Uninsured face long waits at Madison's few free health clinics
http://www.madison.com/tct/news/289398 [2008-6-5]
Tag: Medicine Soap
It was a gorgeous Saturday morning and one of his two days off amonth from work, but Lakhwinder Singh had to spend it inside aclinic on South Park Street, waiting.
He needed to get a prescription refilled for his gout. He can'tafford insurance, and he has no doctor. Without the pills, he said,he would be in too much pain to work his job managing a gas station45 minutes away in Fall River, where he is on his feet 16 hours aday pumping gas, working the cash register, stocking the shelvesand mopping the restrooms.
Singh's bright orange turban was a welcome splash of color in theclinic, where about a dozen people with illnesses from diabetes tostomach pain waited ... and waited. For Singh, it took 4 hoursbefore he got his pills. But patients at South Side MEDiC Clinicrarely complain. Although only open on Saturday mornings, theclinic is free, the medical care is expert and caring, and fewpatients there can afford to go anywhere else.
"I'm lucky to have a spot," he said. "This is one of the few placesin Madison where I can get help."
The clinic, staffed and managed by volunteer UW medical studentsand supervised by a rotating group of doctors, is an example of thefree, discounted and charity care that local providers, privatecorporations, government officials and neighborhood activists havestitched together to address the diverse and growing needs ofMadison residents too poor, too confused, and too scared to seekregular medical care and coverage.
It also reflects the increasing strain this patchwork system isunder.
The first MEDiC clinic was founded in 1990 by seven UW medicalstudents and their professor, Dr. Ted Goodfriend, to accomplish twolofty goals: give medical students hands-on learning whileproviding hands-on medical care to the needy.
"It's a two-way street," said Andrea Schnell, a second-year medicalstudent at UW. "We can learn about medicine and help people at thesame time." The program's dual mission is made clear in orientationmaterials volunteers are required to read. Advice ranges from thepractical -- "If it's WET and HUMAN, wear GLOVES!"-- to thephilosophical -- students are reminded to remain sensitive to whatthe manual calls "vast gaps" in their patients' health care.
Today, the program has expanded to include 450 volunteer studentsfrom the Medical School as well as from UW's pharmacology, nursing,physical therapy and physician's assistant programs. Dozens ofvolunteer physicians supervise. In the course of the year, thisteam sees more than 1,300 patients at six clinics around the city,each of which serves a distinct population with its own needs andchallenges--from the homeless with constant food infections to thementally ill with constant delusions. Thanks to donations andvolunteers, all this is done on a shoestring budget of less than$20,000.
"We don't have an excess of anything except goodwill," said Dr.Goodfriend, UW professor emeritus and now Associate Chief of Stafffor Research at the Veterans Hospital.
At South Side, many patients are immigrants, mirroring the changingneighborhood around them. Just down the street is a popular Mexicanrestaurant, El Pastor, and the Mercado Marimar, a friendlyneighborhood store stocked with Mexican soap operas, frijoles,tortillas and telephone calling cards.
One recent Saturday, the clinic's waiting room was humming withSpanish, Portuguese, Punjabi and English as moms and grandmotherschatted or talked on cell phones. Children played, for the mostpart quietly. They seemed to be used to waiting, too. "All week Ihad a really bad pain in my stomach, like I had to throw up," saidChristian, 9, when asked why he was there.
Christian's mother is from Mexico. Census figures show the localLatino population has experienced explosive growth -- from 5,744people in 1990 to 19,210 in 2004 -- making Latinos 4.6 percent ofDane County's overall population. Community advocates figure thatadding undocumented workers makes the total number of Latinos inthe county more like 50,000 or 60,000. This is the populationserved by South Side, and it presents new challenges.
If patients have no documents, they are ineligible forgovernment-funded medical aid, and after visiting the free clinicfor acute care, they are adrift again.
Even with documents, however, many immigrants find the medicalsystem a maze. Costs are prohibitive. Many immigrants worktemporary and seasonal jobs, which rarely offer insurance coverage.Singh, who moved to the U.S. 25 years ago from India and became alegal resident in 1983, recently moved to Madison from Michigan togive his four children a good education. He said he works from 5:30in the morning until 9:30 at night, six and sometimes seven days aweek. His pay: $2,000 a month, no benefits. "I can't afford $500 amonth for insurance," he said.
Without insurance, medicine isn't affordable, either. In fact,focus groups conducted in 2005 by United Way of Dane County learnedthat Latino immigrants find it cheaper to ask relatives back hometo send them medicine than to buy it in the states. "In our countrywe get public clinics, but health costs in the United States areloca -- crazy expensive," said Mayella, who is from Venezuela andwhose husband was at South Side with severe stomach pain.
Language is another barrier. And fear of being deported. "You cansee it in their eyes. They're afraid we'll ask if they're legal,"said Kathy Williams, clinic coordinator at the BenevolentSpecialist Project (BSP) in Middleton, the only free clinic forspecialist care in all of Wisconsin. Williams, who has watchedBSP's patient load nearly triple in the past five years, added: "Wedon't care if they fell out of the moon."
In a sign of the times, free clinics have sprung up in the past fewyears in smaller towns like Boscobel, Richland Center, Stoughtonand Dodgeville. But the six MEDiC clinics are the only free clinicsin the city of Madison. South Side officials say they do notadvertise. If they did, they would be overwhelmed.
Each MEDiC clinic is only open one shift a week, at most. SouthSide is open Saturdays between 9 and 12.
The waiting starts way before then. Even in brutal winter, the sickline up at the doors by 7:30 to get one of the 12 coveted spots onthe roster.
"For a while, they were coming as early as 6:30," said ClaudiaBulla, a front desk coordinator and Spanish translator, "but wetold them to stop. It was so cold, and they had their babies. Weworried they would get sick just waiting."
On a busy Saturday, especially during the flu season, coordinatorssay they have turned away as many as six patients for the twelveslots. "It was shocking for me," said Jose Delgado, who started asa front desk coordinator just recently. "I'm from East Los Angeles,and you see poor people who need help there, too. But the clinicsthere handle way more than a dozen people. Some had things thatwere pretty bad, and they don't have funds to go anywhere else. Iknew they would end up waiting another whole week."
That's what happened last winter, when Singh brought in his teenagedaughter with a severe sore throat. They were too late and theclinic was full, so he went home and tried "Indian medicine" --steam, herbal tea, and good old Vicks rubs -- to get her better, hesaid. It worked.
But waiting too long for formal care can sometimes be risky. Dr.Nancy Pandhi, the medical director of South Side and an instructorwith the UW Department of Family Medicine, also worries about whathappens to her patients once they leave her clinic. She can givepatients like Christian and Singh only episodic care. Where willthey find a regular doctor and ongoing care?
"We're limited in what we can do," she said. "We do not providecontinuing care to most patients. When it comes to chronicconditions, our hands are tied. We're really just a band-aidapproach for these people."
Some private clinics in town provide free care but only for alimited number of referrals. Doctors and patient care experts sayit can take weeks and even months to get into the two centers runby the only nonprofit clinic in town, Access Community HealthCenters, that offers primary care to the uninsured on a slidingscale.
"The need is greater than our capacity," said Tammy Quall,development director for Access. There were no statistics availablefor how many requests for medical appointments are turned awayevery day, but Quall said that at last count the clinic received 60more calls a day for dental appointments than it could handle.(Since then, Quall said, the clinic has improved the backlog.) Areporter calling to make an appointment for a medical checkuprecently was told to call back in two weeks. When she asked whatwould happen then, she was informed she would probably just have tocall back again in another two weeks.
The result? "People give up," said BSP's Williams. "And that's thereality."
Without regular medical care or doctors, the same conditions thatdrove many patients to South Side last month -- diabetes, pain andhigh blood pressure -- could push them into the hospital withstrokes, heart attacks and serious insulin reactions. Indeed,officials at local hospitals report a spike in emergency roomvisits as desperate and poor patients turn to emergency carebecause they have no other option.
Meriter Hospital, the most visited emergency room in the city, hita record last year for a total 42,627 emergency room visits. StMary's next door has also seen a spike in emergency room visits,which increased 12.5 percent last year from the year before. St.Mary's is doubling the size of its emergency facility, andofficials there are braced to see the problem get worse.
"Definitely, a fair percentage of our patients use the safety netof the emergency room for their primary care," said Dr. KyleMartin, medical director for St. Mary's Emergency Services. "Thetragedy is that a number of people come in and need to behospitalized with diseases like diabetes and high blood pressurethat could be controlled if they had better access. This is aproblem that speaks to the health care crisis in our society."
At the same time, local hospitals are seeing a dramatic jump inrequests for charity care. In 2005, Meriter spent $4.6 million oncharity care, a number that nearly doubled to $8 million by 2007.St. Mary's reports spending $7.3 million on charity care in 2007,up from $4.3 million just a year before.
In an effort to curb expensive emergency room visits, localhospitals, clinics and activists are working on a pilot projectcoordinated by United Way that would hook poor patients up to freecare from primary physicians. Advocates like Dr. PatriciaTellez-Giron, president of the Latino Health Council and a primarycare physician at Wingra Family Medical Center on the south side,fight for an even broader solution. "We are working for universalhealth care for everybody," she said. "Everybody needs to have amedical home."
In the meantime, patients like Singh must cope the best they can.Reached on his cell phone as he was working at the gas station afew days after his visit to the clinic, Singh said he was feelingfine. But he was worried about his wife, who suffers from episodesof arthritis and depression. They are still in debt from the lasttime he had to take her to the emergency room, he said, and hedoesn't know what they can do next time she has a painful bout."She shouldn't have to suffer for a week before she can get help,"he said. "Nobody should have to suffer in this super country."
As for him, he said he'd be OK until his medicine ran out inanother six months. Then it will be time to head back to the clinicand wait some more.
Shawn Doherty — 6/04/2008 8:52 am
It was a gorgeous Saturday morning and one of his two days off amonth from work, but Lakhwinder Singh had to spend it inside aclinic on South Park Street, waiting.
He needed to get a prescription refilled for his gout. He can'tafford insurance, and he has no doctor. Without the pills, he said,he would be in too much pain to work his job managing a gas station45 minutes away in Fall River, where he is on his feet 16 hours aday pumping gas, working the cash register, stocking the shelvesand mopping the restrooms.
Singh's bright orange turban was a welcome splash of color in theclinic, where about a dozen people with illnesses from diabetes tostomach pain waited ... and waited. For Singh, it took 4 hoursbefore he got his pills. But patients at South Side MEDiC Clinicrarely complain. Although only open on Saturday mornings, theclinic is free, the medical care is expert and caring, and fewpatients there can afford to go anywhere else.
"I'm lucky to have a spot," he said. "This is one of the few placesin Madison where I can get help."
The clinic, staffed and managed by volunteer UW medical studentsand supervised by a rotating group of doctors, is an example of thefree, discounted and charity care that local providers, privatecorporations, government officials and neighborhood activists havestitched together to address the diverse and growing needs ofMadison residents too poor, too confused, and too scared to seekregular medical care and coverage.
It also reflects the increasing strain this patchwork system isunder.
The first MEDiC clinic was founded in 1990 by seven UW medicalstudents and their professor, Dr. Ted Goodfriend, to accomplish twolofty goals: give medical students hands-on learning whileproviding hands-on medical care to the needy.
"It's a two-way street," said Andrea Schnell, a second-year medicalstudent at UW. "We can learn about medicine and help people at thesame time." The program's dual mission is made clear in orientationmaterials volunteers are required to read. Advice ranges from thepractical -- "If it's WET and HUMAN, wear GLOVES!"-- to thephilosophical -- students are reminded to remain sensitive to whatthe manual calls "vast gaps" in their patients' health care.
Today, the program has expanded to include 450 volunteer studentsfrom the Medical School as well as from UW's pharmacology, nursing,physical therapy and physician's assistant programs. Dozens ofvolunteer physicians supervise. In the course of the year, thisteam sees more than 1,300 patients at six clinics around the city,each of which serves a distinct population with its own needs andchallenges--from the homeless with constant food infections to thementally ill with constant delusions. Thanks to donations andvolunteers, all this is done on a shoestring budget of less than$20,000.
"We don't have an excess of anything except goodwill," said Dr.Goodfriend, UW professor emeritus and now Associate Chief of Stafffor Research at the Veterans Hospital.
At South Side, many patients are immigrants, mirroring the changingneighborhood around them. Just down the street is a popular Mexicanrestaurant, El Pastor, and the Mercado Marimar, a friendlyneighborhood store stocked with Mexican soap operas, frijoles,tortillas and telephone calling cards.
One recent Saturday, the clinic's waiting room was humming withSpanish, Portuguese, Punjabi and English as moms and grandmotherschatted or talked on cell phones. Children played, for the mostpart quietly. They seemed to be used to waiting, too. "All week Ihad a really bad pain in my stomach, like I had to throw up," saidChristian, 9, when asked why he was there.
Christian's mother is from Mexico. Census figures show the localLatino population has experienced explosive growth -- from 5,744people in 1990 to 19,210 in 2004 -- making Latinos 4.6 percent ofDane County's overall population. Community advocates figure thatadding undocumented workers makes the total number of Latinos inthe county more like 50,000 or 60,000. This is the populationserved by South Side, and it presents new challenges.
If patients have no documents, they are ineligible forgovernment-funded medical aid, and after visiting the free clinicfor acute care, they are adrift again.
Even with documents, however, many immigrants find the medicalsystem a maze. Costs are prohibitive. Many immigrants worktemporary and seasonal jobs, which rarely offer insurance coverage.Singh, who moved to the U.S. 25 years ago from India and became alegal resident in 1983, recently moved to Madison from Michigan togive his four children a good education. He said he works from 5:30in the morning until 9:30 at night, six and sometimes seven days aweek. His pay: $2,000 a month, no benefits. "I can't afford $500 amonth for insurance," he said.
Without insurance, medicine isn't affordable, either. In fact,focus groups conducted in 2005 by United Way of Dane County learnedthat Latino immigrants find it cheaper to ask relatives back hometo send them medicine than to buy it in the states. "In our countrywe get public clinics, but health costs in the United States areloca -- crazy expensive," said Mayella, who is from Venezuela andwhose husband was at South Side with severe stomach pain.
Language is another barrier. And fear of being deported. "You cansee it in their eyes. They're afraid we'll ask if they're legal,"said Kathy Williams, clinic coordinator at the BenevolentSpecialist Project (BSP) in Middleton, the only free clinic forspecialist care in all of Wisconsin. Williams, who has watchedBSP's patient load nearly triple in the past five years, added: "Wedon't care if they fell out of the moon."
In a sign of the times, free clinics have sprung up in the past fewyears in smaller towns like Boscobel, Richland Center, Stoughtonand Dodgeville. But the six MEDiC clinics are the only free clinicsin the city of Madison. South Side officials say they do notadvertise. If they did, they would be overwhelmed.
Each MEDiC clinic is only open one shift a week, at most. SouthSide is open Saturdays between 9 and 12.
The waiting starts way before then. Even in brutal winter, the sickline up at the doors by 7:30 to get one of the 12 coveted spots onthe roster.
"For a while, they were coming as early as 6:30," said ClaudiaBulla, a front desk coordinator and Spanish translator, "but wetold them to stop. It was so cold, and they had their babies. Weworried they would get sick just waiting."
On a busy Saturday, especially during the flu season, coordinatorssay they have turned away as many as six patients for the twelveslots. "It was shocking for me," said Jose Delgado, who started asa front desk coordinator just recently. "I'm from East Los Angeles,and you see poor people who need help there, too. But the clinicsthere handle way more than a dozen people. Some had things thatwere pretty bad, and they don't have funds to go anywhere else. Iknew they would end up waiting another whole week."
That's what happened last winter, when Singh brought in his teenagedaughter with a severe sore throat. They were too late and theclinic was full, so he went home and tried "Indian medicine" --steam, herbal tea, and good old Vicks rubs -- to get her better, hesaid. It worked.
But waiting too long for formal care can sometimes be risky. Dr.Nancy Pandhi, the medical director of South Side and an instructorwith the UW Department of Family Medicine, also worries about whathappens to her patients once they leave her clinic. She can givepatients like Christian and Singh only episodic care. Where willthey find a regular doctor and ongoing care?
"We're limited in what we can do," she said. "We do not providecontinuing care to most patients. When it comes to chronicconditions, our hands are tied. We're really just a band-aidapproach for these people."
Some private clinics in town provide free care but only for alimited number of referrals. Doctors and patient care experts sayit can take weeks and even months to get into the two centers runby the only nonprofit clinic in town, Access Community HealthCenters, that offers primary care to the uninsured on a slidingscale.
"The need is greater than our capacity," said Tammy Quall,development director for Access. There were no statistics availablefor how many requests for medical appointments are turned awayevery day, but Quall said that at last count the clinic received 60more calls a day for dental appointments than it could handle.(Since then, Quall said, the clinic has improved the backlog.) Areporter calling to make an appointment for a medical checkuprecently was told to call back in two weeks. When she asked whatwould happen then, she was informed she would probably just have tocall back again in another two weeks.
The result? "People give up," said BSP's Williams. "And that's thereality."
Without regular medical care or doctors, the same conditions thatdrove many patients to South Side last month -- diabetes, pain andhigh blood pressure -- could push them into the hospital withstrokes, heart attacks and serious insulin reactions. Indeed,officials at local hospitals report a spike in emergency roomvisits as desperate and poor patients turn to emergency carebecause they have no other option.
Meriter Hospital, the most visited emergency room in the city, hita record last year for a total 42,627 emergency room visits. StMary's next door has also seen a spike in emergency room visits,which increased 12.5 percent last year from the year before. St.Mary's is doubling the size of its emergency facility, andofficials there are braced to see the problem get worse.
"Definitely, a fair percentage of our patients use the safety netof the emergency room for their primary care," said Dr. KyleMartin, medical director for St. Mary's Emergency Services. "Thetragedy is that a number of people come in and need to behospitalized with diseases like diabetes and high blood pressurethat could be controlled if they had better access. This is aproblem that speaks to the health care crisis in our society."
At the same time, local hospitals are seeing a dramatic jump inrequests for charity care. In 2005, Meriter spent $4.6 million oncharity care, a number that nearly doubled to $8 million by 2007.St. Mary's reports spending $7.3 million on charity care in 2007,up from $4.3 million just a year before.
In an effort to curb expensive emergency room visits, localhospitals, clinics and activists are working on a pilot projectcoordinated by United Way that would hook poor patients up to freecare from primary physicians. Advocates like Dr. PatriciaTellez-Giron, president of the Latino Health Council and a primarycare physician at Wingra Family Medical Center on the south side,fight for an even broader solution. "We are working for universalhealth care for everybody," she said. "Everybody needs to have amedical home."
In the meantime, patients like Singh must cope the best they can.Reached on his cell phone as he was working at the gas station afew days after his visit to the clinic, Singh said he was feelingfine. But he was worried about his wife, who suffers from episodesof arthritis and depression. They are still in debt from the lasttime he had to take her to the emergency room, he said, and hedoesn't know what they can do next time she has a painful bout."She shouldn't have to suffer for a week before she can get help,"he said. "Nobody should have to suffer in this super country."
As for him, he said he'd be OK until his medicine ran out inanother six months. Then it will be time to head back to the clinicand wait some more.
Shawn Doherty — 6/04/2008 8:52 am
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