Across Virginia, People Are Expressing Their Thanks for the Valuable Services Free Clinics Provide
A sign on an abandoned building across from the South Richmond CrossOver free clinic has letters hanging off, blowing in the breeze, about to fall off at any second. That same feeling of free falling is why most people seek the services of free clinics—they need a safety net.
In Virginia, approximately 1 million people are without health insurance at any given time. Some vulnerable populations are covered by the government: People older than 65 (who’ve earned enough Social Security credits) are eligible for Medicare, and children younger than 18 generally qualify for the FAMIS (Family Access to Medical Insurance Security Plan) programs. However, the gap in between those groups is wide and deep. That’s where free clinics step in, aiming to serve the uninsured between the ages of 18 and 64.
There are several misconceptions about free clinics, the biggest one being that they are for “people on welfare.” In fact, free clinics receive no money from the government and are run mainly by volunteers and grant funding. The typical patient at a free clinic is not someone on welfare, or even necessarily someone who is unemployed. Free clinics mainly serve the working poor, and in Virginia, that means the significant number of people who fall within 200 percent of the federal poverty line and don’t have health insurance. Virginia has one of the lowest eligibility levels for Medicaid coverage in the U.S. (in 2010, the state ranked 48th out of 50), which puts an even heavier burden on free clinics.
Linda Wilkinson, executive director of the Virginia Association of Free Clinics, says the average free clinic patient in Virginia is a 30-something white female who works two jobs, neither offering health insurance. People working in the service industry, hourly employees and the self-employed are among those commonly without insurance. The working poor don’t get paid if they don’t go to work, which makes finding time to get health care a challenge, too. Clinics try to address this with Saturday or evening hours. Each clinic has eligibility requirements for patients and must review paperwork such as identification, proof of income and tax returns during an approval process. People who qualify for care then receive a “clinic card.”
Free clinics serve thousands of people each year, but they could serve many more. Most have waiting lists year-round, no matter their size or location, Wilkinson notes. “Diabetes and other chronic diseases have no season. People are sick all year round, especially the most vulnerable people,” she says.
Free clinics see many patients who fall into the most common “trifecta” of chronic conditions: diabetes, high blood pressure and high cholesterol. “One of the obvious results of a free clinic is that patients are provided care, so hopefully, they will be healthier than if they weren’t receiving care,” Wilkinson says. “It keeps them out of the ER, where the cost of care is exponentially higher.”
Going to the emergency room has long been the last resort for people without health insurance. If they are sick enough, they go, but it’s often a “Band-Aid fix.” After an ER visit, people still lack follow up care, jeopardizing their recovery and often their ability to stay healthy. Emergency room care is the most expensive form of medical care, according to the Commonwealth Fund, a private foundation focused on achieving a high quality health care system. Many people also can’t afford medications they need to maintain their health. Free clinics participate in a program called The Pharmacy Connection, run by the Virginia Health Care Foundation, which provides millions of dollars in medications each year. The expense is much less than the cost of allowing chronic conditions to progress, or for infections to spread.
Another misconception about free clinics is that the quality of care must not be very good if it’s free. “These are doctors who have private practices,” Wilkinson counters “They are the same practitioners, volunteering their time—it’s the same, if not better, quality because they are not bound by time or insurance company requirements.”
Many free clinics start with concerned citizens who want to address a need in their community. Those grassroots efforts often draw in local places of worship, which provide space and encourage their congregants to volunteer. Doctors and nurses offer their professional skills, and many other people in the community do what they can to help—whether it’s filling out paperwork, stocking shelves or asking for donations.
Free clinics rely heavily on donations, grants and volunteers—and they still need more of all of those. While clinics work hard, the needs are outpacing what they can provide. The Health Journal recently visited four local clinics to learn more.
The Community Free Clinic, Newport News
This community-based clinic opened in late 2010 and has no religious affiliation, but the phrase “leap of faith” still comes up a lot. The clinic, also in an area with a high population of working poor, was able to open through a combination of generosity from the city, local health systems and volunteers. A recent renovation brought in three dental rooms to add to medical services.
The clinic serves all of Newport News and Hampton, but 47 percent of patients come from the zip code where it’s located. Thousands of people in that area are living on less than $10,000 a year, says Director of Administration and Operations Gray Bowditch. When the Newport News clinic opened, people also transferred their care from as far away as the Gloucester/Mathews free clinic, Bowditch says.
Curtis Liverman, 50, is grateful he could turn to the clinic for dental care and numerous medications. A diabetic, Liverman is on food stamps and has an application for disability pending. Clinic staff, he says, “treat me like a human being” (to which Executive Director Golden Bethune-Hill replies, “Well, Curtis, that’s because you are a human being!”).
Community Free Clinic of Newport News partners with community groups to educate people about diabetes and HIV/AIDS. Hepatitis C infection is also a huge issue for the clinic, and its Christmas wish list includes hepatologists (specialists in treating disorders of liver, pancreas, gallbladder and bile ducts), as well as cardiologists and pulmonologists.
CrossOver Clinics, Richmond
The CrossOver Ministry was founded by a few doctors 30 years ago and is the largest free clinic in Virginia. Today, three locations serve the working poor in South Richmond, Chesterfield and western Henrico. The clinics are able to offer a range of services due to their size and funding, including pharmacy, dental, vision, mental health counseling, social work services and health education programs.
Dr. Dan Januzzi, the medical director at CrossOver, has been there for more than 20 years. After a short stint in private practice after medical school, he knew he wanted to get back to providing direct care to the working poor. “At the end of the day, I want to be really helping the people in extreme need,” he says “I can make a lot of difference in one day to someone who might not have been seen elsewhere.”
It hasn’t been easy: Other clinics have closed in recent year, and the recession has strained CrossOver’s resources. “We have twice the patient volume and it’s not letting up,” Januzzi says.
Maria Rodriguez, 41, came to the clinic seven years ago, after she had a brain tumor removed when she was on Medicaid. After her recovery, she returned to her job in a restaurant, where her boss convinced her to pick up more shifts; she lost her Medicaid coverage as a result of her higher paycheck. So she comes to CrossOver every three months for treatment of her high blood pressure. People at the clinic are “lovely,” Rodriguez says, and she hopes “they are here forever!”
CrossOver’s current wish list includes more specialists such as nephrologists (kidneys), neurologists (brain) and dermatologists (skin) as volunteers to see patients. They also encourage local churches to organize neighborhood “mission trips” by bringing in volunteer medical and support staff to operate the clinic for a day. “People don’t need to go on mission trips outside of the U.S.; they can come to CrossOver,” says Rachel Payne, communications coordinator.
Lackey Free Clinic, Yorktown
This clinic, located near Fort Eustis and Lee Hall, was founded in 1995 by Dr. Jim and Cooka Shaw. Jim, a pulmonologist, and his wife, a nurse, wanted to give back to the community as part of their faith.
The Lackey Free Clinic is currently expanding with a large addition, a positive step but also another sign of an increased need for health services that residents can’t get anywhere else. Lackey expects to be able to serve an additional 1,000 patients after the completion of the addition in spring 2013.
“During the change in the economy in 2008 and 2009, a lot of small businesses went out of business, and there was a decrease in the number of people with health insurance,” says Carol Sale, the clinic’s executive director. “When people have jobs but can’t afford health insurance, they go ‘bare’ because it’s a choice between something they might need, and things they will need like food and electricity,” she says.
According to Lackey’s literature, one American dies every 12 minutes due to lack of health care. As part of the clinic’s mission to treat people as Jesus would, the staff strives to reach as many people as they can to prevent that. The clinic walls are decorated with scripture verses in many languages as a testament to that effort.
Eddie Wilson, 55, a former truck driver from York County, came to Lackey because he’d mysteriously lost nearly 40 pounds. “It had been eons since I’d been to a doctor. They told me I had diabetes and it was a surprise. It hit me like a freight train—I thought you got that from being obese,” he says. Wilson has been able to get insulin from the clinic, as well as education on how to manage his blood sugar and what to eat. He says he’s feeling a lot better, has more energy and can think more clearly.
The clinic also has been a blessing for Patricia Bunting of Poquoson and Fred Woodward of Newport News, who waited in line at the pharmacy one recent day. Woodward calls it “a gift from God,” while Bunting says that without the medication Lackey provides for her emphysema, “I’d be dead.”
Lackey serves a rural area as well as many people from Newport News, so transportation to and from the clinic is an ongoing concern. The clinic was recently able to get a van to bring people there from the Lee Hall bus stop on certain days of the week. Lackey’s holiday wish list: more dentists and hygienists, as well as donations for the construction of their addition.
The Bon Secours Maryview Foundation HealthCare Center, Portsmouth
This small free clinic, funded by the Maryview Foundation, is on a lot adjacent to the Bon Secours Maryview emergency room. Long wait times at that ER, which caused some people to leave without ever being seen, sparked the idea for the clinic in 2006. Opening a clinic also aligned with Bon Secours’ mission to improve the health of communities.
Portsmouth’s population has a median income below 200 percent of the poverty line, which means 20 to 25 percent of residents are considered poor. Many of the city’s working poor can’t afford care at a community health center that charges for services on a sliding scale.
Dr. Amy Price, medical director for the free clinic, says it has reduced inpatient admissions to the hospital as well as wait times in the ER. “We are saving $5-$6 for every $1 spent at the clinic,” Price says. Patients have to fill out several forms that Price described as “invasive” to qualify for care, but they get excellent services in return. “You pay with your time and paperwork,” she says.
One of the clinic’s biggest challenges is an absence of teaching hospitals on the Southside. Therefore, staff often must send patients to Richmond for specialty care or surgery due to a lack of free care
available nearby, which poses transportation challenges for patients. Additionally, Portsmouth has limited options for fresh and healthy food, so people often eat at fast food restaurants or buy food from convenience stores. Many also have limited experience with cooking or reading food labels. “I tell patients that ‘food is medicine’ all the time,” Price says.
Nurse practitioner Vonda Raines says she asks patients about their diets when their lab results show a sharp change [in blood sugars, triglicerides, blood pressure, etc.]. “A lot of people tell me ‘I don’t feel sick’ but their diets are high in carbs and salt, which are silent killers,” she says.
Patients often need to be re-educated about health issues, Raines adds: “There are generations of people lacking basic education, and they rely on old wives tales. For instance, someone might come in and tell me they have ‘low blood,’ which means hypertension, but they feel like they are taking care of it because they say, ‘I drink vinegar every day.’” Raines, who does a lot of patient education, will gradually pass along accurate information rather than asking for huge lifestyle changes all at once. Seeing her patients “get it” over time is very gratifying, she says.
“We need them to trust us and believe us. They are very cautious of medications, and often terrified of needles,” she says.
Patient Geneva Blow, 63, came to the Maryview clinic after getting laid off from her job. She has high blood pressure and diabetes, along with arthritis and back problems. “I knew I needed to be seen,” Blow says, but she felt the community health center was too expensive for her limited income. The care at the clinic keeps her going, she says. “I know I can get my medication here. Even though I’m getting old, my health is getting better. They referred me to a nutritionist and I’m walking despite my arthritis.”
On this clinic’s Christmas wish list: more interdisciplinary specialty care and transportation options for patients who need to see specialists.
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The Dental Care Crisis: It Bites
Written by Natalie Miller Moore
How long has it been since you went to the dentist? You might feel guilty if you miss your regular cleaning, but many people who go to free clinics for dental care haven’t been to the dentist in a decade or longer.
Dental care in America is a crisis situation right now, especially for adults, according to directors of free clinics across the state. Children who have Medicaid or state-sponsored health insurance can get dental coverage, but adults don’t have that access in Virginia, says Linda Wilkinson, executive director of the Virginia Association of Free Clinics. In addition, many states cut Medicaid dental coverage during the country’s economic crisis.
That has left many more people without access to a dentist than a doctor. According to the Virginia Health Care Foundation, 3.8 million Virginians have no dental insurance, and in some rural areas, there are as few as one dentist for every 5,000 people. For pediatric dentists, the number is exponentially higher.
Dental issues are responsible for five percent of emergency room visits across the country, but doctors there are limited in the care they can provide. They do not do tooth extractions, for example, unless there is a traumatic injury to the mouth or a blocked airway. Most medical doctors are not qualified to perform dentistry, and there are rarely dentists available in the emergency room. Generally, ER staff will provide patients with an antibiotic and/or pain medication and refer them to a dentist—although those patients likely went to the emergency room because they couldn’t afford to go to a dentist. This means that unlike emergency medical care, there’s not even an emergency safety net for dental issues.
According to Dr. Amy Price of the Bon Secours Maryview Foundation Healthcare Center in Portsmouth, the clinic does not currently offer dental services, although the demand is there: dental abscess and pain are the 17th most common reason to be seen in the ER.
Unhealthy teeth and a lack of professional oral care can damage a patient’s overall health, including raising the risk of heart conditions and infections. The impact can be even more far-reaching for patients, Price adds: “It affects their self-esteem, their ability to find work, and their ability to receive other kinds of care. If someone needs surgery, they often cannot be cleared for it because with bad teeth, there is an infection risk.”
The Lackey Free Clinic in York County, which has had just one dental chair, has a backlog of more than 200 people waiting for oral care, according to Executive Director Carol Sale. Oral exams, done after a medical exam is completed, are the largest gaps in care at Lackey, and that’s not likely to change anytime soon: the clinic is undergoing a renovation and expansion that requires closing its dental chair for three months. The good news is that Lackey will have three chairs once the renovation is complete.
Patients often ignore or self-treat problems for years, even decades. “Dental problems don’t tend to present frequently or acutely, so it’s easy to ignore,” Sale says. “Patients think a toothache can be managed with a salt water gargle. They may go years without seeing a dentist, but it’s an abscess that drives them to the ER, because they can’t tolerate the pain.”
Dr. Jesse Hobbs, a dentist at The Community Free Clinic of Newport News, often sees patients who haven’t been to the dentist in 10 or 15 years; one of his patients is 27 years old and had never been to a dentist. Patients who have neglected their mouths for a long time might have teeth rotted to the roots or covered with calcified plaque. Many need an average of five visits before a dentist can start regular maintenance visits for cleanings.
Not surprisingly, many people who have poor oral health and little experience with dentists start off scared. Hobbs often walks patients through the exam and dental work slowly. That patience pays off for patients such as Adrian Harcum, a 45-year-old Newport News resident who came to the clinic for an exam a week after having a chipped tooth pulled. “I had a bad experience years ago, but I’m not nervous,” Harcum says. “They’ve made me comfortable. I’m glad it’s here and I thank the Lord that it’s free.”
While the dental crisis is gaining attention, it is likely to worsen until providers and coverage options expand. Nationally, the Pew Children’s Dental Campaign is working to increase access to dental care for children, especially preventive care. Other groups advocate adding instruction in basic dental care for medical school students, along with dental rotations at hospitals. Several reports, including one from the W. K. Kellogg Foundation (a non-profit philanthropy that supports children and families), recommend the creation of “dental therapist” positions similar to those of nurse practitioners, to help address the care shortages. But there is opposition to that idea from the American Dental Association, which disagrees with the idea of non-dentists performing any surgical care, such as extractions or root canals.
“We are so grateful for dentists who provide episodic care through our free clinics—it’s great and can help with a toothache, to pull it, and the patient is no longer in pain. We just need more dentistry available for the rural and underserved populations,” says Wilkinson.
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Take Your Blinders Off—Find Your Calling
Written by Gray Bowditch
Several years ago, after beginning a career in law, I took a leap of faith and accepted a position at the newly formed Community Free Clinic of Newport News. As a founding Board member, I was quite excited about the clinic’s mission. It was not an easy decision, but a desire to do something more with my time, energy and experience led me to “take the blinders off” and make a move. Not only has it changed the course of my career, it has helped define who I am as a person.
As the clinic’s administrative director, I am continuously approached with the question, “How can I get involved?” And since the clinic is a not-for-profit health center, and therefore relies heavily on the efforts of its volunteers, I am happy to answer their question. These questions come from all types of people, from the union laborer to the corporate executive. However, I get most excited when it’s someone with a known background or a stated interest in health care.
Community Engagement on the Rise
Community engagement and volunteer support of the much-needed community services sector are on the rise in Hampton Roads. People of varying age, gender, nationality, race and profession are becoming more engaged and involved. Younger generations are starting to embrace John F. Kennedy’s famous quote, “To those much is given, much is expected.” Organizations like Riverside Health System have seen almost a 35 percent increase in overall volunteer support from 2011 to 2012. With health care at the center of conversation before the Supreme Court, in Washington D.C., and in Richmond, Virginians are increasingly accepting their civic duty and many times looking for an organization that assists those with health and dental disparities.
Find Your Organization, Find Your Passion!
From constant mass-mail campaigns, to e-mail updates, there appears to be an endless number of non-profit, service-related organizations requesting donations and volunteer support. You quickly ask which organizations most resonate with you and which you should support, either financially with a donation or with your time. Whether you have a clerical or construction background, or if you’re a young nurse studying to become a physician’s assistant, there is a place for you! At free clinics across the state, volunteers are making a real impact on the health of underserved citizens.
In 2010, free clinics in Virginia served approximately 72,191 qualified patients. Member clinics of the Virginia Association of Free Clinics, including our clinic in Newport News, together utilized more than 15,000 clinical and non-clinical volunteers. After being open only 14 months at the close of 2011, our clinic alone had enrolled and treated more than 1,100 patients for care, accounting for over 3,000 patient visits.
Become a Social Entrepreneur, Enhance Your Emotional Intelligence
In business, an entrepreneur recognizes a market opportunity to create wealth and profit. A social entrepreneur recognizes an issue in an underserved population and brings both financial and human capital. In the current economy, with reduced funding from federal, state and municipal sources, utilizing community support to promote social programs is more crucial than ever. A positive side effect of developing human capital is enhancing emotional intelligence. Working with people with different professional, educational and cultural backgrounds is a fast track to a wider understanding of the world at large. To quote Archbishop Desmond Tutu of South Africa: “We think of ourselves far too frequently as just individuals, separated from one another, whereas you are connected and what you do affects the whole world. When you do well, it spreads out; it is for the whole of humanity.”
A New Perspective
Taking your blinders off also means stepping outside of your comfort zone to do and learn something completely new. Volunteering is one of the greatest acts a citizen can do for his or her community and country. Not only are you helping support a worthy cause, but people often find they are enriched and educated by the people they serve.
Join Us, Follow Your Calling
Take a chance. Evaluate your commitment level and your capacity to give. Visit the Virginia Association of Free Clinics website (vafreeclinics.org) to learn more about the different ways you can support or volunteer at a community free clinic near you. From someone who has worked with dozens of volunteers from all different backgrounds over the last three years, I assure you the experience will be well worth your time.