The Cost of Being Uninsured

I had lunch with an old friend the other day. He’s a retired educator, so I wasn’t sure where he stood on the issues of healthcare (in Michigan, teachers have the BEST healthcare).

It was an interesting discussion – he is passionate about healthcare reform. As an educator, he saw how many people fell through the cracks; how many young people did not have access to healthcare; and the high cost of being uninsured.

The costs are not all just the financial costs of going to the doctor and getting prescriptions filled. The cost is in delayed care – those who are unable to see a dentist, and so they have no teeth. With no teeth, you can’t eat. When you don’t eat, your brain and body can’t develop as they should. And you can’t learn. You can’t get a job when you have no teeth… think about it. Would you hire someone with no teeth?

What about the children who have never seen an optometrist? If they can’t see, it makes it very difficult to pay attention in the classroom. Then they are labeled as “trouble-makers” and ADHD. Really what they need is a pair of glasses.

We take so much for granted and assume that everyone has the same values (I get so tired of hearing that word!) and the same resources. But, we don’t. For some families the reality is that food on the table and heating the house are the first priorities – and everything else has to wait.  For that tomorrow that never comes.

The burden is heaviest on the working poor, those families who have jobs – sometimes two or three jobs, but still can’t get ahead. If they get fifty bucks ahead, the car breaks down. In spite of their best efforts, they just can’t make it.

 

Just a hand, not a handout.

Sam was back this week. We have seen him off and on for a number of years. He is a good kid, functions on a pretty basic level. He has two beautiful daughters – ages 8 and 2 years old. The factory where he was working closed and because of some changes in the law, he can’t collect unemployment. He’s not sure how he will feed his family; he doesn’t know how he can look for work with no money for gas – he lives in a remote part of this very rural county. He is one who has been in and out of our system. He is always compliant – he does what we ask, he takes his medications, and when he has work he is insured and we don’t see him for a while.
He is one of the ones I feel the most strongly about supporting. If we can help him stay healthy, he will be back at work. He needs the help that society can give him – he doesn’t want to be idle, he doesn’t want a hand-out. What he wants and needs is a hand. A hand to help him up when he’s down, a hand to guide him because he really is in over his head when it comes to dealing with issues other than survival. Like I said, he’s a good kid, and helping him will make our world a better place.

Kathy

Kathy has been a patient here since 2005. She has one of the most complicated lives I know of. Her husband has lung cancer and has been on and off hospice care for the past six years. She has, at times, had four grandchildren that she was raising while their parents were in jail. And until about a year ago, she worked full time as a cook in a nursing home making minimum wage, with no benefits.

And I think I’m tired.

Her main health issue is diabetes. But like many diabetics, she has multiple health issues including an allergic reaction to one of the most common diabetic medications. She has suffered from stomach problems of unknown origin; she also has had heart problems and eye problems. About two years ago she suffered from a minor stroke – but continued to work, to take care of her husband and the grandchildren.

She finally reached age 62 and was able to draw her Social Security but is not yet eligible for Medicare.

We see her monthly to provide the much needed medications, diabetic testing supplies and emotional support. One of my doctors was opposed to prescribing anti-depressants, but when he heard her story he wrote the prescription!

Through all of this she remains a sweet, caring woman who is more concerned about others.

She deserves better. She deserves a healthcare system that is available to her when she has problems, not one that will be there next Tuesday night.

 

Tim

Tim first came here almost three years ago. He was employed through a local staffing company. He was driving a truck for $10 an hour working full time. Since he was employed by a staffing company, there were no benefits – no insurance.

Then, he injured his shoulder at work and lost his job. The shoulder injury required multiple surgeries, and following the final surgery he suffered a heart attack. He has a 20-plus year history of diabetes, obesity, and high blood pressure.

He had been covered by his wife’s insurance, but when her hours were cut from 40 hours a week to 20 hours a week, they lost their healthcare insurance. She went on the County Health Plan – a program that provides access to physicians, medications and basic out-patient services. He was unable to access the medications he needed on the County Health Plan and ended up at the clinic.

We were able to access the vital medications he needed to control his diabetes and heart disease through the Prescription Assistance Programs. The Prescription Assistance Programs are a method of obtaining brand name medications for a specific patient from the manufacturer. There is paperwork to be filled out, a prescription is necessary, and a place to ship the medication is needed. The clinic serves this purpose. Connie does all the paperwork and all the follow-up phone calls to provide this service.

As I talked to Tim tonight, he shared with me his blood sugar log for the past couple of months. His blood sugar levels are within normal range. He has lost over 60 pounds and is hoping to go off some of his diabetic medication.

His hope now is to find a job. We have helped him to regain his health, and now he is ready to take on the world again. A success story – one of many.

Good Grief

 

 

 

 

 

On November 20, 2012 our beagle Simon lost his battle with cancer. It seems that someone who is such an important part of our lives should have an obituary, so I’m writing one for Si.

Simon Pavka was born about ten years ago in an unknown place, at an unknown time. On a very snowy, bitterly cold New Year’s week-end 2003, he was abandoned by his mother and rescued by John and Nancy Gertig. He was adopted that same week-end by the Pavka Family: David, Jill, Peter, Ann Marie, Buddy – a beagle mix, and Homer – the cat. He was preceded in death by Buddy and Homer.

Simon was a spoiled, neurotic, funny dog who loved to eat and was always ready to go – anywhere! He traveled many miles in the truck and the motorhome. He also loved to ride on the boat at the lake.

He fought a valiant battle against his cancer and taught all of us many lessons – which we will continue to process for years to come.

Memorial donations can be made to Northside Veterinary Hospital’s food bank (OK –I’m just kidding, but don’t forget the animal food pantries during the holiday season!)

This is mostly for me – but, the loss of a pet is part of many of our lives. Right now the pain is so raw that it is sometimes hard to remember that I had almost 10 years of joy with Simon. The grief strikes at unexpected times, in unexpected places; it is worse first thing in the morning and at bedtime (Simon was the first one up the stairs when I said it was time to go to bed!)

But, the grief is good because it means I can still feel. And we know that we did everything that we could for Simon. We celebrated Thanksgiving with the family on Sunday, November 18, 2012 so he saw “his kids” and “his grandparents” and everyone had a chance to say good-bye. Our life will never be exactly the same, but we will move forward. We will always cherish the memories of the dog we loved.

I'm still Smiling

I have never had to buy insulin syringes for the clinic.  But, last week when the nurses came in to volunteer at the Diabetic Clinic, I told them that this was the end of our insulin syringes. I would have to buy some before next month. I was thinking about my resources and where to purchase them.

 About an hour later my pharmacist for the evening, Tim, came in with his arms full. It was insulin syringes! Boxes and boxes of insulin syringes.

Yes, I am smiling. I smile every time I think about it.

Every time that I forget the reason we are here, I am reminded. I am not in charge here. God is. And we are always provided for.

Musings

I grew up in a privileged life. I had two parents, a house with my own bed, clothes to wear, food to eat, and healthcare whenever I needed it.

I did not know I was privileged. I only knew what I lived, what I saw. I did not know that not everyone had two parents, a house with their own bed, clothes to wear, and food to eat. The idea of anyone, especially a child, going to bed hungry just never occurred to me.

We know what we see. And, too often we choose not to see the suffering around us. We choose not to see that there are those in our community who are homeless, hungry, and going without healthcare.

Or sometimes we choose to believe that what others are doing is enough. But, is it enough to provide healthcare to people in our community one night a week, in the basement of a church? What happens when those individuals experience a healthcare crisis on Wednesday or Friday?

As the debate rages in Washington about debt and budgets, let us not lose track of the fact that it is about human lives.

Just Listen

Every now and again, something happens that renews my belief that there is good in all people.

A few months ago, I received a call from a woman who was desperate. She didn’t need medical care; she had Medicaid. But she needed help. Her apartment was infested with fleas and she had a service dog. The dog and the apartment had to be treated, and that used every last penny she had. As a result, she was unable to pay for her much needed medications. As we were talking, she also told me that she could not afford soap or toilet paper or other personal care items. What she most needed, though, were her medications.

Being a skeptic, I called the local drug store to make sure that none of her medications were narcotics; they weren’t – just the medications she needed to manage her chronic health conditions. So, I authorized payment of the medications. Her co-pay was just a few dollars.

When I went to lunch that day, the question came up about people, and whether they abuse our system here at the clinic. That launched the story about this woman. As I shared with a couple of local businessmen the need this woman was experiencing, one of them said: “Give me a list of what she needs,” and the other one handed me $10 – which I handed to the first man, along with a list. The next morning a big grocery bag filled with the needed personal care items was delivered to my door.

Now this is a businessman who is very busy, is very skeptical of people, and enjoys being perceived as “gruff.” But hearing her story moved him to action. He was able to do something concrete to help one individual and he did it. It didn’t cost him much money – just a little bit of time.

I called to let her know I had some things for her. She came by to pick them up, thrilled not so much that she had received all these much needed items, but that she had been heard. She told me she had called several agencies looking for help, and no one had listened to her. She just needed to be heard.

It’s amazing what we can do if we just listen.

Betty

Betty was one of the very first volunteers at the clinic. She and Carol, her neighbor who is a nurse, would come together to volunteer. Betty wasn’t a “medical” volunteer, though she had lived through a serious chronic health crisis herself, and knew the importance of healthcare. Betty had a heart of gold, and would do anything that needed done around here. And, I mean anything. She sorted through some of the dirtiest items I have ever seen. She took on the task of keeping the supply closet organized.

She had a daughter, Julie, who she always said was going to save Chinese baby girls – one at a time. Julie adopted two girls from China during the time I spent with Betty. When Julie was preparing for a trip to China, Betty and I would scrounge around for the items on the list that Julie needed. Some of them were things that we had in surplus here – clean syringes, alcohol wipes, etc. Betty loved her family and would do anything for them.

In April 2004 we celebrated Betty’s 70^th birthday here with a cake and all her “clinic friends.” Age did not slow Betty down at all. She was at the clinic every single Tuesday, and most weeks at least one other day.

Later that year, my husband was diagnosed with Hepatitis C. He had received blood transfusions in 1983 – before the blood supply was tested for all the horrid viruses that are transmitted by blood. My world spiraled out of control – I may be a nurse, but when it is my family, I am completely worthless. I was devastated, frightened and so sad. On Tuesdays, Betty would come in the afternoon early, grab a dust cloth, and come into my office. I’m not sure she dusted on those days – but she listened, she gave me her time, her attention and her affection. I’m not sure how I would have survived those days without her. Betty gave me the priceless gift of herself.

On Wednesday, October 25, 2006, I was in my office with the radio on in the background. I heard that there had been a fatal accident on one of the rural roads in our county. I remember thinking “that’s a bad corner” but didn’t really think much else about it.

That is not until I received a phone call from Julie. Her parents were on their way to see her, and there had been an accident – Betty was dead.

I cannot even remember how I reacted or what I said. Her death was such a shock, and such a loss.

I still miss her. The clinic receives a check every single month from her husband in her memory. We don’t need the check to remember her, but we so appreciate his commitment to the clinic that she loved so much.

 

 

 

 

Simon - a story of four-legged healthcare!

I was going to call this article “My Dog, the Felon.” He really isn’t a felon, but he does have a police record. It’s a long story.

In August, my beagle, Simon was diagnosed with lymphoma, a cancer that affects the lymph nodes. He isn’t quite ten years old, so young enough we weren’t ready to lose him. We embarked into a journey fraught with peril, but of course we didn’t know that at the time. I love to tell people that I live in “de-Nile” a lovely place where I don’t have to deal with reality. I was clearly living in denial as we made the decision to begin chemotherapy on Simon.

The first week went well – he tolerated the medication, was able to eat, and felt fine.

Then, the second week hit. First, he began having some nausea and vomiting; so we started him on medication to control those symptoms. By Saturday, he was having diarrhea, which quickly became bloody diarrhea. So, we added two more medications to control that. He didn’t feel good; I was no longer in denial but had moved right into panic and fear. It was not a good combination.

By Saturday night when it was time to now give him five pills – well, it was a perfect storm of not feeling good, fear, panic and… … as I tried to give him his medication, he bit me.

I pulled my hand away and quickly rinsed it off, trying to calmly (yea, right) assess the situation. I decided the most important thing was to give him his medications – so I gave that job to my husband. Once all the pills were down, we then went to the emergency room.

Have you been in an ER on Saturday night at midnight? Oh, my goodness… not the time you really want to be there. But, there I was. And, the first order of business? To call the county Sheriff to report my dog!

Yes, he was my dog, with all his shots up to date, but we still had to file a report. The Sheriff Deputy came to take my statement, see my wound (and almost pass out), and then they were able to treat me.

I had three stitches; had I known that I didn’t need antibiotics, I probably would NOT have gone to the ER. I did need a tetanus shot – which they forgot to give me (I got it at the Health Department later that week!).

We are now several weeks into the chemo for Simon; my hand has healed. He has taught us so many lessons in this journey. He is one tough beagle dog. When he is nauseated, he just lies quietly on a cold floor; when he is short of breath, he stops; when he is hungry, he eats.

Did we make the right decision to put him through this? I have no idea. I know we were not ready to let him go, and we promised him that if he was ready, we would let him go. So far, he hasn’t given us any indication that he is ready to give up the fight.

He goes to the vet every Thursday, the girls out there love him – and he happily goes in to see them.

It seems somewhat ironic that my dog can get the healthcare he needs, and I have such a hard time getting care for my uninsured patients with cancer. But, that is another story.

Clinic Night

On a typical Tuesday evening at St. Peter’s Free Clinic, the following patients may be seen. Sue, who has a cough and fever, is worried about losing her job if she calls in sick, but she has no health insurance. Lynn is a 50 year old widow, who has been having heart problems since before her husband died, and now has no health insurance. And, Jim, who due to multiple health problems, has recently lost his job and along with it his health insurance. He has no idea where to go for help. While he was at the Clinic he not only received health care and medications, but was given a list of community resources to help him access other needed services and a small box of food to feed him that night. As he left he summed up the sentiment that is often heard by the volunteers at the Clinic, “Thank you so much for being here when I needed you. You were an answer to my prayers."

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Death Comes in Threes.

Is that an old wives tale, or reality? It always seems to be true in my life, and it certainly has been true here at the clinic this year. In the span of less than a year, we have lost three of our original volunteers.

Pat: Pat was the very first nurse to call and volunteer once word about the clinic went out. I had never met her, and had no idea the impact she would have on my life over the next ten years. Pat was a single woman, taking care of her elderly mother. She was bigger than life in so many ways – physically, she was tall and broad shouldered; she had a voice that was amazing; and she had one of the biggest hearts ever. Pat worked the Tuesday night clinic and was instrumental in the development of the Diabetic Clinic, which she also worked each month. She was a member of the Sweet Adeline’s and introduced me to their brand of singing. It became our annual gift to my mother-in-law to take her to the Sauk Trail Sweet Adeline concert.  She was very involved in her community, her church, and in life! She would work on Tuesday night, then head to her ceramics class for “therapy.” An amazing woman! Pat was one of those people that get in your body space – when she was excited or frustrated she would get right in my face to tell me about whatever was on her mind. I remember so clearly one night when she had been complaining to me about something, that I looked at her and said to her, “I love you.”

I was so glad that I had that moment to remember. On Monday, January 23, I learned that Pat had been taken to the local hospital and then transferred to a major medical center. On Tuesday morning, she was dead. What I was told, was that she had a “tear” in her heart. I am not certain exactly what happened, but it was so sudden, so unexpected.

In addition to taking care of the uninsured, Pat herself had been uninsured, until the previous May, when she turned 65 and became eligible for Medicare. She had put off taking care of herself for many years. According to a report from the Institute of Medicine, uninsured Americans get about half the medical care of those with health insurance. As a result, they tend to be sicker and to die sooner. About 18,000 unnecessary deaths occur each year because of lack of health insurance.

Pat’s death was such a loss to all of us – at the clinic, at her church, in her community. She will always be remembered here.

Ella: I had known Ella almost since I first moved here. She was a member of the church, and very active in everything going on at the church. When we started the work for the clinic, she was always there. Well, almost always. The only things more important than the church were her two great-grandsons. And they were both involved in sports, so that was always her first priority. Ella always told us she was going to live to be 100. She didn’t make it.

Ella was diagnosed with cancer and she vowed she would beat it. She did for a while, but it came back with a vengeance. Ella volunteered every Tuesday at the clinic. We found the perfect job for her – she was our greeter. As the patients came in, she would direct them down the hall and welcome them to the clinic. She couldn’t be here during her treatments, but when the doctor released her, she would come and wear a mask so that she could be here.

Ultimately, she was no longer able to be here, and on February 20, she died.

She touched so many people with her life. Her great-grandsons are now young adults, and hopefully they will always carry with them the fierce love she had for them.

 

Dee: Dee was also a member of the church and an original clinic volunteer. She was the best sorter/cleaner I have ever known. I am not sure I ever saw her without a dust cloth or a dish towel. She could organize any mess – and there are always plenty of those around here! Dee was diagnosed with breast cancer not long after the clinic opened. She responded well to surgery and chemo, and was soon back here working. For many years, she helped in the kitchen on Tuesday evenings. The clinic feeds the volunteers each Tuesday with food provided by various groups. The kitchen is a place for the volunteers to rest, refresh and socialize. There is always something going on out in the kitchen! And Dee was a part of the group providing a haven to our volunteers. This spring, her cancer returned. It seems to always be worse the second time around. Before we could grasp the reality of it, Dee had died.

Dee and I shared more than church and clinic – her granddaughter is married to my nephew, and they have two beautiful daughters. So Dee will live on in those amazing girls.

So, if death does indeed come in threes, maybe we are done for a while. I sure hope so – my heart has so many holes in it that I am afraid it might break in two with another loss.

Diabetic Clinic

Tonight is the monthly Diabetic Clinic. Not long after the clinic opened, the need for more diabetic care became obvious. With the help of some enthusiastic volunteers including a provider, a couple of nurses and a student from Hillsdale College, the planning began. The idea was to hold a “group appointment” where all the patients came together at the same time to receive diabetic education, to be seen by a provider, to receive medications and all the supplies necessary to take control of their disease, and to form a support group for one another. I’m not sure our idealized version is exactly what happens, but today, and once a month, a group of 12 to 15 patients with a diagnosis of diabetes come together. There is a provider who comes to see anyone in the group that needs to be seen; he also oversees the medications and test results of all the patients. A volunteer pharmacist and pharmacist technician come in to dispense the necessary medications.

Under the direction of a diabetic educator, the patients sit around a table using light weights while she teaches various aspects of their care. Most of them have had a one on one session with a licensed dietician; they all receive glucose monitors and test strips, with the requirement that we see their blood sugar log for each month. Most months a healthy snack is provided. All the diabetics, from this group or the larger population of the clinic, have access to a podiatrist and to an ophthalmologist.

There are always laughs, groans, and the opportunity to cheer each other on as goals are met. The goals may be weight loss, a hemoglobin A1C level that meets a goal, or it may be an exercise program goal that was met. They support one another, and us. As a group we have seen the birth of babies and the death of one of the providers and one of the nurses. We have also experienced the unexpected death of one of the group.

I am often accused of “spoiling” this group of patients, and that is true to a certain extent. But we have been through a lot together, and every one of them KNOW that I will discharge them from the Diabetic Clinic if they are not compliant. I want them to take charge of their healthcare, and I will do everything I can to support them. If they are not willing to do the work, there is always someone waiting for a spot to open in the Diabetic Clinic.

Article

This link will take you to an article by the Episcopal News Service about clinics providing healthcare to underserved populations: http://bit.ly/w23HPW

Friends of the Free Clinic

One of the many blessings in my life over the past 10 years has been Kristin Lucas. When the clinic opened, I didn’t know her. A fellow church member introduced us, and told me, “You need to know Kristin.” She was SO right about that! Kristin had served as the founder and executive director of the local domestic violence shelter for 19 years prior to her retirement. She had traveled some, and was ready for a new challenge. I don’t think she had any idea how big of a challenge I would be, but we were brought together for a reason.

Kristin knew all the things that I didn’t even know that I didn’t know. I am a nurse. Being an executive director was not in any of the curriculum I took! I had no idea where to begin with so much of the legal/accounting/etc. side of things. But Kristin was there to guide and teach me. She served as chair of the board until she was term-limited out.

Luckily, she had seen a need, and moved to fill that need: the clinic needed fundraisers. She started a group named Friends of the Free Clinic. The group is mostly women who believe in the work of the clinic and have connections in the community. Their mission is to raise money for the clinic. They are amazing!!

Eight years ago, this group decided to host a yearly event to raise money for the clinic – we are now preparing for the 8^th Annual Taste of Autumn. The event is a food and wine tasting, held at the local college. Money is raised by getting sponsorships from local businesses and having the local restaurants provide enough food for a “taste” to the 250 guests that purchase tickets to the event. It is so much fun and an event our community looks forward to every year. The event brings in about one-third of our annual income.

The Taste of Autumn is this Saturday evening – nearly all the tickets are sold and we are really looking forward to another amazing evening. The Friends of the Free Clinic have been hard at work, and as always, I am awed at their dedication and enthusiasm for this event.

The Friends of the Free Clinic also send out fundraising letters each year, asking their family, friends and neighbors to help support the clinic. The response to this is amazing.

The Friends of the Free Clinic are my heroes. The work is not always fun, it certainly isn’t always easy, and yet they do it year after year because they believe in the work we do here. To say “thank you” seems so inadequate, but from the bottom of my heart, I thank them for the work they do!

 

Todd

Todd was standing outside the clinic door when I came back from lunch one Tuesday. The clinic door opens at 5 p.m., but most Tuesdays there is a line by 3 or 4 p.m. But, it was only 2 p.m. when I returned that day. It was a nice day, but I still stopped to ask why he was there that early. He told me he was homeless, and really didn’t have any place else to be.

I asked him point blank – why are you homeless? This is his story, and I know that there are at least two sides to every story – and often more than that. But, this is his story and the only one I know. He and his wife were having issues. He went to the bedroom to be alone and she came in and poured coffee on his laptop computer. He called the police, but she said she was frightened, so he was arrested. He spent a night in jail and was taken from there to the ER because he had pneumonia. He had spent the last two nights sleeping in the smoking hut in the hospital parking lot. He had the clothes on his back, and nothing else.

I told him to come see me when he came in the clinic. I found a blanket, a sweatshirt, some pants and a little food to give him. And I learned a huge lesson. When someone is homeless, possessions are a burden. A blanket was appreciated because of the cool night air, but what was he to do with it during the day, when he was trying to get food or contact friends?

Fortunately for Todd, one of the volunteers here at the clinic works for DHS – Department of Human Services – and she knew of a shelter in a community about 30 miles from here. She gave him her number, and said to call the next day. They were able to get him to the shelter the next day.

I don’t know where he is now. We will probably never see him again. He said he had a friend with a job in a community about an hour from here. Hopefully, that came through for him.

We were able to give him the antibiotics and the inhaler he needed. Maybe we were able to give him hope. Maybe.

My inspiration

This quote from Facebook is part of the inspiration for this blog.  As I have mentioned, I want to change the world. I am realizing what a difficult task that is here in the middle of America – with no power, no money, and no influence. But what I can do is tell the stories of the people I serve. They are real people who are working and trying to live the American dream in a time and place that seems to have been passed by.

The need for healthcare appears so basic that it doesn’t seem possible that it could generate so much debate. I am pretty sure that those debating the question have never gone without healthcare – most of which is provided by someone other than themselves. Our legislators have tremendous healthcare – which we are paying for. Those in business and industry often have healthcare provided by their employer. It is the small business owner, the self-employed and those working at minimum wage jobs who are the most likely to be uninsured.

We had a patient in here this week who is working 40 hours a week, his wife has two jobs, and they have no healthcare insurance. He needed prescriptions for his medications. He could afford his medications, but could not afford the doctor’s visit to get them written.

Their story is not unusual. The population we take care of includes many who are employed. There are some who are disabled, and have no insurance. Did you know that once someone is determined to be disabled that they do not qualify for Medicare for two years? What kind of sense does that make?

Our healthcare system is so broken. And a free clinic in the basement of a church is really not the answer to our healthcare crisis. What we need is access to affordable healthcare for ALL Americans.

 

Homeless...

Last night we had a young woman at the clinic who is homeless. As often as I see it, I always have such a tough time with it.

There is a part of me that thinks “I should take them home with me – I have a room, a shower…” Then there is the pragmatic part of me that knows often the homeless have mental health issues, and I have to protect my family, myself. But I struggle. As I send yet another person back out into the streets – with a blanket, with some food for their dinner and enough for tomorrow’s breakfast – I wonder, am I a good person doing what little I can, or am I a bad person, sending them back out on the streets to survive as best they can?

Malignant Melanoma

Malignant melanoma. Those are two words no one wants to hear. Imagine hearing them, and being uninsured. That is the news one of our patients received from the surgeon last month. Malignant melanoma…

How do you find hope? Where do you turn for answers? In this country, where we have so many resources, why do we still feel that healthcare is for the privileged?

I am always left with so many questions and so few answers when a situation like this occurs. Yes, we can send him to the university hospital, and they will provide care to him – either by qualifying him for Medicaid (unlikely in Michigan) or more likely he will qualify for their “Charity Care” program – and all its stigmas.

10 Years of service to our community!

As we prepare to celebrate 10 years of service to our community, I find myself with such mixed feelings.

I am so proud of the work we have done – it has defined my life. I was never the person with the vision for the clinic, but somehow, I ended up being the right person at the right time to do this work. God has used me in amazing ways – and has used the clinic to guide my personal journey.

On the flip side, I find it so incredibly sad that in the 21^st Century, in the richest country on Earth, healthcare has to be provided in the basement of a church. Really? Where is the justice in that? How can we fool ourselves into thinking that this is just and right?

When did healthcare become a privilege?

With the healthcare dollars currently spent in this country, everyone COULD have access to healthcare if we would just use those dollars better. I clearly don’t have the answers – or I wouldn’t be running a free clinic in the basement of the church. But in my heart, I know there is a better answer.

That said, this is what the clinic has done over the past 10 years. We have provided 3954 individuals with access to healthcare; we have provided 23,940 patient visits and have dispensed medications with a retail value of $7,585,450 to our community.

We have done all of that with volunteer staff, donations and grants. It is truly amazing.

The clinic has a multitude of partners – the local hospital provides lab and x-ray services at no charge; specialists see patients in their private offices; churches and individuals provide meals for the volunteers – many of whom come from their day jobs to volunteer at the clinic; and all those that donate money keep the clinic operational.

It is not always easy. There are some who want to make sure that those we help “deserve” it. I struggle with the concept of the “deserving poor.” Who is it exactly that deserves to be poor? I never can wrap my brain around that concept.

It is not easy because the need is so great.  We started out the first year seeing about 16 patients each week; in 2010, our busiest year, we saw an average of 62 each week. That is a lot of people to be seen by two providers – though, thankfully, not all need to see a provider. Many are here for medication refills.

As I reflect on 10 years, I feel so blessed. The clinic has provided me with work that I love, with friends that share my passion, and with a community that works together, even when we don’t agree.

It has always been my hope that I would work myself right out of a job. That is still my dream – that all the patients we see would have access to healthcare when they need it.

 

Medications

Medications are one of the primary ways that we help people at the clinic. Access to medications is crucial to managing chronic health conditions. Without these medications, individuals are more likely to end up in the emergency room or the hospital.

When we first opened the clinic, the medications available for us were sample medications that were donated by other clinics and physicians’ offices. In the months prior to opening, the women of the church spent hours sorting those samples, writing the expiration date on the boxes and organizing the samples. We had a tiny little closet that was used to store the medications.

Today, we have a budget of $15,000 for medications. We are able to purchase generic medications through our membership with the Free Clinics of the Great Lakes Region. We have worked with the providers to develop a formulary. We still have some samples, but there are fewer and fewer of those available today. Having a consistent formulary has made a world of difference for us. At times in the early days, we had to change medications just because the sample drug we were using was no longer available. Now, we only have to change medications if it isn’t working for a particular patient.

We also access many medications through the Prescription Assistance Programs. These are brand name medications that are free of charge – a specific medication for a specific person. Many of the drug companies participate in these programs, but they can be difficult to navigate. One of the clinic employees does this paperwork as part of her job. Connie is our Patient Care Coordinator, and she does anything and everything associated with the patients’ care needs outside of the clinic.

One of the many blessings I have received on this journey was a couple, both pharmacists, with hearts as big as the world. Keith came first, to help me organize. He told me over and over again – I will do this, but no more. This is all I can do – help you get organized and started. Ten years later, he and his wife Marilyn are still here. Clearly, I have not been able to get organized!!

Keith likes to tell people that I am Romanian, as in that culture when someone shakes their head it means yes, where in our culture it means no. I never understood him to say no.

Keith and Marilyn have been vital to the clinic. Their knowledge, their experience, and their love have made the difference. Because of them, our patients receive great healthcare. One of my favorite spots during clinic hours is in the “dispensary” – the area where the pharmacists are filling prescriptions. I love hearing the conversation between the pharmacists and the providers – trying to determine how to best provide care to a patient, using the resources available at the clinic.

Our resources are limited – no controlled substances; no high priced new medications; no latest and greatest – but we provide the best care that we can for the people who come through our doors.

John died today.

John died today.

He isn’t the first patient of mine to die – not by a long shot. But his death affected me differently than the others.

John was one of the almost 3,900 uninsured individuals served by our clinic. He was a minister, serving two congregations. He had no health insurance for his family. He had been a diabetic most of his life. And for the past 3 years, had been part of the Diabetic Clinic we offer.

This is what I KNOW about John– he was married, had 4 children, 1 grandchild; he had been a diabetic for a number of years – he was a Type 1 diabetic, which means he was insulin dependent because his pancreas no longer produced insulin. His blood sugar log for one month showed everything from 59 – too low, to 513 – way too high.

He was engaging and loved people.

He had been diagnosed with COPD (Chronic Obstructive Pulmonary Disease) but had never smoked. The COPD could have been a result of a hereditary condition that ran in his family. He brought me the information on the condition, and we ordered the lab test to determine if he had it. But….he never had the lab work done.

I would have told you he was one of my most compliant patients – he knew much about his disease, and was meticulous about keeping his blood sugar logs. He had been diagnosed with diabetes over 40 years ago, and really knew his disease – he knew about his diet, about his blood sugar levels and the issues common to diabetics. But he rarely had the routine blood work done that is ordered for diabetics.

I was stunned by his death – and stunned to look back at his records to see how non-compliant he had been. It is one of the real pitfalls with a free clinic – there is no staff to follow up and make sure that ordered lab work is done, there is no consistency with providers so that they know what has been ordered, what needs to be done. Working with limited resources means limited healthcare.

Did that make a difference? Probably. According to a report from the Institute of Medicine, uninsured Americans get about half the medical care of those with health insurance. As a result, they tend to be sicker and to die sooner. About 18,000 unnecessary deaths occur each year because of lack of health insurance.

Nuns on the Bus

This summer I became a “groupie.” I literally chased down a bus full of people that I wanted to meet.

I am not even sure how I became aware of the Nuns on the Bus – probably on Facebook (as much as that scares me). I became obsessed. I was so inspired by these amazing women – doing God’s work in the world, and also being advocates. It is a balance that I have not been able to find in my own life. I love the work that I do, and I know that we touch people’s lives in very real ways, but… I want to change the world. And, for that reason, these women inspired me.

In case you don’t know them, this is from their website:

“Every hour of each day, Catholic Sisters stand in solidarity with all who live in poverty, and we confront injustice and systems that cause suffering.

We cannot stand by silently when the U.S. Congress considers further enriching the wealthiest Americans at the expense of struggling, impoverished families.

As part of our campaign for budget fairness we are taking a bus trip. Our bus will travel to places in many states where Sisters actively serve people in need. For they are our best witnesses to the suffering our federal government must not ignore.

We ask all who visit this website to join us in prayer and to support our work to defeat government actions that would add to the suffering of already struggling families.

This bus trip has been organized and is sponsored by NETWORK, A National Catholic Social Justice Lobby, and the NETWORK Education Program. http://nunsonthebus.com/about/”

The bus was coming through a city just half an hour away and I had to go. I had no idea where they were stopping; I just knew they would be there at 9 a.m. on a Saturday morning in June. So I drove up there, couldn’t find the park so I decided that if I parked near the interstate highway, I would see the bus come by. That is what I did – once I saw the bus, I followed it to the downtown area. I was there when the nuns got off the bus.

It was such a thrill to meet them, to hear them speak and have a chance to talk – very briefly – with them about the work we do here at the clinic. The point wasn’t really meeting them – the point was to be inspired by them – to have my faith in “religious” people restored. I am not a Catholic – but one of my real life heroes is a Catholic nun, so I have a lot of respect.

This group of women changed my life. Their example gave me hope and a renewed passion for the work I do, as well as a hope that maybe, in some small way, I can change the world!

You can watch their story on Bill Moyers at:

 http://billmoyers.com/episode/full-show-nuns-faith-and-politics/

The Clinic Team

Let me introduce you to my staff. I am blessed, through grant money from Blue Cross Blue Shield of Michigan to have the funding for two part-time staff. For better or worse, I am the face of the clinic, but they are the heart and soul of the clinic.

Connie first volunteered at the clinic as an intern for her degree program. She was a young mother, finishing up her education. She was, and continues to be, an inspiration to me. As an intern, she helped me write the job description for the Patient Care Coordinator. We both wanted her in the job, but then it didn’t look like she would be able to apply for it. I went through the process hoping that the right person would apply. And, finally – she did. Connie knew it was the work she was meant to do, and worked out the issues so that she could apply. She may regret that decision at times, but I never have!

As the Patient Care Coordinator, she works closely with the patients and the community resources – whether it is the specialists in the community who see our patients, or the many service organizations that work with the same population that we do. She understands our patients and their lives. She teaches me every day how to serve this population.

Connie serves as the liaison to the community from the clinic as a member of the Multi-Agency Collaborative for Emergency Services (MACES).

A big part of her job is accessing medications at no cost for patients from the pharmaceutical companies. Many of the large pharmaceutical companies have programs called Patient Assistance Programs, and they make brand name medications available to low-income, uninsured individuals. Each company has their own paperwork, set of rules, and process for obtaining these medications. Connie does the paperwork for the patients, coordinates the ordering and re-ordering of these medications, and processes the medications when they arrive at the clinic. It is a huge job – there are currently about 200 patients on the Prescription Assistance Programs, and many of them have multiple medications they receive through these programs. She makes it look easy. But it isn’t!

 The Volunteer Coordinator is Linda. She too started at the clinic as a volunteer – in a job she hated. But fortunately, we saw what her gifts were, and put her to work using them. She is the nicest person you could hope to meet – and makes everyone feel appreciated. I can’t even begin to describe the monthly treats the volunteers find, the cards she sends, the events she plans. Everything is done in order to say “thank you” to those who give so freely of their time here at the clinic.

Linda’s job includes recruiting, training and appreciating the volunteers. We are so lucky that finding the people to work here is pretty easy, but if you have never worked with volunteers – well, there can be some frustrations. Trying to juggle the schedule – to make sure we have the right number of volunteers, in the right jobs… it can be like trying to herd cats. We love our volunteers, but they are  volunteers – which means the clinic is sometimes a secondary concern.

I think the three of us make an incredible team – we each bring strengths that complement one another. I can’t imagine doing this job without them.

 

Uninsured Caregiver

Lauren was one of my favorite patients. She was a beautiful woman – full of life and with a smile that would melt anyone’s heart.

She was 55 years old, had no health insurance, and had not received healthcare for quite some time. She came into the clinic the very first night we were open. She was thrilled to be able to receive the medications she needed for her asthma. 

Lauren was taking care of her disabled husband. And the stress from that was slowly killing her. We saw her regularly at the clinic for the first couple of years; then she didn’t show up for a while.

When she returned, I didn’t recognize her – she had aged 20 years in the months we hadn’t seen her. She had developed a severe dental infection (the uninsured have even less access to dental care than they do to healthcare). As a result, she had lost all of her teeth and could not afford dentures. She had gone from a lovely, vibrant woman to an old, old lady in just a few short months.

And now, her depression was full blown. She was one of the lucky ones as I had a counselor I could refer her to. Often, mental health services are also seriously lacking for the uninsured. She was under so much stress from taking care of her husband alone, and was having suicidal ideation (she had a plan for suicide).

I don’t know the end of Lauren’s story. We were able to get her on the County Health Plan, which isn’t insurance, but it does provide some limited access to healthcare services. Like many of our patients, they come through our system and then move on. We are only here for an instant in the life of many uninsured individuals.

Karen's Story

Karen is a 51-year-old female with a diagnosis of high cholesterol, high blood pressure, and depression. She is a well-educated woman, with a degree in Human Resource Management and nearly finished with her marketing degree. Her son’s suicide at age 20 began a downward spiral in her life. She became severely depressed, lost her job, divorced, and lived with various family members before relocating to this area. Since moving here she has been homeless – living in her car.  She has a friend who lets her shower at her house.

How do you live in a car??? I can’t even picture it – in the heat, in the cold… where do you pee? How do you fix a meal? How do you take care of yourself?

We live in a community that has blinders on about homelessness. There is no shelter, no place to take a shower, no safe place to sleep. We pretend that homelessness is a problem of “big cities,” not a problem here. And, we do nothing.           

Success stories?

I would like to tell you that we have all sorts of success stories here at our clinic. We are blessed to have healthcare providers that care and are committed to providing care to the uninsured. So many times people without insurance put off coming to the clinic. Sometimes they don’t know that we exist, sometimes they are too embarrassed to come here for help. That is something we often forget – for us Tuesday night is a great time. We get to see the volunteers who have become our second family. We get to have a meal together at the end of the evening….so, it is easy for us to forget how incredibly hard it is for someone to walk through our doors.

About the clinic

Let me tell you a little about our clinic. We are located in the basement of the local Episcopal Church. The clinic was the vision of our priest at that time, the Rev. Debbie Semon-Scott. None of the rest of us had any idea of the need, or even what a free clinic was. The vestry (the governing body of an Episcopal Church) invited me to be part of the exploration process. My only qualification was that I was a nurse. We spent nearly a year visiting other free clinics, talking to people, attending a meeting of the Free Clinics of Michigan. In April of 2002, Debbie and I attended a conference put on by the Free Clinics of the Great Lakes Region in Iowa, and decided we could do it – we could open a free clinic. We picked a date: September 10, 2002.

I remember that evening so well – so anxious in both the good way of being anxious and the bad way of being anxious. We had no idea how many, if any, people would walk through our door that night. We were prepared for a dozen, hoping that maybe five or six would show up.

We had nineteen people that night, and have never looked back.

The clinic is open one evening a week - on Tuesday. We open the door at 5 p.m. to start registration. We lock the door at 6 p.m., and close registration at that time. We see however many come through the door during that hour. We never know what to expect.  Since the first of this year, we have seen as few as 41 and as many as 73. Our average is 59.

There are many different things going on during the clinic hours. New patients are all screened for eligibility. It is less about our desire to take care of people and more about our realization that this is not the best option for healthcare – so if someone has other options, we want to make sure they utilize those options. During the screening process consents are signed, other needs may be addressed, and the patient is given information about the clinic. Once this process is finished, the patient is put in line to be seen by one of our healthcare providers.

Returning patients may be in to be seen by a healthcare provider or to get refills on their medications. We provide most of the medications to our patients here. I will talk about medications at another time.

On a typical Tuesday night, the clinic is staffed with two healthcare providers – usually one physician and one mid-level provider – either a Nurse Practitioner or a Physician Assistant. There are anywhere from 3 to 6 nurses working. Our dispensary is staffed minimally by a Registered Pharmacist and a Pharmacy Tech; there are lay people involved in screening, registration, pulling charts and doing data entry. Most Tuesday nights we have 25-30 volunteers present as well as the three paid staff members.

It looks and feels like chaos most of the time, but by the end of Tuesday night, the patients have been seen, the medications dispensed, orders written for lab tests, X-rays and referrals, and the volunteers have been fed.

We lock the doors, turn off the lights, and call it a night.

The Phone

One of the most important parts of my job is answering the telephone. It seems like a routine task that could be assigned to anyone. But the telephone is the most important part of my ministry. The person on the other end of the line is calling with a need. Sometimes it is a need that can be addressed by our clinic. Often, it is not. We don’t have funds to help pay for past medical expenses, we don’t have funds for healthcare provided elsewhere, nor do we have funds for the multitude of needs that people have in today’s society. So, I listen, I problem-solve, and when possible help individuals figure out where to go for the help they need. Some days that is easy, others times not so much.

This was a typical phone call: “I am calling for my fiancé. He has been throwing up – can’t keep anything down, but he won’t go to the emergency room. We just can’t afford to pay for that.” I ask how long this has been going on, and the answer: “For months.”

Introduction

Let me introduce myself. My name is Jill; I would like to tell you that I am a middle aged female, but since I have no intention of living to be 112 years old, I am past that middle aged thing. I am a white Anglo-Saxon protestant female, who finds herself rather unexpectedly working with the low-income uninsured residents in our community. I say unexpectedly, because I never envisioned myself in this place – doing this work, and yet, it seems that my whole life has prepared me for this. As I travel on this journey we call life, I am amazed at how the pieces of the puzzle begin to fall into place. For me, it is proof that God exists. For others, it might just be fate, or circumstance. But I see God in all that I do and in all that I am.

This blog is my attempt to share the stories of my own journey, but more importantly the stories of the staff, volunteers and patients in a free clinic, located in the basement of an Episcopal Church in a rural Midwestern town. It is a specific place, but the stories could be anyone – anywhere. And that is the point of my blog – to share stories that are about people – the people struggling in this economy to keep their families fed; the people for whom healthcare is a luxury they just can’t afford; and the people who give of their time and talent to make some form of healthcare available.