They come every evening—more than 100 hungry souls standing in line outside the Claremont Soup Kitchen in central New Hampshire. Though they arrive for hot meals, many are also in dire need of medical attention, for problems ranging from diabetes to psychiatric illness to frostbite. And for a year, in two new exam rooms in the soup kitchen’s dining room, Christine Breuer ’09 and Erik Andrews ’09 organized that crucial care.
Breuer and Andrews are students at Dartmouth’s Geisel School of Medicine in Hanover, N.H., an Ivy League enclave 30 miles from postindustrial, poverty-stricken Claremont. When the duo were awarded Schweitzer Fellowships in 2013 to undertake a public health project, their thoughts gravitated to the soup kitchen, where previous students had founded the embryo of a health clinic in 2012. Last summer Breuer and Andrews set about expanding the nascent clinic into a health care hub.
Because of their student status, the pair could not directly administer care. Instead they developed a screening process, gleaning data such as blood-glucose levels, body-mass index and substance-abuse history, which they used to route patients to hospitals and specialists. For patients who hadn’t seen physicians in years, the screenings could prove revelatory. “Many people who come to the soup kitchen are either pre-diabetic or have advanced-stage diabetes and don’t even know it,” says Breuer.
Breuer and Andrews quickly saw, however, that connecting patients with doctors wasn’t enough. Many patients did not know how to apply for Medicaid. Some could not read hospital forms. Others had no way of getting to the doctor. Seemingly minor challenges became insurmountable barriers.
Helping patients navigate logistical obstacles was, says Andrews, his and Breuer’s greatest contribution. Being students made them less intimidating, and it gave them more time to develop personal relationships. When a homeless man named Alan was tentatively diagnosed with lung cancer at the ER but had no way of getting to a pulmonologist, Breuer and Andrews picked him up at 5 a.m. and gave him a ride. (Alan’s tests were negative; in February he wrote to Andrews to say he’d gotten a new job and home.)
“We have all these systems to get this guy a $5,000 test,” Andrews says, “but we can’t get him a 30-minute car ride? There’s this term you hear a lot in medicine: ‘patient has poor compliance.’ Well, there are a lot of reasons for noncompliant patients.”
As success stories like Alan’s spread, other facilities began taking note of the clinic in the soup kitchen. Dartmouth-Hitchcock Medical Center donated exam tables. Medical supplies came from the nearby Good Neighbor Health Clinic. Valley Regional Hospital supplied flu shots. Students and nurse practitioners began pitching in hours.
Further growth, however, will be accomplished by other Dartmouth med students. Breuer and Andrews handed off the clinic’s reins this spring. For the next year, Andrews will hold a pathology fellowship at Dartmouth-Hitchcock, and Breuer will travel the country completing clinical rotations. Behind them, they leave a clinic that’s strong and growing stronger—and with them, they take valuable lessons. “It’s made me aware of the barriers patients face,” says Breuer: “Can they read? Can they write? Can they drive? The gaps to care can be very simple.”
Ben Goldfarb ’09 is a freelance writer whose work has appeared in The Guardian, in OnEarth Magazine and elsewhere. Photo by Joshi Radin.