by Leslie Layton
Thomas Lewry and Scott Marshall had stopped for a blood-pressure check on a November Thursday at the Fire House Certified Farmer’s Market in Oroville’s Southside.
A pair of Chico State nursing students wrapped the cuff first around one man’s arm, then the other’s, and started pumping. Marshall talked about his health problems, and as he did, the screening began to seem increasingly inconsequential.
Marshall, 61, has stage 4 bone cancer. He’s homeless. Some days, he says, his legs hurt so badly, “I get to where I can’t walk, straighten up.” UC Davis Medical Center has apparently offered him treatment, but he says that would confine him — at heart he is still a fisherman — to a hospital bed for whatever time he has left. He said he keeps on rolling, even when his body is wracked with pain, much like the song Ol’ Man River.
Observe the nursing students at work for a little while, and you see that the blood-pressure screening produces more than just a measure of a heart beat. In this neighborhood of broken sidewalks and boarded-up businesses, student nurses Katie Carrico, 22, and Lee Yang, 25, were here to listen in a place where people aren’t often heard.
Yet, in a semester of Thursdays, Carrico and Yang did more than just listen. By Nov. 4, when they had completed their outreach project for a public-health class, they had persuaded a few clients to walk more, see a doctor or smoke less.
For a few hours every week, the students took their place on the fringe of a guerrilla health-care movement underway nationwide. Throughout the country, a loosely-woven network of volunteers and non-profits offer battlefield medicine as they serve both middle-class and poor people falling through the health-care system’s cracks.
In Chico and other American cities, volunteers have converted church meeting rooms to doctors’ offices, hoarded prescription drug samples that can be used at faith-based clinics, and are coaching patients on how to advocate for themselves in a complex system. Citizen-run clinics can’t offer surgery or x-rays, but volunteer nurses and doctors can encourage and direct. Sometimes, bake sale-funded services save lives.
Teleen Santillán, 40, says volunteers at Chico’s Shalom Free Clinic that opens on Sunday afternoons saved her life in April 2007. A doctor conducted a urine test and told her to go to the hospital — without insurance and without delay. “I said, ‘No, I can’t go, I can’t pay,'” she told Shalom staffers. “They said, ‘Just go, and figure out what to do about the bill later.'”
Later is now, and after several hospital stays, Santillán said she owes more than a half million dollars in medical costs. Increasingly, underinsured residents of Butte County undergo financial ruin because of medical bills. They often show up at Legal Services of Northern California’s credit-card debt seminars, sometimes bankrupted because of an illness or accident.
“We’re seeing a new clientele, more middle-class people,” said Laurel Yorks, a public benefits paralegal. “Most employers can’t afford plans with low deductibles. That’s where the slide to desperation and poverty can start — with huge deductibles and co-pays.”
Stone Soup Health Care
Every Sunday, a line has formed by 1 p.m. outside the Congregational Church annex in Chico. Some of the people in those lines look stunned that they’ve found themselves at a free clinic. Shalom opens, and after checking in, some will wait four hours before they see the doctor. But the “waiting room” lacks the strained silence that characterizes doctors’ offices.
Sometimes, volunteer Robert Dresden plays guitar for patients seated in folding chairs. Bowls of fruit and soups or lasagnas seem to appear magically on a table.
Since it opened four years ago, Shalom has become a magnet for volunteers. Often, former patients who have been helped in moments of desperation want to repay the clinic. One Shalom volunteer, referring to the multiple offerings that come from people every Sunday, referred to an old fable, saying the clinic is “stone soup put into practice.”
The Shalom thrift store in downtown Chico helps support the clinic, and co-founder Nancy Morgans-Ferguson said organizing some 500 volunteers is a full-time job in itself. The clinic sees about 1,000 patients a year, the majority of whom are college-educated. “We’re seeing people who have lost their jobs and homes and insurance,” said Morgans-Ferguson.
They come for a range of services, from diabetes screening to energy balancing and psychiatry. But Morgans-Ferguson seems to know that what Shalom really offers is that ingredient so often missing in mainstream medical care. “What we can offer is as much time as [patients] need,” she said.
Shalom volunteer doctor Ken Logan noted there are many things the clinic can’t do in a health-care system that he calls “helter-skelter.”
“I would love to not need the Band-Aid of Shalom,” Logan said.
For now, the Band-Aid is needed because so many people — like Teleen Santillán — slip through official safety-net programs.
Santillán lost her health-care insurance after a temporary teaching job ended several years ago. She couldn’t afford to pay for care, and stopped taking diabetes and thyroid medications. In spring 2007, she landed at Chico’s Enloe Medical Center, and the non-profit hospital’s social workers tried to help her get enrolled in Medi-Cal, California’s Medicaid program.
But she couldn’t meet the tough eligibility criteria, even after cashing out a $20,000 retirement fund. Her health problems continued for the next several years, and her unpaid bills mounted as Santillán went in and out of the hospital. Her debt was turned over to a collection agency, and Santillán said her inability to pay if off has “made me sick literally and figuratively.”
Helter-Skelter System
Figuring out where to go for charity or government-funded care is a question of picking your way through a maze of programs, and full Medi-Cal coverage often excludes the working poor. “People are tired, overwhelmed and don’t feel well. Then they have to battle the system,” said Chico State public-health nursing professor Kristine Warner.
That’s one reason Warner dispatches nursing students to marginalized communities. Her students set up booths at both the Chico Chapman and the Southside markets. “We’re really providing health education and referrals,” Warner explained. “People feel very comfortable getting their blood pressure checked, and it gives us a chance to talk to them.”
Each Thursday, Carrico and Yang gave about a dozen people a blood-pressure reading, and in many cases, that measure sounded an alarm. On several occasions, Yang was approached by Hmong residents who knew he spoke their language and were interested in how he could help them.
The screenings are also a learning experience for Warner’s students. “Students see some of the struggles a marginalized population has,” Warner said, “and learn how to talk to people without being off-putting. From our standpoint, they see how they can impact a community. Out in the community, the people they see have the power.”
Her students regularly refer people to doctors and clinics. But they can’t force their clients to go, and Warner notes that for many, transportation is an obstacle.
Shalom’s Ken Logan worries that under the new health-care reform law, the system will still be profit-driven. But the law will extend Medi-Cal — government-funded health insurance — to an estimated 2 million more Californians.
In the meantime, people like Santillán are increasingly disenfranchised — not by lack of skills or ambition — but by a system that treats health care as business. Until reform comes, many people will depend on stone-soup projects like Shalom Free Clinic. And some will end up in hospital emergency rooms with medical problems that should never have become emergencies.
This series was funded by a health reporting fellowship from New America Media. This story was condensed from its original version on Jan. 5.