Services

Continuity of Care Advocacy
The Continuity of Care Advocacy (CoCA) division of the Suitcase Clinic was established in January of 2001 in response to frustrations voiced by students, service providers and clients surrounding the lack of continuity in health care for the uninsured, along with the numerous barriers that people without health insurance face when seeking medical services. During the 2001-2002 year, CoCAs established a relationship with LifeLong Medical Care, a local community health center, in order to improve the care of Suitcase Clinic clients who cannot be fully treated due to the inherent medical limitations of the Suitcase Clinic.

The CoCA’s offer referrals for any further services that clients may need which we cannot offer on-site. They can set-up clients with appointments at The Lifelong Clinic (TLC) and also accompany them to their services. The CoCA position is ideal for anyone who is interested in health advocacy work, breaking down barriers to health care for the uninsured, and establishing close relationships with homeless and uninsured clients seeking medical services.

Health Education and Supplies

The health education division provides free health education flyers, pamphlets and other resources with useful information on smoking cessation, breast cancer, skin conditions, drug and alcohol abuse, Sexually Transmitted Diseases (STDs) including HIV, public health diseases such as tuberculosis, local medical clinics (Berkeley Free Clinic and LifeLong Medical Care), local cultural events, etc. We also make hygiene supply kits for needy clients, including such items as soap, shampoo, conditioners, razors, deodorant and toothbrushes, available every week.

Regarding hygiene supplies:

Hygiene supplies will not be available until the drop-in center commences operation;
Clients are not allowed to enter the storage closet at any time or under any circumstances;
If requests for particular products (i.e. unscented soap) are made, a Health Educator can bring out an assortment of choices to the common room and let the client choose which products suit him or her best;
Caseworkers will be trained in Health and Medical Sciences 98/198 to request hygiene packs from any person available at the Health Education and Hygiene Sypply table;
A sign can be posted on the storage closet door notifying clients that they are not allowed to enter the storage closet. If they do not abide by the policy a Clinic Coordinator can be notified to inform the client of the reasons the policy was implemented;
Deodorant, toothpaste, toothbrushes, shaving cream, and large bar soaps will be distributed on a monthly basis, with the recipient being recorded in Hygiene Supply Log. All other supplies can be distributed as needed.

If a client denies that they are the recorded person in the Hygiene Supply Log, or that they received supplies on the recorded date, the following rules apply:

Within two weeks, don’t distribute supplies;
Within three weeks, the first time, record the incident and give out the supplies. The second time, record the incident and do not give out the supplies;
Try to look at driver’s license or other identification if possible, for future reference.

Donations
The Suitcase Clinic is a non-profit student-run organization, with all funding originating from the continuous work on grants done by the Administrative Coordinators, from the Associated Students of the University of California, and from generous gifts from members of the community. Any and all donations are tax-deductible and greatly appreciated. Donations can be monetary in nature or can include equipment for our clinics. We accept donations ranging from toiletries (razors, soap, shampoo, conditioner, toothbrushes, toothpaste, floss, lotion, etc.) to clothing, blankets and jackets. Please contact us via phone or e-mail to set up a pick up time or for more information about donating supplies to the Suitcase Clinic.

Medical services
Medical services provide basic medical care and health education to the clients, including on-site treatment, health consultations, referrals, and free influenza vaccinations during flu season. In addition, medicines and supplies are provided at the discretion of the doctor based on client needs.

Medication
The Suitcase Clinic does not stock, dispense, or prescribe narcotics or benzodiazepines. The Suitcase Clinic does not offer antihypertensive medications on an ongoing basis. The Suitcase Clinic does not stock insulin or drugs for treating epilepsy. Prescription drugs can be distributed to patients only with physician approval after a drop-in center visit or if a Suitcase Clinic physician previously authorized a medication refill. Outside prescriptions are not filled at the Suitcase Clinic unless the patient is willing to see a Suitcase Clinic physician.

Universal Precautions

In the instance of a low risk level with no route of transmission, the isolation technique is handwashing. A typical situation is general patient care and contact with intact skin;
In the instance of a moderate risk level with a route of transmission in contact spread from bodily fluids, the isolation technique is the use of gloves and gowns. A typical situation is blood drawing and dressing changes;
In the instance of a high risk level with a route of transmission in contact splash and aerosol spread from body fluids, the isolation technique is the use of gloves, gowns, and eye/face protection. A typical situation is suctioning, bronchoscopy, emergency procedures and surgery.

Infectious Disease Control

A. Handwashing: All staff who provide direct medical services to clients should wash their hands as directed below. Handwashing remains the most effective infection control procedure and will be done according to this procedure.

Hands are to be washed:

When coming to work;
Before and after physical contact during client care;
Before putting on gloves;
After removing gloves;
Before sterile procedures;
After contact with blood or other bodily fluids;
After using the bathroom;
Before and after eating;
When going off duty.

Hands are to be washed in the following manner:

Tap water and antimicrobial soap should be used;
Generate a lather by rubbing hands, applying friction to skin of wrists, between fingers and all other surfaces;
Rinse thoroughly and dry with paper towels;
Use anti-bacterial hand wipes when water unavailable;
When exposed to blood/bodily fluids, wash with antimicrobial soap or 60% alcohol with tap water;
Handwashing is imperative after removing gloves.

B. Universal Precautions: Universal precautions are steps all health workers should take to minimize the risk of spreading infectious agents. The particular cautions taken depend on the risk level involved, except for handwashing, which should be performed as above, regardless of risk level.

C. Wound and Lesion Management: All staff providing direct medical services to clients should maintain this policy.

All wounds and lesions that are draining purulent material shall be evaluated for infection control. Procedure:

A wound draining purulent material should be cultured if possible;
Gowning is required if soiling is likely.

D. Needlestick: All staff providing direct medical services to clients should maintain this policy:

All needlesticks, punctures, and cuts occurring during the course of treating clients, or while handling used instruments, should be treated as potentially infectious;
Dispose of sharps properly in red sharps containers;
Clean wound by squeezing or bleeding under running tap water;
Report injuries to supervisors;
Sharps are to be disposed of without recapping;
Sharps containers are to be visually inspected daily;
When sharps containers are ¾ full, the physician should properly dispose of them.

E. Biohazardous (Infectious) Waste: All staff providing direct medical services to clients should maintain this policy:

Infectious waste should be placed in the red plastic bags and potentially infectious sharps should be placed in sharps containers;
Infectious waste is defined as: items saturated in blood or body fluids to the extent that it drips or pools;
Infectious waste includes: lab and pathology waste, body fluid-filled containers, needles/sharps/syringes.

F. Disposal of Infectious Waste: All body fluids should be considered potentially infectious. All staff who proved direct medical services to clients should maintain this policy:

Sharps:

All sharps and syringes are to be discarded intact in a puncture resistant red container;
Needles must not be broken, bent or recapped;
The physician must dispose of the sharps container once it is full.

Body Fluid Spillage:

Use gloves to remove spillage;
Use antibacterial solution to clean the area;
Wipe with disposable absorbent materials;
Disinfect with 1:100 solution bleach for smooth surfaces and 1:110 solution for porous surfaces.

Medical Division Referrals
If the Suitcase Clinic is unable to provide the health care services your client needs (i.e. x-ray, laboratory services, gynecological care, T.B. testing, long term follow-up) you can refer the client to the LifeLong Medical Care clinic. We currently have a referral system established with their Berkeley Primary Care Access Clinic. This clinic has a sliding scale method of charging fees. Although a minimum of $15 fee is charged to everyone, no one will be turned away due to an inability to pay. The following protocol will help your client get the additional medical care she/he needs:

Get two referral forms entitled “Berkeley Primary Care Access Clinic, Inc./West Berkeley Family Practice – Outside Referral.” Take a carbon sheet and a copy of the brochure that provides the address and hours of the clinic and a description of their services. When filling out the form place a carbon sheet between the two pages, so the Suitcase Clinic can keep a duplicate of the referral;
Help the client fill out the top portion of the referral form: Name, address, gender, date of birth, and insurance type;
Have the doctor help fill out the rest of the form. There is usually a long waiting list at the clinics (three weeks to three months), so if your client needs to be seen sooner, have the physician write specifically when he or she thinks the client needs to be seen. This will give the patient priority. If the case is very urgent, you can call the clinic the next day and let them know your client needs to be seen right away. They have agreed to give Suitcase Clinic clients priority if we call to let them know about urgent cases;
Give the brochure about the clinic to your client. Let the client choose which clinic they prefer to use – Berkeley Primary Care Access or West Berkeley Family Practice. Tell the client he/she must call or stop by the clinic they choose for an appointment. The client should notify the clerk that he/she was referred by the Suitcase Clinic;
Give one copy of the referral form to the client and tell them to bring the form to their appointment;
Place the other copy in the patient’s record [yellow = you keep];
Place the patient’s record in the “To File” folder as usual.

Important Note: Not all patients should be referred to Berkeley Primary Care Access Clinic. Patients over 55 years of age should be referred to the Over 60 Health Center. Residents of West Berkeley should be referred to West Berkeley Family Practice. Emergencies should be referred to Highland Hospital and/or 911 should be called. Anonymous HIV testing is done at Berkeley Free Clinic but not at BPCAC. Referrals should be tailored to the patient’s needs.

OTC Screening Protocol
The following protocol for clients entering a drop-in center and requesting over the counter drugs (OTC) is recommended:

I. The caseworker should form a subjective impression of the client’s emotional state and present this to the relevant health worker.

II. The caseworker should ask the client, “Are you willing to discuss your symptoms/problems further with the optometry student, medical student, or doctor (whoever is appropriate)?”

If the client DOES NOT want to discuss his/her problem further the Medical or Optometry Student Volunteer should be informed, and if the OTC drug is present, the caseworker will dispense the drug to the client. If the drug is unavailable or for some reason the health workers feels the client should not receive the drug, the client should be told, “we’re out.” If the client becomes angry and threatening, the caseworker should notify experienced clinic personnel immediately and if necessary, the caseworkers could enact emergency safety procedures;
The Medical Division keeps a logbook of all OTC medications that are distributed without physician approval. Before giving out any OTC medications, the Medical Student Volunteer should check the logbooks to see if the patient has received non-physician approved meds before. The logbook lists the client’s name, the reason for the medication, the type and amount of medicine, and the name of the medical student who distributed the medicine. For most OTC medication requests, one should consider the information contained in the logbook before distribution. The decision about OTC medicine distribution is subjective; a physician should be consulted if the medical student has any doubts. In general, caution should be taken in distributing medications to people with a history of gastric, liver, or kidney problems and with people who are taking other meds on a long term basis;
If the client agrees to discuss his/her symptoms further, the relevant health worker should be notified as per normal protocol. The caseworker should never decide by him/herself if the client should receive medication;
Changes to the Medicines/Medical supply list and/or to the above protocol should be approved by the Clinic’s supervising doctors and by a majority of the medical students involved in the Clinic.

Requests for Acetominophen (Tylenol):

Do you have liver disease?
Do you drink more than 2-3 alcoholic drinks per day?
Are you taking any medications for tuberculosis (isoniazid)?

If client answers YES to any of these questions, proceed to questions about Ibuprofen (Advil):

Do you have peptic ulcer disease?
Do you take any medications for high blood pressure?
Do you take any blood thinner medication?

If client answers YES to any of these, he/she must see the doctor to receive the medication.

For request for nasal decongestants (Sudafed), if the client answers YES to having high blood pressure, he or shee must see the doctor to receive medication.

The client must see the on-site physician in order to receive aspirin.

Record Keeping
The Medical Division Office will maintain the following records and supplies:

Locked cabinet containing old medical records and diskettes with current patient information;
Medical Division training materials;
Keys to the Suitcase Clinic and the medications cart;
Medications and medical supplies;
A Medical Division schedule listing the physicians and medial students working at clinic on a given evening

Medical Division Coordinators
The medical division is staffed by medical students in the UCB-UCSF Joint Medical Program and by volunteering physicians and nurse practitioners from the community.

Position Requirements:

Suitcase Clinic member and active volunteer for at least one semester prior;
Trained and recruited by previous Medical Division Coordinator to fill position;
Commitment to stay in position as long as interested and have a willingness to recruit and train a replacement when ready to leave the position.

Duty-Specific Responsibilities:

Maintain communication with the Clinic Coordinators;
Keep keys for medical division of clinic;
Maintain and restock medications for clinic;
Organize schedule of student and physician volunteers;
Attend Planning Committee and drop-in center specific meetings and encourage other medical students to attend;
Make sure to have enough copies of necessary forms at all times;
Conduct the intake of medical patients with the Clinic Coordinators and determine what order to see patients;
Determine what order to see patients;
Provide medical referrals for those who can’t be seen;
Match medical students with clients;
Ensure smooth running of clinic;
Facilitate the recording of all distributed materials by the medial students in the medication log book;
File the medication log sheet in the University Hall binder ASAP so the medical coordinator can restock as needed;
Conduct a debriefing session;
Clean and lock up.

Wellness Initiative
Flickr gallery: http://www.flickr.com/photos/21393898@N03/

In a time when society often fixates on the immediate and acute concerns of individuals, there is a need to address the long term problem of mental well-being of homeless/low-income clients. Unfortunately, medicine today has adapted to this fast paced world by providing fast treatments which fail to target the roots of problems. Individuals are labeled as “broken,” and examined just as one would examine a broken household appliance. Many medical treatments neglect the benefits of investigating the patient’s mental state, which is just as valuable as addressing physical ailments.

To address the targeted homeless and low-income population’s need for mental health services, we should first define what “mental health” is exactly. We define it as “a state of well-being whereby individuals recognize their abilities, are able to cope with normal stresses of life, work productively and fruitfully, and make a contribution to their community.” To empower individuals and improve their well-being, self expression can be a very effective tool. Expression ranges from art and poetry to dance and meditation; it is an outlet for creativity which empowers individuals by acknowledging that everyone is an asset and can contribute through these media. It equalizes the parties involved, reciprocates great ideas, and encourages individuals to feel a positive sense of self.

Within the greater society, individuals in homeless and low-income populations are ignored and ostracized by society; their expression is one of the last rights that they can call their own. Encouraging homeless individuals to express their feelings can help them forget about their challenging situations and enable them to vent their frustrations towards society.

Through the collaboration of students from various disciplines and backgrounds, the Wellness Division strives to provide opportunities to deliver holistic care that empowers and educates clients rather than just mitigating their symptoms.

Wellness Coordinator
Position Requirements:

Suitcase Clinic member and active volunteer for at least one semester prior;
Remain in position for a two semester commitment.

Duty-Specific Responsibilities:

Coordinate with different campus groups to provide creative workshops for clients at Suitcase Clinics;
Coordinate with the UGSIs to help put on end of the semester exhibits, displaying works by clients;
Update Clinic Coordinators about exhibits and workshops, and try to involve all Clinic volunteers to help elicit client expression;
Keep in mind that Wellness Initiative is supposed to be the arm of Suitcase Clinic that directly empowers clients by invoking creative expression.

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