Healthcare with Heart: Clinics Provide Free Services Across San Diego County

During a rare lull in her busy afternoon, Alia Holyfield loaded a washer in the back room of an Oceanside health clinic. Before that she had answered phones, took a patient’s blood pressure and medical history, and checked inventory in the supply room.

It’s all in a day’s work for Holyfield, a student manager at the free clinic, one of four in San Diego County run by the School of Nursing (SoN) at Cal State San Marcos. Known collectively as the Student Healthcare Project, the clinics are managed by students who work under the supervision of licensed volunteer physicians, nurse practitioners and SoN faculty to provide free services to poor and uninsured community residents.

Holyfield, who will graduate this spring with a bachelor’s degree in nursing, hones her clinical skills by performing EKGs, changing catheters and doing pregnancy tests. She is learning about clinic operations as she manages inventory and updates electronic medical records.

The experience has made her keenly attuned to the needs of the clinic’s patients—the working poor, uninsured, the homeless and those who struggle with mental health and substance abuse issues.

“Working here has been an amazing experience for me,” Holyfield said. “This allows me to give back to patients who have had very little access to care. I have learned how to build trust and rapport with our patients. It’s wonderful to see that they look upon the clinic as a place they can come to.”

Dr. William “Gerry” Hardison, volunteer medical director of the Student Healthcare Project, has observed firsthand the impact of the clinic experience.

“The experience is unique for student nurses,” said Hardison, a retired physician. “They are case managers. They are social workers. The patient clientele that they see here, they will never see anywhere else. They learn a tremendous amount. I have learned a lot.”

The Student Healthcare Project was the brainchild of SoN faculty member Linnea Axman who broached the idea to her graduate students five years ago. Mary Baker and Michelle Alfe, now faculty members at SoN, jumped at the opportunity. The group began to work on the details of opening the first free clinic that could serve the homeless population in Ocean Beach while providing SoN’s baccalaureate and graduate students the opportunity to fulfill clinical rotation, community service and leadership requirements.

The Ocean Beach clinic opened in 2010. Three other locations were added in Ocean Beach, Oceanside and National City.

Baker is a teacher, mentor and sounding board for the nursing students who run the four clinics. As clinic co-director, she splits her time between all four sites as she guides students through every aspect of clinic operations, whether it’s writing grants, finding the best source for supplies or securing space for a wellness class.

“Being here teaches students some things they can’t learn in a classroom,” Baker said. “It changes the way they look at homeless people and others who are underserved. They hear their back stories and get to know them as people.”

One patient the students have come to know well is Terry Tyler. Soft spoken with a ready smile, the Philadelphia native had not seen a doctor in more than a decade until his swollen legs brought him to the Oceanside clinic about a year ago. Since then, the clinic has become his medical home. He comes in for regular checkups and has been able to manage his blood pressure. He helps around the clinic in any way he can. He pointed out with pride the pictures he had hung in the hallways and exam rooms for a recent fundraiser.

“I would be near death if it were not for the clinic,” said Tyler who lives in an Escondido shelter. “These people are my family. I feel at home here.”

The clinics offer a wide array of services including primary care, health education, mental health services, lab tests and case management for patients of all ages. In 2014 there were a combined 3,000 patient visits at the four locations. Nursing students also assist patients with enrollment in Medi-Cal and Covered California health plans, the CalFresh nutrition program and services such as transitional housing.

“We try to pick students that we feel would be the best fit here,” Baker said. “They have to be independent. They are responsible for everything from cleaning the bathroom to calling 911 if it’s necessary.”

Laketa Ducat, a nursing senior, fits the bill. She came to the Oceanside clinic to fulfill leadership requirements last fall and organized group walks, yoga classes and nutrition programs for patients and area residents. Energized by her experience, she returned in January as a clinic manager. Her responsibilities range from greeting patients to maintaining electronic health records, supervising volunteer staff and ordering clinic supplies.

Like many other students who work at the clinic, Ducat is grateful for the opportunity to serve patients who have had little access to health care.

“I hear from them about their struggles and needs, and celebrate their triumphs no matter how small,” she said. “I am given a daily opportunity to put a new face on a health care system that previously represented poor experiences or even failures in the past for our clients. I don't take that charge lightly. Our entire society benefits when we empower individuals to manage and care for their health.”

Like their students, SoN faculty members are drawn to the clinic for the chance to make a difference. Among them is Susan Andera.

“We are the medical home for people of all ages. Many did not have one before we came along,” said Andera, a nurse practitioner. “There’s definitely a great need. It’s challenging work. We give a lot but we get a lot more back.”

The SoN Student Health Project depends on donations from individuals and grants from private foundations for funding. Baker and her students write grants. They have reined in costs by securing free space donated by churches. They have formed partnerships with pharmacies and labs for subsidized medications and lab services. Recently, students organized a sale of art donated by local artists.

“We have some great partners who help us but it still costs a lot of money,” Baker said.

To learn more about how you can support the Student Healthcare Project, contact Mary Baker at sonhealthproject@csusm.edu.