By SUSAN IPAKTCHIAN

As Lyen Huang watched the Vietnamese patient laboring to breathe, he knew it didn't have to be this way. For years, the man had suffered from high blood pressure in the arteries near his lungs but couldn't afford medical care. As a result, he was now experiencing congestive heart failure and a handful of related maladies that left him winded after walking a few steps.

The man had come to Pacific Free Clinic, operated by students from the School of Medicine. Huang, a second-year medical student and one of the clinic's managers, comforted the patient while the physicians in attendance tried one potent medication and then another to control his blood pressure before concluding he needed care at a nearby emergency room. The doctors called ahead so he wouldn't have to wait and to explain that he shouldn't be billed because of his limited financial resources.

"It gives you a lot of motivation when you realize that this man's condition could have been controlled," Huang said. "He wouldn't have needed to be put on heavy-duty drugs or be admitted to the hospital if he had received proper treatment early on. It makes you feel very useful to realize we can offer him something; if nothing else, he can come back and talk to us."

The patient is typical of the more than 700 others who have been treated at Pacific Free Clinic, which marks its first year of operation this month. About 94 percent of them lack insurance and are between the ages of 18 and 65, making them ineligible for Medicare or other types of health-care assistance.

Medical student Bory Kea receives instruction from Todd Ferris, MD, at the Pacific Free Clinic. The San Jose-based community clinic, which is staffed by Stanford medical students, faculty and community volunteers, just celebrated its first anniversary. Photo: Lyen Huang

The clinic operates out of Overfelt High School in San Jose and is open on Saturdays from 10 a.m. to 2 p.m. It provides free basic health-care services for low-income adults, most of whom are Vietnamese, Chinese or Hispanic. Stanford medical students started the clinic after participating in outreach projects at Asian cultural festivals where they found that language and financial barriers prevented many Vietnamese immigrants from visiting a doctor.

In addition to the medical students, the clinic is staffed by physicians, undergraduates and community members who volunteer their services. While medical students run the clinic and take medical histories, physicians perform the actual exams and diagnose the patients.

"I got involved because it was a chance to do community service, which is one of the reasons I went to medical school, and it was also a unique experience to set up a free clinic and see the behind-the-scenes work that goes into it," said John Nguyen, a second-year med student and a clinic manager.

"We know the clinic is a stop-gap measure," added Huang. "We can't see all of the patients who need our services, but we see it as a way to help connect the patients with other resources in the community."

Operating the clinic has given the students an eye-opening view of the gaps
that exist in the American health-care system. When the clinic opened last May, the students assumed they would mostly be treating one-time complaints -- colds, flu, rashes -- and conducting routine checkups and screenings. But Huang and Nguyen said it quickly became clear that most patients needed treatment for chronic problems, such as high blood pressure and diabetes.

"They may have lost their job and can no longer afford their blood-pressure medication, so they come to the clinic complaining of headaches caused by high blood pressure," Huang said. "We could just treat the headache, but that doesn't solve the underlying problem."

The clinic's 15-member steering committee decided last summer to treat patients with chronic conditions, even though the students recognized that treating a recurring number of patients might limit the number of people the clinic could serve. In addition to providing medications, the clinic refers patients to other health-care programs in Santa Clara County that base their fees on a patient's income and are better suited to providing long-term care for those with chronic conditions. The students have also developed "contracts" in which patients outline dietary and exercise goals.

Looking toward the clinic's second year, Huang and Nguyen said they plan to continue reaching out to community groups and searching for additional resources. "We would like the community to guide us," Huang said.

The clinic is jointly sponsored by the School of Medicine and the School Health Clinics of Santa Clara County. Other supporters include The Health Trust, Blue Shield of California, the California HealthCare Foundation, Kaiser Permanente, Chanwell Medical Group, East Side Union High School District, Nancy Chen, the city of San Jose and the David and Lucile Packard Foundation.

Those interested in volunteering can e-mail pacific@med.stanford.edu. The clinic particularly needs volunteer physicians and Spanish and Vietnamese interpreters.

Pacific Free Clinic first birthday stats

• Total patient visits: 730

• Total individual patients: 452

• Total on-site screening visits: 240

• Average appointments per day: 27

• San Jose residents: 78%

• Uninsured patients: 94%

• Unemployed patients: 30%

• Patient visits requiring an interpreter: 71%

• Patient visits resulting in referral to another medical organization: 40%