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Sarah Axelrath

A future helping the homeless, prisoners and those with substance abuse issues

(May 2017) Sarah Axelrath’s one-year break between a bachelor’s degree and medical school turned into two when she chanced into a job working with intravenous drug users.

While preparing to apply to medical school, she became a case manager with [SA1] Community HealthCorps in Lakewood. For a year, she helped homeless clientele access health care, Social Security benefits, mental health services, food banks and crisis care.

Axelrath also volunteered once a week at the Harm Reduction Action Center [SA2] in Denver, working with homeless injection drug users, many with untreated medical issues and a distrust of the health care system.

“I fell in love with that, too, so I badgered a manager for a full-time job there and deferred my acceptance at CU for a year.”

Axelrath, the daughter and sister of psychologists, had long been interested in social justice work, one of the reasons she attended Oberlin College in Ohio for her undergraduate degree. In a town famous as a stop on the Underground Railroad, the college offered Axelrath the freedom to fashion a gender studies major.

“I had the foresight to know that this might be the last opportunity I would have to study social studies and humanities – to try to be a more well-rounded person,” she said. “I have not regretted it for a second. It opened my eyes to the way the world has always been, for better or worse.”

After starting medical school in 2013, Axelrath, a member of the CU-Unite urban care track, continued to volunteer at the Harm Reduction Action Center, often persuading classmates to join her.

In 2014, she was invited to attend a week at the Betty Ford Center in California to study the pathophysiology of addiction and evidence-based treatments.  In her fourth year, she took part in an away rotation at Montefiore Medical Center, working at a methadone clinic in the South Bronx, and at Rikers Island jail to establish a Suboxone clinic for prisoners suffering from opioid withdrawal.

“It wasn’t as scary as I thought it might be, but it was a little scary,” says Axelrath, who also describes the experience as “super interesting, intense and eye-opening.”

She became convinced that she wanted to continue working with the homeless, prisoners and patients with substance use disorder.  

“Honestly, I think of it as a continuum of care. The homeless are in violation of the law just by being publicly homeless. Add to that substance abuse and they are always at risk of going to jail. That’s where they get their medical care and mental health care … You can follow a person through the revolving door, the street, the hospital, jail, back and forth and back and forth. It’s the same people but different settings.”

Axelrath, 28, witnessed firsthand the changes the Affordable Care Act made between 2011 and 2012 when she was working as a case manager. The first year, many homeless adults with substance use disorder could not qualify for health care. But, in 2012, her job changed dramatically because suddenly more people became eligible for Medicaid. She realizes that many of these patients will not be able to pay for her services when she becomes a physician if they lose access to affordable healthcare coveragein the coming years

“I can’t hang up a shingle and expect homeless folks to come see me. I’m nervous. I’ll need help from the political side of things to make my career even possible. Otherwise my skills are worthless. I’ve gone to medical school for nothing.”

She was pleased that her passion for the underserved was well received during her residency interviews.

“I’m certain that the only reason I got positive feedback on the interview trail was because of my interest in the homeless and substance use  disorders. That’s what set me apart from other applicants. With opioid abuse and overdose sweeping the nation and impacting record numbers of people and families from all socio-economic categories, my interest is very timely. There was a lot of enthusiasm on the trail.”

She credits her mentors at CU and elsewhere for helping her refine and retain her interest in underserved communities. She advises incoming medical students to seek support.

“Work hard to figure out what it is about medicine that is going to make you happy for the next 60 years and find good mentors to take you under their wing and teach you everything they can. Grab it and don’t let go. Don’t let anyone talk you out of it. People love their own specialties, and they like to try to recruit you into that specialty. They mean well, but once you set your sight on something, double down on it. Hold on tight. It will get you through tough challenges.”

Axelrath will serve her primary care residency at Massachusetts General, her first choice because on her interview day she met residents who were working in jails and needle exchange programs.

“They pulled out all the stops and let me know that there’s room in residency to do work that is important to me. They introduced me to people who were actually doing it so I could imagine what it would look like.”