A Shared Experience

Sharewood's Website

Sharewood is a free health clinic run by TUSM students that offers clinical, case management, laboratory, and other health care services. Sharewood is open to everyone, including the uninsured, and no appointment is necessary.

The clinic operates every Tuesday night from 6:30 to 9:30 p.m. in the First Church in Malden, at the end of Pleasant Street in Malden, Massachusetts.

Managed by first and second year TUSM students, Sharewood is staffed by TUSM volunteer physicians and medical students, as well as other health professions students and translators. Tufts undergraduate volunteers manage front desk operations and assist with fundraising and patient outreach efforts.

Founded under the guidance of Dr. Brian Lisse, an associate professor at TUSM, the Sharewood Project derives funding for its operating costs solely through fundraising and donations. The name Sharewood was inspired by Sherwood Forest in the story of Robin Hood, where the theme revolved around helping the less fortunate.

Students called the project "Sharewood" because they felt the project is about a mutual give and take where those receiving health services provide a learning opportunity for the students of Tufts University School of Medicine. The experience is shared rather than given.

The newest addition to the Sharewood project is the OB/GYN clinic, which provides free services to those who cannot afford it elsewhere. The OB/GYN clinic became available in July, 2011. Moira Rashid, the OB/GYN clinic's director, answered the following questions:

Why a woman's health clinic at Sharewood?

Last year I worked as a sexual health counselor at Sharewood. Working in sexual health, I realized that many, if not most, of the health concerns of our female patients were out of our scope of care, there were large gaps in our services that are very much needed by our patients.

There wasn’t much we could do for women beyond testing for sexually transmitted infections and pregnancy testing, which was often frustrating for both the patients and the counselors. Not only this, but from a staffing perspective, it became clear that myself and my classmates were largely unequipped to counsel patients appropriately or how to best help them find care.

When someone told me about the grant and I suggested that I apply, I knew that it would be a really amazing opportunity for Sharewood to improve our patient care.

Why focus on women's health separately from other health issues?

The need to focus on women’s health issues separately is twofold.

First, women have a very unique set of health concerns. While men and women obviously share many of the same general health concerns, women face a huge and unique range of health issues surrounding reproductive health.

There are countless barriers that exist that limit a women’s ability to control her health and reproduction, whether its lack of access to affordable birth control, honest care about the choice of how to proceed with a pregnancy, or simply having access to a facility that can offer screening for cervical cancer or treat common vaginal infections.

More commonly than general health concerns, a woman’s ability to access reproductive health services can have huge impacts on her ability to work, to care for her family, or to live the life of her choosing. In other words, while any disease has the potential to impact a person’s day to day living, I think that women’s health concerns have much more potential to cause huge impacts on her life if access to care is denied. A pregnancy, for example, can change a person’s entire future.

And very common infections gone untreated can easily leave a woman without the ability to have children. In order to hold an equal position in society, women need to be able to control their reproductive health. They need to have access to care that allows them to treat common infections that may have huge impacts on their fertility, care that allows them to decide when and under what circumstances they become pregnant, and care that allows access to screening for potentially life threatening conditions.

The breadth of these concerns, their ability to have such enormous impacts on a woman’s life, and the current barriers that exist for women to access reproductive health services, require us to focus on women’s health care separately from other health issues. Furthermore, offering care also requires a subset of knowledge that is underrepresented in medical education.

Every medical student learns how to take a patient history, but we are not taught the intricacies of women’s health or how to sensitively talk about birth control, pregnancy options, or other common concerns. Therefore, in order for us to effectively provide care we need training that focuses on a unique set of skills and a knowledge base set specifically on women’s health apart from other health issues.

Who wrote the grant application — what was the process like? What institution or body did you apply to?

In the year before I started working at Sharewood, a few students in the class above mine had worked to try and create some women’s health services at Sharewood. During my time working at Sharewood last year, they sent me the grant application and suggested that I apply.

Although I was not the official grant writer, I decided to take the opportunity and responsibility of both applying for the grant and working to carry out the grant proposal to start women’s health services at Sharewood. Last May I wrote and submitted the grant application. In August, we got the good news that ours was one of five clinics in the nation to receive the grant.

The grant was given to us by the Reproductive Health Access Project (RHAP), an organization that works to expand access to reproductive health services in primary care settings in the United States. They had worked previously with New York University to establish a free womens clinic in New York City and with the success of this clinic wanted to offer other student run free clinics the opportunity to establish or expand women’s health services.

Now, each of the five schools that received the grant are working in various ways to improve women’s health services at their clinics. After we got the grant, I was a little lost as to where to begin such a huge project. Luckily, in the fall I found a physician mentor who was pivotal in getting the process started and helping me establish a long term plan. I have also been lucky to work with the physician who helped to start the NYU clinic with RHAP that I previously mentioned.

Both of these physicians have also been very influential in helping us work closely with the Malden Family Health Center for patient referrals and student trainings. This year, we also added a new position of Women’s Health Coordinator to the Sharewood board. In January I began working with Women’s Health Coordinator, Frannie Koenig (M14).

With the two of us working together on the project, planning and working to get the clinic running really picked up steam. More recently another second year student, Katie Chang, has joined our main planning team and has also had a very important role in the success of getting the clinic started this summer.

When was the grant awarded, and for how much?

The grant was awarded in August of 2010 and is for $5000 over the course of one year.

What are the grant's requirements?

As grant recipients, it is our job to work toward the mission of RHAP, which seeks to expand access to reproductive health services in primary care settings. The overall purpose of the grant is to provide us with funds to establish or expand women’s health services over the course of one year.

More specifically, this grant aims to eliminate the very significant barrier of start-up costs that so often prevent good ideas from ever becoming reality. While this grant focuses on start up costs, the hope is that once services are established, we will work towards implementing a plan for the future sustainability of the project.

In our proposal, we laid out a plan to both expand upon our already existing sexual health services while also adding new women’s health services and creating an environment at Sharewood that more adequately qualified to address the health concerns of our female patients.

To gauge our progress and the use of our funds, we will be preparing a presentation for RHAP next month on what we have accomplished over the past year and our plans for future sustainability.

How many students and/or professionals will be running the clinic?

Many students, volunteers, and physicians will play a role in the functioning of the clinic. Frannie Koenig, who is a second year medical student and my partner on this project, is the Women’s Health Coordinator this year and is in charge of administrative duties and the overall functioning of the women’s health clinic.

Katie Chang, another second year student, Frannie, and myself will continue to develop the clinic over the course of the coming year with our two physician mentors. Prior to this project, Sharewood has had a sexual health clinic with a small team of 5-6 specially trained sexual health counselors.

Members of this team will be primarily responsible for interviewing and counseling our patients. In September we will be holding our first women’s health training where the sexual health team and the Sharewood board will learn about common women’s health topics encountered in the clinic, such as birth control counseling, pelvic exams, common vaginal infections, and other common concerns.

Students from the Sharewood board, other medical students, and Sharewood volunteers will also contribute to staffing the clinic. Each week, we also have either a resident physician or attending physician who will oversee the clinic, work with students to see patients, and continuously help us to improve our services.

Is OB/GYN the field these students are working to be in?

Certainly, I think that some of these students are specifically interested in the field of ob/gyn. More so, however, I think that the students most closely involved with this project and our new women’s health services are passionate about women’s health and improving access to reproductive health care.

These students understand that women often face significant barriers to equality due to lack of access to reproductive health care, and low income women and minority patients that make up a large portion of Sharewood’s patient base are even more significantly impacted.

 Speaking from my own perspective, I care deeply about using my career to improve access to reproductive health services, and this is what has motivated me throughout my work on this project. I think that the other students involved feel the similarly.

What services will be provided at the clinic?

Because of the limited facilities of Sharewood and our ever-changing staff and volunteer base, we try to avoid acting as a main primary care provider for patients. As much as we can, we try to link people with MassHealth and consistent primary care physicians.

That being said, there are situations in which Sharewood is a woman’s only option for care. For these women, I want to make sure that we are offering the most comprehensive, high-quality, and sensitive care possible.

Initially, we are trying to address the concerns that we see most commonly at Sharewood, namely, vaginal infections, birth control, and pregnancy testing needs. Two other relatively common concerns that we would like to address are domestic violence and sexual assault.

Since opening, we have primarily begun to offer pelvic exams, which allow us to address, diagnose, and treat common problems that our patients have and also allow us to more effectively refer patients for serious conditions. We have established a solid referral system with Malden Family Health Center for free contraception while we work to establish our own sustainable supply of contraceptives.

We will also now be offering prenatal counseling and referrals, and referrals for many other services. Additionally, we will continue to offer STI testing and pregnancy testing, with students more intensively trained in these areas. In addition to services, one of the main priorities of our project is to establish a 1-2 time yearly training for students who will be working at Sharewood in the women’s health clinic.

Many topics dealing with women’s health are largely undertaught in medical education. We want to make sure that we are offering high quality services to patients who have no other source of care, so it’s very important that students are trained to be both knowledgable about these topics and also able to talk to patients in a nonjudgemental and sensitive manner.

The training will include topics such as how to do a pelvic exam, how to distinguish between common vaginal infections, contraceptive options counseling, pregnancy options counseling, and how to approach patients who are dealing with sexual assault or domestic violence. We are working with our physician mentors and the Malden clinic residents to establish our training, the first of which is set for September of this year.

Who will the services be provided to?

Sharewood mostly serves low income patients, including local homeless populations and many immigrants who have recently arrived in the US or simply don’t have access to a regular source of health care. Despite the mandatory insurance laws in Massachusetts, which undoubtedly help thousands of people, there are still many people in need of basic health care who fall through the cracks.

Many of these patients are unaware of services or do not qualify for MassHealth. We will be offering women’s health services to any patient who is at Sharewood and needs them. We see women of all ages with varying concerns ranging from pregnancy testing to the need for a mammography referral.

We will do what is in our power to help them at Sharewood or refer them if their concerns are out of our scope of care. Our newly established services will be merging with the sexual health clinic to create a broader Sexual and Reproductive Health clinic within Sharewood.

Most of our patients will likely present to this area of the clinic and we are currently working out a more specific system to efficiently manage patients who present to the general clinic with reproductive health concerns.