As the day wanes, medical student volunteers with the USF Health Tampa Bay Street Medicine (TBSM) Refugee Clinic are inventorying medical supplies and vaccines before patients arrive for evening appointments.

“In the past six months our patient population doubled,” Azd Al-Mashal, MD, co-founder of the USF Health TBSM Refugee Clinic, said before the start of another busy Wednesday night.

The USF Health TBSM Refugee Clinic provides free medical care to refugees from all over the world, adults and children who now have a common bond of being refugees in the Tampa area. TBSM is a student-run organization dedicated to improving the health of vulnerable populations in our community. The TBSM Refugee Clinic offers medical provider visits, prescriptions, over-the-counter medications, labs, imaging, mental health services, preventative care and hygiene kits to refugees and asylum seekers who don’t have insurance. The clinic is held twice a month, evenings on the second and fourth Wednesday, at USF Health Carol and Frank Morsani Center for Advanced Healthcare.

“Ten years down the line, I definitely want to see Refugee Clinic continuing its incredible momentum of growth,” said Richa Bisht, MD, the former co-director of the USF Health TBSM Refugee Clinic.

To donate to the USF Health Tampa Bay Street Medicine and the Refugee Clinic, please visit giving.usf.edu

When patients take active roles in their own health care, outcomes improve. That’s the premise for a pilot program taking place in the USF Health’s Division of General Internal Medicine through a grant provided by the Centers for Disease Control and Prevention.

The six-month $12,000 study is a pilot project aiming to measure the efficacy of providing patient education group sessions to help patients control their diabetes, said Crystal Jacovino, DO, assistant professor of medicine and co-principal investigator for the study.

Diabetes patients watch a cooking demonstration as part of the nutrition section of the group education program.

“Each month, the group meets to discuss key topics that can help patients better manage their diabetes, from having a better understanding of the disease and its effect on their bodies to managing their medications to nutrition and physical activity,” Dr. Jacovino said.

“Measured against a control group, vitals and blood work will reveal whether the focused group education approach gives patients the information they need to take more active roles in successfully managing their diabetes. When we take a multi-disciplinary approach to patient care we are all working together to help educate our patients and improve their condition.”

Jerry Brown offers cooking tips for eating better carbs, as Dr. Jacovino reads a product label showing nutrition content.

As part of the study, the 12 patients in the education group were chosen randomly among consenting patients meeting the study criteria (Type 2 diabetes, ages 18 to 85 and A1C > 9%). The group of 12 is meeting once a month for six months; the program started in June and is set to wrap up in November. Members of the group also discuss their own concerns with other group members and health care experts and share tips each has learned for improving their own diabetes management. The results will help USFPG providers determine future programs for providing a group medical care model, Dr. Jacovino said.

The project also provides a critical learning opportunity for the resident physicians in training in the Division of General Internal Medicine, said Lucy Guerra, MD MPH FACP FHM, associate professor of medicine, associate director of the internal medicine residency program for USF Health, and director of the Division of General Internal Medicine.

“A major aim of the project and a core component of national resident educational goals is to offer innovative ways of delivering medical care,” Dr. Guerra said. “In this project has involved residents in every diabetic group visit, giving them that opportunity to see firsthand another option that could help their future patients succeed with managing their diabetes.”

Prior to the cooking demonstration, patients are taught best approaches to meal planning.

The education program is also part of a broader effort across the USF Physicians Group to create a patient-centered medical home for patients that coordinates care and reinforces a stronger patient-doctor relationship. In addition, the patient education program in the Division of General Internal Medicine dovetails with USF Health’s overall diabetes efforts that encompass not only patient care but also research and outreach.

Photos by Eric Younghans, USF Health Office of Communications.

She’s a grandmother to 16 grandchildren, she’s taking a cruise to the Caribbean, and she’s going to Miami to get a boat. These are details June Ryan wants her health care team at USF Health to know about what’s going on in her life so she wrote them on a large poster as part of the Tell Me More event that aims to improve communication between physicians and their patients.

June Ryan shares new details about her life with Dr. Kevin O’Brien.

Held Feb. 15 to 19, the event is part of Solidarity Week and is sponsored by the Arnold P. Gold Foundation to raise awareness for compassionate patient care. Using the “Tell Me More” prompt, patients write at least three things about themselves on a poster, offering details about their own lives that the health care team might not know. Collected and posted on walls within clinics, the written information serves as a reminder that patients are more than the symptoms they present.

“The details patients provide us about themselves help us start conversations with them and offer a better way to humanize their medical experience with us,” said Lucy Guerra, MD, associate professor and director of the Division of General Internal Medicine for the USF Health Morsani College of Medicine.

“Sometimes we miss these details and knowing them could impact the health care we provide. These details can give the health care team a better understanding of what’s going on in the patients’ lives and what might be affecting their health, details that otherwise might not have been presented. That information helps us define better health care plans that patients are more likely to follow through on.”

At the Byrd Institute, Jasmin Perry writes down her three points with Dr. Crystal Jacovino.

The annual campaign is held at medical schools, patient care facilities and other organizations across the country. At USF Health, health teams in the Division of General Internal Medicine, the Department of Family Medicine, and the primary care clinic at the USF Health Byrd Alzheimer’s Institute stepped up to participate in the week-long campaign. In addition to forms for writing their three personal details, patients were presented with information about Solidarity Week, a button calling for Solidarity for Compassionate Patient Care, and an apple.

Walter Chapin (far right) talks with his health care team, from left, Karin Hussein, first-year medical student, Santosh Reddy, MD, second-year resident, and Dr. Crystal Jacovino.

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Shenita Sanders, certified medical assistant for USF General Internal Medicine.

This is the first story in a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

It’s in Dr. Lucy Guerra’s genes to be completely drawn in to the team-based patient care offered at USF Health. Her own Latino heritage includes a close-knit family that is involved in nearly every aspect of life, including each other’s health.

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Knowing she is living true to who she is, she practices team-based medicine every day, putting her patients first, reinforcing the concept to medical students and residents she teaches, and watching the students, in turn, practice it as they provide free care to the local underserved community at the BRIDGE Clinic.

Dr. Lucy Guerra in the midst of teaching medical students and residents at the Morsani Center for Advanced Healthcare.

Dr. Guerra wears multiple hats in her career as a physician. She is associate professor, director of the Division of General Internal Medicine in the USF Health Morsani College of Medicine, co-faculty mentor for the BRIDGE Clinic, and associate director of the Internal Medicine Residency Program.

She doesn’t see them as multiple roles, but as one job, she said, a testament to her preference for working at an academic medical center.

“We all need to change our concept of what medical care is and to think of it as having evolved to a very patient-centric model,” Dr. Guerra said. “It’s more about working as a team to provide the best care and realizing the patient is part of that team. It’s a trend we call value-based care. When patients come to a place like USF Health, they’re going to always meet with the physician and other health care providers – a nurse practitioner, social worker, pharmacist or physician assistant – and it’s always going to include medical students and residents because we are an academic teaching institution.”

But an academic medical center is more than patient care and Dr. Guerra is emphatic in her efforts to incorporate USF Health’s other missions into her world.

“Our other missions – research and teaching—are equally important to patient care because you really can’t do one well without the other,” she said. “If we don’t have the research component then we can’t find better drug therapies and better behavioral therapies to treat patients. And sometimes I think this needs to be emphasized more because patients don’t necessarily realize that. The research part is very ethereal – you just don’t see it in action. Patients think of research as being done in the lab. But when you’re coming here, to an academic institution, you have the opportunity to participate in research studies and get involved. If patients realize they can participate in some kind of research study that will make a difference for the next generation of patients that come after them then wow, what a contribution they’ve made to medicine, as well to the future of their own grandchildren.”

For the teaching mission, Dr. Guerra said that, beyond the science of medicine, she tries to remind her students and residents why they chose medicine as a career.

“People who are learning and in a learning environment sometimes get caught up, just like I did, in studying or trying to get good grades or trying to pass, and you have to keep reminding them why they chose this profession,” she said. “For a physician, a nurse or anyone working in health care, it really needs to be a commitment. You’re making a commitment to somebody else – the patient. If you can ground a student in that, then they’re going to be the better health care provider for it.”

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She conveys that same philosophy to her colleagues, urging them to always remember why they went into medicine, to do their best to block out the added duties, patient charts, and demanding schedules and return to their core reasons for choosing medicine as a career.

Sometimes, she said, it’s as simple as looking at the young and eager medical students and residents to reignite the passions that carried them through medical school.

“Participating in things like BRIDGE, or teaching students and residents, can remind them why they went into health care to begin with,” Dr. Guerra said. “They’re seeing what they were a few years before or a decade before. And that’s the difference we find working at an academic medical center, where you have a lot of younger people around all the time from different disciplines.”

What keeps her motivated, staying on track with a demanding career? Among many things, she looks to her own father, who was a physician in Cuba and Spain before coming to America.

“I admire my father because he was always studying, learning English and trying to pass the medical boards here,” she said. “And he was older when he did that, in his late 30s, and worked three jobs during that same time. I just thought if someone could care so much about something, that’s what I’d like to do.”

Photos and multimedia story by Sandra C. Roa, USF Health Office of Communications. 

The partnership will increase access to specialty care for uninsured residents served by the USF Health student-run program and significantly increase the number of patients seen.

By Saundra Amrhein

Further strengthening ties between the two institutions, Florida Hospital Tampa has committed $1.2 million in donated goods and services to the University of South Florida to help expand community-centered medical care through the USF Health BRIDGE Clinic.

The BRIDGE clinic – a nationally recognized, student-run free community clinic now in its eighth year – provides primary medical care for more than 800 underserved patients a year from the University Community Area one night a week inside the USF Health Morsani Center for Advanced Health Care.

Leadership of USF Health and Florida Hospital Tampa as well as medical faculty and student volunteers pose for a photo on opening night of the BRIDGE Clinic at Florida Hospital.

Now, Florida Hospital Tampa’s donation of goods, services, office space and personnel will help significantly increase the number of uninsured patients seen through the BRIDGE clinic, expand specialty care and procedures, and cut weeks off the appointment waiting times for new and established patients, said Dr. Lucy Guerra, a volunteer co-medical director and one of several attending USF Health physicians at BRIDGE.

The additional resources for the BRIDGE clinic extension at the hospital – set up inside Florida Hospital Tampa’s renowned Pepin Heart Institute, located on Fletcher Avenue across the street from the university – will also help mitigate the plight of working families who cannot afford or qualify for insurance in the new federal health insurance marketplace but who also don’t qualify for Medicaid, Dr. Guerra said.

Officials from both institutions said they are thrilled about the partnership, which adds to their ongoing research and patient care collaborations across the Tampa Bay region.

“We’re incredibly grateful,” said Dr. Charles Lockwood, senior vice president of USF Health and dean of the Morsani College of Medicine. “This is a clear indication that our missions are completely aligned. We are here for the patients.”

Dr. Peter Bath, vice president of mission for Florida Hospital West Florida Region, echoed Dr. Lockwood’s sentiments and said partnering with the hospital’s next-door neighbor to provide health care for struggling families was a continuation of the hospital’s mission.

“This is a natural extension of what our mission is all about, caring for people and giving back to our community,” Dr. Bath said. “We know needs are significant for the underserved and we will continue to look for ways to help the community throughout all of our nine Florida Hospitals in the West Florida Region.”

USF medical student volunteer Jordant Vanzant checks the blood pressure of BRIDGE Clinic patient Sandra Avilez.

The donation and partnership stem from more than a year of meetings spurred by both university medical students seeking more resources for their high-demand clinic, and the encouragement of one of the hospital’s doctors.

Dr. Marian Menezes, a physician on staff at Florida Hospital Tampa, remembers how his wife – Dr. Lynette Menezes, the assistant dean for international affairs at the USF Morsani College of Medicine – convinced him to attend the BRIDGE clinic’s annual fundraising talent show more than a year ago.

“I fell in love with what they were doing,” Dr. Menezes said. He immediately sought out ways to help.

The medical students relayed their concerns about space, patients’ waiting times and the need for more specialty care for patients with serious medical problems. Currently USF doctors waive their fees for BRIDGE patients for certain surgeries and specialty procedures, but there are still facility fees and other types of expenses that add up to thousands of dollars. Dr. Menezes brought the issue to the attention of his colleagues at the hospital.

Expanding services offered by the BRIDGE clinic at Florida Hospital Tampa will significantly cut down patients’ wait times for appointments, which can run from three to four months, said Michelle Blanco, a USF fourth-year medical student and executive student director at the clinic.

“Now being able to tell your patients we can see you in the next few weeks – it’s very exciting,” Blanco said.

The patients will also have increased access to surgeries and specialty tests and procedures in areas like radiology, gynecology, orthopedics and surgery. “Both efficiency and quality of care are going to increase at BRIDGE,” Blanco said.

L to R: Dr. Theron Ebel, a critical care physician at Florida Hospital Tampa, with USF Health Morsani College of Medicine faculty members Dr. Eduardo Gonzalez and Dr. Lucy Guerra, co-medical directors of the BRIDGE Clinic, and USF medical student Kathryn Dean.

The expanded BRIDGE clinic, like the current one, will continue to pair medical students with supervising physicians. In addition to the USF Health doctors who volunteer at the Morsani site, the new site will bring in volunteering physicians from Florida Hospital Tampa. As the numbers of participating hospital physicians grow, the clinic at the hospital may increase its capacity from one Thursday night each month to opening as many as four nights monthly.

Dr. Krishna Tewari, a hospitalist physician at Florida Hospital Tampa, will be among the first. He said he plans to volunteer at least two nights a month.

“I’m excited to see the work here,” Dr. Tewari said.

The expansion also creates more volunteer opportunities for USF students from the colleges and schools of pharmacy, physical therapy, public health and social work – as well as student interpreters. They currently rotate through the current BRIDGE clinic and its 13 exam rooms at the Morsani Center.

Ali Antar, 22, nearing the end of his second year of medical school at USF, said with the expansion of BRIDGE, he would love to volunteer even more time at both sites. After a year at the original BRIDGE clinic location, the experience has deepened his understanding of the practice of medicine beyond what he’s learning in the classroom.

“When you’re a lower classman, any real clinical experience changes your perspective,” Antar said.

Meanwhile, patients are grateful for faster access to needed care.

“I went to get this appointment in October,” said Sandra Avilez, 51, sitting in one of the four BRIDGE clinic exam rooms inside the Pepin Heart Institute at Florida Hospital Tampa on the night of the expansion’s opening.

Avilez, formerly a customer service representative, lost her health insurance coverage with her job when her company moved her department and positions to another state. She hoped to get a check-up with a doctor at BRIDGE, because she was recently experiencing hot flashes. While waiting for an appointment these last few months, she did her best to keep herself informed about her health condition by reading articles and taking vitamins.

She was relieved to see the new BRIDGE clinic office space open at Florida Hospital Tampa in late February. It enabled the staff to bump up an appointment for both Avilez and her 77-year-old father.

“We were luck they could move up our appointment,” Avilez said. “Our date was for the end of March.”

Sandra Avilez, who lost her health insurance coverage with her job when her company moved her department to another state, was relieved to get an appointment sooner than expected at the BRIDGE Clinic.

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Photos by Eric Younghans, USF Health Communications and Marketing