City on a Hill -- A free medical clinic

Every second Saturday of the month I try to go over to Milwaukee to work at the Free Medical Clinic. This is run by a missionary organization called City on a Hill (http://www.cityonahillmilwaukee.org/) that does wonderful work in inner city Milwaukee. The clinic is held every second Saturday of the month. It runs from noon till about 5 pm. Anyone can come. No money is charged. The photo alongside shows the last of several hundred poeple getting in on a Saturday afternoon in September 2010. Did I mention, there is a free lunch and an opportunity to take home a grocery bags of basic foods?

Most medications are provided with the visit, free of charge. This is an amazing work. There are about 3-5 doctors who volunteer on a regular basis. We have a filing cabinet and each patient has a 'chart'. Vitals are taken by volunteer nurses. There are allied services such as free foot care, smoking cessation, flu shots (in the season) and occassionally optometry and physical therapy.

Diagnosis is an interesting experience. Labs and x-rays are very expensive and not available on site. Most diagnosis therefore relies heavily on history and physical exam (aren't we supposed to be able to diagnose most things that way? ;-) ). I have gotten to hear some interesting aortic stenosis murmurs, perform incision and drainage of a cyst, clean out a cerumen impacted ear using a syringe and an IV catheter and palpate some impressive goiters like this one.

In medical school, I was taught the biopsychosocial model of medicine. I believe in the biopsychosociospiritual model: illnesses can have a spiritual component as well. Poor choices or decisions in life, unforgiveness, bitterness, anxiety, guilt -- where else can you place these in the biopsychosocial model?

Working here once a month teaches me to appreciate what we have. The first time I went, I treated a homeless man for pneumonia and a family for scabies. I could not believe I was in one of major cities in the United States.

We sometimes have premeds and medical students come along and with the patient's permission shadow us while we work. We often have to write out our own labels for the prescriptions, count out the pills and fill the bottles ourselves and then explain the instructions to the patient. It gives one a sense of appreciation for other members of the medical team that we have back in our 'not-free' clinics -- receptionists, medical assistants, nurses and pharmacists to mention a few.

Perhaps the most touching aspect of the work is how grateful the patients are that we come. They say thank you again and again, as if we are the ones that are inconvenienced and suffering. I don't presume to know how to fix our broken healthcare system, but when I see out of work, homeless folk with diabetes, hypertension, skin conditions and other chronic medical problems who must make do with a once a month free clinic with a limited selection of drugs, I know I must do something. So I go.