STARTING A FREE CLINIC IN A RURAL AREA

Health Progress, Mar/Apr 2004 by Grimes, William R

People in a small Kentucky town pool their talents to solve the access problem.

Today millions of Americans lack regular access to health care. Although we usually think of such people as city dwellers, the fact is that many can be found in our nation's rural areas.

What can be done to help the uninsured and disadvantaged? If people are truly made in the image of God, and, as his children, have a right to his gifts, including health care; and if we as Christians and ministers of the compassion of God really have the desire to care for those most in need-what should we do?

One set of answers is offered by the Christian Community Development Association (CCDA), a Chicago-based organization that specializes in training Christian community leaders for impoverished areas. Born in rural Mississippi in the 1960s, the organization now has members around the world.* The CCDA describes the plight of the uninsured as a "desperate condition" that calls "for a revolution in our attempts at a solution. . . . These desperate problems cannot be solved without strong commitment and risky actions on the part of ordinary Christians with heroic faith."

To its members the CCDA says: "Go to the people. Live among them. Learn from them. Love them. Start with what they know. Build on what they have. But of the best leaders, when their task is done, the people will remark, 'We have done it ourselves.'"

My own introduction to the plight of the uninsured came from one of my good friends, a nurse practitioner named Julia Mancss. Julia was concerned about the fact that the hard-working poor of our area-rural eastern Kentucky-were not getting the health care they needed. Because of her concern, she had taken a job on a mobile clinic operated by St. Joseph Hospital in Lexington. The clinic, which travels around the area, specializes in treating the urban poor and uninsured in Lexington.

"We can do the same thing right here, in the hills of eastern Kentucky," she said to me one day. "Just imagine: We could have a mobile clinic and go from community to community with health care and spread the 'good news' at the same time."

From then on, each time we met (usually following services at St. Julie Catholic Church in Owingsville, KY), she brought up the idea. "When arc we going to do this? It needs to be done now. Let's get it on the road."

Then, one day in December 1999,1 was standing on the sidewalk in Owingsville, waiting to watch the town's annual Christmas parade, when my friend Dave Daniels happened to come by. Owingsville, a village of about 1,000 people, is in the mountains some 45 miles cast of Lexington. Dave is a planner for the district's health department. I told him that I was concerned about the area's growing number of uninsured people. He was concerned, too, and he had the demographics to back up his concern.

Not long after this, Julia, Dave, and I began meeting regularly in the church basement to discuss the problem. We knew from our reading that it is necessary, before tackling such problems, to analyze the community involved and see what assets arc available. According to one source, community development must start from within the community. "Development of policies and activities [should be] based on the capacities, skills and assets of lower income people and their neighborhoods." Every community needs its "movers and shakers." But in order for a community to mobilize, everyone involved must participate to one degree or another. "Community builders soon recognize that these groups [composed of people with low incomes] are indispensable tools for development, and that many of them can in fact be stretched beyond their original purposes and intentions to become full contributors to the development process" [Emphasis mine].2

CREATING A FREE CLINIC

Here's how we went about "stretching" the Owingsville community to fulfill the promise of a free health care clinic.

Jeff, a carpenter who is himself uninsured, came first to our assistance and offered help with the planning. A local bank had given us the use of an empty store, but the building was in bad shape. The building had to be gutted and rebuilt. Jeff helped put up the new walls that would divide the structure into a waiting room, offices, a laboratory, and examination rooms. Charlie, a semiretired hardware store manager and electrician, put in new wiring. Danny, a contractor, directed the drywalling. Since Danny was uninsured as well, he became one of our first patients when the clinic finally opened.

Ron, who works at a local lumber company, got us discounts on building material. Scott, a journeyman plumber, put in all new plumbing, including five sinks and new water lines. Scott, who also has no insurance, has significant heart disease. We have been taking care of him for a year now.

Roy, who owns a heating and air-conditioning company, thinks I saved his life. Some years ago he came into the clinic where I worked complaining of chest pain. I started him on life support and sent him to the hospital in an ambulance. Now he is always eager to help and will get involved with me on any project. He installed a whole new heating and air-conditioning system in our building.