By: Nicole Pham, Andrew To, and Andrew Rasiah.
“Tienes dolor?” This is the question we ask our patients as we carefully palpate their painful feet. Many of our patients work long hours and are constantly on their feet. They have little time to spare, but today is our free clinic and their only chance for proper healthcare. We ask the patients how long they have been in pain for, and for some it is months that have led to years. Today, my patient painfully walks into the room, using her husband as a crutch for support. She tells me she cannot bear being on her feet any longer. Her pain began after working long hours in a canning factory. With the doctor’s supervision, I gave her a plantar fascia injection in both feet. Watching her walk with no more pain reminded me of how grateful I am for podiatry and the care that our clinic provides for its patients.
Clinica Tepati and Shifa Clinic are two student-run clinics in Sacramento, managed by UC Davis’ students. Starting 2011, the California School of Podiatric Medicine (CSPM) has been collaborating with the UC Davis students to provide podiatric care to its patients. Both clinics provide free healthcare for underserved populations. Clinica Tepati sees a majority of Hispanic communities, while Shifa Clinic sees a majority of Middle Eastern communities.
When a patient enters the clinic, their vitals are taken first. UC Davis students will perform blood pressure, temperature, respiratory rate, and pulse measurements. Podiatry students will then enter the room and provide a comprehensive foot exam. We first obtain the history of the patient to understand what foot complications they are experiencing. We also ask about their family history and social behaviors to fully understand the lifestyle of our patient. In our lower extremity exam, we test 4 different components: musculoskeletal, neurological, dermatological, and vascular. In the musculoskeletal component, we first feel for the range of motion in the first ray and ankle. Then we test for the strength of the patient’s feet. We ask them to evert, invert, dorsiflex, and plantarflex against our hands, that are providing resistance. In the neurological component, we perform a vibratory test with a tuning fork to test for intact vibratory sensation. Another test is testing for loss of protective sensation using a device called a monofilament. In our dermatological component, we exam the patient’s skin, nails, and between the toes to look for signs of abnormalities which may include: redness, fungal nails, dry skin, ulcerations, etc. The last component is vascular, we will feel the Dorsalis Pedis pulse and the Posterior Tibial pulse in the patient’s feet. If we are unable to palpate the pulse, we will use the Doppler ultrasound to listen for the pulses. After performing the lower extremity exam, we will talk to the attending doctor and form an assessment and plan for the patient.
However, with these student run clinics, they have access to much earlier patient interactions, even getting a chance to perform procedures that would otherwise have to wait until the later years of schooling
Every student desires for the day when they can finally enter clinic to see patients and to put what they learned on paper into practice. For most curricula, students do not get patient interaction until their 3rd and 4th year rotations. However, with these student run clinics, they have access to much earlier patient interactions, even getting a chance to perform procedures that would otherwise have to wait until the later years of schooling. For many students, reading a step-by-step guide to cut nails or to debride a callus seems very easy on paper; it’s just a snip here, snip there, or shave here and there. But applying these skills is very different. Here at Clinica Tepati and Shifa, these are more than often very common procedures to do and we get a lot of time to perfect and hone our skills. Most recently, a few of our students even got to do some steroid injections, which is only talked about in lectures for treatments. With the guidance of our wonderful attendings, they help the students get comfortable during these procedures and walk them through the process.
It’s heartwarming when we apply these treatments and see their frowns turn instantly to smiles
Clinic allows us to give back to the community, both with our knowledge and our skill set in providing them with a better lifestyle. Healthcare is becoming more expensive as each year passes, and it becomes hard for those with many disabilities to pay or even get referrals to see specialists. Our clinic helps alleviate some of those burdens by providing free healthcare on a monthly or even weekly basis. In podiatry, we give them immediate relief, whether it is simply providing new shoe inserts to give arch support, or a toenail trim that minimizes pressure off the toes when wearing shoes, or steroid injections to help with plantar fasciitis. It’s heartwarming when we apply these treatments and see their frowns turn instantly to smiles. The instant gratification in these patients spreads the word about our clinic so that we can provide greater care for the whole community.
Podiatric medical students lead busy lives, filled with classes, exams, and clinical rotations. The amount of time that all of these activities take would far surpass that of full time employment. One may ask why students would choose to spend their Saturday mornings volunteering at Clinica Tepati, treating patients who they may never see again. The skills that one gains from this volunteer opportunity can be gained through rotations organized by the school. Clinica Tepati and Shifa Clinic offer students a different experience: the opportunity to serve an underserved community that may not otherwise receive important medical care. These are the patients who may “tiene dolor” after spending long hours on their feet and who may not have health insurance or any other options for relief. The opportunity to treat a patient like this and immediately have a positive impact is something that should be valued and not taken for granted. The students can not only take away their newly honed skills, but they will have left with indelible memories that will guide their future practice and how they interact with patients. Each student will remember at least one patient, like the woman who needed her husband as a crutch to walk into the clinic. She would ultimately leave pain-free after plantar fascia injections that most clinicians perform regularly and with ease. It is stories like this which is why it is so crucial for podiatry students to be involved in community service. It is a reminder of the humanity that is behind every complaint and condition. Medicine is a calling, and Clinica Tepati is a way for students to answer that call.
Pictured left to right: Nicole Pham, Andrew To, Andrew Rasiah
By: Nicole Pham, Andrew To, and Andrew Rasiah.
Student Organization: Clinica Tepati/Shifa Clinic
School: California School of Podiatric Medicine
Finalist – Writing Competition 2020
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