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Notes from the field

Geisel medical student Jason Laurita ('16) looks over a patient's chart with Dr. Jack Turco, an associate professor of medicine at Geisel. Laurita and Turco are among the many Geisel students and faculty who volunteer at the Good Neighbor Health Clinic.

Good neighbors

By Lori Ferguson

The positive energy is palpable from the moment you cross the threshold. The space has the cozy feel of a friend's living room, decorated with a gently worn Oriental rug, comfortable chairs, and a coffee table strewn with magazines and newspapers. A large wood-burning fireplace dominates the opposite wall. The psychological effect is one of an outstretched hand. You've arrived at the Good Neighbor Health Clinic, a free primary-care clinic located in White River Junction, Vt.

The vision of Drs. Paul Manganiello and Peter Mason, the clinic was founded in 1992 to provide free primary medical and dental care to uninsured and underinsured residents in the Upper Connecticut River Valley. "I helped to get the clinic off the ground, but Dr. Manganiello is the godfather of the clinic," Mason avers. "He had a sense of what the community needed and he worked tirelessly to make it happen." Initially housed in rectory space donated by St. Paul's Episcopal Church, the clinic was later relocated to the former Gates Memorial Library, which was transformed into a community health center with the help of a $500,000 grant procured by the office of James Jeffords, at the time a U.S. Senator from Vermont. From the outset, the physicians received tremendous support from community residents as well as from Alice Peck Day Memorial Hospital and Dartmouth-Hitchcock Medical Center. "There was clearly a perceived need," Mason recalls. "People came out of the woodwork to help."

Lori Ferguson is a freelance writer in New Hampshire.

The passage of time has not diminished that support. Good Neighbor Health Clinic began as an all-volunteer organization and, two decades later, little has changed. Today, though, the clinic does boast four full-time staff: executive director Armando Alfonzo, volunteer coordinator Pam Vernon, medical clinic coordinator Stacey Luciw, and nurse case manager Ceil Furlong. But the lion's share of the burden for running the facility still rests on the backs of the dedicated volunteers—25 to 30 Dartmouth medical students, approximately 40 physicians (both active and retired), and some 80 community members—who staff the facility.

Ilana Prior ('16) staffs the smoking cessation program at the clinic.

The volume is impressive. In 2012, the staff treated approximately 850 patients in 2,000 visits at the main clinic in White River Junction as well as in satellite clinics in Lebanon and Enfield, N.H. Good Neighbor is also now helping with the creation of a new clinic in Claremont, N.H. Patients' dental needs are addressed in the clinic's companion facility, the Red Logan Dental Clinic, located in the building's lower level. In 2013 alone, the dental clinic treated nearly 600 individuals. "The services provided at the dental clinic are offered at no charge to patients; all of the providers donate their time," notes Jim Gold, the acting dental director.

"This place is different," Mason stresses. "It began as completely volunteer-run, and it's still that way to a large extent. We've never taken insurance; almost everything we've accomplished has been done with donations. The patients are grateful and the volunteers all feel good about what they're doing. This is a place for us to demonstrate how health care can be delivered in a caring, compassionate fashion, without regard to people's ability to pay."

Dr. John Sanders talks with medical student Bridget Curley ('16) and physician's assistant Heather Wittmann. "Bridget is an absolute wonder," Sanders says.

The approach of Good Neighbor Health Clinic is two-pronged, Mason explains. First and foremost, the institution is dedicated to providing primary-care services to those in need, be they uninsured or underinsured. "There's a common misperception that a lot of the patients we see are down and out, and that's simply not true," Mason notes. "Many people are simply struggling to make ends meet. When you're struggling to put food on the table and pay the rent, medical and dental care is not a high priority." Of equal importance, however, is the clinic's commitment to providing case management to patients with emotional problems who may benefit from an advocate's assistance in navigating the health-care system.

Among the clinic's deeply committed volunteers is Bridget Curley, the medical student liaison and a second-year medical student at Geisel. Curley is enthusiastic about the clinic and clearly grateful for all that her volunteer experience has given her, both personally and professionally. "I find working with the patients very rewarding," she says. "They're incredibly grateful for our help and for simple things such as a voucher to cover a prescription or a $10 gas card to allow them to travel to the clinic. They're trying to take care of themselves; we appreciate that and they appreciate us." It's also inspiring to see so many physicians donating their time, Curley notes. "The doctors working here are incredible teachers and they're constantly looking for ways to involve us in the process of caring for the patients." Learning the loopholes of an expensive health-care system and figuring out how to work effectively within that system are also important lessons, Curley says.

Pam Vernon, the volunteer coordinator at the clinic, works closely with Curley, who is the medical student liaison.

In addition to seeing patients herself, Curley is instrumental in getting other students involved by organizing volunteers from the Geisel School of Medicine as well as from Dartmouth College. Second-year medical students fill various roles at the clinic, including those of nurses, clinic managers, and admissions desk personnel. Additionally, 10 students commit to running the clinic's special programs: the all-volunteer Mascoma Clinic in Enfield; the 'Live Free Smoke Free' smoking cessation clinic; the diabetes clinic; the diabetes education program; and the vision-screening program. Curley also recruits undergraduates to staff the clinic's newest initiative, the "Health Desk," a service which allows the clinic to provide continuity of care through referrals to other state programs.

"Bridget is an absolute wonder," observes Dr. John Sanders, a physician who volunteers at the clinic. "She keeps the students organized in a very calm way and she's always recruiting for the clinic."

Volunteer Coordinator Pam Vernon concurs. Involved with Good Neighbor Health Clinic for the past 14 years, Vernon served on the board for two years and was then hired as the volunteer coordinator in September 2012. Vernon derives great satisfaction from her work at the clinic and has found working with Bridget and the other students particularly gratifying this year. "The medical student liaison role was created just a year before Bridget came on board, and she has really defined the position," Vernon says. "She has helped me to identify student jobs, screen volunteer candidates, and solidify their commitments." Curley has also been helpful to Vernon as she works to codify protocols for running the various special programs so that first-year medical students transitioning into roles as second-year volunteer leaders will have a clearer idea of what's required.

Kristina Torres-Lockhart ('16) and Dr. David Beaufait work with a patient. Despite being staffed almost entirely by volunteers, the clinic handled more than 2,000 patient visits in 2013.

All of this hands-on experience is excellent training for the medical students, Sanders says. "Many of our students have somewhat specialized preceptors, so working in the clinic allows them a much broader experience. By working in a primary-care facility, they're exposed to a wide range of conditions, including musculoskeletal issues, infectious disease, mental health, et cetera. The clinic experience is also great for the development of their physical diagnosis skills—taking history and physicals from the patients is great practice." The Geisel School of Medicine doesn't require volunteer work from its students, Sanders notes, but it does encourage it. "The clinic experience teaches students to use the resources available to them in any given situation and also makes them more aware of the diverse practice opportunities out there.

"It's wonderful working with the medical students," Sanders concludes, "and the nice thing is that there's no personal reward except for the satisfaction of helping people. The administrative burden within traditional medical practice has gotten so great that, in many ways, it's taken the fun out of it. The clinic, on the other hand, is pure joy."

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Geisel School of Medicine at DartmouthDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College