Providing quality health care to all and figuring out how to pay for that care are issues of global concern. Nurses, as the largest group of health care providers in the United States (Bureau of Labor Statistics, 2008-09), have significant interest in the current debate on health care reform in Washington, D.C.

Amaus Health Services opened its doors two years ago at the Cathedral of the Immaculate Conception in Syracuse, New York. Seated, front: Lynn-Beth Satterly. Back, from left: Paul Drotar, Neal Quartier, Ellie Grella, Fran Bergan.

“One of the difficulties we’re struggling with as a nation is that we have nearly 50 million people who are uninsured,” says Barbara M. Carranti, RN, MS, CNS, clinical assistant professor at Le Moyne College in Syracuse, New York, USA.

Carranti doesn’t just talk about the problem of health care access for the uninsured. She puts her words into action as education coordinator for Amaus Health Services, an innovative health care clinic in downtown Syracuse, staffed by volunteers, that provides health care to the medically indigent.

Founded two years ago at the Cathedral of the Immaculate Conception, Amaus serves the homeless population and others who have difficulty accessing health care. Carranti oversees nursing students from Le Moyne College as they participate in the care of these vulnerable patients as a requisite of their community-health nursing course.

Many people assume that the homeless and the unemployed are lazy, Carranti says, or that it’s easy to sign up for government-subsidized health care. That’s not the case. The homeless population often faces a number of barriers, including mental illness or a history of incarceration, that make it difficult to find a job that provides medical benefits.

“Medical indigence is not a simple problem,” she says. “You can’t just go into an office and sign up for government subsidies—there is paperwork to go through and qualifications to meet. We have a social worker and volunteers who help people get into the system. But even after they are qualified, they continue to come back and want to use our services, because they feel that atmosphere—that we do appreciate that they are a cultural group in and of themselves.”

Foundation and philosophical roots
The name of the clinic, Amaus, comes from the Hebrew spelling for Emmaus, a town referred to in the Bible. According to Luke 24:13-35, when Jesus’ disciples were walking from Jerusalem to Emmaus the Sunday after he was crucified, they did not recognize a fellow traveler as Jesus—until he shared a meal with them and opened their hearts to God’s love. The clinic’s philosophy is based on that biblical concept.

Barbara Carranti, education coordinator at Amaus Health Services in Syracuse, New York, looks over shoes that college students collected for clinic patients, many of whom are homeless. Photo by Chuck Wainwright, Le Moyne College

“In one of our brochures, it says that at Amaus Health Services, we seek to recognize and acknowledge human dignity and God’s presence in all whom we serve,” says Ellie Grella, a volunteer who is a staff nurse in the neonatal intensive care unit of St. Joseph’s Hospital in Syracuse.

“It’s very rewarding; it’s a different type of medicine,” she adds. “The patients are so appreciative of anything you do for them—whether it’s putting a Band-Aid on a sore, or giving them medicine, or just treating them with dignity.”

Inspiration for the clinic came from the rector, Monsignor Neal Quartier, who challenged a parishioner committee at the Cathedral to think of new ways the church could serve the poor. One committee member who was instrumental in establishing the clinic, Medical Director Lynn-Beth Satterly, is a physician and assistant professor of family medicine at Upstate Medical University.

Collaborative education fosters positive relationships
Carranti, Satterly and the other health care providers all have a connection to a local college or university. The primary mission of the clinic is, of course, to deliver health care. But, Carranti says, there is also a secondary mission: to instill in students the importance of caring for the underserved, and to encourage them to provide this service after they become licensed practitioners.

Through collaborative education at the clinic, nurses, medical students, physician assistants and other members of the health care team learn from each other.

“I’m a nursing instructor—a master’s prepared clinical nurse specialist,” Carranti says, “but I spent all day yesterday working with two medical students. We want them to appreciate the fact that just because I’m not a physician—or in the case of Dr. Satterly and other physicians relating to my students—just because we’re not from the same discipline, we can still teach each other. It sets up more positive relationships, not only among all of us as health care providers, but also among the students, who work together much more efficiently and appropriately.”  

The patients are so appreciative of anything you do for them—whether it’s putting a Band-Aid on a sore, or giving them medicine, or just treating them with dignity.”

—Ellie Grella

Members of the multidisciplinary team sometimes relate in ways that are different from roles they might play in a hospital setting. Last year, the first- and second-year medical students wanted to staff a flu clinic. The problem: Because the first two years of medical school are spent primarily in the classroom, they hadn’t yet learned how to give injections. The solution?

“Some of our students who were already licensed RNs—either graduate or RN-to-BS students here at the clinic—taught a two-hour class to the medical students on how to give injections,” Carranti says. “The following week, the medical students did the flu clinic, and the nursing students were their supervisors.”

Innovative growth
Grella, the NICU nurse who volunteers at the clinic, recalls that when Amaus Health Services first opened its doors, the staff started out taking blood pressure readings on a few patients. The number of patients has grown to more than a thousand in a little over two years, and the variety of services has increased as well.

“One of the most amazing things is, the clinic started out very grass roots, very small, but Dr. Satterly had faith and a vision,” Grella says.  

“The patients that we have—I love these people. I’m learning from them what it’s like—whether it be living on the street or in a shelter—because when they come to us, they open up. They feel very safe at our clinic. It’s more than just medical. It’s spiritual; it’s listening; it’s being there for them; it’s our presence.”

Carranti and Satterly have presented papers at family medicine conferences, and local media have published articles about the clinic’s work (see additional resources at end of article). During the flu clinic this year, Carranti plans to collect data related to the interdisciplinary education process of registered nurses teaching first- and second-year med students how to give injections.

Clinic broadens students’ health care perspective Participating in the Amaus clinic has provided us with further insight into health concerns of individuals in the Syracuse community. We are more aware of different barriers to health care that the uninsured and underprivileged face when seeking help. Spending time in the clinic and with clients has provided us with an opportunity to practice and perfect our physical assessments, gather health histories and use therapeutic communication. In this setting, we also have become more familiar with the process of making patient referrals to doctors and the steps patients must go through to obtain and use federal aid (Medicaid, Medicare and Supplemental Security Income). Initially, we were unsure how the community utilized and responded to a clinic of this nature; however, we were pleasantly surprised. The clients we see and help are unbelievably grateful for any services we provide. This relationship goes both ways: We are indebted to these individuals because they have enlightened us with a broader perspective of health care. The Amaus clinic is based on the premise that everyone has the right to health care and deserves to be treated with dignity and respect.  —By Caitlin Alvin and Molly Eppley Senior nursing students Le Moyne College

“Nursing students are taught these skills in a rigid, competency-based environment,” Carranti says. “With medical students, it’s really not that way. It’s ‘see one, do one, teach one.’ Maybe we can blend the best of both worlds and make it a fun activity for the students, as well as help us get through the flu shot clinics, which are extremely stressful. We inoculate about 80 people inside of 45 minutes.”

Carranti plans to ask some nursing students to do pre- and post-interviews and collect data related to how the med students felt about being taught by a nurse, and how the nurses felt about being teachers.

Facing challenges
The biggest challenge, Carranti says, is engaging practitioners—physicians, nurse practitioners and physician assistants—to volunteer their time. It’s not that they are unwilling, but many are in practices where they must see a certain number of patients. If they take half a day or a day away to volunteer, it affects not only them, but their support staff and the income from their practice.

Other practitioners are hesitant to volunteer their time because of malpractice issues. Through donations, the clinic has covered malpractice insurance for a couple of retired physicians. But, for practicing physicians, doing volunteer work can be more risky.

“Getting practitioners is really critical to our survival,” Carranti says. “Right now, we’re only open about eight hours a week. During the winter months, we could be busy every day for 8-10 hours. If a physician has an academic commitment and has to leave early, we have to cut the list. It’s very painful to do—we turn people away all the time.”

A partial solution to this problem has been found in physicians who say that, although they cannot work each week at the clinic, they are willing to treat patients in their office, at no cost, who have been referred by clinic staff.

Rewards of volunteering
In a sense, Carranti’s volunteer work with Amaus Health Services continues the legacy of her father, Pio Carranti, who was a deacon at the Cathedral parish for more than 20 years. His personal ministry was serving the poor who were homebound.

“Since I’ve been involved here, people have shared with me that my father had been extremely interested in helping to establish a medical clinic, but they could never find a way to do it,” she says.

Another rewarding aspect for Carranti, who has worked full-time in academia for the past 10 years, has been the chance to return to clinical practice. In previous positions, she worked in acute care and was involved in active clinical practice with students in hospitals or in long-term care facilities.

“When this opportunity came up, I viewed it as not only important for my students but also an opportunity for me to be in a clinical environment with my students,” Carranti says. “That is priceless. Students need to see their faculty members in practice. I cannot stand in front of a classroom full of nurses and have any credibility if I am not practicing.”

In addition to her volunteer work at Amaus, Ellie Grella (left) goes on medical missions to Guatemala. She has been a NICU nurse at St. Joseph’s Hospital in Syracuse, New York, since 1978.

For Grella, the chance to volunteer at the clinic came along at the right time in her life. In the 1960s and 1970s, she had a strong desire to join the Peace Corps, but marriage and children were her priority at that time. Her children are now grown, and the timing was right for her to volunteer at Amaus and also to participate in medical missions. In March, she will travel to Guatemala for the third time.

“The first year I went on a mission, I was so overwhelmed with the poverty in Guatemala,” Grella says. “I’ve never seen anything like that—how they exist from day to day.” Earlier this year, she returned to the Central American country and was overjoyed to see that progress had been made, in the form of a new play area for children that the mission team built in front of the church.

Grella recently was accepted to Loyola University’s School of Ministry, where she will pursue a master’s certificate in pastoral care. “When you study pastoral care and theology, it all comes together in helping the person spiritually, physically and mentally. A lot of my nursing background is scientific, but I’m bringing in the spiritual aspect now.”

From caring for patients to collecting shoes
Students who work at Amaus Health Services also participate in special projects. Before Thanksgiving each year, the clinic offers a foot care clinic, during which students clean and inspect patients’ feet. Students from participating colleges also collect socks and shoes and request donations from footwear companies.

“The students do the fundraising for that, so they learn a different aspect of service as well,” Carranti says. “For a lot of these students, it’s the first time they’ve had to call a manufacturer and solicit donations, and that’s a whole experience in and of itself.”

For Carranti, it’s been especially rewarding to see some of the students who worked at the clinic to fulfill a class requirement return later as volunteers.

The clinical experience at Amaus is an exceptional opportunity for students, Grella says. “When I did community health for my bachelor’s at Syracuse University, I went out with a community health nurse,” she says. “But this is the most wonderful way to learn community health—seeing patients from the community who are very vulnerable. They are seeing the real world.” RNL

Jane Palmer is assistant editor, Reflections on Nursing Leadership.

Additional resources:
Knauss, T. Amaus Health Services, a tiny clinic for the homeless, turns a corner. The Post-Standard. Retrieved 14 October 2009 from http://www.syracuse.com/news/index.ssf/2008/07/
amaus_health_services_a_tiny_c.html

O’Brien, J. Turning faith into action, doctor treats the poor through Amaus clinic. The Post-Standard. Retrieved 14 October 2009 from http://www.syracuse.com/progress/index.ssf/2009/02/
turning_faith_into_action_doct.html

Reference:
Bureau of Labor Statistics. (2008-09). Occupational Outlook Handbook. Retrieved 13 October 2009 from http://www.bls.gov/oco/ocos083.htm