Giving the Underserved Hope and Care During COVID

For the past 30 years, JeffHOPE, the student-run organization of Sidney Kimmel Medical College, has distinguished itself by improving access to health care for the homeless and underserved population of Philadelphia.

Established in 1991 by a group of medical students who identified a need in the homeless community for proper medical care, JeffHOPE – Health Opportunities, Prevention & Education – also educates students, residents and faculty members about medical issues, homelessness and poverty.

But in the unprecedented times ushered in by the COVID-19 pandemic, JeffHOPE was forced to temporarily shutter all operations. In early March 2020, given the disproportionate impact of the pandemic on people experiencing homelessness and the lack of available personal protective equipment (PPE) for clinic volunteers, JeffHOPE leaders decided to suspend in-person services. This coincided with the suspension of on-site volunteer activities at JeffHOPE partner sites.

Fourth-year students Julia Dewey and Maddie McGovern share how students go above and beyond to help their clinic patients.

A study recently published in Academic Medicine details how JeffHOPE’s student leaders were able to get the organization’s clinics up and running again. The paper was authored by Drs. Caitlin Weiss and Ashley Traczuk, at that time JeffHOPE’s co-presidents, along with Dr. Robert Motley, JeffHOPE faculty advisor.

“Once the shelter clinics were mandated to cease operations, it didn’t take long for the students to realize that there was an equally strong mandate that said, we can’t just sit on the sidelines,” Dr. Motley says.

Prior to the pandemic, JeffHOPE operated an evening clinic at five different locations within Philadelphia each week. Four clinics operated within shelters, and one clinic operated at a nonprofit center promoting harm reduction among people with opioid use disorder and housing insecurity. Each clinic was led by a third- or fourth-year medical student and a physician preceptor, and staffed by medical student, resident and faculty physician volunteers. Fifty-six preclinical students volunteered weekly in trained roles, such as triage, education and counseling, sexually transmitted infection screening and advocacy and resource navigation.

“This pandemic has been life changing and incredibly difficult for all, however seeing how this pandemic disproportionately impacts our patients has been heartbreaking,” says JeffHOPE clinic coordinator Anusha Koka, a second-year medical student who works at the Sunday Breakfast Rescue Mission. “For our team, we aimed for any avenue in which we could help lessen the burden of this pandemic on this already vulnerable population.”

The road to reopening the clinics began when student leaders conducted a needs assessment with shelter stakeholders, including administrators and long-term residents, to identify service priorities. Those conversations, held in June and July of 2020, led the student leaders to prioritize services such as smoking cessation, health education, advocacy services, including connection to primary care, hygiene supply distribution and acute short-term medical care.

“Our whole mission for the year was to do whatever we could to get five out of five clinics up and running,” says Julia Dewey, a fourth-year medical student and, along with fellow fourth-year medical student Maddie McGovern, current co-president of JeffHOPE.

Adds McGovern, “We utilized the opportunity of everything being closed to say, ‘How do we get JeffHOPE’s foundation even better now than it was in the past?’”

In addition to the needs assessment, the organization’s student leaders developed a list of key components for safe patient engagement and care delivery. A hybrid telehealth approach was developed to reduce in-person exposure for patients and volunteers and to involve preclinical medical students remotely. Three iPads were acquired via an internal grant.

In the hybrid model, clinical students were present on-site in full PPE to facilitate operations and disinfection of the iPads. Preclinical students participated in their trained roles remotely, which also reduced face-to-face exposure for patients and on-site volunteers.

The first clinic reopened in early September 2020. According to the study published in Academic Medicine, over the first 13 weekly clinic sessions, 98 patient visits occurred among 44 unique patients. Of these 98 visits, 21 were in-person only with a clinical student and preceptor, while 77 also used the hybrid telehealth model to connect via iPad with a preclinical student. Two patients were sent to the emergency department for COVID-19 testing due to symptoms revealed during preclinic screening and physician triage. No students tested positive for COVID-19 after volunteering on-site, and no patients tested positive for COVID-19 after visiting the clinic.

“With the pandemic, overdose deaths have increased, so it was really important that we got back out there and made a difference,” says second-year medical student Azra Dees, a JeffHOPE clinic coordinator and triager at Prevention Point, a harm reduction group in Philadelphia’s Kensington neighborhood. As a triager, Dees screens each patient for COVID, checking them in for treatment and monitoring the flow of the clinic. “Many of our patients distrust the medical system due to previous experiences. We are their only type of health care.”

Since December 2020, all five JeffHOPE clinic sites have reopened using the pilot clinic’s hybrid telehealth model and additional iPads that were acquired.

The study’s authors concluded that their primary objectives of safely piloting clinic operations in the shelter, engaging preclinical and clinical student, and providing JeffHOPE services to individuals experiencing homelessness were met.

Undoubtedly, the study’s findings will see JeffHOPE’s student leaders continue to refine the organization’s operating procedures so it can continue to meet patient needs. The role of telehealth within the clinics may be one of the study’s more intriguing findings.

“How do we continue to utilize telehealth?” Dewey asks. “There are so many potential partnerships that are difficult to achieve in person and maybe telehealth is how we can harness even more resources for the patients that we see.”

That JeffHOPE survived the pandemic and will continue to meet the needs of the underserved populations of Philadelphia – as well as provide invaluable lessons for future clinicians – is perhaps the best news of all.

Says Dewey, “JeffHOPE gives you such a different sense of what medicine is and the importance of how medicine means so much more than what you see in the clinic, what you’ll see on rotations, what you’re learning in class. It's creating future healthcare providers who have a realistic sense of all the community factors, all the social factors that go into the picture of health care.”