The TAP-IN Blog

So, Why Volunteer? The Volunteers Speak...

Hi

At TAP-IN, we have had some people volunteering their services to free clinics for some time, while others have just begun to engage.  I thought it would be interesting to ask those volunteers to share their thoughts on the big question: "Why Volunteer?"  What follows (hopefully) will be some perspectives and personal testimony on why some health care professionals choose to volunteer in the first place...

"We never thought we'd have to do this."

Nadine Sheehan, manager of the Neighbors Caring for Neighbors clinic in Mount Clemens, Michigan, is seeing a lot of new patients these days - patients who can't believe they're having to seek care at a free clinic after years of having the security of coverage by employee insurance plans. Now, according to this story in the Detroit News, local health clinics are being flooded with patients.

The clinics -- some of which are funded by partner hospitals, others through private donors or grants -- are seeing a rise in demand due to the economy, said James McCurtis, spokesman for the Michigan Department of Community Health. And they are filling a crucial need as more Michigan residents lose their jobs and the health insurance that goes with them, he said.

"(Free clinics) are definitely essential now," McCurtis said. "People are strapped for money. There has to be a safety net."

Patients at free clinics can wait weeks for an appointment or several hours as a walk-in. One free clinic in Mount Clemens has a six-week wait for patients, but vows to see people on a walk-in basis if they have urgent problems, said Sister Nadine Sheehan, manager of the Neighbors Caring for Neighbors clinic, which is funded by Henry Ford Macomb Hospitals.

The clinic has had 1,000 more visits this year than last and cares for 40 to 50 new patients a month because of lost jobs and health insurance. The clinic only takes Macomb County residents. "Many of our patients are working but they're working in low-paying jobs that don't have insurance," Sheehan said. "It's people who've not been in this situation before. They cannot believe they have to go to a free clinic.

Of course, Mount Clemens and the greater Detroit area are not alone in seeing this rise in desperate people; as the jobless numbers approach 7 percent, it's not just the working poor who need support, it's the rising ranks of the unemployed, who "never thought we'd have to do this."

For a brief period of time after the dot com bubble burst in 2001, I found myself without health insurance or the means to afford it. It was a frightening time. When you know that even a minor injury or illness might wipe out your savings, you don't want to do anything or go anywhere. You know that the stress alone is likely to make you sick or aggravate your pre-existing conditions. It can quickly become a downward spiral of both your health and your finances.

Taking the step of getting in line for treatment at a free clinic can be a difficult one for people accustomed to having regular employment and insurance, but as one of the patients interviewed for this news story said,

"It's a real blessing if something seriously goes wrong," he said. "These places help out a lot. I'd probably be suffering because of fear to go to the hospital. This takes a lot of the relief off."

Caregivers and Patients Tell Their Stories in New Online Magazine

It's brand new to the web. Appropriately, it's called Pulse and, as it describes itself,

Pulse is an online magazine that uses stories and poems from patients and health care professionals to talk honestly about giving and receiving medical care.

Pulse is also an online community, a chance for patients, doctors, nurses, social workers—everyone—to come together, share our experiences in health care, and explore our common wish for a humane system of health for all.

Pulse invites high quality submissions of stories and poems by "patients, caregivers, doctors, nurses, social workers, therapists, students and anyone else who wants to share his or her experiences of giving or receiving health care."

It's not hard to imagine that there are plenty of stories and poems that could be written about medical volunteerism, being uninsured and being cared for at a free clinic.

A Clinic Fights to Keep Providing Services

There are heroes out there, across the country, who simply won't stand for people not having options for health care. They sacrifice their own time and their own savings and financial security so that people more unfortunate than them can at least get some medical attention for themselves and their children.

Many regions in the U.S. have growing populations of families and individuals barely able to cover the essentials of housing and feeding themselves, much less paying for health care. In such areas, medical and health care services see little potential of profit, so they don't build facilities and don't provide services. Into the gap come free clinics or - in the case of West Valley, Utah - self-supporting clinics that serve both the completely uninsured and those who can pay through an insurance plan or Medicaid.

The WestView Community Health Center is "always near collapse due to short funds, and in the current slow economy, the clinic is seeing more patients while earning less money," as reported in the Salt Lake Tribune. LaRohnda Dennison and her mother, Goldie, founded the clinic after recognizing the lack of coverage in the West Valley area. They converted their medical billing service into a clinic that provides insurance counselling to its patients. But as the number of uninsured patients rises, the income from the barely insured is proving to be less than operating costs.

The clinic averages between 125 and 150 patients per day, many of whom lack insurance.

"We don't turn anyone away," LaRohnda said.

That means the $250,000 it costs to run the clinic each month comes from those few patients who do have insurance or Medicaid. The clinic has a financial counselor on hand to see if patients qualify for public assistance, but many are put on a sliding-fee scale and just pay what they can.

Maribel Huanco recently visited the clinic when her 18-month-old son, Mark, had a cold and fever.

Huanco lacks insurance, and said through an interpreter she could not afford health care for her three children without the clinic. She feels very comfortable with the Spanish-speaking staff, and believes even though the care she receives is inexpensive, the quality is second-to-none.

Huanco also received prenatal care at the clinic, which is one of the greatest areas of expense. The clinic employs two obstetricians, who each deliverabout 35 babies each month.

LaRohnda Dennison said the clinic could save thousands by stopping prenatal care because medical malpractice insurance is so high for the specialty, but she knows continuity of care leads to healthier pregnancies and healthier babies.

Many of those infants keep coming to the clinic after birth. Matthew Agresta, a family practice physician at the clinic, estimates 70 percent of his patients are children.

He sees between 20 and 30 patients each day, and treats a wide range of ailments. Much of his time is spent on well-baby care and other pediatric checkups, but he also removes moles, places IUDs and performs circumcisions and vasectomies.

To save patients money, the clinic's doctors perform many procedures that would normally be done by specialists.

Another challenge for Agresta and the other doctors is uninsured patients tend to wait longer before coming in for treatment. The doctors often see more advanced disease progression, which is usually harder to treat.

Follow-up visits are also difficult, because many patients are hard to track, not knowing their birth date and lacking a home address or phone number.

Free Clinic Patients and Volunteers Tell Their Stories

Among the 47 million American's without health insurance, many rely on free clinics located in their communities for vital health care. Some of these clinics now provide stories about the patients they help, with some allowing the patients to testify through the Web about their experiences with the volunteer professionals who serve their needs.

In Richmond, Virginia, the Fan Free Clinic features "success stories" of patients (described with pseudonyms) whose lives have been positively transformed by the medical, social and mental health services the clinic provided them.

The Saban Free Clinic in Los Angeles also provides success stories that are clearly meant to serve multiple purposes: to encourage the uninsured to seek treatment and support; to attract funding; and to motivate volunteers to participate.

The North Carolina Association of Free Clinics Web site has published a testimonial from a couple who credit one of its clinics with saving their lives.

The Saturday Free Clinic of Columbia St. Mary's Hospital in Milwaukee is coordinated by sophomore medical students from the Medical College of Wisconsin. On their Web page they tell the story of one patient's successful outcome a the clinic and of one former volunteer student who continues to volunteer now that she has become a full-fledged physician.

Finally (at least for this post) there is the Gennesaret Free Clinic in Indianapolis, which publishes a series of stories told by its volunteers about their positive experiences working for the clinic.

Of course, we hope that all clinics will somehow tell their stories and provide the photos and videos that will expose their good work to the public and to the many potential volunteers who are needed across the country.

Dallas Area Exemplifies Free Clinic Expansion

An article in the Dallas Morning News describes the proliferation of "charity clinics" in north Texas and quotes the executive director of the National Association of Free Clinics as she describes the critical role that such clinics play in covering the needs of America's uninsured. As Nicole Lamoureux told the reporter,

"Free clinics are the best-kept secret in America. Instead of waiting for the problem to be solved, free clinics are offering a solution right now."

The article focuses on the clinic-based activities of Julia Grenier, a 72-year-old nurse who treats a largely immigrant population of patients at the Plano Day Labor Center, one of 40 free clinics in the Dallas area.

"The hospitals totally ignore that we are saving their bottom line," Mrs. Grenier said as she bags supplies at her clinic. "Every visit here is a potential emergency room visit there. We stop problems from growing here."

CBS News Reports on Michigan Clinic

Reporter Seth Doane remembered the clinic that had impressed him this past winter in Mississippi, especially the selfless volunteer nurse practiioner who was "working as hard as she could to serve a population that had very limited access to medical care." So when he heard stories of a much-praised doctor working at a clinic in Flint, Michigan, he knew it would be a story worth telling on the network's evening news. In a blog article describing how his reporting came about, he told the backstory:

I learned about the clinic after reading a couple of local stories about a volunteer there, Dr. Samuel Dismond, who recently won a community service award for his work. Dismond is a thoughtful, gentle man who told me that it's "rejuvenating" to volunteer at the clinic. Though he also said that "it can be a frustration to me, as a healer, [to see] so many people we're not able to help and not help adequately.

There are plenty of people in Flint that do, indeed, need help. Home to General Motors, there have been a number of layoffs as factories have been closed down and shifts have been cut. When we were at the clinic, Dale Willis who had just been permanently laid off from his job at an auto-parts supplier came in for the first time. Willis was clearly shaken by the loss of his job and worried that it would be hard to find another one at his stage in life. Willis told me that he'd even consider taking a job as a janitor if he needed to. "If you'd asked me at 21 what I'd be like at 51, I'd say, in a lot better situation than I am now!" Dale said.

The actual video that was shown on the CBS Evening News on June 11 can be seen here.

"One day I will give back." A Doctor Starts a Clinic

She and her four siblings were raised by a poor single mother. When they needed medical care, a kind local doctor was gracious enough to take care of them for free. Now that she's a practicing obstetrician-gynecologist, who has worked in Las Vegas for 20 years, she's determined to pay the favor forward and provide care for some of the 300,000 uninsured citizens of Clark County.

Dr. Florence Jameson is putting the pieces together for a community clinic that will be staffed in large part by retired doctors. Her plan is to call the clinic Volunteers In Medicine of Southern Nevada, following the VIM model founded by Dr. Jack McConnell on Hilton Head Island, South Carolina. There are now over 60 clinics in the VIM Clinic Alliance, all making use of a guide and a program of assistance provided by the VIM Institute.

Dr. Jameson combines the support from VIM with her own strong convictions and network of contacts as she  puts her clinic proposal together.

Jameson said about 20 doctors have committed to work at the clinic — and that’s just through word of mouth.

Eventually, she estimates, the clinic will need as many as 70 physicians, 30 nurses and a few pharmacists. The clinic hopes to tap into the pool of retired doctors for most of its staffing needs, she said.

Stories of the Uninsured

WBUR. a National Public Radio affiliate station in Boston, runs "an occasional series" of first-person stories about being uninsured in Massachusetts. This is the current story, by a man holding down two jobs but who is unable to afford the health insurance not provided by either of those jobs, but now made mandatory by Massachusetts law.

An excerpt:

While at the October meeting I had the opportunity to speak with a Health Connector Official in the hall. I asked him why the health care reform law was based upon income only and NOT income vs. expenses. He just smiled and stated a person could file for an exemption. When I asked what the guidelines would be for an exemption, he said he didn’t know-they hadn’t been developed yet. His smirk made me feel as if I was being patronized.

Retired Michigan Doc Starts Two Model Clinics

"Anybody who spends one day with me would realize how important this is," said Dr. Barry Saltman at a recent businss brainstorming session attended by 200 people in Lansing, Michigan.

"This" is extension of a regional healthcare system for the uninsured, modeled on the two Care Free Medical Inc. clinics he founded after retiring. Together, the  2 initial clinics now provide medical and dental care for 5,600 patients.

The goal is to build a system that could provide services to everyone, regardless of income or whether they have health insurance.

Saltman called for the forum to build on other area health care resources, such as his clinics in Mason and Lansing.