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Camillus House News
Q&A Profile: Dr. Ross Collazo of Camillus Health Concern
by Janet Rice
Dr. Collazo shares a light moment with an elderly patient on a recent visit.
Director of Health Services at Camillus Health Concern (CHC) Dr. Ross Collazo answers some probing questions about his near 15-year career at the medical clinic and the clinic’s mission to care for the medical needs of people forgotten by many in society.
Q: What was the main mission of Camillus Health Concern when founded, and what is it now?
A: CHC’s mission remains the same over time. That is, to provide quality and compassionate health care, with a pragmatic approach, to the homeless of Miami, within the framework of Camillus’ mission of Christian hospitality. Our providers and staff, on a daily basis, must be willing to go beyond their job description to be advocates for the homeless, who generally, on their own, cannot successfully navigate the complexities of the healthcare system. Advocacy is really the distinguishing feature we strive for.
Q: Why did you choose to run the medical operations at CHC when you could probably make more money and have less hassle working in private practice?
A: Initially I looked at this position as a stepping stone to private practice, maybe a couple years… I also thought that I could get my student loans repaid through the federal government. As it turns out the original clinic site on 1st Avenue was not an eligible site for loan repayment. Our present location is. We moved to this location in June 1998, four years after I started in 1994.
But more importantly, it became clear soon enough after being here that this was a place where one person, with a little help, can make a big difference for these individuals. CHC is lucky to have several dedicated physicians and nurse practitioners that meet these challenges every day.
That is not to say that working in this environment is a breeze. There are unique challenges that make some days very difficult. However, every week, you have at least one encounter or experience that reminds you what it’s all about, and makes you go home saying “I have nothing to complain about. “ I tell my kids all the time, “I complained because I had no shoes, then I met a man who had no feet.”
On the slightly selfish end, through this vocation I have a life that allows me to spend time with my boys nearly every night and weekend. In private practice, that would not be possible.
Q: Is it difficult to hire staff?
A: Yes, but we’ve been very lucky to hold on to a core of providers and support staff, who are very dedicated, very mission oriented. However, inevitably, people burn out and replacing them is difficult because you need to find both competency and compassion, work ethic and mission, all rolled up into one. We have a physician position that will be filled on 7/31/08. That position was vacated on 5/16/2007! You can imagine that picking up the slack during that time, has taken a major toll on the others.
Dr. Collazo (right) is shown here earlier in his career teaching medical students on rotation at Camillus Health Concern.Q: What accomplishment(s) of Camillus Health Concern makes you proudest?
A: We have an excellent QI program that begins with our data management system that prompts providers on every visit... when certain recommended interventions were last done and when they are due. Prompting clearly increases compliance with getting these interventions done. We track over 30 measures/indicators related to health promotion, disease prevention, that is, cancer screening; PAP smears, mammograms, colonoscopies, etc, as well as secondary interventions like checking cholesterol , getting eye and foot exams, for patients with diabetes... the list goes on. We can provide any intervention, considered standard of care to any homeless person, who can be motivated to comply with these measures. This usually happens in the setting of patients who are undergoing or have completed substance abuse treatment programs or who are successfully embedded in our behavioral health service. These two services are indispensible and we have to work hand-in-hand with them to achieve successful outcomes. The other big accomplishment is providing a dental service that not only deals with emergencies but also provides dentures and restorative care.
Q: What aspect did not or has not yet met your hopes and expectations?
A: We need to expand Behavioral Health Services (BHS) to become a centrally coordinated, multiple-provider service that can deal with a larger number of persons who are homeless. Presently Camillus Health Concern’s BHS meets only approximately 20 percent of our total user population. Dental also can be expanded. There, we are hitting less than 20 percent of the total.
Q: What are your greatest challenges?
A: Trying to meet all these needs with a very limited budget. We are usually unable to take care of EVERYBODY who wants to be seen, on any given day. Limited funding and limited personnel restrict who can be seen. We get a lot of walk-ins and we just can’t see everyone, every day. We get them in the next day or refer them to the emergency room, or just get them in another day as soon as possible. We also have patients with complex problems. Their communication skills are limited, as is their knowledge of the healthcare bureaucracy. As medical professionals, we have to learn how to “spoon feed” patients about everything from how important it is to follow up on appointments to getting their medications refilled regularly. Food, a safe place to sleep… these are typical patient priorities, not medical care.
Q: How do you keep faith in your work? How do you deal with discouragement?
A: I just try to focus on the one or two patient visits every day that had good outcomes because there are a lot of failures despite our best efforts.
Q: What is the most emotional aspect of your work?
A: (Laughs) It’s definitely the gratitude from patients. I had one Haitian man come and give me a flowered shirt – it was a big deal for him. All I had done was sit down and take some time with him and at the end of our visit he had a good sense of what to do to keep himself well. He snuck in the clinic to find me and give me a hug. There are a lot of patients who inspire empathy and sadness – and also happiness. They remind me all the time that I have nothing to complain about.
Q: What aspect of your work gives you the most satisfaction?
A: Good clinical outcomes for patients who have a lot of problems… when I’m able to help someone with limited resources get their foot in the right door to solve their problems. It’s the little things.
Q: How do you motivate your staff?
A: I try to motivate by example. If it’s a horrible day I try to focus on the right things. If the staff sees me being pleasant to patients, hope trickles through to the rest of staff.
Q: What problems do you see the most in patients?
A: Mostly, we see mental illness, complications of substance abuse, high blood pressure, diabetes, heart disease, dental problems and HIV.
Q: What are the difficulties in treating the homeless?
A: It’s difficult for them to navigate the healthcare system – all the testing, questions, paperwork, appointments, etc. The list of problems is endless. Where does a diabetic store his/her insulin? How do they get access to quality meals at predictable, regular intervals? How does a hypertensive patient avoid fatty and salt-laden meals? How does a man with psychosis get better on medication when he can’t get a descent night’s sleep on a public side walk? What chance does a recovering drug addict have of getting a descent job when he has no teeth left in his mouth? I can go on forever.
The other problem is that there are people in our society who have no sense of responsibility or compassion for these people. Patient dumping is a regular phenomenon at our shelter. Often times in their gowns and underwear. I once had to tell a medical resident off, after discharging a blind, illiterate man to us, with a written instruction sheet to call a specific number to get his follow up appointment! You have to care! If you have a medical degree, you have to always do the right thing for the patient FIRST.
Q: Have you noticed any trends (good or bad) in recent times?
A: Happily, we see a lot less severity of illness in HIV than we used to – the rate among the homeless is still way above the national rates, but it is lower than it was 10 years ago. If they are HIV positive, we are able to often catch them early and prolong their lives with medication. Project Safe Street’s work with HIV education seems to be paying off.
