Dr. Gerald Saliman, a volunteer physician at the Samaritan House Free Medical Clinic of San Mateo, wrote a wonderful article about “The Joys of Volunteering” that appears in the current issue of the San Mateo County Medical Association Bulletin. Aside from volunteering, Dr. Saliman is an internist at Kaiser Permanente South San Francisco Medical Center.
A patient that I recently saw had survived the 2005 Hurricane Katrina, but was now facing a more serious threat to her life. She came to see me at Samaritan House Medical Clinic in San Mateo a few months after the hurricane. She was complaining of abdominal pains, nervousness, and diarrhea. Her previous physicians had treated her with a cocktail of proton pump inhibitors (for presumptive peptic ulcer), antidepressants and sleeping aid remedies to no avail. I had seen a few patients with post-traumatic stress disorder, and this patient looked unusually thin for this to be the sole explanation. I suspected there may be something else going on. I requested she obtain an ultrasound of her abdomen and then an abdominal CT scan, which were both performed at Peninsula Hospital. On her next visit I broke the news to her that she had a carcinoid tumor. Her reaction was unlike any other patient’s reaction to similar news. She hugged me! It was a relief to her that everything she had experienced now had a physical explanation. She was overtly appreciative for the care she received at Samaritan House Medical Clinic.
In addition to working as an internist at Kaiser Permanente South San Francisco for 30 years, it has been my joy to volunteer at Samaritan House Medical Clinic at least once a month for the past several years. I have found volunteering to be rejuvenating because it is a reminder of why I chose to become a physician. The goal at the free clinic is simply to help patients without other outside demands on doctors. At this clinic, there are no Medicare coding requirements, no electronic charting, and there is little worry about litigation.
Although most of the volunteer physicians have already retired, I am lucky to have discovered this opportunity during my working career. I knew about this free clinic because I was acquainted with Dr. William Schwartz, one of the founders. Prior to volunteering at Samaritan House, I served on the board of directors of non-profit organizations and fundraised for charitable causes. However, the opportunity for a direct service experience where I could use my skills really appealed to me. The Samaritan House Medical Clinic seemed like a perfect fit.
I enjoy meeting patients from all over the world including those from Russia, Samoa, Philippines, Turkey, the Middle East, Egypt, and almost every country in Central and South America. The patients I see at this free clinic are the working poor. They earn a little too much to be eligible for Medi-Cal, and they don’t have health insurance through their employers. Patients have shared their personal stories with me, and this has resulted in many rewarding relationships. In general, these patients are very appreciative no matter what can be done to help them.
The medical conditions of these patients are similar to those seen in the pay-for-service world, but their health status is compounded by poor nutritional status, occupational stress, poverty, and family issues. Working there reminds me to look at each patient as a person, not as a collection of maladies. I recently treated two patients in their 50’s for strokes related to underlying hypertension and poor compliance with their medications. When a patient has food insecurity and housing concerns, his highest priority may not be to take blood pressure medicine to prevent some seemingly remote condition such as heart attack or stroke. Even though Samaritan House Medical clinic provides free medication to patients, issues besides cost might prevent patients from taking a prescription. For example, patients may not have transportation to pick up their medication, they may not be able to take time off of work to obtain it, or they may forget to take it in the midst of their busy schedule. It is difficult for me whenever I observe the natural progression of a disease process when there could have been an opportunity for preventive intervention. This is a challenge in any practice setting, but more so serving underprivileged patients.
One of the ways it helps to deal with these challenging issues is the unspoken camaraderie among the physicians and the entire staff at Samaritan House Clinic, including the nurses, office assistants, and interpreters. We are bonded in our desire to improve the health of the people in our local community. I have become aware that there are many unfortunate people who live in our neighborhoods who don’t have access to medical care. Although many physicians travel to remote countries to help others who are impoverished, we have many people in San Mateo County who have trouble obtaining the care they need. Some residents, such as the patient with a carcinoid tumor, would not be alive if it weren’t for us.
For more information on volunteering at the Samaritan House Medical Clinic, contact their Medical Director, Dr. Stuart Viess. He can be reached by email at email@example.com or by phone at (650) 578-0400.
Saliman, Gerald. “The Joys of Volunteering.” San Mateo County Medical Association Bulletin (July-Aug. 2011): 7.