¿Por qué necesito entrar?
Sitting in her Upper West Side apartment talking to her pregnant patient via translator, third-year medical student Brianna Hickey can sense the anxiety in her patient’s questions.
Why do I have to come in? Why can’t this be done over video?
Unable to access her patient’s medical record, Hickey persuades her to visit Columbia’s obstetrics practice alone by promising that the doctor would only ask if it was medically necessary. Partners are not allowed, except in the case of delivery.
What is the clinic going to do to protect me when I go in?
“The clinic staff is going to be wearing masks,” Hickey recalls saying. “There are tents outside to allow for social distancing, but we still really want you to come in.” Her patient seems to ease up, but the next section of Hickey’s call script requires her to follow up by asking what her patient has been doing to keep herself safe.
I’m not leaving my home.
Hickey tries to imagine what she would do if confronted by the same dilemma, knowing that her advice to visit the doctor contradicts everything in the news and that her patient may be fearful of how the virus will affect the baby. “I know it’s really scary, and I know that you care so much about your health and you want to do the right thing,” she says. “But we really need you to come into the clinic.”
Hickey’s call on Thursday, April 2 was one of dozens made that day by an obstetrics public health outreach team consisting primarily of Columbia students. The team is organized through the Columbia COVID-19 Student Service Corps, a new student volunteer organization with more than 1500 volunteers, spanning over 10 schools and 20 projects. Their work has inspired CSSC chapters at schools across the country.
The organization is run by an oversight committee made up of administrative, faculty, and student co-chairs. It launched on March 18 with the purpose of funneling medical school students eager to get involved in the fight against COVID-19 into a handful of projects that could support the New York healthcare system and community.
Throughout New York City, hospitals are facing extreme shortages in supplies, particularly personal protective equipment and ventilators, in addition to more patients than they can possibly treat. An initial meeting with a host of educators and clinicians from throughout the medical center had given the oversight committee a peek into what it looked like inside and hospital workers identified several major areas where students could step in remotely, forming the basis of their first few projects.
The group’s largest project, Telemedicine, is made up of over 250 students helping drive the adoption of a new telehealth platform that is crucial to keeping patients out of hospitals. Students help patients with upcoming appointments get onto the platform and closely monitor those who have been recently released from the hospital. Other projects are similarly ambitious in scope. Volunteers have helped to staff NewYork-Presbyterian’s work health safety and COVID-19 community hotlines. Information Services, another project rivaling Telemedicine in scale, summarizes, produces, and translates emerging hospital materials and COVID-19 literature. Hero Meals, the primary subproject under Mental Health and Well-Being, has raised over $200,000 to feed healthcare workers throughout the city, supporting small local businesses in the process.
Although the CSSC has a wide range of projects and subprojects, most volunteer work consists of interacting with patients and community members directly. The scale of their work is immense, with the community hotline alone making 600 calls a day. The work can be difficult, as medical guidance only goes so far to address patient concerns, but faculty support, training and escalation protocols are in place to prepare students as much as possible and ensure that major decisions are made by someone better qualified. Hickey says that her volunteers tell her about calls where their patient lost a job, couldn’t afford groceries, or had a miscarriage—problems that no volunteer can solve. Even fear of the virus is not easily dealt with.
Third-year medical student Zachary Pitkowsky echoed this sentiment when speaking about a call he took for the community hotline, one where a woman in a New York City apartment called asking about how to protect herself and her parents because someone she lived with was feeling sick.
“The guidance that we can best give from the CDC is knowingly not going to be particularly helpful,” he says. It often fails to take into consideration more complicated urban living situations.
Nonetheless, the CSSC’s efforts have had a clear trickle-down effect, spreading outward from graduate student living rooms to the apartments of fearful grandparents and patients with COVID-19 to the kitchens of local restaurants––all coming together to alleviate the burden of front-line healthcare workers. Edelman and Soo-Hoo have watched their initiative spark wide-scale patient and community support and encourage relentless student enthusiasm, despite the emotional toll that the work can take.
Although the CSSC’s official launch was on March 18, Edelman and Soo-Hoo had begun organizing the group almost immediately after the student-run free clinic that they worked at closed following New York’s first COVID-19 cases in the beginning of March. Losing their primary outlet for providing care to the community frustrated both of them, but they knew that their peers felt similarly and were determined to continue supporting patients however they could.
“I felt that I had something to give and I couldn't give it,” Edelman says.
Edelman reached out to Soo-Hoo, the joint clinics manager of all five student-run free clinics, and within a few days they had started a free-clinic task force. The task force soon exploded into something with a much wider reach after the medical school suspended clinical rotations and sent all students home.
For many, this was the moment when they fully grasped the gravity of COVID-19. Having been pulled from hospitals, students were seeking other ways to get involved. It became clear to Edelman and Soo-Hoo that the task force should pivot to addressing the crisis as a whole and mobilize as much of the student body as possible. In their eyes, by engaging students who felt similarly powerless, they could give them a fraction of control and agency in a pandemic that offers little.
On March 15, the CSSC was inaugurated by its leadership over the group’s first official Zoom meeting. They developed a service learning framework to ensure that students would learn and grow from their experiences, with organized training and reflection built into each volunteer opportunity. There ensued a mad rush to pull all of the different projects together in time for a schoolwide webinar just three days later, where Edelman and Soo-Hoo planned to present the organization to the wider student body and recruit volunteers.
The day before, Soo-Hoo spent 12 hours on Zoom. It was a day crucial for achieving the momentum that the group wanted. It was also her birthday. She had planned to be in Patagonia celebrating, but instead kept it to herself and doubled down on what was most important. Edelman’s birthday was the following week. He didn’t tell anyone, either.
24 hours later, the CSSC had been catapulted into motion by 300 sign-ups, nearly as many students as had attended the webinar itself. It would be 800 by the end of the week.
With no time to waste, faculty and student leaders worked hard to onboard volunteers, training them and setting them up with any relevant software. Some projects got rolling even before their infrastructure had been fully developed. Simon Liebling, student leader of Information Services, describes how the project had barely been thrown together when they first started receiving translation requests from the hospital. He would get an email from someone at NewYork-Presbyterian and consider which of his friends might be able to translate for him. “I would shoot them a text and ask them to do it and they would have it back to me in a couple of hours,” he says. “There were cases where people sent things to their parents for help with translation.”
The CSSC has since systemized its operations. Edelman and Soo-Hoo supervise half of the CSSC’s projects each, and every project has at least one faculty and student leader. The leadership spends much of their time on Zoom or Gmail, checking in with volunteers throughout the day and finding work-arounds to the constant road bumps inherent in the crisis.
Today, when a hospital advocate reaches out to Information Services with a translation request, a team leader scans through a spreadsheet of 120 volunteers speaking over 25 different languages and emails the appropriate students.
Yet many teams have struggled to gain the critical mass needed, hampered by the limitations of their volunteers. OB Public Outreach, for instance, predominantly deals with Spanish-speaking patients, shrinking the volunteer pool that they can draw from. Several project leaders also mentioned difficulties reconciling students’ other responsibilities with the needs of the CSSC. By responding rapidly and decisively, however, student leaders have been able to meet their obstacles head on. OB Public Outreach is now staffed by 62 volunteers.
In OB Public Outreach, like many other projects, student and faculty leaders give volunteers regularly updated call scripts with escalation screening, public health guidance, and other resources. Students use these resources to address typical concerns, assess patients, and determine if they should go to the emergency room, in which case they reach out to their student leader and a physician. Anxiety is pervasive on these calls, and while many simply offer basic advice and information, they can also serve as opportunities for patients to seek affirmation of the knowledge that they already have and test their preparation.
Hickey describes realizing this with her first patient. She began by lecturing, but after noticing the patient’s lack of response, started asking questions instead. The rest of the call went much smoother.
“A lot of people are paying very, very close attention—especially pregnant women—to their health in this setting,” she says. “And so that was a really nice way to connect with the patient. To hear, ‘Oh, you are doing these things already, you don't need me to tell you these things.’ And then they were more receptive when I had more information to give.”
Pitkowsky noted a similar experience when addressing community members with fear-based concerns. “Maybe being helpful in that sense is not that we have the information that is going to alleviate their pre-existing anxieties,” he says. “But just being able to be someone on the other end of the phone who can hear what they’re going through and why they’re anxious.”
This fact has influenced patient-call scripts. After assessing basic symptoms, telemedicine volunteers have pages of mental health checks requiring them to ask questions like, “Are you feeling depressed?” and “Are you feeling anxious?” and try to refer them to other resources.
The attention has paid off. A couple of weeks ago, telemedicine volunteers followed up with several patients to ask about their customer satisfaction. Their feedback? That they wanted even more calls because of the reassurance they can lend.
“Maybe being helpful in that sense is not that we have the information that is going to alleviate their pre-existing anxieties, but just being able to be someone on the other end of the phone who can hear what they’re going through and why they’re anxious.”
The enthusiastic response to the CSSC’s work has not been limited to their patients. Several projects seek to harness the surrounding community’s desire to help as well. Hero Meals is the most notable effort in this direction, though a new PPE collection group is a significant second.
Hero Meals was originally inspired by Off Their Plate, a student-run group at Harvard that organizes meals for front-line healthcare workers in Boston. Beginning as one of the CSSC’s original projects, Hero Meals has now raised $200,000 from community members, private donors, and partnerships with city fundraisers. In their first few weeks of operation, they provided over 10,000 meals to NewYork-Presbyterian employees across nine sites. Because of the success of their efforts, NewYork-Presbyterian has since launched infrastructure to feed 100 percent of its workers three meals a day and Hero Meals has pivoted to support public hospitals in need, partnering with NYC Health + Hospitals. Given the severe disproportion in resources between public and private hospitals and increased risk of poorer communities of color, their support will likely be felt even more.
The project has achieved its success by funneling pre-existing community efforts toward supporting healthcare workers more efficiently and impactfully, as well as creating an outlet for regular people who want to contribute but have no direct means to.
Andrea Lifrieri, a second-year medical student and the student leader for Hero Meals, describes the outpouring of community support that the group has received as equally generous and disparate. Donations are often on the scale of “hundreds of cookies or socks,” she says, which Hero Meals can then organize and distribute evenly among hospital workers.
For a Westchester high school athletic director with family members that work in a hospital, this meant collaborating with Hero Meals to have his team start a social media initiative sponsoring hospital meals and encouraging local sports teams to donate to their nearest hospital.
The money Hero Meals has raised goes to supporting small local businesses who prioritize workers’ wages, often local favorites. Many restaurant owners are eager to help and provide discounted service because they or their workers have friends and family in the hospital. Lifrieri describes restaurant owners who have told her that their livelihood would be in danger without Hero Meals.
Despite the tangible value of the CSSC’s work and the comprehensive support structure of the organization, many students acknowledge that it has taken a toll on their mental health as well. After ending his call with the woman worried about her parents, Pitkowsky was left sitting alone in his apartment, waiting for his next call. “You’re just kind of in this void by yourself. It amplifies the strangeness and uncertainty that comes with ending a conversation like that,” he says. “It can be a little defeating.”
The school has organized reflection sessions to help students process what they are doing, but the difficulty of their work is only made worse by the looming fact that despite the CSSC’s valiant efforts, they can never catch up to the true needs of the healthcare system. This knowledge makes the frequent hitches in their plans even more stressful.
“I think New York is doing a lot of the right things,” Edelman says. “But that doesn’t mean that tomorrow is going to be better than today. Tomorrow is going to be worse than today and that's going to keep happening for at least a week or two.” Every volunteer knew when they signed on that the pandemic would continue to worsen, but the realities of death and an overwhelmed healthcare system hang over them nonetheless.
While patient calls are often difficult, they tend to be their own reward and can even foster hope. At the community hotline, many of the people who call in have recovered from the virus and are now facing the unprecedented question of what to do next. Pitkowsky describes patients who want to participate in research studies or donate plasma or know how cautious they still need to be, all of which can be easily addressed and serve as sparks of optimism during a dark time. These acts serve not only as a reminder that most people do recover and but also as examples of the subtle power of goodwill that the crisis has seemingly inspired in everyone.
Restaurant owners will often tell Lifrieri their personal stories of how their lives have been changed by the pandemic to help explain why they want to help out. Their desire to support healthcare workers is fervent, no different than any other demographic pulled into the orbit of the CSSC.
The community hotline sometimes receives calls similar to Hero Meals, with community members looking to donate whatever they think might be useful. “You feel like there’s a yearning to be helpful in any way they can,” Pitkowsky says.
Every day, the CSSC leadership opens their Zoom meeting with something that brings them joy, such as watching a heartwarming video or going around in a circle answering a lighthearted prompt. Soo-Hoo recalls one prompt asking what place they looked forward to traveling after the pandemic was over. Her answer? Patagonia, where she had been en route to for her birthday the day before the CSSC’s first meeting.
WATCH: The cast of Come From Away read letters written from members of CSSC to Healthcare Workers.
Yet Soo-Hoo has never questioned her decision to devote herself to her work for the CSSC and her commitment is shared by her volunteers. The leadership for the community hotline, which consists of over 100 volunteers, recently got their feedback from the first two weeks. Students gave a 94 percent satisfaction rate for the opportunity and the physician assistants expressed extreme gratitude for their support.
Student leaders across all projects unanimously commented on the sheer eagerness and perseverance of their volunteers. “The outpouring of support has been breathtaking,” Hickey says.
Aury Garcia, student leader of Telemedicine, says that she continues to get emails from volunteers a mere hour after sending them the software and instructions saying, “All right, I set it all up, I’m ready to go, when can I get a patient?”
Enjoy leafing through our seventh issue!
A prior version of this article mischaracterized the role of faculty leadership, the scope of the projects, and the training provided to volunteers. Adjustments have been made to correct these mistakes. The Eye regrets the errors.