The Greater Good
The galvanizing notion first took hold against salt air and cotton fields. In 1965, visionary Tufts Medical School professors Count Gibson and Jack Geiger conspired to create the nation’s first public health clinic, located in a simple structure adjacent to the harbor at Columbia Point in Boston. They followed this up two years later by launching the Delta Health Center in Mound Bayou, Mississippi, deep at the heart of an impoverished rural region beset by health problems typically seen in developing countries.
From those two seeds sprang the network of more than 1,000 public health clinics that Americans know today. So in late March at a reception on the Boston campus, when Alan Solomont glanced around a room filled with medical students eager to talk about their service-learning experiences in the community at large, he saw the past reframed in their faces.
Solomont, A70, the Pierre and Pamela Omidyar Dean of the Jonathan M. Tisch College of Citizenship and Public Service at Tufts, cited the legacy of Gibson and Geiger right at the top. “Your Community Service Learning programs are pillars of that [same] commitment,” he said, calling the medical school “the repository of its DNA.” The desire to address health disparities and work with the underserved provides a long, unwavering line at the medical school, he suggested, a line even more keenly drawn in recent years as a term of community engagement has entered the school’s curriculum as a requirement for graduation.
Beginning with the Class of 2014, all Tufts medical students have been asked to fulfill a minimum of 50 hours of service to an established community-based organization in the Boston area, or, if they prefer, to create an independent project of their own. The service may be rendered during any of the student’s four years, but must be completed within a 12-month period. Finally, as part of the new Tisch College and Tufts University School of Medicine Community Service Learning (CSL) program—whose funding is shared between Tisch and the medical school—students must write a personal “reflection” on their experience, thereby crystallizing its lessons for them.
The Tisch CSL program is led by course co-directors Mark Pearlmutter, M84, and Laurel Leslie, professor of medicine, pediatrics and public health and community medicine, and a part-time CSL coordinator, Jennifer Greer-Morrissey.
A cultural shift of some kind has dramatically raised the allure of community service among current applicants to medical school, observers say. Pearlmutter recalls that 30 years ago, when he was enrolled at Tufts, “we used to have a handful of students” who would go off and volunteer at community sites independently. Now, he reports, when he addresses incoming medical classes and asks how many in the room have already done some form of community service, a huge percentage raise their hands.
Medical students stand to gain a great deal from exposure to the world beyond the clinic walls, Pearlmutter says. “It opens up their eyes,” he says. “Volunteering like this involves working with a disenfranchised population, and students who do it have a healthier outlook on caring for the individual patient.” Scott Epstein, M84, dean of educational affairs, says simply, “It makes them better doctors.”
In this story, Tufts Now offers a sampling of recent student engagements with the community.
Out on the Street
By Rebecca Lee, M16
On the night after Thanksgiving, the night he died, I imagine Sam lying outside the Harvard Square subway station. He takes swigs from a pint of cheap vodka and makes friendly conversation with nobody in particular. It was one of the first bitterly cold nights of the winter, with temperatures dropping well below freezing.
In December, 7,255 homeless men, women and children were counted in Boston’s homeless census—a 3.8 percent increase over the previous year. Although many had found a place to sleep in shelters and motels across the city, 180 of these individuals were living on the street—the so-called “rough sleepers.” These are the patients the Boston Health Care for the Homeless Street Team cares for.
Since beginning medical school, I have been lucky to join the Street Team. I’ve worked with their physicians in the drop-in clinic for the homeless, done street outreach, participated in weekly team meetings and visited patients in their apartments. Sam was one of the first patients I met. I actually mistook him for another volunteer because of the gentleness with which he helped the other patients and how well groomed he was, with a white button-down shirt, rimless glasses and combed-back hair. He was well spoken and clearly intelligent; his life fell apart when he started drinking.
Gradually, I got to know Sam, in clinic, on the street and when he was an inpatient at a respite center in Boston that caters to the homeless. I began to piece together snippets of his life. He was once married; he had children. He had emigrated to the U.S. from Pakistan as a young man. We frequently talked in a mix of Urdu and Hindi, languages I had been eager to learn for a long time. There were rumors of New York restaurants that he had owned.
The last time I saw Sam in the drop-in clinic, he was not well: in a wheelchair, inebriated, with damp clothing arranged haphazardly around his body. I helped him peel off the layers of second-hand sweatshirts, which had towels stuck into the pockets for additional insulation. I needed to take his vital signs. He started crying. “Everything hurts,” he said. “I’m such a mess.”
A little while later, I was in a rush to leave to get to class across town. I stopped by Sam’s wheelchair to say goodbye. “Study hard,” he told me. “I love you.” I thought about the lectures I had had in the past year on not crossing boundaries in the patient-doctor relationship, about the importance of maintaining distance. But words can be healing, too. “We all love you too, Sam,” I said. “I hope you feel better soon.”
A police officer found Sam’s body at 2 a.m. on a brick step outside the Harvard Square T station. He was one of three homeless patients I knew who died that week. All had numerous contributing factors leading to their deaths—histories of trauma and abuse, abandonment and bad luck, illness and addiction. All were rejected from their communities for reasons that were, to a degree, out of their control, and so they died on the street.
The Upward Path
By Adam Cardullo, M17
Ideas in Medicine was begun in 2010 by Jonathan Brower, M13, and Michael Kwak, M13, as an outreach between the medical school and the Eugene Wright Science and Technology Academy, a middle school in Chelsea, Massachusetts.
More than 88 percent of the students at Wright hope to attend college, but ultimately only 14 percent will do so, according to recent figures. Looking at this trend, the idea behind IDEAS was to integrate medical curriculum into a seventh-grade classroom and have Tufts medical students act as educators and mentors.
This past year, a bunch of us paid regular visits to the school. All told, there were some 20 medical students involved (six from the class of 2017 and 14 from the class of ’16) and between 25 and 30 seventh-graders, depending on the day. We showed the kids how to make their own ice cream, using a recipe to help teach them fractions. We held an egg-drop competition. We had a day where we demonstrated physical diagnosis tests with reflex hammers, penlights and tuning forks.
At the end of the year, we usually invite the students to Tufts to see what a medical school looks like. While they’re here, we teach them basic life-saving skills, such as CPR. A lot of the kids tell us later that it’s the best field trip they’ve ever been on.
By Catherine Logan, M09
I launched the Team Cathedral Project back in 2009 when I saw the need for better athletic screening at Cathedral High School, located in the South End, near the medical school. Pre-participation examinations, or PPEs, are required for student athletes, with the goal of identifying medical or orthopedic problems that may put them at risk for injury.
Historically, dozens of Cathedral students each year had trouble getting PPEs and so were missing out on sports. My first job was to set up a free PPE screening at the school at night, tapping the expertise of Tufts Medical Center doctors and residents who volunteered their time.
Since those early days, Tufts medical students have been essential to the growth and evolution of Team Cathedral. Our program now includes free medical coverage during athletic events, pre- and post-injury ImPACT concussion testing, a thriving mentoring initiative and educational events, such as a field trip when the junior class spends a day at our medical school.
The field trip has become a highlight for both Cathedral and Tufts students. While here on our campus, the high schoolers engage in career panels, fitness testing, a visit to the anatomy lab and the always popular casting session, where they learn how to put casts on one another.
As someone who’s pursuing her residency in orthopedic surgery in the Boston area, I’ve been lucky enough to stay involved with Team Cathedral post-graduation. We’ve made a good start. The Team Cathedral project’s success and sustainability relies on its devoted medical student volunteers, who now number 20, representing all four classes. My hope is that a network of Tufts alumni with an interest in musculoskeletal health and activity, as well as community service, will enable us to expand the scope of our services in the coming years.
By Semonti Hossain, M16
My life in Boston seems like a dream when I compare it with how I lived for a week on a medical mission in Haiti. The rush to wake up in the morning, speed-walking to class with coffee in hand…
I had to guide myself in a world of new customs, climates and cultures. And that was part of the promise I made to myself when I went. Aside from the clinical experience—the opportunity to conduct a public health project in maternal health and mortality and the chance to interact with Tufts medical staff—I just wanted to figure out what it meant to be me.
Unlike my colleagues from medical school, I was never shocked by the poverty in Haiti. If anything, I loved it. It reminded me of Bangladesh, a land where half my roots belong. The thick smog, the arrhythmic honks pulsating through the streets, the leaking sewage, the utter chaos of Cap-Haïtien, just like Dhaka city. The naked children dancing barefoot on the sidewalk, shouting “I love you! I love you!” to the bus full of Americans, a Dhaka déjà vu. Something about this devastatingly poor country brought me back to the essence of Bangladesh.
By Marcus Sublette, M14
For my community service learning project, I volunteered as a computer skills instructor at the New England Center for Homeless Veterans in downtown Boston, just off the Government Center T stop. Founded in 1990, the organization is one of the largest of its kind, serving several hundred veterans each day. The center assists veterans who are homeless or are at risk of becoming so in getting a long-term job and living independently.
Most of my students were middle-aged and did not grow up using computers, and many had not had a job where computer use was required. Their lack of computer skills was a major barrier in applying for and obtaining employment.
I developed my own curriculum. Of the six students I had on the first day, two were very familiar with computers and wanted to learn Excel and PowerPoint. The other four didn’t even know how to turn on a computer. They had never set up an email account and could barely use the Internet. To teach all of them, I had to run the course like a one-room schoolhouse.
When I taught PowerPoint, I asked them to create a short presentation on a topic of their choice, something that they knew a lot about. One of my students had worked as a barber for 32 years, so he created a presentation on how to give a haircut. Another student had always wanted to run a restaurant, and he created a slide show menu of what meals he might serve. PowerPoint was very popular.
Teaching these men helped me to gain a better insight into homelessness. In one class, I taught a man how to use Google Maps. As I was explaining what the application could do, he asked to look up a home address in rural Georgia. As we looked at the picture of the house in “street view,” he quietly started crying. He explained to me that this was the house of his daughter, whom he had not seen in many years. Just seeing the house again brought all of his sadness and loneliness and the isolation of years of homelessness to the surface.
By Nathan Potter, M17, and Jennifer Moyer, M17
Nathan: Jenny and I started planning this together back in the early fall, once we found out we were both interested in health care within prison systems. We approached the South Bay House of Corrections in Boston, where the warden put us in touch with a deputy who was very enthusiastic about the idea. She said it filled a need there really well.
We’ve done one workshop so far, talking with a group of 30 men about ways of coping with and reducing stress. These are prisoners near release who are working in the community during the day and then coming back to the prison at night.
Jenny: We see health from a broad perspective. We tell the men that they have to eat, exercise and sleep in a good way, and also try to maintain healthy relationships so that when they leave, they have a healthier life in general.
Nathan: Right now there are five medical students involved at the jail. Jenny and I got the ball rolling. Our hope is that next year, when the first-years start, we’ll be able to get a new group of people involved so that the program is self-perpetuating.
Jenny: Our next step is to set something up where students can be matched with people released from prison for a kind of mentorship. The students could help ex-prisoners deal with their anxiety and mental health issues to keep them from going back to jail.
This article first appeared in the Summer 2014 issue of Tufts Medicine magazine.
Bruce Morgan can be reached at email@example.com.