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The Camillus Health Concern provides both medical care to homeless persons and experience in community medicine for students at the University of Miami School of Medicine. The Camillus Health Concern is affiliated with, and attached to, a homeless shelter in downtown Miami. Opened in 1984, the clinic now treats more than 110 patients each day and has 25,000 patient charts. The clinic provides general medical care and other services including podiatry, mental health counseling, social services and preventive health services. First- and second-year medical students can work at the clinic to fulfill requirements for the Community Clinical Experience program. Third-year students spend from one to two weeks in the clinic. All patients are seen first by students and then by an attending physician. Students are responsible for discussing treatment plans and follow up with patients. Medical students consistently rate their time at the clinic highly., Objective.--To present the educational opportunities provided by a model clinic for homeless persons. Design.--Descriptive. Patients or Other Participants.--Patients are those who are cared for at Camillus Health Concern clinic for the homeless in Miami, Fla. Other participants include students, residents, and faculty affiliated with the University of Miami (Fla) School of Medicine. Intervention.--Affiliation of the clinic with the medical school has shifted the clinic from a pure service model to an education and service model. Main Outcome Measures.--Numbers of patients and encounters are presented, as well as student and resident rotations, numbers, and hours. Results.--Shifting to an education and service model has increased productivity of the clinic while providing a unique, multifaceted educational experience to students, residents, and faculty. Conclusions.--Those factors that contribute to the success of this education and service model include the professional satisfaction that results from providing care to patients who previously have not had access to health care; a team approach that includes faculty, students, nurses, and social workers; an environment that fosters clinical judgment rather than expensive tests; and the opportunity to teach social responsibility in the process of providing health care. We encourage other schools to consider the development of clinics for the homeless as alternative ambulatory training sites.

Background: There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned.Methods: A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease).Results: The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases.Conclusions: The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries. [ABSTRACT FROM AUTHOR]

Background: There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned., Methods: A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease)., Results: The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases., Conclusions: The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries.