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HELPING THEMSELVES: A patient visits Shelter Health Services in Charlotte, N.C.
Sam Cranston/Genesis
HELPING THEMSELVES: A patient visits Shelter Health Services in Charlotte, N.C.

Patient dedication

Healthcare | Charity clinics often focus on changing unhealthy behavior, but it takes a long-term outlook and patients who want to change

Issue: "Race to the finish," Nov. 3, 2012

Atlanta’s Good Samaritan Health Center sits on a hill in a modern, $2.3 million white building that’s wildly different from the run-down tire shops and soul food joints surrounding it. The road leading here is narrow and lined with weeds and construction cones. 

Inside, full-time staff physician David Derrer moves through one of his typical days, with 14 scheduled appointments before noon. “I’ll probably work through lunch,” he says, while making notes on a patient’s file. He steps into a room and greets Kirk, a young African-American man who recently lost his job and home. Kirk lives at a local homeless shelter until things get better. With high blood pressure, he can’t get work as a truck driver. 

“Are you still smoking?” Derrer asks. Kirk nods: “You got any meds for that? You know, to quit?” Derrer looks at him: “Are you ready to quit?” Kirk chuckles and looks down, shaking his head. Derrer pats his arm. “I’ll give you medicine when you’re ready.” Then he prays with him: for the blood pressure, for the need to quit smoking, and for work.

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Sharon, a middle-aged African-American woman, is one of the patients who has changed. She carries a quart-sized plastic juice bottle full of water wherever she goes, but she didn’t used to. Six years ago she first came to the clinic with unmanaged diabetes. She had been caring for her daughter with cerebral palsy, leaving no time to take care of herself. Without insurance, she had no way to pay for her regular medical care. 

Doctors at Good Samaritan taught her the importance of exercise, nutrition, and drinking plenty of water. Sharon now exercises more and eats better. Since her daughter’s recent death, she has let some of her new habits go, but she plans to go back to them. During her daughter’s final days, Sharon says she found comfort and help from her doctors at Good Samaritan. She still seems surprised that one doctor took her hands and prayed with her: “How many doctors you know take a personal stand with you?” 

Changing patient behavior: That’s a crucial challenge for clinics serving poor and uninsured patients. Many are overweight and suffer from chronic diseases like hypertension, diabetes, and heart disease brought on by stress and bad habits—smoking, drug and alcohol abuse, and poor diets. These patients frequent hospital emergency rooms, which aren’t designed to treat chronic disease.

Charity clinics have increasingly stepped into that gap. Shepherds Clinic in Baltimore offers relationship-emphasizing wellness programs, focusing on long-term rather than short-term change. Shepherds, which sits on a knoll surrounded by bright pink rose bushes, has walls painted in variations of yellow, blue, and green. Jessica, the brown-haired receptionist, greets patients as they walk in, calling some of them by name as they approach the desk. 

Located in a rough section of Baltimore, Shepherds serves “a stressed-out population.” The surrounding neighborhood has record high rates of homicide and hypertension, statistics that form a powerful contrast with Shepherds’ bulletin boards that advertise the clinic gardening club, yoga classes, and healthy eating and cooking workshops. 

The clinic’s working poor patients don’t have insurance. They make too much money for Medicaid, so if they didn’t come to Shepherds, they’d be using the local emergency room. Executive director Jack VandenHengel says the clinic’s patients are focused on paying rent, avoiding eviction, and keeping utilities on: “People come here at their wit’s end. Their world is falling apart. … They need a primary care physician who will pay attention to them over time.”  

The clinic’s staff confronts a fatalistic mentality that asks, “Why would you do anything different if you’re just going to be dead?” That’s where classes about cooking healthy foods, gardening, and exercising fit in: They encourage patients to take off bad habits and put on better ones. Even with all the offerings, the clinic staff can’t force patients to take advantage of the free resources. It often takes months before a patient ventures beyond the examining room to see what else the clinic offers.

Patient counselor Susan Hildebrant is deep in conversation with a man who wandered into Zarephath Health Clinic in Zarephath, N.J. He didn’t have an actual appointment: He just needed to talk. Hildebrant says part of her job involves talking to people who don’t have friends, family, or other support networks. Sometimes those random conversations open up opportunities to discuss spiritual things.

The clinic serves mostly low-income Hispanic families, but it also sees students and anyone unemployed and without insurance. Sometimes patients see the doctor. Sometimes they see both counselor and doctor. Hildebrant explains to patients basic stuff: why it is important to eat healthier food, how to budget, and what to cook. She says her patients see fast food as a better meal than banana and peanut butter, which costs about the same but is healthier. Hildebrant says many Hispanic diabetics find it hard to limit their intake of rice, a cultural staple.

With reporting by Tiffany Owens, Christina Darnell, and Kira Clark

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