This month we talked with Nageen Farmand, a physician assistant who, after finishing her training at Western University of Health Sciences in 2006, has dedicated the majority of her work to the uninsured and homeless populations of Los Angeles.
What is the background of The Saban Free Clinic, where is it located, and who does it serve?
The Saban Free Clinic, also known as “The Los Angeles Free Clinic”, serves as a medical home for those that are homeless, uninsured and underserved. There are three sites, all located in Los Angeles. The Beverly site is primarily run by residents and specialty care providers; Ophthalmology, Orthopedics, Optometry, Dermatology, Rheumatology, Psychiatry and Cardiology. These specialists volunteer their services for free and are there about twice a month. The Hollywood site sees a greater homeless population and high-risk youth (especially runaways). The Melrose site (where I work), offers primary care services, including chronic disease management, pediatrics, mental health counseling, OB/Gynecology and dental services. We also have Sports Medicine residents and Physical Therapists that are there twice a month.
What lead you to begin working at the Saban Free Clinic?
My passion to want to work with underserved populations started before I applied to PA school. I volunteered for the Orange County Rescue Mission, an organization that extended health care to homeless communities. I found the patients, who were from all walks of life, so interesting. I also volunteered for Save Our Selves clinic, which offers free medical care to uninsured patients. The staff there was so dedicated and passionate about their work, which was inspiring to me. In my third year of practicing as a PA I began to envision where I really saw myself thriving. I imagined a teaching environment, serving the underserved; I really wanted to make a difference. I was doing a lot of work in the urgent care setting at the time but I was yearning for continuity of care. One day I started to research community clinics in Los Angeles and I came across an opening for a full time Physician Assistant for The Saban Free Clinic. It was exactly what I was looking for. I applied and almost 4 years later I am still here and grateful for every day.
What does a typical day in the clinic consist of?
A typical day starts and ends either at 8:30- 5:30 pm, or 1pm-9 pm. My day is a mix of culturally diverse patients, mostly middle aged, with some occasional children and elderly. We see a large Latino population which makes speaking medical Spanish an asset. I manage a good majority of chronic disease patients with diabetes, hypertension, hyperlipidemia, and asthma. Education and prevention on healthy lifestyle changes are discussed everyday. Many visits are well woman exams consisting of breast exams, pap smears, STD screening/counseling, and contraceptive care. We can have “walk-ins” throughout the day, which gives you the “urgent care” feel—those in hypertensive urgencies/ emergencies, chest pain patients, lacerations, headaches, colds, and gyn issues are a few examples!
What is the biggest challenge of working with the underserved population?
Since our patients do not have health insurance, access to specialty care for evaluations or diagnostic procedures does not occur right away. A typical referral to the Los Angeles County/USC county hospital to see Gastroenterology, Urology, ENT, Neurology, Endocrinology, and Radiology may take 6-12 months. This can be frustrating for those patients you are concerned about. If there are major red flags, the best way to get them “into the system” is to send them through the Emergency Room.
What is the biggest reward of working with the underserved population?
Our patients are so appreciative of your care. They trust and rely on you, and it almost feels like they are family once you’ve been taking care of them for so long. When it’s been a long day and you’re tired, yet you walk into the exam room your patient jumps up to give you a hug and is so happy to see you, what is a better feeling than that?
Where do you see the clinic and its population in another 5 years?
Times have been tough for the clinic financially this year, yet our CEO and the Board of Directors are dedicated to making sure we keep our doors open for those most vulnerable and in need of our services. We will be implementing Electronic Medical Records soon which will allow things to run more efficiently. With the implementation of Econsult, I envision being able to communicate with specialists regarding the management of our patients, electronically. I definitely see us becoming busier.
Working in a community clinic can be challenging, because you’ll come into contact with patients who have multiple comorbidities that have not had medical  attention in years. Keep in mind that you won’t have easy access to every lab and diagnostic test. Rely on your patient history and physical exam. Trust your intuition. Learn medical Spanish! Never be afraid to ask questions, look things up, and if you have a good supervising Physician, that is by far one of the greatest blessings.
* This article was republished from our May 2012 copy of the NEXUS - A free PAGH publication provided to members. 

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