The road to Ozanam: A place to teach, learn and heal

IntroductionHomelessness is a significant public-health problem due to its associated increased risk for poor health status. In particular, various indicators of housing instability are related to chronic conditions (e.g. hypertension, diabetes, and asthma), acute conditions (e.g. infections and injuries), communicable diseases (e.g. tuberculosis, sexually transmitted infections), and premature mortality (1-4). In addition to physical ailments, there is an increased rate of substance abuse, mental health disorders, and social instability among the homeless compared to the general population, providing additional challenges to effective healthcare delivery (5, 6). Homeless persons experience increased barriers to accessing healthcare and managing their health conditions (7, 8).In New Orleans, Louisiana, Hurricane Katrina and subsequent disasters, including Hurricane Rita and the BP oil spill, had devastating and persisting consequences for the healthcare infrastructure, particularly for underserved individuals (9, 10). The hurricane exacerbated existing health disparities in New Orleans, with both immediate and sustained adverse effects on disease management, mental health, and mortality (11-14). In addition, homelessness has increased 70% since Hurricane Katrina, with current estimates of over 9,000 individuals meeting the U.S. Department of Housing and Urban Development definition of being homeless (15). As a result, a greater burden of responsibility for providing care for the underserved has shifted onto community-based health and social-service organizations.Ozanam Inn is one of the few shelters for men in the Greater New Orleans area that, in addition to housing, provides extensive social and occupation- development services. The student-run weekend clinic in Ozanam Inn homeless shelter was reopened in January 2010 after being closed since Hurricane Katrina in August 2005. Student leaders of the longstanding, weekday tuberculosis testing program at Ozanam Inn restarted the clinic after recognizing that access to and knowledge about affordable health and social services was limited in this population and in the overall New Orleans region. Patients and shelter administrators requested additional medical and social services beyond the capacity of the existing tuberculosis-testing program.Through continuous feedback, evaluation, and communication, the clinic leadership strives to meet the evolving health and social needs of the patient population in collaboration with the shelter administration. The stated mission of the Ozanam Inn Weekend Clinic is to "expand access to primary care and promote wellness to the homeless community of New Orleans, while also providing a flexible and dynamic atmosphere for students to develop professional skills through a multidisciplinary approach to healthcare." The purpose of this paper is to describe the community-based approach of this clinic in addressing the healthcare needs of the homeless in New Orleans.MethodsProgram design and patient selectionThe student-run clinic takes place on Sunday afternoons throughout the calendar year. The clinic is held in administrative offices and designated healthcare offices in a homeless shelter. Patients are recruited by posting fliers around the shelter and by making an announcement over a loudspeaker system both inside and outside the shelter before lunch service. Additional outreach and promotion strategies for patient recruitment include posting clinic flyers in public locations throughout the city, posting updated clinic information on our own and other publically accessible websites, periodically volunteering to serve the homeless population in other capacities, and participating in community-based health outreach events. All services at the clinic are provided free-of- charge. All patients that seek care within the scheduled hours are seen on a walk-in basis, regardless of ability to pay, housing status, age, gender, or any other socioeconomic or demographic factors. …