The Free Clinic Project of UCSD is not your typical free clinic. In this free clinic, doctors, students and community volunteers throughout the San Diego County provide medical, pharmaceutical and dental services in three different San Diego locations to just about anyone who seeks treatement.
Established in 1997 at the Pacific Beach Methodist Church by UCSD School of Medicine’s Dr. Ellen Beck and a handful of UCSD medical students, the clinic was formed with the desire to provide health care for those in need. Although the clinic initially provided limited medical care, over the last six years the project has expanded to two additional sites in San Diego County, at the First Lutheran Church in dowtown San Diego and Fred Baker Elementary in the Mountain View neighborhood, and now boasts a three-tiered system that includes a medical clinic, a pharmaceutical clinic and a dental clinic at each site.
Unlike many other social programs, the Free Clinic Project provides medical and dental care to anyone who seeks treatment ‹ patients are not screened based on their apparent financial need.
“”In an attempt to maximize outreach in community dental care, it’s not appropriate to look at the financial restraints of patients because there’s such a spectrum of neediness and we want to provide for all those who are humble enough to come and ask for help,”” said Jeremy Horst, a UCSD alum and former student director for the dental clinic.
The clinic’s posted motto is “”Serving the Underserved.””
“”[The underserved] are the working poor, the homeless, nonlegalized immigrants, people who have been laid-off, families at the end of their means, people who have homes but no jobs, people who have jobs but no homes, older folks who aren’t benefiting from social security,”” Horst said.
Glen Stroman, a culinary cooking instructor at the downtown San Diego clinic was one of the patients to receive free dental care. He applauds the effects the clinic has had on the surrounding community and is grateful for the dental clinic, having just gotten the remaining part of a painful wisdom tooth extracted by retired dentist Dr. Jack Curren.
“”The dental clinic is really helpful because you have a hard time finding dental service any place without it costing an arm and a leg,”” Stroman said.
Since its inception in 1997, the project has increased both the spectrum of available treatment and the enlisted help of faculty, students and the community. The clinic operates at a different location every Monday, Tuesday and Wednesday evenings, and treats, on average, 20 to 25 medical patients and five to 10 dental patients during three hours. The medical portion of the clinic is run through the UCSD School of Medicine and is part of an elective course available to UCSD medical students. These students treat the patients under the supervision of UCSD faculty and non-salaried clinical doctors from the community. All of the doctors, however, work at the clinic on a volunteer basis, and many of the students continue to volunteer at the clinic well after the course is over.
The pharmaceutical aspect is run in conjunction with the UCSF School of Pharmacy and the UCSD School of Pharmacy and Pharmaceutical Sciences. As part of their ambulatory care core curriculum, fourth-year UCSF students help train first-year UCSD pharmaceutical students. Like the medical students, the pharmaceutical students often return to volunteer in following years due to the rewarding relationships they have formed with patients and doctors.
Beck explained that although some of the students participate as part of a credited course, the effort the students give toward the clinic exceeds that required of the curriculum.
“”Students contribute far more hours because they’re committed to it ‹ there’s a beautiful sense of ownership,”” she said.
While the medical and pharmaceutical clinics are primarily managed by medical and pharmaceutical students, the dental clinic is operated by UCSD undergraduates. Because UCSD does not have a dental school, undergrads interested in the field of dentistry are trained by existing student volunteers and dentists in how to manage the dental facilities. Students are involved in nearly every aspect of the procedure, including patient intake, preparing instruments for the dentist, clean-up and post-op instructions to patients. At the Baker Elementary site, the clinic even performs removable orthodontics, a practice that is near impossible to find anywhere else in California for free.
“”Our focus, goal, mission of the clinics is to rectify patients’ oral health for the point of restoring the power of their lives,”” Horst said. “”It can be to get a job, to restore their self-image, or restoring dentition so they can eat healthily.””
The patients, however, are not the only beneficiaries. Wilson Leung, the current student director for the dental clinics, described the many benefits of this sort of hands-on experience.
“”You can think of this as boot camp for dental school,”” Leung said. “”After being part of the program for over a year and going off into dental school, you will be way ahead of everyone else.””
Largely initiated by UCSD alumni Eric Goldlust and developed by Horst, the dental clinic has grown tremendously since its beginning in 1999. In 2000, Horst also founded the Pre-Dental Study Club at UCSD to supplement a lack of dental information offered by Career Services Center and the deteriorated UCSD Pre-Dental Society. Horst explained that the Pre-Dental Study Club sprang from the free dental clinic, and is open to any major.
Under the supervision of newly appointed dental advisor Dr. Irvin Silverstein, the Pre-Dental Study Club will host an impressive line of guest speakers this fall, including admissions deans from seven dental schools. The events, scheduled for every Thursday night starting Oct. 2, will be open to all interested students.
In addition to organizing the upcoming events for the Pre-Dental Study Club, Silverstein has been significantly instrumental in acquiring volunteer dentists for the upcoming year.
He praised the Free Clinic Operation, describing the benefits students receive in “”knowing what dentistry is all about,”” feeling the “”satisfaction of helping other people,”” and getting them “”in touch with filling out their applications [for dental school].””
Leung said that there were benefits of learning from the volunteer dentists because they essentially become the supervising dental faculty during the clinic’s sessions.
Leung and Silverstein will also oversee the renovation of the Pacific Beach dental clinic this year, as well as making essential updates to the other clinic sites.
While the clinic provides extensive service to the public, the amount and type of treatment the clinic can offer is seriously hindered by the project’s limited finances. Beck explained that because of the tireless effort of UCSD School of Medicine Deputy Vice Chancellor and Dean David Bailey, M.D., as well as the enormous support of Vice Chancellor and Dean Edward Holmes, M.D., the project was able to obtain funds from the UCSD School of Medicine, which in turn encouraged private foundations to make similar contributions.
Nevertheless, the clinic is responsible for acquiring much of their supplies and monetary funding from outside sources. Private organizations such as California Endowment and the Alliance Health Care Foundation, in addition to several other medical companies and local foundations, have made significant donations. Beck clarified that despite these donations, the cost of simply maintaining the clinic is great and entails increased support from private organizations and the surrounding community.
“”The need is infinite, and we can only provide a drop in a bucket,”” Beck said.
Pharmaceutical clinic faculty member Dr. David Adler said there is a “”very small budget”” the pharmaceutical clinic has for purchasing medicine. While they are able to maintain a supply of generic drugs largely used for acute illnesses, the clinic must turn to other resources for more costly medication in treating chronic ailments. The Patient Assistance Program, a program mandated by Congress that provides free medication to indigent patients, is where the clinic turns to on behalf of many of their patients’ needs. Procuring drugs from individual companies, however, can be a prolonged and painful period as each pharmaceutical company has its own standards and regulations for Patient Assistance Programs, and may not highly prioritize providing medicine to social programs. For needy patients at the clinic, this can mean at least an eight-week waiting period, and often even longer.
To combat the detrimental delay, Adler will be working with a group of pharmaceutical representatives toward creating a service project that will provide medication in the form of samples or larger quantities during the waiting period.
“”We’re certainly interested in samples that would fit our formulated needs from places that have samples and aren’t using them,”” Adler said.
He asserted, however, that the donated samples must be within the expiration date and must fit their formulated needs in order to avoid useless donations, which actually end up being a great disservice.
Beck’s goal for the upcoming year is to create a network that includes all surrounding clinics and hospitals in the San Diego region. In this network, patients would receive respite care, wound care and a place to rest during what he called, “”that interim period between the hospital and being in the streets.””
Beck, a native Canadian, affirmed that universal health care is possible for the United States, but feels that the country must mature and not fear social responsibility. She hopes that her ideas on a single-payer system of health care, where insurance companies are demoted to a minimal role, and setting price controls on pharmaceuticals and certain medical procedures will be heard and implemented.
“”People’s sickness and death shouldn’t be a source of profit,”” Beck said.
In this effort, Beck is working toward increasing resources and the quality of services available at the clinic. Although the UCSD Free Clinic Project has already served as a model for five other universities throughout the United States, including UC Irvine, Beck hopes that significant changes will be made in order to provide health care to all in society.
“”We all have a social responsibility,”” Beck said. “”Everyone does. Otherwise, how does a society survive? Social responsibility is an appropriate human behavior. Individuals do it all the time, but it is time for the country to take social responsibility ‹ to provide health care for all people in America.””
The UCSD Free Clinic Project will be holding a fundraising event in the Price Center Ballroom on Oct. 21.
