CoSMO Celebrates 10 Years of Caring for Neighbors

On a drizzly Saturday morning in March 2004, Columbia Student Medical Outreach (CoSMO), a student-run primary care clinic for the uninsured, welcomed its first four patients. It was a moment long in the making. For nearly four years, the founding group of medical and nursing students had been seeking out the approval, funding, and help they needed to breathe life into the project. Similar attempts at Columbia had failed. But after obtaining the blessing and aid of NewYork-Presbyterian and Columbia plus grants and donations from private sources, the effort bore fruit when CoSMO officially opened its doors at 21 Audubon Ave.

Over the past decade, CoSMO has become a pillar of the community, delivering free medical care, labs, health education, and prescriptions to a roster of nearly 200 patients. Once a week, 15 to 20 students from all CUMC schools plus faculty advisers volunteer their free time to help some of society’s forgotten members.

“CoSMO offers more direct, intense engagement with the patient, ideally with their full story,” says Cyrus Boquín, MD, MPH, CoSMO medical director and faculty adviser since 2006. “Of course we go through all the medical problems, but I think, since these patients are coming from an often undocumented background, the importance of talking about their humanity is even greater. There’s something different about this person’s story in front of you. They’re invisible or unvalued by a lot of our nation—but not here.”

The clinic was created to fill a void; while emergency rooms care for the uninsured in moments of crisis, what happens to these patients—many of whom are suffering from recurring ailments that require expensive treatments—after they return to the community?

“When you read medical school admissions essays, you see that people write, ‘What I want to do is to help people.’ Well, that’s what we’re doing here,” says Dr. Boquín, assistant professor of medicine at P&S. “We’re here to serve. It’s remarkable how passionate everyone is about this service commitment.”

Though CoSMO’s mission remains the same, recent health care reforms have introduced new opportunities and new responsibilities. With the Affordable Care Act, tens of millions of Americans—including many of CoSMO’s patients—are eligible for insurance for the first time. “There’s no mandate for free clinics to help people get insurance,” says Zoe Sansted’16, CoSMO’s outgoing chair of social work. “Our job, up until this year at least, was to care for people who needed our care—we do a really good job at that. But we decided as a clinic that, in addition to caring for people who meet our eligibility requirements, it was our responsibility as humans to also help them get the best care they possibly can.”

While the Affordable Care Act will help millions get health care insurance, it does not completely solve the problem that CoSMO was created to address. The need for a clinic dedicated not only to the uninsured, but also the uninsurable is as acute as ever.

By paying prescription costs for all patients, the number of whom has grown considerably, CoSMO has become imperiled by its own success. At the moment, it is not accepting any new patients. Despite receiving limited funds from P&S, most of the clinic’s considerable expenses—
Dr. Boquín estimates the costs as high as $30,000 a year—are met by donations. Fundraising efforts, including readings by Pulitzer Prize-winning author Junot Díaz and the poet Martín Espada, have been helpful in keeping CoSMO afloat.

How the clinic helps the community is clear, but CoSMO also has value in the benefits to students who volunteer. First-year medical students, working under the tutelage of third- and fourth-year students and faculty advisers, get an opportunity to interact with patients before they embark on their year of clinical rotations. Also, the governing council—entirely made up of students—provides students with early administrative and leadership experience.

“From my perspective, this is an essential part of our education—medical students, nursing students, everyone,” says Maryl Sackeim’14, one of CoSMO’s three co-chairs. (Margot Cohen’14 and Nicole Edison’14 are the other co-chairs.) “Students learn how to really care for patients beyond their medical needs. And working with people who are going into different fields of medicine makes it a dynamic, vibrant teaching environment.”

CoSMO’s interdisciplinary nature makes it a rich learning experience that augments the education that takes place in the classroom and during rotations. Students training in medicine, nursing, social work, health education, dentistry, and physical therapy are all in the same place, unified by a shared sense of activism. This synergy of expertise and moxie leads the student volunteers to creative solutions and a renewed sense of purpose.

“This is the remedy to burnout,” Dr. Boquín says. “CoSMO is a unique, hallowed site of professional reinvigoration for me. It’s hard to imagine a better, more emblematic representation of professional activism. We need more of it as a nation, as a city, as a world.”