/p>\n

On-the-job training<\/strong><\/h2>\n

Student volunteers form the backbone of the clinic, as was evident on a recent Tuesday afternoon. They began gathering at the Dayton Street Opportunity Center, a facility that offers a variety of resources for Aurora residents, well before patients arrived for appointments that begin at 5:30 p.m. It\u2019s an unassuming setting that includes six exam rooms, up from the three available two years ago. An open seating area serves as the waiting room near tables where students handle triage and take patients\u2019 vital signs.<\/p>\n

\"Patient
Pancho Bustamante speaks with a team of clinic providers during his visit. From left: interpreter Diana Merjil; med student Hieu Duong; nursing student Monica Mana.<\/figcaption><\/figure>\n

The clinic schedules in advance repeat and follow-up patients. The routine includes check-in at a table set up near the door, triage, an examination and basic medical care. A care coordinator meets with them to identify other needs that can affect their health \u2013 food, housing, transportation, and so on \u2013 and point them to available resources.<\/p>\n

Before any of this happens, planning for the evening begins. In a conference room behind the seating and triage areas, clinic directors, managers and preceptors go over summaries of the scheduled patients to prepare for their visits and identify resources they might need.<\/p>\n

Go with the flow<\/strong><\/h2>\n

But as in any clinic, the nights rarely if ever go exactly as planned, noted Miles Viseur, a second-year med school student. Viseur began working in the DAWN Clinic as an interpreter; he\u2019s now a student director, working with the clinic\u2019s teams to meet their needs and keep patient flow moving as smoothly as possible.<\/p>\n

\u201cThere are still a fair amount of no-shows,\u201d Viseur said. \u201cWe balance that with walk-ins; we may see three to eight a night.\u201d<\/p>\n

The no-shows and walk-ins are wild cards that make for unpredictability and can increase patient wait times, Viseur said. The clinic\u2019s additional capacity has increased the challenge. In 2015, the students typically saw eight or nine patients a night, he said. With the additional exam rooms, the number is 18 to 22.<\/p>\n

That makes for an operational challenge, but large numbers of volunteers have stepped forward for training that includes learning to use an electronic health record, preparing for a patient encounter and learning to discreetly solicit health information from patients in interviews. Viseur estimated that two-thirds of his class of 184 signed up to volunteer in the clinic. Aster Degu, a second-year physical therapy student, said about half of her class 68 are \u201cvery involved.\u201d (Physical therapy students see patients in the DAWN Clinic on Wednesday nights.)<\/p>\n

Ready for action<\/strong><\/h2>\n

Shortly before the clinic begins business, the back area hums with activity as volunteers arrive and await their assignments. It\u2019s a mix of planning, socializing and networking that reflects another important feature of the DAWN Clinic. Medical, nursing, pharmacy, and public health students not only freely mingle, they learn to work together to meet patients\u2019 needs.<\/p>\n

\u201cInterprofessional care is one of the things that sets DAWN apart,\u201d Viseur said. \u201cI\u2019ve learned from other students. Med school is almost all lectures, so it\u2019s nice to be able to see how different skills are applied to real patients.\u201d<\/p>\n

This night\u2019s real patients are waiting, so student director Rachel Ancar, a med student working on her PhD, calls for the volunteers\u2019 attention. Second-year med student Rachel Pauley heads to the triage tables, her assignment for the night.<\/p>\n

\"A
Student director Rachel Ancar (center) speaks to volunteers just before the DAWN clinic begins seeing patients Aug. 15.<\/figcaption><\/figure>\n

Ancar briefly explains how to set up a patient encounter and reminds the volunteers to assess each patient\u2019s risk. She also outlines for the preceptor physicians the process for recording and prescribing medications in the DAWN clinic\u2019s electronic system. A volunteer then describes the challenges of meeting the medical and social needs of a patient with COPD<\/a>. A colleague listening says the case is a reminder that patients\u2019 problems often persist and may even worsen despite their providers\u2019 best efforts to develop a care plan.<\/p>\n

\u201cEverything can change,\u201d he said.<\/p>\n

That\u2019s especially true among the patients that DAWN serves, said volunteer Belinda Enriquez, who earned her master\u2019s degree in toxicology last December and is now on a pre-med track. They are, by definition, underserved. They lack not only medical and behavioral health care but in many cases basic necessities like food, clothes, housing and physical security.<\/p>\n

\u201cWe have to be aware of the social determinants of health,\u201d said Enriquez, who worked in a free clinic as an undergraduate at the University of California San Diego before joining the DAWN Clinic as an interpreter. \u201cIt\u2019s important for us to be culturally competent and conscious of the disparities in the community.\u201d<\/p>\n

Help close to home<\/strong><\/p>\n

The clinic\u2019s work falls close to home for Degu, the physical therapy student, who graduated from nearby Aurora Central High School and has volunteered at DAWN for a year. Her parents are refugees from Ethiopia.<\/p>\n

\u201cI could relate to the patients,\u201d she said. During a Wednesday night clinic session, she typically spends an hour with each patient. \u201cThere is less awareness [among them] of physical therapy,\u201d she said. \u201cI\u2019m passionate about it. I\u2019m able to help get them active and healthy and back to work and the activities of daily living.\u201d<\/p>\n

A key clinic aim is to establish the trust with patients that will encourage them to return regularly to the clinic and learn to manage their own care. That heightens the importance of tightening the clinic\u2019s workflows and minimizing wait times. As Enriquez put it, \u201cMany of our patients believe this is the only place they can stop for care. We feel the responsibility to them.\u201d<\/p>\n

In the clinic on this night is a man who offers a vivid example of how important the clinic can be to its patients and the community. A year and a half ago, Pancho Bustamante, 45, was close to death. He suffered from severe liver disease, the result of heavy drinking over a period of years. Describing his then-bloated condition, he extends his arms over his stomach as a pregnant woman would.<\/p>\n

\"Photo
The DAWN Clinic shares space in downtown Aurora’\u0092s Dayton Street Opportunity Center.<\/figcaption><\/figure>\n

Bustamante\u2019s body had few reserves, said Brett Friedman, a DAWN volunteer and student with the Colorado School of Public Health. \u201cHe was emaciated, skin and bones,\u201d said Friedman, who was part of the care team, including DAWN Clinic medical director Joseph Johnson, MD, who helped Bustamante get on a road they hoped would lead to recovery.<\/p>\n

A pair of hospitalizations at UCH left Bustamante with a stark choice. An ultrasound revealed the severe damage to his liver. \u201cThe doctor gave me two choices,\u201d he said in Spanish as Friedman and volunteer Diana Merjil interpreted. \u201cI could die or live life.\u201d<\/p>\n

Taking control<\/strong><\/p>\n

In an exam room, Bustamante speaks with second-year med student Hieu Duong while nursing student Monica Mana documents the encounter on a laptop. Duong asks about his medications and pain in his abdomen. He says he still feels a little bit of discomfort, but he pulls up his shirt to show that his stomach is mostly flat. He\u2019s alert and articulate. For a time, he said, he couldn\u2019t lift much weight and detailed cars to earn some money to pay for his medications. Now, however, he can lift more and has gotten regular maintenance work, he added.<\/p>\n

\u201cI\u2019m getting stronger, gaining muscle,\u201d Bustamante tells Duong as she examines him.<\/p>\n

Friedman notes that the DAWN Clinic helped to stabilize Bustamante\u2019s life by assisting him with getting food and medications. Establishing trust with him was just as crucial, Friedman added. \u201cWe showed him we cared, that we could help with more than just giving him a pill.\u201d<\/p>\n

But to recover, Bustamante had to take responsibility for his own health. He said he stopped drinking well over a year ago, drawing a smile and two thumbs up from Duong.<\/p>\n

Friedman and Johnson \u201cgave me energy to live,\u201d Bustamante said. \u201cI realized the seriousness. I chose for my family to watch out for myself. You have to fight for your life. Nothing is free.\u201d Several times during the conversation he credits God for his retreat from death.<\/p>\n

After Duong and Mana finish, care coordinator Beatrice Guillermo comes in the room and converses with Bustamante in Spanish about additional help the clinic might provide. She can refer him to the School of Dental Medicine on the University of Colorado Anschutz Medical Campus, which provides services to underserved patients at discounted rates \u2013 and sometimes for free.<\/p>\n

\u201cWhatever they tell me, I follow,\u201d Bustamante says before the clinic\u2019s medical team comes in for a final consult. \u201cThey pay attention to you if you need something.\u201d<\/p>\n

Not many patients have as dramatic a story as Bustamante\u2019s. But without regular care, many are at risk for sliding into serious illness, particularly those with chronic conditions like diabetes and hypertension.<\/p>\n

\u201cWe help these patients get primary care when they have nowhere else to go,\u201d Johnson said. \u201cThat helps to keep them out of the emergency department.\u201d<\/p>\n

The clinic has broader goals, Johnson added. It already provides specialty services, including ophthalmology, pulmonology, dermatology and psychology, the third Tuesday of every month. In the coming year, Johnson said he wants to build relationships between the clinic and discharge planning teams at UCH.<\/p>\n

Whatever the challenges, the responsibility for meeting them largely will fall with the student volunteers. \u201cThat\u2019s why we are here,\u201d Viseur said.<\/p>\n

\u201cWe all have a common motive,\u201d he said. \u201cA lot of us should be studying right now, but we have an additional desire to be here.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

In health care, as in all professions, there are many ways to learn. Students in medicine, nursing, pharmacy, physical therapy and other areas spend plenty of time burying their heads in books, scribbling lecture notes and asking questions of their instructors well before they put their acquired skills to the test with a patient encounter […]<\/p>\n","protected":false},"author":2143,"featured_media":11971,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4750,609,943],"class_list":["post-11961","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-access-to-care","tag-dawn-clinic","tag-jeff-thompson"],"acf":[],"yoast_head":"\nDAWN Clinic brings care to those who need it most - UCHealth Today<\/title>\n<meta name=\"description\" content=\"In health care, as in all professions, there are many ways to learn. 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