Building Trust Between The Homeless & The Medical Community

By:   May 17, 2016

In 2014, members of the first class of physician assistant students at the newly opened MEDEX Tacoma training site considered taking on a community outreach project in addition to their classroom studies. “It was important to us that we leave a mark,” says Kate Osborne, then a member of Tacoma Class 1 and co-founder of the Tacoma Foot Clinic.

Kate and her cohorts had heard about the Sunday community breakfasts held at Urban Grace Church, a nondenominational ministry and the only remaining church in downtown Tacoma. “We came and observed the breakfast one morning, and got a sense that this is a place where we could really help,” Kate says.

Each Sunday, around 300 free breakfasts are served at Urban Grace Church. According to Pastor Ben Robinson, the folks who come through the community breakfast are evenly split between the actively homeless and those that are more food insecure. “Of course, the church is surrounded by a lot of subsidized housing,” Pastor Robinson adds.

Aimee Edmunds of MEDEX Tacoma Class 3 works with a client at the Foot Clinic.

Depending on their situation some clients might walk between five and eight miles a day, and their feet show the stress.

Amanda Brown of MEDEX Tacoma Class 3 washes the feet of a client from the Urban Grace Church community breakfast.

MEDEX student Frantz Alphonse carefully inspects the feet of a client at the Tacoma Foot Clinic. Frantz came to the MEDEX PA program after years as a US Navy Corpsman.

Frantz Alphonse of MEDEX Tacoma Class 3 (right) works with a gentleman who dropped in from the Urban Grace Church community breakfast.

MEDEX student Frantz Alphonse works to clean and repair the client's nails.

Doug Aguirre, a member of MEDEX Tacoma Class 3, works with an elderly gentleman who is both diabetic and blind.

The makeshift foot clinic is full up. Once a month MEDEX physician assistant students volunteer their time to care for the feet of the homeless and poor in Tacoma.

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For Kate and her classmate, Mike Carter, the need was clear. At the community breakfast they encountered people who were on their feet all the time. “Depending on their situation these people could be walking between five and eight miles a day,” says Mike. The remedy seemed clear as well. “We could help educate them in foot care, but also help them with their feet,” says Kate.

Now alumni of MEDEX Northwest and working in their profession, Kate Osborne and Mike Carter remain firmly attached to the Tacoma Foot Clinic, which is held on the second Sunday of each month at Urban Grace Church. Along with current PA students from MEDEX Tacoma Class 3, they show up at 8 am to set up the makeshift clinic in a small room off the breakfast dining hall. An announcement is made to the 300 or so people present, and interested individuals find their way into the clinic, where they are greeted and directed to a chair for something more than a pedicure.

“It’s having something looked at,” says Pastor Robinson. “It’s having medical professionals care for them. They’re building relationships with medical professionals, especially notable since there’s a lot of mistrust between the homeless population and the medical community.”

“It’s having something looked at,” says Pastor Robinson. “It’s having medical professionals care for them. They’re building relationships with medical professionals, especially notable since there’s a lot of mistrust between the homeless population and the medical community.”

Pastor Ben Robinson

Pastor Ben Robinson of Urban Grace Church in Tacoma

“I’m hearing that folks are looking forward to the foot clinic,” he says. “What I hear is an appreciation for the human connection.”

For the MEDEX volunteers, it’s an opportunity to connect with a population that’s often marginalized and pushed aside, to treat them with dignity and care. “As a pastor and leader of a faith community, I see this as so in line with the model of Jesus, who washed people’s feet,” says Pastor Robinson.

The majority of the clients seen at the Tacoma Foot Clinic are in some state of moderate distress with their feet and foot care. “Normally we see pretty bad fungal infections, calluses and diabetic foot ulcers,” says Mike Carter. “You see a lot of swelling as well.”

Missy Griffith and Mike Carter, PA-C, work with a 60-year-old man presenting with severe bilateral lower extremity edema.

Missy Griffith and Mike Carter, PA-C, work with a 60-year-old man presenting with severe bilateral lower extremity edema.

On occasion, individuals show up in acute distress, where the condition of their feet indicates something much more serious. Mike explains. “A gentleman we saw today has long-standing diabetes. Most likely he’s got underlying heart failure and cardiac issues, as well as severe bilateral lower extremity edema, which was cutting off blood supply to his feet and leading to actual gangrene of his toes. He’s got open wounds— open sores on both of his feet— which are not going to heal properly due to the amount of swelling and the underlying chronic medical conditions. Unfortunately, he’s most likely going to need those toes amputated at some point in time if he does not get follow-up care, as needed, very soon.”

The client is 63 years old and on the streets. After spending time with him, Mike has little faith in the client’s ability to follow through and get the care he needs. “Absolutely terrible,” he says.

The client revealed to Mike that his cellphone had been stolen, along with his antibiotics and water pills to get rid of the edema. “He watched a man eating those on side of the road from his stolen bag. So, between lack of access to medications, and the fact that he was in the ER last week and they said there’s nothing they would do for his feet, I think that his chances of getting the care he needs are pretty slim. I think this is a true failure of the system.”

Mike Carter, PA-C, and founding member of the Tacoma Foot Clinic, listens intently to the story of a 63-year-old man who arrives presenting acute symptoms.

The gentleman, who is homeless, has diabetes as well as severe bilateral lower extremity edema, which is cutting off blood supply to his feet and leading to gangrene of the toes.

The client has open wounds on both of his feet which are not going to heal properly due to the amount of swelling and the underlying chronic medical conditions.

Mike Carter, PA-C, and Missy Griffith, a current physician assistant student at MEDEX Tacoma, do what they can to address the condition of the client's feet.

The edema is evident in the client's hands as well. Mike Carter believes this indicates underlying heart failure and cardiac issues.

Amanda Brown of Tacoma Class 3 talks about care options with the client. The hurdles to obtain proper medical treatment are seemingly insurmountable for someone on the street.

The severity of this man's situation has caught the attention of many of the volunteers at the Foot Clinic.

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Vanessa Bester, site director of MEDEX Tacoma, agrees. “A lot of people assume that because we have the Affordable Care Act that everyone has access to healthcare now, and that’s not the case,” she says. “Seeing this gentleman today, I’m very frustrated we can’t give him the care that he needs right here and now. This sort of thing really lights a flame in me to start pushing and figuring out how we can raise more funds, get more support to expand, and eventually provide full clinical services.”

Never short on vision, Vanessa spells out exactly what they need to be able to expand their reach.

Kate Osborne, PA-C, checks in foot clinic clients as they arrive.

Kate Osborne, PA-C, checks in foot clinic clients as they arrive.

“Money,” she says. “And we need space. Urban Grace is a wonderful setting where they have provided us room to do our work for free. But if we were to expand and provide true medical care, we would need true clinical space with running water and exam rooms.” In the current quarters at Urban Grace, the MEDEX volunteers must lug water in 10-gallon jugs back and forth from the kitchen to provide warm water for the foot care.

Despite the makeshift nature of the foot clinic, however, happiness in the room is tangible. The MEDEX volunteers are enthusiastic and attentive. The clients are basking under the light of such attention. It all seems worth it, every bit. Pastor Robinson is appreciative. “With MEDEX it’s been a good natural match,” he says. “They were looking for a good spot. We have access to a sometimes elusive population with needs and a good setting to offer care. The church doesn’t have the capacity to offer direct services ourselves, so to find a partner organization like MEDEX was ideal. It’s a good model as we continue to look forward and think about what other organizations we may partner with.”

For current MEDEX didactic students, participation in the foot clinic offers a much-needed relief from the classroom and a reminder of what they’re working towards. Prior to PA school, Missy Griffith was a paramedic for 10 years in Bremerton. Now she is a member of MEDEX Tacoma Class 3, and has taken on a leadership role with the clinic for her class, a mantle that will be passed on to a member of class 4, as Missy enters her clinical year.

Kate Osborne, PA-C and alumni of MEDEX Tacoma Class 1, was one of the founding members of the Tacoma Foot Clinic.

Kate Osborne, PA-C, trims the toenails of a client from the Foot Clinic, and instructs him in proper self care.

Individuals who show at the Urban Grace Church community breakfast are split between the actively homeless or those that are more food insecure. The Foot Clinic represents a partnership between the church and the MEDEX Northwest Tacoma site.

After treatment at the Foot Clinic, each client receives a clean pair of socks.

Missy Griffith and Aimee Edmunds, both students of MEDEX Tacoma Class 3, work with two women who have arrived at the Foot Clinic.

Missy Griffith, a former paramedic prior to MEDEX, trims the toenails of a female client.

Missy Griffith has taken on a leadership role with the Foot Clinic for her Tacoma Class 3.

One of the benefits of the Foot Clinic is that clients are treated with dignity and care. It’s an opportunity to connect for a population that’s often marginalized and pushed aside.

This client revealed that she's had multiple foot and ankle surgeries over her lifetime in an effort to keep her upright and walking.

Frantz Alphonse, a student of MEDEX Tacoma Class 3, works on the feet of a female client at the Foot Clinic hosted by Urban Grace Church.

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Arriving at her first foot clinic, Missy was struck by what an impact such a small task could have on the community, and how thankful the people were. “I think that’s been true for everyone in my class who’s come and volunteered,” she says. “They’re all just like, ‘Man, this makes us feel better than anything else we’re doing,’ because we’re in the classroom in our books all year long. We’re not seeing patients.”

In April both Mike Carter and Kate Osborne were presented with the 2016 MEDEX Humanitarian Award at the annual MEDEX Reception. Vanessa Bester looks on at the right.

In April both Mike Carter and Kate Osborne were presented with the 2016 MEDEX Humanitarian Award at the annual MEDEX Reception for their work with the foot clinic. Vanessa Bester looks on at the right.

For Missy and other volunteers in the didactic year, the foot clinic brings them back to why they’re in PA school after all. “I was really honored to be able to take it over from Kate and Mike, because I know it was hard for them to let go of it, and I can see why. It’s awesome that they’re still involved in helping to keep the clinic going.”

In lieu of expanded clinical services, there are things needed to keep the Tacoma Foot Clinic afloat. Chief among them are material supplies: packages of men’s white classic crew socks, Lysol wipes, travel size lotion, pumice stone, emery boards, oatmeal bath single packets, travel size soap, toe nail clippers, garbage bags and Ziploc bags.

Vanessa Bester also makes a direct appeal to MEDEX alumni. “Please contact me,” she says. “Contact Mike or Kate, and get a hold of us at medxfoot@uw.edu. We are always looking for preceptors to help guide our students in foot care. We’re looking for people who really want to get down in the trenches and help. If you know of a place where we could use clinic space on the weekend, if you work in general surgery, or with any kind of resources that could help us start providing a broader base of care, contact us.”

Volunteers--Tacoma Foot Clinic

Foot clinic volunteers on Mother’s Day, left to right: Amanda Brown, Vanessa Bester, PA-C, Kate Osborne, PA-C, Mike Carter, PA-C, Missy Griffith, Aimee Edmunds, Doug Aguirre and Frantz Alphonse.

The MEDEX Tacoma Foot Care Clinic takes place the second Sunday of each month from 8:30 to 10:00 am at Urban Grace Church, 902 Market St, Tacoma, WA 98402. For more information, to give your time, materials supplies or money write medxfoot@uw.edu.

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