Free clinic aims to fill health-care gap

 

Karen Weinberg, one of the organizers of free medical clinic planned for early October, seeks volunteers for the project at a June event at the Washington County Fairgrounds. Joan K. Lentini photo

 

By TRACY FRISCH
Contributing writer

EASTON, N.Y.

A large-scale free medical clinic planned for this fall at the Washington County Fairgrounds aims to fill some of the gaps in a health system that still leaves many people without ready access to care.

The pop-up clinic on the weekend of Oct. 2-3 will offer free medical care -- including dental and vision services -- to anyone who shows up. Volunteer physicians, nurses, dentists, opticians and other health professionals, as well as nonmedical volunteers, will power the event.

A grassroots group of local people calling themselves the Southern Adirondack Health Initiative has been working for months to organize the clinic, which supporters say will be open to all regardless of residency, income level or insurance or immigration status.

The local group is working with an international philanthropic organization, Remote Area Medical, to stage the event. Remote Area Medical has been supporting similar medical clinics across the nation and internationally for more than 35 years, but it has never held one in upstate New York east of Buffalo.

Local organizers say they see a dire need for the services the clinic will offer, and they hope to establish it as a recurring annual event.

Although a much greater percentage of the population is covered by some sort of health insurance today than had coverage before the Affordable Care Act went into effect in 2014, a significant number of people in the United States still cannot afford to see a doctor or dentist on a regular basis.

Advocates say 1 million New Yorkers lack any form of health insurance, and many more are underinsured, with plans whose high deductibles and co-pays prevent them from seeking care except in emergencies.

“Health care by affordability makes no sense at all,” said Don Franks, a Glens Falls retiree who is one of the lead organizers of the local clinic.

Backing grassroots efforts
Remote Area Medical, or RAM, was founded in 1985 with the goal of bringing health care to remote areas of the developing world. Its founder, Stan Brock, established the group’s headquarters in eastern Tennessee.

Seven years later, RAM held its first domestic clinic in Sneedville, Tenn., a tiny county seat in the middle of the state. Today, 95 percent of RAM’s work takes place in the United States.
This nonprofit group takes as its mission to prevent pain and alleviate suffering by providing free, quality health care to those in need. Since its formation, RAM estimates it has provided free health care services valued at $174 million to more than 863,000 people with the help of 172,000 volunteers.

Last year, although the Covid-19 pandemic forced RAM to cut back on its activities, the organization reports it still served more than 76,000 patients.

RAM, which is supported mainly by small donations, owns tractor-trailers and various types of medical equipment required for clinics. It also supplies a handful of paid staff as well as the disposables for clinics organized by local groups.

Remote Area Medical is not a top-down organization that selects regions with needy populations and then offers them medical clinics. Instead, it goes to communities where it has been invited. Local communities organize their clinics, raise funds and recruit volunteers.

Each clinic is the result of months of collaboration between RAM and a host community group. The local group is responsible for finding and ranking promising sites for the clinic, recruiting doctors, nurses and other health professionals as well as lay volunteers, and extensively publicizing the clinic to ensure that the target population is aware that it is happening.

Particularly in rural areas, the local group also works to create transportation options for people who need assistance getting to the clinic.

RAM maintains a database of pre-screened volunteers. To participate in the October clinic in Washington County, healthcare professionals must be licensed in New York.

 

Volunteers turned organizers
The effort to organize a local RAM clinic began with two people who live 30 miles apart and were not acquainted: Karen Weinberg, who lives in Shushan, and Franks, who recently relocated to Glens Falls from Seattle. Both became passionate about the idea after volunteering at Remote Area Medical clinics in other parts of the nation.

Weinberg operated a sheep dairy for 20 years at 3-Corner Field Farm in Shushan with her husband, Paul Borghard. She first learned of RAM more than a decade ago when she and her husband watched a “60 Minutes” report about the organization’s free clinics.

The results impressed her so much that she promised herself she would get involved with RAM at some point when her life allowed for it. At the time, her extensive farm responsibilities, including weekly trips to sell the farm’s cheese, lamb and other products at the Union Square Greenmarket in Manhattan, crowded out the possibility of taking on any unrelated projects.
The couple shut down their sheep dairy not long after husband received a cancer diagnosis, and Weinberg’s daily activities changed drastically. Nine months after Borghard’s death, Weinberg said, she was ready to resume her life and pursue a new challenge.

“I was looking for things to do to add value to my life,” she recalled. “The first clinic I was volunteered for was at a fairground in Harrisonburg, Virginia. I worked at registering patients. I looked around and it was just like Washington County.

“Doing patient registration, you hear people’s stories,” she added. “Most people were working, and many had insurance.”

In fact, about 50 percent of the people who come to RAM clinics have health insurance, according to the statistics collected by the organization. Most of those with insurance have plans that do not cover vision or dental care, however, and many have medical plans with large deductibles or co-pays that discourage them from seeking care.

“It was quite clear that the rhetoric being thrown around about people not having health care -- that it’s their own fault – is incorrect,” Weinberg said.

Weinberg soon became a core RAM volunteer. That status means she is trained in a specific area -- in her case, patient registration -- and that she will travel anywhere RAM needs someone trained in that area. She has helped at RAM clinics all over the country, from Nevada and Iowa to Louisiana and Florida, where she worked at a disaster clinic after two hurricanes.

“Where I can’t drive, I’ll be flown,” she added.

She soon became determined to help organize a free clinic in her own county.

“After I had participated in a couple clinics, I started talking to RAM,” Weinberg said, adding that she had one main question for the organization: “What do I need to learn to bring a clinic here?”
She settled on an answer: “I’m going to learn enough to be dangerous.”

 

Joining forces
Franks sought out volunteer work after he retired. Before moving to Glens Falls, he went back to school and obtained a paralegal certificate in the state of Washington, which enabled him to do legal clinics. He now mediates small claims in the court system as a volunteer – an experience he said has made him realize just how little some workers are paid.

In 2014, while he was still living in Seattle, he volunteered for two days at a four-day RAM clinic there. It made a lasting impression on him.

“It was so much more worthwhile than anything else I had done,” he said. “In four days, they gave away $6 million in medical services to 3,500 patients.”

The clinic ran for 14 hours a day, offering medical, dental and vision services.
“It was so well organized – it was run like the military,” Franks recalled. “One building would open at midnight so people could wait inside. At 3 a.m., they gave out tickets to people in the order that they arrived there.”

After moving to Glens Falls a few years later, Franks began to explore how to make a RAM clinic happen in his new community. He approached various local organizations to see if they might be interested in supporting a clinic, and he introduced the idea to the Adirondack Health Institute, where he volunteered on a committee set up to address barriers to health care access. The result was the formation of a new committee focused on setting up a local RAM clinic.
When Franks first approached RAM about doing a clinic, he was told that another person in the region – Weinberg – already was pursuing the idea. Weinberg joined the host community committee Franks had been organizing in January 2020.

 

Choosing the best site
Before RAM will commit to holding a clinic in a community, the local host group is expected to select three possible sites and rank them in terms of the logistical problems each would present for a clinic.

Franks said that by the time the Warren-Washington host community group was ready to invite RAM to come check out its sites, the pandemic was raging and nonessential travel was on hold. But the site inspection has now been done, and plans for the fall clinic are moving along.
Organizers anticipate serving between 200 and 400 patients at the October clinic.

“That’s a substantial number, but not as large as it will become in the future,” Franks said, explaining that he would like to see the clinic return on an annual basis.

RAM is already saving dates in September 2022 for a second clinic, he added. Meanwhile, the host committee is setting up the Southern Adirondack Health Initiative as an official nonprofit organization that can host a RAM clinic every year and work on other related projects.
Finding the right place for multiday free clinic can be challenging.

“A RAM clinic needs a lot of space, a lot of power, and a lot of parking,” Franks explained.
For-profits entities with suitable facilities are often reluctant to donate their valuable space for a whole weekend, and nonprofit public institutions may be under pressure to supplement their other revenues by renting their facilities.

Although the barriers to potential sites may be logistical, more often they are financial, said Poppy Green, RAM’s senior clinic coordinator.

In some cases, for example, a facility owner might expect the host community group to come up with a substantial rental payment. Or the owner may be unwilling to commit sufficiently far in advance if they think they might still attract a lucrative rental offer from someone else.
Because of her experience volunteering at a RAM clinic held at another fairgrounds, Weinberg thought of the Washington County Fairgrounds as a potential local site.

“I stopped at the fairgrounds about a month after they did a food distribution there,” she recalled. “Rebecca Breese, the co-manager of the fair association, happened to have been in my daughters’ 4H club, which I participated in as a parent.”

Breese was very receptive to the request.

“As someone who grew up in this community” in the town of Jackson, Breese said, “I was very excited. I saw that this was something we could really benefit from.”

She said she presented the idea to the fair board, which responded enthusiastically. The board is donating the use of its 133-acre site and buildings, and it has supported other events such as food distribution and Covid vaccination clinics.

“Our role is to serve the community,” Breese said.
The fairgrounds property is easy to find and is a familiar to many people in the clinic’s target region. About 50,000 people per day attend the Washington County Fair during the week of the fair, and as many as half of them come from Warren County.

Another plus, Weinberg said, is that the fairgrounds is a location where the region’s undocumented farm workers would likely feel comfortable seeking care.

 

 

 

Open to all
Although its organizers conceived of the local clinic as serving Warren and Washington counties, RAM clinics have no geographic limits, and everyone is welcome, no matter where they live.
“I have been at clinics where people have driven 400 miles,” Weinberg said.
Weinberg, who has strong ties to the local agricultural community after many years of running her own farm and cheese-making operation, pointed out that there are large numbers of undocumented people working in local agriculture and related operations. Almost invariably, these immigrant workers don’t have access to affordable health care. They can’t obtain health insurance if they’re undocumented, and many face other practical or logistical barriers to obtaining care.

“Our economy is so dependent on those people,” Weinberg said, adding that the health issues of agricultural workers can quickly become an issue for local farmers if, for example, “you have someone who needs glasses driving your $175,000 piece of your agricultural equipment, and they can’t afford glasses or their glasses break.”

Weinberg said the clinic’s organizers plan to reach out to area agricultural businesses to enlist their help in spreading the word to farmworkers, and they’ll target other populations that lack access to health care.

“Our clinic will have Spanish interpreters,” she said. “We will reach out to the Amish community. I have been at RAM clinics where there were Syrian refugees. RAM brings in translators.”
But she also predicted that, based on her experience registering patients at other RAM clinics, “the majority of people in need are going to be working, white, and native to the area.”

 

Signing up providers
Recruiting the health care professionals who’ll volunteer their time for a clinic is one of the most important tasks for a host group. Leading this effort locally are Diane Donovan, a registered nurse with 40 years of experience, and her son Daniel, who just completed his training as a licensed practical nurse.

Donovan just completed her first year as a full-time clinical instructor and a classroom teacher in the LPN program at BOCES, the regional vocational education program. Though she will turn 70 later this year, she said her motivation to teach nursing is its potential to “ignite the spark” in her students to become advocates for their patients.

“There are all sorts of things that nurses do,” she said. “We can go to our legislators and tell our patients’ stories without violating HIPPA. We can give examples without identifying them.”
It was in her role as an advocate that Donovan came in contact with Franks at the Adirondack Health Institute, where they both served on a committee looking at health disparities and helping to connect individual patients with services. Through that work, they involved Hudson

Headwaters Health Network and Glens Falls Hospital as well as individual physicians.

She came to that effort because of her experience as a nurse and also as the adoptive parent of two now-grown children with HIV.

“I’ve been involved in the HIV community for many years,” Donovan said. “This group of people is underserved in rural areas.”

As a nurse who has worked in a variety of health-care settings and with a range of patients including those with developmental disabilities, Donovan is familiar with the many barriers to health-care access.

“Our health-care system is broken,” she said, ticking off some of the many problems she has observed.

There are people in rural areas without a working vehicle -- and elderly people who don’t drive. Another challenge is the absence of insurance for dental, hearing and vision problems.
There are elderly people who take their blood pressure medications every other day because they can’t afford the cost.

Many of the working poor don’t qualify for assistance, and subsidized insurance plans available through the Affordable Care Act marketplace may still be too expensive for some. Others are too daunted or otherwise unable to navigate the process for obtaining assistance.

 

Connecting patients to care
Although a single RAM clinic can’t solve all of these problems, it can provide essential services for people who currently are left out of the medical system or underserved.

“At a RAM clinic, everyone gets a physical, and you also stand a chance of getting a tooth cleaning and a filling and glasses,” Donovan said. “We’re hoping to have women’s health services.”

And the organizers are also doing what they can to provide for follow-up services for patients at the pop-up clinic.

The Glens Falls Hospital employee who runs the mammogram programs for Warren, Washington and Hamilton counties, for example, will be on hand at the RAM clinic to schedule people for mammograms locally, with the hospital picking up the bill. They won’t be able to offer mammograms during the RAM clinic, however.

The clinic also will hand out free do-it-yourself screening kits for colorectal cancer.
And organizers hope those attending the clinic will be able to sign up on site for coverage through the Affordable Care Act marketplace. The clinic will include a sort of resource fair, with various agencies and organizations promoting free services. Catholic Communities Services will hand out information on how to sign up for the Supplemental Nutrition Assistance Program, and organizations such as Legal Services Societies and Planned Parenthood also will participate.

 

A passion to serve

Green, RAM’s senior clinic coordinator, has been the local host group’s primary liaison with the organization.

“At RAM clinics, we never ask anyone for their ID or proof of insurance, or to verify their income,” he said. “When area agencies are on site at a clinic, we ask that they adhere to our guidelines.”
Green, who’s originally from Lenox, Mass., said his association with RAM began with an internship while he was a student at Hamilton College. The opportunity involved moving for the summer to rural Tennessee, where he slept on a friend’s couch.

“It was my first clinic in Wise, Virginia, that got me hooked,” Green recalled. “The children particularly resonated for me. I was seeing families where the parents were not much older than me, whose children’s only experience at the dentist involved camping in a tent.”

In a phone interview from southernmost Texas, where he was conducting site inspections for a future clinic, he said his first summer internship proved to be such a meaningful learning experience that he wound up returning for two more summers while in college, through a second internship and later as a volunteer.

This year marks his seventh summer working with the organization, now as a paid staff member.
As a pre-med student at Hamilton, Green said he had intended to go on to medical school. But his experience at RAM clinics changed his focus to public health. Although much of the focus of public health traditionally has been on prevention and early intervention to prevent serious medical issues, Green said the free clinics give a different perspective.

“There are a lot of people suffering,” he said. “To speak about prevention to someone who has six abscessed teeth does not address their need at the moment.”

Green predicted that a lot of the volunteers for the October clinic will come from Washington County.

“We bring in equipment and liability insurance and a team with operational know-how, but every clinic is mostly staffed locally,” he said.

Green confirmed the observations of members of the host committee that many of the people served by RAM clinics have health insurance but nonetheless lack access to care.

Even with the advent of the Affordable Care Act, demand for the clinics’ services has showed no sign of declining, he said. To the contrary, demand has continued to grow, especially for dental and vision care. Most health insurance plans to do cover these critical services without a supplemental policy.

Another issue that comes up with RAM patients is health-care literacy.
“A lot of people don’t have the ability to advocate for themselves,” Green said.
RAM suspended its clinics for several months last year at the outset of the Covid-19 pandemic but has gradually resumed operations with new precautions and requirements.

One change, for example, is that pop-up clinics no longer have several hundred patients clustered together while waiting to be seen. To prevent transmission of the coronavirus, RAM is using larger spaces, bringing in less equipment, recruiting fewer volunteers, and serving fewer patients.

Green said all clinic patients receive discharge papers with a phone number to contact us if they get sick with Covid. The night answering service goes to Green’s mobile phone.

Since the beginning of the pandemic, he added, no one who worked at or attended a RAM clinic has reported contracting Covid-19.

 

Spreading the word
Besides recruiting medical professionals, the local host committee has begun reaching out to the general public to promote the October clinic. Organizers are showing up at Food Truck Friday events at the Shirt Factory in Glens Falls and at the Washington County Fairgrounds, where nonprofits are able set up tables to promote their events.

Franks said he has also been going around to spread the word among the staff in various healthcare settings.

At the Glens Falls Veterans Administration outpatient clinic, he was surprised by the staff’s strong interest. He soon learned that veterans served by the VA do not have dental coverage, and many need these services.

Franks stressed that there are many opportunities for people to help – and certainly no lack of things that will need doing. No medical training is necessary to serve as a patient guide or to wheel around patients in wheelchairs. The clinic will also welcome translators, and there are numerous other task areas waiting to be filled.

 

To volunteer, go to www.ramusa.org and click on the “Volunteer” tab in upper right corner. Fill out the form, whether you are a medical professional or not.

Donations to support the clinic may be sent to Southern Adirondack Health Initiative, P.O. Box 100, Shushan, NY 12873. The memo line of checks should be marked “Southern Adirondack Clinic 2021.”