By Dawn Brazell
Public Relations

Sporting a patriotic hat, patient Bettie Gaines shows off her lively spirit. Unfortunately, her body's just not keeping pace. Talking to physical therapy students about how she can gain more mobility and hip strength, Gaines is one of the first to take advantage of an expansion of MUSC's award-winning CARES (Community Aid, Research, Education and Support) clinic.

Patient Bettie Gaines talks to physical therapy students Corey Patton and Sarah Nameth. Advisor  Dr. Sara Kraft, left, oversees the treatment in the new after-hours clinic on Ashley Avenue.

The physical and occupational therapy after-hours clinic, which takes referrals from unfunded and underfunded patients, is the latest addition to the CARES clinic, a non-profit organization managed by medical and health profession students providing free medical care to the underserved, uninsured population. The CARES clinic, which recently won the 2011 South Carolina Governor's Volunteer Award, operates in conjunction with East Cooper Community Outreach (ECCO) in Mount Pleasant. Physical and occupational therapists had been going to that location, but wanted to switch to the larger MUSC facility downtown where they have more equipment for patient care.

Dr. Wanda Gonsalves, center, with Drs. Katherine Spikes and Justin Ellett in Columbia to receive an award for CARES.

Amanda Peck, a third-year physical therapy student, said the clinic allows students to get hands-on experience and build mentor relationships, while patients get access to the latest in therapy that would otherwise be unavailable.
She took the CARES elective class her first year, and has been volunteering ever since. The beauty of the new clinic is that it is based on the formula that has made the clinic such a success — it runs mostly on the energy and enthusiasm of MUSC students and their faculty mentors.

Patty Coker-Bolt, Ph.D., assistant professor in the Division of Occupational Therapy, said that the staff is excited to open this new specialty branch of the clinic. Clinics will be held from 6:30 to 9 p.m. on Tuesdays evenings in the Ashley Rutledge garage at 158 Ashley Ave.

"It has to happen. Our students need it," she said of the hands-on learning the clinic offers, "and our community needs it. Maybe there are some exercises that could help patients reduce their pain that they wouldn't be able to access otherwise."

With this expansion of the clinic, occupational and physical therapy services will be increased with hopes of also receiving referrals for therapy services from other free clinics such as Barrier Islands Free Medical Clinic and Crisis Ministries.

"There's a vision to expand this all around. We think the potential is big. The population of unfunded and uninsured patients is certainly growing in our region and state due to cut backs in Medicare and Medicaid services, a decrease in those who qualify for these programs and persistent unemployment that can lead to loss of insurance coverage."

Coker-Bolt said therapy in many cases increases a person's chances of getting or keeping a job. The clinic lets students see how their work in occupational therapy helps a real person, who may be having difficulty driving, dressing or grocery shopping. "For me the excitement is training them to use what they're learning in the classroom."

One challenge of the expansion is that the therapists want to maintain ties with their colleagues at the East Cooper site of CARES. Coker-Bolt said they realize the value of interprofessional training and will be intentional about maintaining ties with East Cooper CARES through consults and telemedicine practices.

Medical student Peter Bailey examines Kenneth Dickerson in the CARES clinic in Mount Pleasant.

Wanda Gonsalves, M.D., one of the main founders of CARES, said volunteering with CARES provides students an opportunity to work interprofessionally in real-life situations. Thrilled about the recent award, she's been amazed by how much the program has grown. She was involved with a similar program at the University of Kentucky and wanted to help students develop a similar clinic at MUSC. She started an elective in 2004 at MUSC for first and second year medical students to devise their own program.

After eight months of hard work in areas from marketing to business management, the clinic opened its doors in 2005 in Mount Pleasant. "It grew much faster than we did at Kentucky. I knew how to do it and what worked and what didn't."
She also knew the students had to have ownership. Even when they suggested something that she thought wouldn't work, she would let them do it, she said. Service learning is a key mission of CARES. The clinic, with hours Monday, Tuesday and Thursday evenings from 6:30 to 9 p.m., is open every week except Christmas, serving about 1,000 patients a year.

Gonsalves said she can't imagine a training program without such an experiential training model and believes all students should participate. "Things don't stick unless you're doing it. We should be doing a better job of educating the students because you learn by doing. It changes their lives. It keeps them involved in serving the underserved. I just love the fact that the students learn so much when they are there."

The Liaison Committee on Medical Education (LCME), a leading accrediting authority for medical education programs, now requires service learning as one of its standards. Gonsalves sees the role of CARES just continuing to grow. The program now offers student electives all four years and is incorporating more involvement from diverse medical specialties and health professionals. Upper-level students are paired with their less-experienced classmates so that students learn how to mentor and collaborate.

CARES improves patient care, given that students in the electives do qualtiy improvement projects that identify ways to better serve patients. There also is a student board that oversees the clinic's operations.

For the students, there are wide-ranging benefits, from being a valuable resume builder to the real-life exposure of community service.

Dr. Natalie Gregory works with medical student Elena Gore at CARES in Mount Pleasant.

Faculty benefit as well. Gonsalves, who balances her roles as physician, associate dean of resident inclusion and diversity education and medical director for the Physician Assistant Program, said she never gets tired of being a CARES adviser and volunteer. However, the clinic needs more faculty volunteers to give more breaks to the regular core group.

Faculty members who volunteer support early pre-clinical experiences, something needed at MUSC, she said. They also model the importance of community care.

"I like the idea of giving back. If we weren't there and weren't helping, many of these people would end up in the emergency room."

7 Great Things to Know about MUSC's CARES

1. It changes lives.
Wanda Gonsalves, M.D., said it's not just the underserved, uninsured patients who benefit from the non-profit clinic, but also the students. She gets calls from graduates years later to say what an impact it had on their lives.

2. Service learning works.
CARES is one of the best learning environments for students. It gets students into contact with patients faster. "They have to write reflections of their time in clinic, and it's amazing to see what they say they've learned."

3. It prevents ER visits.
Prevention is one mission of CARES. Gonsalves said they work to help patients control serious, chronic conditions which results in fewer ER visits.

4. All specialities are needed.
One misconception is that faculty volunteers need to be specialists in primary care. They pair specialists with primary care doctors, so new volunteers don't need to be worried that they'll be out of their depth.

5. It lets students get real.
Though students learn from the "standardized" patient interviews, there's no substitute for the real thing. "Students learn how to really take care of their patients. And the patients are OK with them learning that."

6. The people are normal.
"Some people would be surprised to learn these are people — not homeless. They just don't have insurance."

7. Busy people volunteer.
Her faculty volunteers are some of the busiest people on campus, the perfect role models for students to see in action. Faculty members would be surprised by how much they would be blessed by the experience, she said.

For more information, visit http://www.thecaresclinic.org or call 876-7097.