While this venerable community institution, the Fair Haven Community Health Center (FHCHC) located at 374 Grand Ave., will be celebrating its 35th birthday in the coming weeks of August, a lesser known, but no less valuable community resource housed within the same elegant Victorian buildings, will be toddling toward its first anniversary.
The HAVEN Free Clinic, founded and all-volunteer-staffed since November by Yale health professions students concerned about access to medical care for the poor, complements the sliding scale-based FHCHC by offering primary care absolutely free.
“Word is getting out,” said Mary Bartlett, a nurse practitioner (beneath the LAB sign in the photo) who is one of the three medical directors of HAVEN, along with Laurie Bridger and Mario Perez. “People tell their brothers or cousins, and we frequently have entire families showing up.” 
On the day a reporter visited, a family of three came in for physical exams. They were greeted by front desk coordinator Kathleen-Jo Elayada, a second-year medical student at Yale. The reason for the visit? The family was preparing to become a foster family and the Department of Children and Family Services requires every family member, even children, to have a physical.
Although the clinic is open only on Saturdays 9 to 12, the all volunteer teams of translators, junior and senior medical students, nurses, and their “preceptors,” or fully trained physicians, have logged approximately 350 patient visits thus far, with new patients arriving every Saturday.
The approach is entirely team based, with the patient, on arrival, being paired with a translator, if need be, and a junior and senior medical or nursing student. They in turn consult with the “preceptor” or attending doctor or nurse practitioner at each stage — history, diagnosis, treatment, and follow through.
In addition to excellent and respectful patient care going on here, there’s also a lot of learning. It’s no wonder hundreds of students from Yale’s public health, medical, and nursing programs, such as Anna Salmon consulting here with a patient, have participated since November 2005.
Some surprising findings about the state of health in Fair Haven have emerged. “When we began,” said Bartlett, “we expected our patients to be largely female, but a very large percentage are turning out to be men, and some 75 percent are also undocumented Latinos. Many are employees working ‘under the table,’ that is at manual labor or construction, at hotels or restaurants, and many work 12-hour shifts and can’t get to the FHCHC, which is open only during week.”
For them, HAVEN is just that, a port of entry into the health system. One of the student coordinators, Rachel Solomon (in the red shirt, consulting with a team at the end of the hall), also a second-year medical student at Yale, said, “It’s not surprising we have patients with untreated hernias. They work in construction! Recently we also had two patients who tested positive for tuberculosis, and one patient with liver failure. Many of these people have long and complicated medical histories but have received little previous care.”
In addition to the perennial problems — hypertension, diabetes, and high cholesterol — which HAVEN staff treat not only medically but also with important doses of patient education — a reporter asked if there were other surprises. “What has been unexpected,” said Solomon, “is the amount of medical debt, usually from emergency room visits, that the patients are saddled with because they had emergencies and weren’t able to follow through with, or received sufficient guidance, to get through the paper work to receive ‘free care’ in the emergency rooms. So they left with huge bills, don’t want to continue that, and so come to us.”
Although the statistics HAVEN has reflect patient profiles only through May, on average medical debt was $10,498 and average income was $10,274. Those numbers are badly out of balance. And there have been other surprises.
“We also didn’t expect,” said Bartlett, “the number of patients presenting with gastro-esophageal reflux disease, and also depression, especially among the men.”
Solomon and Bartlett weren’t sure, but they speculated GERDS was associated with depression and other emotional states that well may be related to the working conditions of the patients. In addition to the burden of medical debt patients may be carrying, they said, “These men come from Mexico, Guatemala, and Ecuador,” said Solomon. “They are very far away from home, work brutal hours to send money home, live in crowded conditions, and without a lot of support. That can be depressing!”
Where do these largely uninsured patients go next, when, beyond the primary care that HAVEN can provide, expensive drugs and specialists are needed?
That’s the medical rub, according to HAVEN staff. While HAVEN has secured generous grants from Rite Aid, which can provide, in one instance, for example, upwards of $100 worth of monthly generic medication for free (many proud patients insist on paying $1 or whatever they can afford), and while companies like Quest Diagnostics offer very reduced fee lab tests, finding volunteer medical specialists is the next big challenge.
“We badly need mental and dental health specialists, ear, nose and throat physicians, and ophthalmologists,” said Solomon, “who will contribute time.”
A cardiologist and a rheumatologist come in to see patients, the coordinators explained, and some private medical group specialists are participating on limited bases. But that’s the tip of the iceberg of medical need.
“Even something as simple as obtaining glasses,” said Solomon, “can be a challenge to the uninsured and undocumented.” HAVEN’s arrangement with the Hill Health Center Eye Clinic, for example, provides the least expensive ophthalmologic eye care in the area, but it’s still $35, and there’s usually a wait. Then, afterwards, with a prescription, where are the glasses, at minimum $150, to come from? “‘I’m trying to get a job, but can’t see to read!’” Solomon said, with intended irony. 
As its own first birthday approaches, HAVEN would like to expand but it’s committed to high quality care for patients and won’t extend services until they’ve secured a network of specialists to guarantee quality and follow-up. That may happen, with the dedicated people of HAVEN. After all, FHCHC began in 1971, with a budget of $5,000, as a free clinic too. Today they serve on a sliding scale basis 12,000 people annually, some 37 percent of whom are also uninsured.
“In my idealistic world, ” concluded Mary Bartlett — when she’s not at HAVEN on Saturdays she changes her cap and during the week is a specialist, on HIV-AIDS at FHCHC— “every single medical office in the state should set aside a session for free care. Two hours a week or one day a month. Whatever, but something. While I’m hoping there will be a kind of global trickle down effect from the huge health grants being provided by Bill Gates and Warren Buffet, the need down here in the neighborhoods is too great to wait.”
Amen, and thank you, Mary Bartlett, and HAVEN.
I love yale