By Norene Casas
Photos by Mark Sobhani
Pushing his walker across the floor tiles, the man shuffled into the clinic on a rainy Wednesday evening. Every two steps he took advanced his walker just an inch more.
Finally making it to the examination room, he sat still as a doctor began studying his weathered face and frail arms, identifying each pink, scaly spot as precancerous. Medical students gathered closely to learn.
“We will freeze this one,” said the doctor as he pointed to one of the spots. “This one I want to take a deeper look at as it might already be cancerous.”
As one of the city’s estimated 3,000 homeless, the man’s years spent in the punishing South Texas sun were scarred into his skin. The doctor provided much-needed medical attention, and students from the Joe R. & Teresa Lozano Long School of Medicine scribbled notes. This wasn’t a routine class in a lecture hall or lab. These students were learning more than can ever be taught in a classroom.
Since Haven for Hope opened its doors in 2010, UT Health San Antonio has offered a Student-Faculty Collaborative Practice at the resource center that provides services for more than 1,500 men, women and children every year who are experiencing homelessness in Bexar County.
From addressing chronic pain to emergency dental care to vaccines and treatment for skin ailments, the students put into practice what they learn in the classroom under the direction and supervision of faculty. In return, they offer the care that many homeless people lack.
According to the Centers for Disease Control and Prevention, the homeless population has a mortality rate that is four to nine times higher than those who are not homeless. There are an estimated 40 million people in the U.S. living in poverty, 19 million experiencing housing insecurity and 28 million who lack health insurance.
The risk of homelessness and poor health is a concern for 1 in 8 Americans, the CDC reports.
Because of their broad reach and deep impact, the Haven for Hope clinics offer valuable experience for students from all disciplines, said Richard P. Usatine, M.D., professor in the Department of Family and Community Medicine and assistant director of medical humanities education through the Center for Medical Humanities and Ethics at UT Health San Antonio.
“It’s about humanity. It’s about realizing that there are 7 billion people on this planet and we are all the same,” he said.
Dr. Usatine helped start the university’s first student-faculty collaborative practice in 2005. Over the years, it has expanded into a network throughout San Antonio that now offers six clinics—including the one at Haven for Hope—operated by medical, dental, nursing and allied health students.
“They can see that what they are really headed for is a life of service, not a life of memorization and testing,” Dr. Usatine said. “Their eyes are opened to so many different truths and things that extend their compassion.”
Within a year of the School of Medicine opening its clinic at Haven for Hope, students and residents of the School of Dentistry followed using clinic space in partnership with San Antonio Christian Dental Clinic to provide a wide range of dental services. It has since expanded to offer immediate emergency dental care.
The physical therapy clinic began in 2016, and gives students the opportunity to treat chronic pain in the homeless, most of it caused by poor health care and sleeping in inadequate conditions.
“People here are the least likely to receive health care in a private doctor’s office and, because they have the greatest needs, they are the most vulnerable,” Dr. Usatine said.
In addition to practicing techniques and procedures, students get the opportunity to practice empathy.
Students often believe “people living on the streets are different,” Dr. Usatine said, but after serving at Haven for Hope, they walk away with a story or two that impacts how they will provide health care in the future.
Holly Ann Ardoin changed her career plans after her rotation at the dental clinic. The fourth-year dental student saw patients who were around her age, but with teeth blackened and rotted by long-term methamphetamine use.
“I delivered a denture to a 25-year-old girl, and it showed me how strong addiction is,” she said. “I always felt like I was going to give back, go overseas and do dental work there, but I now feel there is so much need at home. There is work here to be done.”
Although it takes a lot of training to care for patients, it doesn’t take a lot to care. That’s an important message that Dr. Usatine wants students to take away from their time at Haven for Hope.
“We are all human beings, and everyone needs to be treated with dignity, love and compassion,” said Dr. Usatine. “Whether a person is homeless or using alcohol or heroin or methamphetamines, they deserve health care. They deserve to be treated well.”
Every time he sees a patient at Haven for Hope, first-year medical student Tommy Pham thinks about his brother. As the student director of the Haven for Hope dermatology clinic, Pham volunteers weekly and often serves patients who struggle with alcoholism and depression—two things his brother also struggled to overcome.
It was Pham who first saw the old man who slowly shuffled into the clinic on a rainy Wednesday.
Pham and other students examined his weathered skin imprinted with the brand of too much sun—too many days spent outside, without shelter.
When his appointment was over, Pham walked with him to the door and told the man how much he appreciated his patience with him and the other medical students.
“He finally looked up and looked me in the eyes. He had that old, really soft smile, and said, ‘Thank you.’ That is all he said. Really gently, just ‘thank you,’” Pham said.
“That look in his eyes, seeing him smile for the first time all night—it gave me a sense of hope. Then he turned around with his walker and went back to Haven.”