Quisqueya Lora immigrated to New York in 2006 all by herself. Because she was unfamiliar with America’s health system and unable to afford health insurance, she expected to live without access to doctors.

After six months in the United States, a priest told Lora about a free health fair in Washington Heights, where she learned about CoSMO (Columbia Student Medical Outreach), a primary care clinic on Audubon Avenue that treats patients who don’t qualify for Medicaid but also can’t afford private insurance.

Unaware that she had any health problems, Lora, 57, waited three months for an appointment. At that first meeting, doctors diagnosed diabetes and high cholesterol in her and prescribed medications.

Speaking through an interpreter, Lora says she is now taking three medicines – one for high cholesterol, two for diabetes – that she could not afford because infrequent babysitting provides her only income. Reflecting on her experience with CoSMO, she smiles widely and calls the doctor who treated her when she first arrived her “guardian angel.”

In Washington Heights, where Lora lives, the majority population is Dominican, and most uptown immigrants are unaware of their subsidized or free health care options. The statistics are consistent nationwide: 28 percent of Latinos are uninsured, compared with 17 percent of the U.S. adult population, according to the Pew Hispanic Center.

To its 450 uptown patients, CoSMO is something of a savior. Housed in one of New York-Presbyterian’s Urgicare clinics, it is staffed entirely by volunteers, mainly Columbia University medical and nursing students.

CosMO is open on Saturday mornings and the occasional Thursday evening; its co-chairs, typically fourth-year medical students, often alternate weekends. A rotating volunteer physician is also always on hand, sees every patient and writes prescriptions, if needed.

CoSMO will see 8 to 10 patients on an average Saturday; walk-ins are rarely accommodated because patients must first meet with a health care facilitator to ensure they do not qualify for Medicaid. Initially, Alianza Dominicana, a community development organization, referred most patients, but many now hear about the clinic through family and friends, said Magni Hamso, one of last year’s co-chairs who still volunteers.

CoSMO is one of the main reasons Hamso attended Columbia for medical school. She wanted to get in-depth primary care experience and to learn how a clinic operates. In her first year, before she had any practical medical experience, she volunteered as an interpreter and secretary; now that she has been a co-chair, she has sat on the governing council and managed the entire operation, including the executive committee and the fundraising and finance sub-committees.

Because its patients can’t afford health insurance, let alone pay for medicines, CoSMO absorbs most prescription costs. (Patients are asked to pay if the price is under $10.) These costs are crippling the clinic: while New York-Presbyterian Hospital absorbs most operating expenses (and some hospital departments, like radiology, shoulder costs incurred by CoSMO’s patients), the hospital can’t pay for medication. Most of the drugs CoSMO prescribes are generics but some, like Actos, used for diabetes treatment, can cost as much as $4 a pill.

The clinic got a $20,000 startup grant from the Association of American Medical Colleges, but volunteers have since asked family and friends for donations. Strapped for cash, CoSMO held a fund-raiser last year featuring a talk by Pulitzer Prize winning author Junot Diaz; a similar event will be held this year. But these fundraisers take a lot of time to organize, something the volunteers struggle to find on top of the hours they spend at school and in the clinic. After four hours at the clinic on a Saturday, one first year medical student hit the library to study anatomy for the rest of the day.

CoSMO also runs into problems with wait times. Because students run the clinic, a regular checkup can take three hours, says Hamso.

Francisco Liz knows all about it. He had an appointment at 8:30 a.m. on a Saturday and didn’t leave the clinic until noon, even though he had to be at work at 11. He spent some of his waiting time dozing off in one of CosMO’s four patient rooms.

Still, Liz, a native Peruvian who has lived here for 14 years, didn’t complain. Though he used to work in a restaurant, he hasn’t had a full-time job in eight months and can’t afford the private health insurance he needs to take care of his diabetes and high blood pressure.

Liz, like Lora, doesn’t mind that CoSMO is student-run. “It’s good because they treat us very well, and I know the last step is for the doctor to go over everything,” he says in Spanish through a student nurse acting as an interpreter.

The excessive wait is almost inescapable in a student-run clinic, which serves as both a teaching environment and a fully operational clinic. Something as simple as drawing blood can be lengthy because the patient must wait as the senior nurse reviews the procedure with the student who wields the needle.

Amelia Lo, a senior nursing student completing her master’s degree, used her four years of experience as a bedside nurse to improve the clinic’s workflow last year. Lo says CoSMO gets bogged down because a new team shows up every Saturday and the volunteers often do not know who is in charge of which patients. But she didn’t let the inefficiencies get to her – she reminded herself that all the people involved volunteer their time so getting angry would only diminish the learning experience. Because of her work, the clinic now has a patient flow chart kept in the main office and continually updated throughout each session.

Despite the wait times, CoSMO offers a quality of care comparable to that of commercial HMOs and superior to Medicare and Medicaid, based on an internal evaluation that assessed screening for hypertension, Type 2 diabetes, and cancer.