Community Health Care- your tax dollars working!

As our current economic crisis is evolving, health care is taking a huge hit for many families.
Add up the rising costs of everything, and many individuals and families are forced to gamble on staying healthy while stopping any health insurance they have. Then include in the equation the number of people without insurance due to downsizing and layoffs, you hit a terrifying number of individuals and families who are simply without the means to meet their needs for basic health.

Fortunately there is a network of community health centers in the country, acting as a safety net for those tumbling out of the normal working class system of insurance. These centers are typically funded through grants along with federal and state tax dollars. Tobacco taxes along with the settlements of tobacco companies, while the daily frustration and resentment of smokers, is often a consistent resource of much needed funding.

These centers provide a health care home to recipients of Medicaid and Medicare. Fewer and fewer private practices can continue to make ends meet with the shrinking reimbursement rates and slower payment times, and are simply forced to continue providing services in order to stay open and meet the needs of those with private insurance.

These clinics also provide insurance to those who need a safety net, including the uninsured and those whose resident status makes any sort of other coverage impossible. (this is not a forum for immigration issues, but the reality is that without some available clinic, we would have migrant workers unable to harvest our food, children with no health care, mothers with no prenatal care, and tragically sick members of the family of humanity)

My clinic is part of the Salud Family Clinic system. Salud means health in Spanish, and much of the original focus was providing affordable care to migrant families. (The clinic still runs a mobile unit, making rounds of farms and small communities in Eastern Colorado along with all clinics being along the front range,northern I-25 corridor and Eastern plains) With much of the staff being bilingual, and a cultural awareness focusing on the Spanish speaking community, we now meet the needs of thousands of Colorado families who would have little to no health care otherwise.

Of course our system is overwhelmed. We see more patients than in any way is possible, work in consistently busy and challenging conditions, and do our best to provide the very best care that we can in spite of the day to day mountains we face. The pay is less than average, the day entirely too full, and the clinic more overcrowded and dingy than private practices. But every single day we are appreciated. We know at any given moment we impact lives deeply. Despite at times feeling as if we provide a huge quantity of care instead of a huge quality of care, we know deep down that we do incredible things with every task, every smile, and every breath.

Not only that, but I truly work with some of the best coworkers I have had the privileged to work with in my entire life. We keep each other laughing, keep each other going through the rough times, and hold each other up when we feel as if we might fall into frustration. The only reason we are there is because we choose to be. There for our patients, and there for each other. Our bonds are the sort that can only be forged by challenging situations survived over and over.

Of course, we are being stretched even further every day. A system already bulging at the seams is squeezing in even more pieces.Each provider sees an average of 28-30 patients a day, which when you add it up should be a 24 hour day in and of itself. Each patient encounter includes labs, referrals, vaccines, prescriptions, procedures, counseling, education, so on and so on.

I could keep you here telling you heartbreaking stories of the families in our clinic. The single mother who now struggles with MS. The undocumented woman who is left behind, along with 4 children, by a husband killed in a tragic accident. The young 30-something white male who can no longer work construction due to a painful hernia which he desperately needs surgery for. The father of 2 with one on the way, always struggling to get by and now diagnosed with uncontrolled diabetes. The young person with Aids, the developmentally disabled, the mentally ill. On and on and on and on. Every face is a new story of good people.

We found out Thursday that the clinic has received additional funding that will allow us to be open until 9 at night (currently closing at 5 now) and Saturdays. The number of patients we will be able to care for has just increased dramatically. For the families for whom a missed day of pay in order to go to the doctor means a bill unpaid, groceries un-purchased, this can mean the difference between surviving or not.

The news is so new that we are not entirely clear at the bottom levels where the funding came from, but we suspect it is our share of the increased health care funding our current administration has injected into the struggling system.

If you wonder just what those dollars are being used for, here is your story. In this case it is not about mismanagement by those in power. It is not about overspending, consumerism and dishonesty or thoughtlessness. It is 100% about good people, a struggling country, and the basic right to health.

It is good news in hard times. Isn't it about time?

The big day

So here it is, another year. Though really, I feel the same as yesterday. It has been a wonderful day though. I did choose to work, and take my paid day off in a couple of weeks with a weekend and a floating holiday. Thanks for the messages of love from so many.

I have to say it is a little funny to call mom and start to tell her something, and her say "Oh, I read the blog!" Well, Hi Mom!

I want to address healthcare. I know this is my pet issue, because I am a consumer (well, isn't everyone? But I am a serious consumer, with a chronic illness) as well as part of the health care system.

It is broken. it is heartbreakingly broken.

Today I helped prepare a woman for a casting of the wrist she broke 2 weeks ago. She was seen then in the ER.They only splinted it, and sent her to her "Primary Care Provider" for the casting. I imagine they wanted wait until after swelling went down a bit.(I want to believe that was the reason, and not a lack of desire to provider additional services that would not be paid for. Surely, but I imagine that sort of passing the buck is not uncommon in the nation when hospitals are being swamped by the needs of the uninsured, the poor, the weary)

The idea, the expectation of her having a primary care provider is ridiculous. She is homeless, transiently passing through town, wanting to head out on her "adventure" as soon as she can. She was told to call my clinic, because we are the net that catches the falling souls. Unfortunately we only have so much room in our net.

We are fighting a huge flu outbreak, along with a wicked virus. Each day we are sending established patients to the ER or Urgent care because we just can't see any more patients. You have to understand that most Dr's offices see 20 or so patients a day, give or take a few. The Dr's in my clinic see between 28 and 32.(In fact I know of one wonderful pediatrician who managed to get 19 very sick children through his rooms in just the morning, because he had to attend meetings in the afternoon) We are seeing as many people as physically possible, and we can barely keep up with that many. (each visit comes with prescriptions, labs, messages, orders, recheck appointments, referrals, so on and so on. I have never left working feeling as if I completed my job, because it will never even be near caught up. We are just always doing damage control, triage and mop up)

So we have to limit how many new patients we see each day, in order to save as many slots as possible for the established patients. Other clinics can say "no new patients, our practice is full". Not community health care. Federal and state dollars come with the stipulation that nobody is turned away. Nobody is turned away, but we have to slowly add new patients.

I know personally that things were squeezed a bit to get this patient in, this woman with the broken wrist. Most likely it would have been another week, if the "rules" were followed. To clarify, any children we get in immediately if they are sick or injured. They don't have to wait, we will squeeze them in that day if needed. OB patients (pregnant women) are in the same category. Just to start prenatal care they may need to wait a few weeks, but if they are hurting or bleeding we will put them in no matter what. (even if the Dr's all have their 28 slots full, which is why we end up with 30 or more patients most days)

How is it that in a country with as many resources as ours, people would have to wait weeks to get an arm casted? How is it that with so much money involved in the health care system, we have a wide chasm many fall into? Why is it that the burden of meeting the immense needs of the many are left in the hands of a few?

So as I was washing this woman's arm, which had been under a splint and bandages for two weeks, she kept washing her face, her other arm, with the soapy water. She said it was so dusty outside. I asked where she had been showering and she said she had used the one at the day shelter about once a week, but she felt awful. I had her stuff two packages of baby wipes in her pockets to take with her. I asked where she had been sleeping, and she said that after the friend she moved out here to live with kicked her out, she had been just doing her best to find out of the way places to go unnoticed at night. Some nights she was in the shelter, but she was afraid of the other people there.

I must add here that I see all sorts, the very mentally ill, the disabled, the addicted, and I really think she was not entirely hopeless. I can see that probably not long ago she was productive, functioning. I don't know her full story, nor did I ask. I just want to be the gentle smile and word of encouragement to those in front of me. That is why I am community health care. I have learned not to invest my heart, because then there is nothing left of me. this has not been the easiest lesson for me in this life.

She was clearly in a lot of pain. the process of washing and then casting her arm was not entirely gentle, and she shed some tears. She said that if she still had any of the vicodin she was given in the hospital she would have taken one ahead of time, but they were stolen. Her hospital record said that she was given 20 pain pills. It would have been entirely understandable if she had used them up in the two weeks she has been in pain, without a cast.

The Dr said not to worry about it, she would write her a prescription for more, say 20, but there would be no refills.

The patient asked her if she could make the prescription for less than that. In my healthcare experience, NOBODY asks for less pain pills. Even healthy people might think that the will use the few extras just in case, to have tucked away in case they re injure that knee or whatever.

This woman, in extreme pain, who has had to wait 2 weeks to get her wrist properly immobilized, said that she would have to panhandle in order to get enough money for a few pain pills. She asked for the Dr to only write it for 5.

Our system is broken. Seriously broken. This could be you, your mother, your sister, your old 2nd grade teacher. It could be the college student living on ramen or the new father, who gives up his own needs to meet the needs of his child.

The crisis out there, the one that most people don't see, it can't be fixed by just a few soldiers. We need an entire national effort to stop this.

I truly weep as I watch this finally being addressed by an administration. I don't care how many people tell me that individuals need to be responsible for their own health care. That it would be an un-democratic move to move in the direction of socialization. I invite any naysayers to just spend an afternoon sitting in the waiting room of a community health care center. Last I heard, it is likely that many of them will see themselves reflected in the faces of the estimated 40% who have no health insurance. That number is expected to rise in the next few years.

I wanted to pull a handful of bills out of my wallet, to help this woman manage her pain. but I can't fix it, I can't save them all alone. Are you willing to help? If so, send an email or letter to your representative, and tell them that health care reform is important to you. It is important to us all. Tell them that you believe every single American has the right to basic health care.

I was the first to sign her cast. I drew a great big red heart, with the words "Be Strong" boldly printed in black. I hope she is strong, and is ok in the end.

Picture this if you will.....

Mom sitting in the living room, back to the dining room, with her feet up for a few minutes after a long hard day in Community Health Care. The 17 yr old girl is helping her 7 year old brother on his homework. Suddenly she exclaims "No! This is so confusing, I can't even understand this problem!"

Yes, this is the same eloquent, well spoken teenager a few blog posts ago! It is moments of laughing hearts that makes being a parent such a wonderful journey.

So, can we talk health care? Our health care system is a disaster. I know that is not a surprise to most of you out there. The view from all sides of this (including from up in the tree) are equally devastating.

I am a health care consumer. I have a chronic illness, complicated by many factors. I have chosen a provider who uses integrative medicine to treat my illness and keep my quality of life relatively acceptable. Because my insurance considers this provider to be out of network, I pay more out of pocket. This is in addition to a multitude of tests, specialist consultations, an average of a surgery or other hospitalization each year, and prescriptions.

I would like to pursue alternative treatments for my illness, such as massage and acupuncture. If I do pursue alternatives, however, my insurance will only pay a small portion if any of that cost if any. Yet my insurance will happily pay for a prescription instead, that will mask my symptoms but not correct any of the underlying problems. In fact, they will only make me pay up to a specific amount each year, then they pay the rest. So it is to my benefit to be more and more reliant upon a pill to fix me.

Yet I am the lucky one in the whole picture. I saw a patient in my clinic today with the same health problem. She is unable to work due to her condition (partially because of inadequate care?) so she has to access the community health care center. She does have health care, but it is with a provider who is so hard pressed to even begin to meet the overwhelming need that she squeezes more patients into a day than my primary provider does. (This is partially due to the lower reimbursement rate by Medicaid and Medicare, and the need to increase quota in order to stay afloat as a clinic.) In fact the need is so great that on top of the higher number of appointment slots she has created, she double books over half of those appointments to accommodate the awful flu sweeping the community, the children who must be hospitalized, and the very ill.

As frustrated as I get with my reality as a health care consumer, I am even more devastated to watch daily the disastrous system that has evolved in an attempt to meet the needs of a huge segment of our population. This segment is growing bigger daily, due to the state of the economy, and more and more families loosing insurance. So to meet the increasing need, the community health care system is being spread thinner, thinner and thinner. Our culture, our country, our political leaders, have fed into a system of insurance companies, copays and deductibles, and it has lost sight of the purpose. The need is the help people restore or maintain health, to have a good quality of life, to be able to contribute and be functioning parts of society. Yet that need is met by the few, by the desperate, by the "system".

I am quite tired tonight, after a day in the trenches. I know my thoughts are not quite coherent, and I may edit this later, but I see the need daily. I see the crisis before us, I experience the frustration of not being able to fix the problem. I feel inadequate every single day. I can't possibly get every patient back to see the Dr while also doing vaccines, returning 30 calls, finding 20 charts, calling the hospital 3 times, drawing blood 12 times, and trying to find a specialist to see 4 of our high risk patients. Really, if each Dr in my clinic sees 32 patients in a day (which is the approximate goal established in order to make the clinic viable) then we can't do it. We can't do it with the resources we have, the manpower we have, the facility and the energy. it is draining, exhausting and discouraging. I want to be part of a system that really meets needs, that provides what our people need.

The system needs fixed............