Two UBC medical students will be leaving a powerful legacy behind when they graduate this spring. Thanks to Katharine Smart and Steven Mathias, more than 200 medical students now spend 3 to 7 hours per week volunteering at the Downtown Community Health Clinic in Vancouver's Downtown Eastside, where they work beside students from a range of health professions.
The Community Health Initiative by UBC Students, in partnership with the Vancouver/Richmond Health Board, offers the students an unusual opportunity to step into the world of inner-city health care.
Smart and Mathias say their motivation came from the limitations imposed by the medical school curriculum and their belief in the need to learn about a broader spectrum of health care, views born of their own experiences in developing countries.
At medical school, says Smart, most training takes place in the “very contrived environment” of hospitals and students lack a connection to the community.
“We were frustrated,” adds Mathias, who also found the time to serve as head coach of the UBC Thunderbirds women's hockey team. “Lectures were meant to open up our minds to what was going on, yet we were in a lecture hall in a hospital. A drug addict was brought in to talk about what it was like to live on the street, but that was a misrepresentation of the issues because until you sit down in their community and walk the streets that [addicts] walk, I think it's difficult to have an understanding of what's going on.”
The cornerstone of the clinic experience is the opportunity for students to spend “real time” with patients, something that's often impossible during typical family medicine encounters. “Students are told to take their time, but family practice hasn't changed,” says Mathias. “You still see a patient every 10 minutes. So we wanted patients and students to get to know each other.”
In the program, first- and second-year students serve coffee and meet with patients in the waiting area, while third- and fourth-year students provide primary care under a physician's supervision. “The most rewarding part is seeing students develop relationships with residents [of the Downtown Eastside],” says Smart.
The opportunity to work cooperatively in an interdisciplinary team is an important aspect of the program, says Mathias, because it is rarely available during medical training. Although UBC's medical students often work beside students and professionals from other programs, he says, they “really aren't” working together.
The pair say their interdisciplinary, community-based approach was fuelled by their experiences in South Africa and Haiti. Smart, from Swift Current, Sask., studied political science at UBC, and this sparked her interest in international development. She decided that medicine would allow her to combine “something academic with something practical, where you can actually work directly with people and make a difference in communities.”
While in medical school she spent 2 electives in South Africa, where she came face to face with the impact HIV is having on children. The experience convinced her to pursue a career in child advocacy. Smart, who will soon enter a pediatrics residency in Calgary, hopes to teach and practise in northern BC communities and overseas.
Mathias, who is from Ottawa, saw large numbers of AIDS patients when he worked with a family doctor in Haiti. That work taught him that “there was a lot of therapeutic value in my communication with patients.” After completing a residency in psychiatry in Vancouver, one of his major interests will be work in addiction medicine.
Overall, says Mathias, the challenges created by the Community Health Initiative by UBC Students — funding, defining the student's role and coping with staff apprehension — have provided a true learning experience. Sometimes, he says, it felt “like turning a 747 around.”
Signature
Heather Kent
Vancouver
Figure. Katharine Smart: leaving a contrived environment behind Photo by: Photo courtesy Katharine Smart
Figure. Steve Mathias, playing in annual physicians' hockey tournament in BC Photo by: Photo courtesy Steve Mathias