Free medical clinics alleviate financial concerns for many cash-strapped central Iowans
By Amber Williams
"Health is the greatest gift..." - Buddha
Why then, does it come at such a cost?
In Des Moines, 10 percent of the population was without health insurance in 2009, some of whom tell tortured tales of health conditions that go untreated. They learn to live with the symptoms that ail them — a wheezing cough, searing infections, sprained joints, even asthma. They either don't qualify or can't afford health insurance. And often large medical institutions turn them away because they're not taking new patients.
Meanwhile, in 2009, physicians in Des Moines averaged an estimated salary of more than $200,000.
That obvious imbalance, and "a calling from God," is exactly what inspired Dr. James Blessman to begin a string of free clinics throughout the city.
"I was a physician making good money, and I thought I needed to reach out to the community and help with my spare time — which I didn't have a lot of spare time, but eventually I found others in the medical field who could volunteer their time, too," Blessman said.
It started in the early 1990s at the United Methodist Church in Polk City. Then, a second free clinic emerged at the Maple Street Baptist Church on Des Moines' east side — a neighborhood in desperate need, Blessman said. Today, there are 31 small, community-run free clinics across the state now housed under the Free Clinics of Iowa organization.
"It's great they have a support network in us, but it's unfortunate that the need is so great," executive director Wendy Gray said. "It's a sad state of affairs."
When the Free Clinics of Iowa started taking local free clinics under its wing seven years ago, there were only a dozen under its umbrella. That number has grown to 31.
"Originally when we got started, our mission was just to help other free clinics get started," Gray said. "Now, we've evolved to be an initiation, operation and collaboration of free clinics across the state… And we, as a central office, don't go into a community with a need and start a free clinic. It's always the community coming to us because of need.
And according to Gray, Free Clinics of Iowa members have had a 150 percent increase in patient visits statewide between 2005 and 2009.
"We function as an agency but without the dues," she explains. "Our philosophy is, we exist to ease the administrative burdens off the free clinics, not put more on them."
The Free Clinics of Iowa helps clinics get organized. It provides them experience in initializing and maintaining new clinics and offers policies and procedures for fund-raising and volunteer recruitment and retention, which hits the two primary needs for operating a free clinic.
The initial challenge Blessman faced starting the first free clinic was finding qualified people who were willing and able to donate their time. Soon he partnered with Registered Nurse Becky Stover, who was a member of the Polk City church where it all began.
"When they announced they were going to start a clinic, I decided, that's going to be my mission field," Stover said. "I always wanted to go on a mission."
But instead, the mission came to her. And 15 years later, she is the Clinic Manger at the Margaret Cramer Clinic, located in the First Assembly of God church on Merle Hay Road. Stover reported nearly 600 patients were served last year at her clinic alone, which is only open for two hours, at most, one night a week. It has one of the highest numbers of people served of all the free clinics in the city.
"Sometimes the doctor might come in and say, 'I've had a long day, so I can only see 10 patients tonight,' and I have to honor that," she said. "Because if I don't have a provider, I don't have a clinic. Our staff is all volunteer. Nobody gets paid."
In that one night, every Thursday, the Margaret Cramer Clinic serves about 15 patients on average, she said. It is one of eight Free Clinics of Iowa located in Des Moines alone. They are tucked away in basements and back rooms at churches or schools offering all the same services as a traditional clinic but with challenges that are all their own.
"There is not a single free clinic that's not being inundated with patients right now. They're just getting slammed," Gray said. "There is a huge need and not enough options for people.
"So many think that these are people on the fringe of society, and they're not," Gray said. "It's just not that climate now, because of the recession, the unemployment rates and the dysfunction of our health care delivery system."
Gray's point is exemplified by the high levels of patient participation at the new West Des Moines and Waukee free clinics. Even in what she said are considered "the more affluent neighborhoods," the people come in droves. They're not the backpacking vagrants or indigenous people that historically might have made use of free health services years ago.
Most free clinic clientele, in fact, are working-class families who are "falling through the cracks," Gray said — people who are too old for Hawk-I insurance and too young for Medicare (ages 18 to 64). Many people have defaulted to working part-time jobs due to the recession, which usually makes them ineligible for health benefits.
While the clientele numbers have grown, the free clinic staff and the space proportionately have not, Stover said. And aside from finding a qualified staff of volunteers, funding is also an obvious hurdle. The entire process relies on those two key elements — people and money, Blessman said. Some volunteers donate their time by writing grants for the clinic or organizing fund-raisers.
"All the things you need to run a for-profit clinic, you need at a free clinic, but on a shoestring budget," he said. "But Gov. Robert Ray was a friend of mine. He granted us $40,000 to help, and that's kind of how we started the first 10 to 12 clinics… In those days, we invested about $4,000 into open spaces in churches."
So fellowship halls, vacant offices and church child care centers were transformed into clinics that now serve as many as 25 people on an average three-hour day. The Free Clinics of Iowa members alone draw more than 15,000 Iowans every year.
Yeah, but is it really free?
All that sounds well and good, but what's the catch? The word "FREE" is boldly tossed around like a lure for suckers in need, and it's attached to nearly every too-good-to-be-true deal out there. But in this case, and with the Iowa Health systems free clinics as well, the promise is kept.
Certain clinics may have some stipulations — such as the Southeast Polk Children's Clinic in the Christ of Kings church in Altoona that only serves people from birth to age 21, and the Jim Ellefson Free Medical Clinic on East 33rd Street that will not treat chronic illnesses — but it's free just the same.
"We don't ask for any financial reports or anything," Stover said. "You could drive up in a Mercedes, and we wouldn't even know, and we'd still treat you."
Technically, though, most of the Free Clinics of Iowa locations prefer to help the uninsured and the underinsured. That is, people who have health insurance and suffer from a condition that their insurance will not cover can be treated at the free clinic, and Stover said that is often where they turn.
"We ask them if they have insurance, and even if they do, sometimes we still see them," Stover said. "There are some things their insurance just won't cover. We don't turn anyone away unless the patient load is full."
And for that reason, Stover and other free clinic managers throughout Iowa are forced to turn people away every day. Most are a first-come first-served operation, which means the lines can start early and grow quickly, as each clinic is limited on the hours it can be open.
"We have enough volunteers to staff our clinic without too much overload on anyone, but the economic downturn has played a part in our growth, which is not an area where we want to keep growing," said Dr. Julius Conner, who volunteers at the Corinthian Family Health Clinic downtown — one of the city's oldest and most-used free clinics, according to Gray.
Conner reports 218 people were served there last year. The clinic started in 1994 strictly for child immunizations, which became even more popular after state laws changed to make immunizations mandatory for elementary school enrollment, he said. Now immunizations make up about 85 percent of the clinic's service.
But free clinics are struggling even more as the scope of service expands further into chronic diseases that require more comprehensive care. Clinic managers and providers across the city are reporting more patients seeking treatment for heart disease and diabetes, and there is little the free clinic can do for them.
"We believe that providing a bit of help is better than ignoring the need altogether," Gray said. "The free clinics offer quality health care, and there is certainly a lot of compassion, but we are not a medical home. A free clinic is not going to provide the continuity and comprehensive care that you'll get at a traditional office."
Gray reports 30 percent of free clinic patients are there for chronic diseases like diabetes and hypertension. Although referring those patients to a medical agency doesn't usually help them, there is little else clinic managers can do. In response, Free Clinics of Iowa have developed training and education programs for patients on adequate disease management. Like Conner, Stover reports more people with chronic diseases at the Margaret Cramer Clinic as well. Though the clinic tries to keep antibiotics on hand, its medical resources are far limited compared to hospitals and doctors' offices.
"The free clinics are legal clinics just like a doctor's office, except we're limited because of hours," Stover said. "We're not meant to be a medical home, but we end up being that for a lot of people. And we're just not designed for that."
If it's free, don't you get what you pay for?
Because it's free, of course the clinics overflow with patients. That means long wait times if patients don't get there early. It means tight quarters during the process. And it also means a more limited scope of treatment, admittedly. But Gray assures the quality of care is no less than a for-profit clinic or hospital.
The providers are trained and certified through the state "with active unrestricted licenses to practice," Gray said.
"Those doctors and nurses aren't going to do anything to jeopardize that," Gray said. "If a free clinic doesn't meet the adequate standards set by the state, than a provider wouldn't be involved with it."
Stover assures the facility and the equipment are sterilized according to the same standards as well. And the staff strictly follows those mandates, too. But the atmosphere of each clinic depends on the space provided. While most are housed in church offices and basements, Gray said the Jim Ellefson Free Medical Clinic, for example, leases a building that was once a pharmacy for a nominal fee. And the Des Moines University Free Clinic is available via mobile unit.
While the doctors, nurses and facilities meet state medical standards, even the non-medical volunteer staff must undergo extensive background checks prior to being approved to perform office and customer service duties, Stover said.
In addition, because so many of the clinics are housed in churches, many of the volunteers are recruited from the parish, which usually means genuine compassion, helpfulness and home-cooked food for waiting patients.
But I need my body saved… not necessarily my soul
When Blessman first started the free clinics, they were admittedly very faith-based, which is fitting considering they were, and are, typically housed in churches. It was not only a way for the good people of the parish to reach out and fulfill their "missions," like Stover, but it was good PR for the church, too.
As the free clinic initiative grew into more of a secular business, Blessman admits he began to lose interest.
"Early on it was more religious and spiritual… now it's a more social clinic, and that's fine with me, but my real calling was that God wanted me to do this," Blessman said. "So, when it lost its religious feel, I became less interested.
"So, I walked away from my practice and started doing full-time missions," he said. "I traveled to 70 different countries, but about seven years ago God called me to settle in South Africa."
Now, at 66, Blessman and his wife, Beth, still live on a big safari game farm there. With the help of hundreds of supporters in Iowa, including Gov. Terry Branstad, Blessman Ministry orphanages provide health care, eye glasses, education and meals to more than 1,600 children every day.
"It's literally saving their lives," he said. "It's making them better thinkers, better studiers and healthier overall… They will become the future leaders of this country."
It takes a village
Dr. Blessman gets a lot of help in his South African mission, just like the free clinic chains do here, as well. Des Moines University medical students are allies on both fronts. Forty DMU med students travel to Blessman's camp every year to learn how to treat AIDS, tuberculosis and malaria as part of their Global Studies program.
"It teaches them how to practice medicine in a Third World environment," Blessman said. "It makes them have to think with their brains instead of just with test results."
The students are also among the free clinic volunteers in the Des Moines area.
The Free Clinics of Iowa members would likely not be able to provide such vast services for so many people if it wasn't for such a strong and committed support network. Donations and support come from people, agencies and grants, including a 2009 initiative by the Iowa Health Care Foundation to remodel several Free Clinics of Iowa facilities. They also have received about $3,000 a year from Iowa Nebraska Primary Care — the Iowa Collaborative Safety Provider Network (which Stover sadly said was defunded by 20 percent this year).
And, it was a $300,000 grant from the Robert Wood Johnson Foundation that enabled the first of the free clinics to operate for four years after opening.
"They not only gave us their money, but they taught us how to do free clinics," Blessman said. "It's a great thing. They also provided a national network where we could learn from each other."
Blessman Ministries and the Free Clinics of Iowa are always looking for donations and volunteers. Visit www.BlessmanMinistries.org and www.FreeClinicsOfIowa.org to learn more. CV