The University of Texas Rio Grande Valley School of Medicine started in 2016 with the promise to help a medically underserved region. Students are helping to keep that promise.
When they opened their first student-run clinic in Peñitas in March, they expected to see a lot of illnesses tied to poverty — diabetes, hypertension, and the like. They were not wrong.
The clinic is in the heart of the Pueblo de Palmas colonia, one of almost 1,000 colonias sprinkled around Hidalgo County. Colonias are makeshift communities in unincorporated areas that typically have poor infrastructure, low incomes, and large Hispanic populations.
“We picked that site for a specific reason,” said Kevin Mutore (see photo, right), a first-year medical student who helped start the Peñitas clinic. “There is a definite need, and we’re trying to fulfill that need.”
For medical students, examining and treating any patient can be educational. But among the cases UTRGV medical students see, one was exceptionally noteworthy for any doctor: a woman came in to get help with her neurofibromatosis, a rare genetic disorder that causes tumors to form on nerve tissue.
Not surprisingly, the case got special attention.
“That patient stayed 30 or 45 minutes after her appointment just so that we could do a sort of grand rounds, with a physician leading about the diagnosis and the disease in general,” Mr. Mutore said. “There were about 15 to 20 medical students around the physician [who was] explaining how rare a disorder this was. And the patient was super, super nice. She was excited to be part of our education.”
The Pueblo de Palmas clinic reflects the dual mission of the UTRGV medical school — to help a medically underserved region while also educating future physicians. There are certainly other student-run medical clinics in Texas. In fact, they served as a template for this one. But traditionally, medical schools seldom let students stray from the lecture hall until the third and fourth years.
At the UTRGV School of Medicine, the ruling philosophy is to get students to do hands-on work in the community as fast as possible. (See “Fulfilling a Dream,” September 2017, Texas Medicine, www.texmed.org/UTRGVdream.)
“This [clinic] is a lesson in leadership, practice-based medicine, systems health, health care disparities, and social determinants of health,” said Eron Manusov, MD, clinical associate professor in the Department of Family and Community Medicine, and one of several faculty advisors for the clinic. “These are things they’ll be doing once they get to residency. But they’re doing it on their own already — with leadership from [faculty]. But by far they do the vast majority of the work.”
Setting up the clinic was a lot of work. The clinic’s board, composed of Mr. Mutore and nine other students, had to do months of research while selecting a site, recruiting staff, and getting backing from school officials. The board members also secured funding, which came from several sources, including the medical school and a $1,200 grant from the Texas Medical Association’s Be Wise — ImmunizeSM program.
With guidance from Dr. Manusov, the students agreed the best site for the clinic was Proyetco Desarrollo Humano (PDH), a Catholic community center in the colonia that already had two fully stocked medical examining rooms, as well as a behavioral science room. The PDH had held sporadic clinics with the help of out-of-town physicians, but nothing had been done on a regular basis until the student clinic came along.
“It was all sitting there waiting,” said Dr. Manusov. “They just needed some providers.”
The student clinic is held on the third Saturday of each month from either 9 am to 1 pm, or 10 am to 2 pm. The schedule will go to twice a month by the end of the year, and hopefully accelerate even more as the clinic gets fully established, Mr. Mutore says.
UTRGV’s long-term goal is to have a network of clinics around the Rio Grande Valley — some university-run and others student-run. The top priority for all of them is to be financially sustainable. Dr. Manusov says the biggest obstacle to that is the same thing that makes the clinics necessary — the patients are poor and few have insurance.
“Probably 60 or 70 percent [of adult patients in the colonias] have nothing — no insurance,” Dr. Manusov said. “So it’s really an issue of funding. Who pays for this?”
Allan Fonseca, a first-year student who is also on the board, says the clinic currently uses a mix of grants, funding from the medical school, and individual contributions. The clinic also is trying to set up a referral network of specialists. Fortunately, UTRGV has specialists who can help with some issues. But outside physicians who help do so because they understand the level of poverty involved, Mr. Fonseca says.
“We’re not going to send [these patients] somewhere they’re going to be charged tons of money they can’t afford, or somewhere they’re not going to have the sympathetic kind of care we’re trying to deliver to them,” he said.
This kind of sensitivity to economic issues is one of the reasons UTRGV School of Medicine was created.
Though the Rio Grande Valley has plenty of suburbs and shining office buildings, it’s also one of the poorest regions in the United States. People here earn median household incomes of $31,547, compared to $54,727 statewide and $55,322 nationwide. The four counties that make up the region — Cameron, Hidalgo, Starr, and Willacy — have an estimated average poverty rate that is nearly three times the national rate of 12.7 percent.
People in the Rio Grande Valley also have much higher rates of illnesses tied to poverty, such as diabetes, hypertension, and heart disease. And the region’s semi-tropical climate makes it prone to warm-weather illnesses like Zika virus and chikungunya, which are less-prevalent or nonexistent in other parts of the state.
That’s why students who come to the UTRGV School of Medicine are encouraged—though not required — to find innovative ways to deal with the region’s many health issues, such as the student-run clinics.
“One of the main reasons I chose UTRGV was because when I was here during interview day, there was a group of people who were committed to improving the access to health care in this region in general,” Mr. Mutore said.
The clinic was set up in part to help bring down rates for preventable medical conditions like diabetes, Mr. Fonseca said. Another key goal is to replicate this first clinic in other colonias, many of which have no running water or electricity.
“The colonias in this county are the worst of the worst when it comes to medical care,” he said. “So I would be confident in saying these are the most underserved people in the country.”
Meanwhile, the students running the clinic are getting a much deeper education than they would from just lectures or learning modules.
“Actually seeing diabetes and actually hearing murmurs in the heart — it really solidifies what you’re learning in the classroom,” Mr. Fonseca said.
One of Mr. Mutore’s chief concerns is making sure the student clinic doesn’t become the latest in a long line of health care efforts in the region to appear and then suddenly disappear.
“There are a lot of health missions [to colonias] that are kind of drive-by medicine,” he said. “You’re there for a while and you’re gone. We want to focus on being sustainable — a mainstay in the Peñitas community.”
Building and running the clinic has been the kind of work Mr. Mutore says he loves.
“There’s so much need down here that you get to contribute and you’re expected to contribute [as a medical student],” he said. “It’s just a great feeling.”
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Tex Med. 2018;114(6):32-34