Monday, July 13, 2015
Two Years At The Free Clinic: So Successful We May Fail?
by Carol A. Westbrook
I walked into an examination room, introduced myself, and shook the hand of a 32-year old man whom I will call Fred. One of the biggest people I have ever met, Fred weighed in at 485 pounds.
"What can I help you with?" I asked.
"I'm here for three reasons, Doc," said Fred. My left shoulder just started hurting me, and it's getting so bad I can't lift my arm. I also have a back problem that's going on for a couple of years. It's so bad I had to quit my job at the lumberyard. And I have a rash on my skin."
His shoulder pain, he said, began about three weeks ago. After a quick exam I diagnosed him with adhesive capsulitis--frozen shoulder. He will need physical therapy, maybe surgery, but would eventually recover.
The back pain is another story. It started slowly about two years ago, shooting down his right leg. The side of the leg is now numb, and he has difficulty walking. It was easy to recognize that he had an advanced case of lumbar disk disease, which damaged his sciatic nerve. This condition will need back surgery.
Back and shoulder pain are among the most common problems we see here in the Care and Concern Free Medical Clinic, where I have been a volunteer physician for the last two years. Many of our patients work at blue-collar jobs, doing manual labor or heavy lifting. They have lost their health care insurance because they had to quit their jobs due to these injuries, and that is why they seek free medical care. But Fred was awfully young for these problems, no doubt because of his massive size.
"I can give you something for the rash." I said. "The shoulder pain and back problem will take a bit more doing. You should have physical therapy for your shoulder, and you need to see a back specialist as soon as possible before it's too late to do anything. And you have a fourth problem--your weight."
"At 485 pounds you will be lucky to live to age 40," I continued. "You need to lose about 300 pounds. Realistically you can't do this on your own. You should consider bariatric surgery."
Fred was discouraged because he knew that our free clinic does not have funds to pay for surgical specialists. He was caught in the middle, like many of our clinic patients. He has no health insurance because he is unable to work in a full time job with benefits, but he can't fix his medical problems and get back to work without insurance. It's a vicious cycle of poverty.
When I reported on the Care and Concern Clinic in this column two years ago, (see "Third World Medicine in a First World Town, Sept 9, 2013), all I could offer to someone like Fred was sympathy, arthritis medication, and a promise to sign an application for disability benefits, should he apply. But things are different today. I can offer him a way out. The difference is that insurance is available through the ACA or Affordable Care Act, also known as ObamaCare.
I urged Fred to apply for medical insurance. Yes, he will have to pay his premiums with almost no income, but he will almost certainly qualify for a federal subsidy, thanks to the recent US Supreme Court Decision allowing subsidies to continue.
"When your insurance comes through we'll send you to the best specialists for your back and shoulder. We'll also refer you to a bariatric program for weight-loss surgery. Pretty soon you will lose that weight, your back and shoulder will be better, and you'll be able to back to work again."
Fred is motivated. He really wants to get back to work and will follow through. And I am gratified. I feel that I helped him avoid that downward spiral into poverty, and perhaps even saved his life. This is why I volunteer here at the clinic.
Things haven't changed much at the Free Clinic since I started as a volunteer two years ago. We still provide free exams, diagnostic testing, lab work and medications to the uninsured. Thanks to a generous donor, we now have an online translation service, MARTI, My Accessible Real Time Trusted Interpreter, to assist with non-English speaking patients. The picture at the right shows a few of our volunteers learning how to use MARTI. We are still staffed with dedicated volunteers, about two dozen at last count. And we still hold our weekly clinic on Wednesday evening, serving all on a first-come, first-serve basis. We registered our 9,000th patient this month!
What has changed, though, is that our patient numbers have sharply declined this year. Whereas previously we'd register 30 to 40 patients each week, we are now seeing as few as 4 or 5! All the other regional charity clinics are reporting similar declines, too. This has been attributed to ObamaCare. But I believe there is more to it than that, since we didn't see this decrease last year.
The health exchanges of the Affordable Care Act opened in October 2013. During the 2014 year, I would ask my patient why they didn't enroll in an ACA insurance plan. Their answer was invariably, "I can't afford it." The insurance plans are not free, and the subsidies are low. For a person who has barely any income at all, the priorities are to spend it on the immediate necessities--such as rent or food--rather than on health insurance that he might not need at all. ObamaCare didn't make much of a difference to our patients; it was still out of reach.
What has changed this year, though, are jobs. According to a recent report from The Institute for Policy and Economic Development at Wilkes University, unemployment in our county has finally fallen to pre-recession levels, from 9.3% in 2013 to 7.3% in 2014. The poverty level has also dropped by about 2%.
Jobs provide health insurance benefits or, at the very least, enough income for an individual to afford insurance through an ACA exchange. This is borne out by the increasing numbers of people obtaining ACA insurance in our state. For example, 472,697 people enrolled in such plans in Pennsylvania during the 2015 open enrollment period, 15% higher than anticipated! Of these, 41% were new enrollees.
Those new enrollees included many of our patients! I am proud to think that we contributed to this success by all the pre-employment and job application physicals we performed in the Free Clinic, helping people obtain jobs as they became available.
Because our numbers are low, the clinic is going to take a summer recess for the first time ever, closing our doors for two months at the end of July. Have we been so successful that we have failed? Will we need to close our doors permanently?
"There are absolutely no plans to close the clinic permanently, there will always be people who need our services," writes Gloria Blandina, the clinic's volunteer director.
Yes, there will always be those who have fallen between the cracks in society: because they don't have work, or can't speak the language, or are just caught in the vicious cycle of poverty and can't find their way out. We will do our best to serve them. In the meantime, I will feel great pride in the volunteer work I do in the clinic, and I'll enjoy my free Wednesday evenings this summer.
The Care and Concern Free Clinic is a ministry of St. John the Evangelist Church, in Pittston, PA. You can learn more about the clinic or the other Care and Concern ministries on the parish's web page (Click here for the link).
Posted by Carol A Westbrook at 12:15 AM | Permalink