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.