Community clinics serve 1 in 11 Americans. They are a safety net under pressure

NEW YORK (AP) — Alyssa Reyes has been going to Plaza del Sol Family Health Center for her medical appointments for more than a decade. Although she moved away some time ago, the 33-year-old keeps coming back, even if it means a two-hour journey by bus.

That’s because the doctor who takes care of her also takes care of her two children. Because if she is ill, she can come without an appointment. Because Queens Clinic staff helped her apply for health insurance and food stamps.

“I feel at home. They even speak my language,” Reyes said in Spanish. “I feel comfortable.”

Plaza del Sol is one of approximately twenty facilities operated by Urban Health Plan Inc., one of approximately 1,400 federally designated community health centers. One in 11 Americans turn to them for routine medical care, social services and, in some cases, fresh food.

Clinics serve as an essential safety net for low-income people of all ages in every state and territory of the United States. However, this is a safety net that is under pressure.

Since 2012, community health centers have seen a 45% increase in the number of people seeking medical care, and have opened more locations to offer their services and expanded their coverage to more than 15,000 locations.

Many clinics are understaffed and struggling to fill doctors, mental health professionals, nurses and dentists. Those responsible also explained to The Associated Press that the issue of funding is a constant concern, as the debate over the federal budget, which has been going on for months, makes it difficult to plan and hire long-term staff.

Despite this, clinics are trying to improve the health of their communities and access to primary care, confronting disparities that begin long before a patient walks into the office.

Tackling health disparities

Community health centers, in one form or another, have existed for decades, and when urban and rural hospitals close or reduce services, they are largely what is left to serve the community.

Dr. Matthew Kusher, clinical director of Plaza del Sol, says there are things prescriptions can’t change, like preventing the spread of flu and COVID-19 when people live in apartments with one family per room And it is impossible to keep them in quarantine.

“What we provide here is only 20% of what it costs to spend on someone’s health,” Kusher said. “Their health depends more on other factors, on poverty and lack of access to food, clean water or healthy air.”

According to the U.S. Health Resources and Services Administration, nine out of 10 health center patients live at or below 200% of the federal poverty line. Besides:

– In 2022, approximately 1.4 million health center patients were homeless.

– One in five did not have insurance.

-Half were enrolled in Medicaid.

– One in four felt better served in a language other than English; About 63% in the United States were racial or ethnic minorities.

“We are clearly addressing these disparities in the communities that need it most,” said Dr. Ky Rhee, president of the National Association of Community Health Centers. “We have a workforce that works tirelessly, and is flexible and diverse, representing the people they serve. And that trust is important.”

Yelisa Sierra, medical specialty case manager for Plaza del Sol, says she often hears questions from people who need clothing, food or shelter. Recently, the clinic has seen many recently arrived immigrants. You wish you had a better answer to the question you hear most: Where can they find a job?

“It’s not just a medical need, it’s emotional,” says Sierra, sitting in a narrow office next to a crowded waiting room. “They need someone to listen to them. “Sometimes, it’s just that.”

Fifty years ago, Dr. Aqlema Mohammed started as a medical assistant at the urban health plan’s first clinic, the San Juan Health Center. It has served some families for three generations.

“Working in this community is very rewarding. “I walk in the door, or walk down the street, and I get hugs,” he said. “All the time: ‘Oh Dr. Mo! Still here.'”

Mohammed’s biggest concern is the staff. Many pediatricians retired or looked for other jobs after the worst of the pandemic. It’s not just about the money, either: He says job seekers tell him they want quality of life and flexibility, with no weekends or long hours.

“It is a demanding job and a big problem because we have many sick children and many sick patients, but we do not have enough professionals to take care of them,” Mohammed said.

Former pediatricians sometimes turn to virtual visits to ease the burden, and that helps, too, he said.

When patients cannot resort to remote health care, El Nuevo San Juan Health Center strives to provide them with home care. About 150 seniors receive home visits a day, said Dr. Manuel Vazquez, vice president of medical affairs for the city health plan, which oversees the home health program.

Many times the home visit is not covered, but the team does it free of charge anyway.

“We said, ‘No. We have to do this,'” he said.

building bonds of trust in the community

In the wake of the “Freedom Summer” of the Civil Rights Movement, one of the nation’s first community health centers opened its doors in the rural Mississippi Delta in 1967.

Today, Delta Health Center in Mound Bayou, Mississippi has 17 health centers in five counties, including free-standing clinics and some schools.

Workers face challenges that have been passed down from generation to generation, such as hunger and limited transportation. Cooking classes and vegetables from the community garden. In nearby Leland, a town of less than 4,000 people, there is a clinic that is open on Saturdays, because many people do not have cars to make the 15-minute highway trip to the nearest small town, Greenville, and there are no cars there. There is no public transport. ,

According to Tamica Simmons, director of public affairs for the Delta Health Center, this type of access to preventive health care is important as area hospitals are reducing neonatal and other specialty care services.

“If you have a heart attack, you have to be flown by helicopter to Jackson or Memphis, where they will have the equipment needed to save your life, should you die on the way,” he explained.

Another key to centers’ ability to improve health disparities is understanding and becoming a part of their communities.

Plaza del Sol is located in the Corona neighborhood, which has a density of immigrant and mostly Latino populations, which was the epicenter of the spread of COVID-19 in New York. Staff is required to speak Spanish. They regularly visit a local church to organize vaccination drives reaching hundreds of people. Angelica Flores-daSilva, the center’s director, says a community director called her directly asking for help vaccinating children and preventing them from being expelled from school.

In Mississippi, workers are trained to look for signs of abuse or to know that a patient who “complains and fights” about filling out forms probably can’t read. They distribute clothes, food and other aid as if they are giving it to everyone.

“People hide their circumstances very well,” says Simmons. “They hide illiteracy well, they hide poverty well and they hide abuse very well. “They know exactly what to say.”

To continue serving the communities they want, those responsible at the center say they squeeze out every penny, but they need more money.

A $2.1 billion increase in federal funding for centers to match 2015 funding levels, taking into account the growing number of patients and inflation in the health care sector, according to an analysis sponsored by the National Association of Centers of Community Health. Will have to do.

“You can’t be overwhelmed by the problem,” Simmons said. “You just have to take it day by day, patiently patiently.”

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Associated Press data writer Kasturi Pananjadi contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. AP is solely responsible for all content.