Despite standing face to face with one of his patients and her husband, Dr. Nick Nguyen must dispense his medical advice into a cell phone.
On this particular night at the Sharewood Project, a free health care organization run by Tufts University Medical School (TUMS) students, there are no volunteers who speak Hindi, the patient's native language. Nguyen, a clinical associate, is speaking with the patient's daughter, who in turn will translate his advice.
This is not an uncommon scene at Sharewood. The free clinic sees many patients who speak little or no English, and a translator is not always readily available.
The clinic is located in the First Church of Malden and is held on Tuesday nights from 6:30-9 p.m. Any patient who walks in the door has access to services including general health care, HIV and sexually transmitted infection (STI) testing, and registration for MassHealth, state-sponsored free health insurance for certain low- to medium-income state residents.
The clinic was founded in 1996 by first-year students at TUMS with the help of Dr. Brian Lisse, a clinical professor who had previously helped create a free community health center in Danielson, Conn. Although Lisse agreed to oversee the Sharewood clinic, students are in charge of running the entire operation.
The name "Sharewood," chosen by the students, was meant to combine the ideas of Sherwood Forest from the story of Robin Hood -- who steals from the rich to give to the poor -- along with the message of a shared learning experience.
Originally, the clinic only provided general health services, but has since expanded. It has seen an on-and-off presence from members of the Tufts dental, nutrition and optometry communities, as well as an acupuncturist and a psychologist. A more recent addition is a representative from MassHealth now working at the clinic every Tuesday, attracting an increasing number of clients.
Also present at the clinic every week are two members of the Board of Medical Students, a group of four Case Management/Women's Health Coordinators. Nicole Salg, a second year medical student, is one of the case managers, and said that the board is an integral part of the project. "[We compose the] social service side of Sharewood," she said.
As Sharewood is one of the few places providing free services, HIV and STI testing have become increasingly popular at the clinic. Students often go to the clinic to avoid their schools' health service costs.
A Hepatitis B initiative is run concurrently with Sharewood, though it is coordinated by Harvard students, who provide both testing and vaccination against the virus.
Dr. Anthony Schlaff, director of the Masters of Public Health program at Tufts, commended Sharewood for its contributions. "[Sharewood] adds value to the community," he said.
But Schlaff expressed some concern that the free clinic model is flawed due to a lack of continuity of care and specialists. According to him, a community health center that sees both paying and uninsured patients is a better model for public health; however, he acknowledged Sharewood's effects on the community.
"[One thing I] respect about Sharewood is that they understand the limits to the model," Schlaff said.
While they offer a growing assortment of health services, a practice that Sharewood has been forced to abandon is that of the general physical. According to second-year medical student Rachel Shing, one of the two Sharewood publicity coordinators, athletes were taking advantage of the opportunity for free physicals.
"[Sharewood saw] the entire Everett High School soccer team," Shing said. Patients must now have an acute problem in order to receive free care. Using the clinic's limited time and resources for general physicals detracted from its ability to attend to patients with more pressing issues.
All workers at Sharewood are volunteers. Upon arriving at the clinic, patients are greeted by undergraduate students, who show them to a room, take their vitals and chief complaint, and then turn them over to a medical student volunteer.
The medical student will examine them further and subsequently consult with a resident or attending physician, who will point out questions that should have been asked and help the student come up with a plan of action. The student and physician then return to the patient together to explain the next steps.
With the exception of board members who are required to attend each week, medical students volunteer at the clinic on a random basis. Despite the lack of scheduling, the break room is generally full of medical students -- a phenomenon that could be linked to the educational benefits tied to working there.
"It is extremely valuable that medical students get exposure to [Sharewood]," Shlaff said.
Undergraduate volunteer positions are in very high demand among pre-med students and are promoted by the Pre-Med Society at Tufts. Because they are so popular, a schedule is made limiting the number of undergraduate volunteers per night.
Shing, who volunteered at Sharewood as an undergraduate before doing so as a medical student, said that volunteering is extremely valuable to pre-med students. "[Volunteering helps students decide if] this is really what [they] want to do," Shing said.
In response to overwhelming interest by undergraduate students, an undergraduate board was formed last year. According to junior Laura Berger, the undergraduate publicity co-chair, the board is meant to ease the burdens of the medical students. "[The medical students] are really busy," Berger said.
Shing agreed that the undergraduate board is very useful in taking some of the pressure off of the medical students. "It's awesome having [the undergraduate board]," Shing said.
The board also helps undergraduates get more involved with the clinic, since undergraduates typically do not see many of the patients.
Sharewood's expanding network of volunteers and growing publicity efforts have created a pronounced effect. Sophomore Gregory Marecki, who is in his second year volunteering at Sharewood, has seen patient numbers increase from four or five a night to 25 a night. "[The increase in patients can be] chalk[ed] up to the T ads," Marecki said.
