Caring for the Upstate's most vulnerable: Free medical clinic braces for surge in patients
Scott Anderson is among the most vulnerable people in the community as the country battles coronavirus.
The 53-year-old Greenville man works in the kitchen of a local fast food restaurant earning $10 an hour.
He doesn’t have health insurance. He can’t afford it.
And since his shift was cut to five hours a day because of the virus, he can barely afford his bills either.
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One recent spring day, he sat on a bench outside the Greenville Free Medical Clinic waiting to get his medication for a chronic health condition.
“I was surprised that they were open. I thought they closed it down like they closed everything else down,” he said. “But I’m glad they’re open. It’s terrible what’s happening now.”
While the clinic is still providing care, it’s much different than in the days before the coronavirus, said Executive Director Suzie Foley.
An average 75 to 100 patients come by every day, mostly to pick up medication, she said. And about 30 to 40 patients are cared for by telephone. Overall, volume is off about 50%, she said.
But with thousands of people losing their jobs, and often their insurance, amid the pandemic, the clinic is bracing for an onslaught of new patients in the coming weeks — patients like Anderson who are already among the most vulnerable in society.
“They need us and they’re counting on us,” Foley said. “And our staff has really been great about their dedication to continuing our services.”
At higher risk
Free clinic patients are often at higher risk for coronavirus than others, said Dr. Georges Benjamin, executive director of the American Public Health Association.
They are the grocery store clerks and bus drivers and other public-facing workers who don’t have the option to work from home and shelter in place, he told The Greenville News.
They typically have no insurance and often no paid sick leave. So if they don’t work they don’t get paid, and if they don’t get paid they don’t eat, he said.
Many are from communities of color and are low-income with disproportionately high levels of chronic conditions like diabetes, heart disease and asthma, which not only makes them more vulnerable to the coronavirus, but to get sicker and die from it as well.
In South Carolina, for example, blacks make up about 27% of the population, but 41% of COVID-19 cases and 56% of the deaths as of April 15, according to the state.
And with the lack of testing available, most people with less severe symptoms are told to just go home, Benjamin said.
“If we had (testing) early on … we would have had a different tool to help by doing contact tracing, more targeted isolation and quarantine,” he said. “But it’s been two months and we still don’t have the tests.”
These patients often live in small apartments and bungalows, often with several others, making physical distancing more of a challenge, he said.
And if someone does get COVID-19, quarantining and caring for them at home while providing good infection control can be tough.
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This also is a group with a disproportionate number of smokers, particularly in tobacco country, making them more likely to get sick, Benjamin said.
“This is a population that’s at enormous risk,” he said.
“The challenge as we have an outbreak is that we must not forget about the fact that we have people with underlying disease that need care,” he added. “And we must continue to care for them.”
A new normal
Coronavirus has changed lots of things at the Greenville Free Clinic, Foley said.
The number of people allowed inside is limited. Most in-person visits have been eliminated in favor of telephone appointments. And medications are typically brought to patients who wait outside.
A month ago, it closed its satellite offices in Greer, the Golden Strip and the Northwest Crescent, which operated one or two days a week.
Now only the downtown location is open with no evening hours and is closed Fridays.
“It seemed to be the wise move … with potential exposures,” she said.
Patients are screened when they call for an appointment and those with COVID-19 symptoms are referred to the virtual visits provided by hospitals, so COVID patients aren’t seen at the clinic, she said.
A couple of patients have tested positive but were not hospitalized, she said, while tests of two staffers came back negative.
Specialty visits have been rescheduled into late May and June when it’s hoped that volunteer providers will be back, she said, and the only dental visits being done are for emergencies.
The situation at the Taylors Free Clinic is much the same to protect patients and staff, said Karen Salerno, executive director.
In-person visits have been limited and most cases are handled by phone, she said. Patients, staff and anyone else coming to the clinic are screened at the front door for temperature and travel history.
Providers who aren’t onsite work from home responding to patient questions electronically and reviewing labs and prescription refills.
Front desk staff wear masks and anyone in the building must be masked and gloved, Salerno said.
All non-essential services, such as nutrition classes and in-house X-rays, were discontinued while a temporary walk-up window for prescriptions was established.
As the pandemic progressed, all volunteers were furloughed and staff schedules were staggered to limit the number of people onsite and make sure they are 6 feet apart when possible, she said.
Any patients suspected of having COVID-19 are funneled to a hospital to be tested and treated if necessary, she said.
“We’ve taken every measure we possibly can,” she said. “With all that, we feel like we have as safe an environment as we possibly can and still maintain the services we want to deliver.”
The clinic provided more than 4,600 patient visits last year and filled more than 21,000 prescriptions, Salerno said.
“We want to continue to supply services that our patients desperately need,” she said. “Most are very hard-working people that have had to make some very tough choices and just cannot afford medical care and don’t have access to affordable medical care.
“By the time they land on our doorstep, they face the tough choice of feeding their family or buying medicine.”
A lack of equipment
But like many health care facilities in the age of coronavirus, the Taylors clinic doesn’t have enough personal protective equipment, or PPE.
“We have enough gloves and enough eye shields,” she said. “But N95 masks we’re extremely low on.”
Each staff member has her own N95 mask — normally a single-use item — which they are wiping down with cleaner and reusing for days.
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“If it’s questionable, they will wear a surgical mask underneath the N95, which is extremely uncomfortable,” she said. “But those we have enough of that we can discard after a single day’s use.”
PPE is in short supply at the Greenville Clinic as well.
“We were fortunate to receive a shipment of 250 N95 masks from our national partner Direct Relief,” Foley said. “We had a handful prior to that so we virtually would not have had many at all.”
Direct Relief works to improve the health and lives of people affected by poverty or emergencies. It’s providing $1 million to clinics for operating support and for PPE to protect patients and staff.
Some 2 million people get health care at the nation’s 1,400 free and charitable clinics and pharmacies each year, according to the agency. They run with little to no government funding and rely on the support of donors, partners and 207,000 volunteers, the agency said.
Nicole Lamoureux, CEO of the National Association of Free Clinics, said that without clinic services, medically underserved patients would be forced to use hospital ERs for care — a problem anytime, but particularly during a pandemic.
Hand sanitizer and disinfectant wipes have been hard to come by, Foley said, but because of its dental clinic, the Greenville center has enough face shields and gowns.
Preparing for more patients
The staff is holding up, Foley said. But it’s a stressful environment.
And there’s additional tension because of the uncertainty about what comes next. South Carolina hasn’t reached its peak number of cases, which is expected at the end of April.
And combined with record unemployment resulting from businesses closing down, the staff is preparing for an influx over the next couple of months.
And that’s at a time when donations are off.
“With the stock market, and foundations and individuals watching their portfolios kind of crumble in front of them,” Foley said, “we’re not alone in believing that through the end of this year and into next year, it will be a challenging time for all nonprofits.”
Last year, the clinic had about 3,500 patients who made 12,000 visits, Foley said.
The typical patient is more than likely a woman in her 50s with a household income of about $1,000 a month, she said. They usually have one or two chronic diseases — the most common is high blood pressure — and take an average of four medications, she said.
These days, many are also suffering a great deal of anxiety because of the illness and the economy, she said.
“There are so many on that bubble of living pay check to pay check,” she said, “ … and many have already experienced some of the business disruption of losing their jobs.”
The Taylors Clinic has also seen a drop in donations, Salerno said.
“We have very faithful and generous donors. But when the economy takes a hit, then donors have to make a tough choice too. We pray a lot,” she said, adding that the clinic's biggest fundraiser, which brings in a third of its budget, is being transitioned to a virtual gathering.
Salerno said the community is hurting and their patients are part of that community.
“I’m really, really proud of our team and how they have stepped up," she said.
"We want to be able to continue to maintain the provision we have for our patients,” she added. “They literally have nowhere else to go.”
Liv Osby is the health writer at The Greenville News. She can be reached at email@example.com, 864-298-4422 or @livgnews.