The following story first appeared in the Summer 2005 Glenmary Challenge.
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Rural Clinics
Putting the 'care' back in health care in Mission Land, USA
By Father John S. Rausch

SERVING THE UNINSURED: Bill Grimes and Julia Maness, both members of Glenmary's Owingsville mission, help staff NewHope Clinic which provides free health care in Kentucky's Bath County.

The 27-year-old man staggered into the Health Wagon with one eye shut and a jaw severely swollen with two abscessed teeth. He had the toothache for two weeks; but, without health or dental insurance, he decided on home remedies. He tried aspirin, then whiskey, then lukewarm salt water. The pain persisted. Finally, in desperation, he applied motor oil directly to the nerve to kill the pain.

When Sister Bernie Kenney, the nurse practitioner in charge of this mobile clinic, heard his story, she panicked, knowing the toxins in the oil could travel directly to the brain. She quickly gave the fellow antibiotics to counter the infection. Then, hoping he would survive the motor oil treatment, she used her grandmotherly charm to arrange a payment plan with a near-by dentist to have his teeth pulled.

Two-week toothaches—and irregular heartbeats and type 2 diabetes—go untreated in many rural areas where health resources and health insurance are scarce.

The federal government has designated more than three-fourths of all rural counties as Health Professional Shortage Areas based on need and availability of health-care professionals. A cavity thus turns into an abscessed tooth, and untreated diabetes claims a limb through amputation.

Nationally nearly 45 million people live without health insurance. In 2001 the U.S. Census Bureau found about 13 percent of rural residents lacked health insurance, approximately the same as urban dwellers. But that number jumped to 22 percent in remote rural counties where terrain and driving distances contribute to a sense of isolation. And for households without health insurance, the fear of an added financial burden causes many rural people to put off medical attention until the problem becomes acute. 

One response to the rural health-care crisis has been establishing free clinics to serve unmet needs. These clinics tape together their finances with grants, donations and various subsidies, but refer Medicaid and Medicare patients to other health providers because the clinics cannot deal with the paperwork.

Health-care providers affiliated with Glenmary favor a single-payer system for universal health care. But while society struggles to find a way out of the current health-care crisis, these front-line healers offer some alternative ways of thinking that shift the emphasis in medical practice from costly high-tech solutions to personal attention that puts the “care” back in health care.

Three examples of free clinics in Glenmary mission areas provide a snapshot of how primary health care is being provided for the rural uninsured.

Helping Hands Clinic
When social service agencies surveyed the needs of Todd County in Western Kentucky in the 1990s, they found a significant population of medically uninsured, both among local folks and newly-arrived Hispanics. With only two doctors in the county and no medical facility, people traveled a minimum of 20 miles to the closest emergency rooms in surrounding counties—a burden for folks without reliable transportation. 

Glenmarians Brother Ken Woods (a licensed practical nurse), Father Tom Charters (then pastor of Glenmary’s two Todd County missions), and lay missioner Aida Moreno began meeting with those interested in addressing the problem. The solution: Helping Hands Health Clinic which opened in 1999 just off the main square in Elkton.

The nonprofit clinic is open four days a week under the direction of a nurse practitioner and receives weekly oversight from Dr. Tom Grabenstein of Clarksville, Tenn. The 50 to 60 patients each week come with chronic disorders like diabetes, heart and lung diseases, hypertension and obesity.

Brother Ken recalls checking one patient with an irregular heartbeat and then summoning the nurse practitioner. She recognized the severity of the problem and sent the man to Clarksville to undergo bypass surgery. “He would have died without the clinic,” Brother Ken says.

“I’ve heard patients say many times, ‘It’s God’s will that you’re here,’” says Brother Ken who left Elkton for another assignment last year.

Free clinics monitor chronic illnesses treatable with daily medication and spot the life- threatening situations that larger medical facilities can handle. On the cheap, they improve the quality of life for rural folks.

NewHope Clinic
Before moving to NewHope Clinic in Bath County in Eastern Kentucky, physician assistant and nurse practitioner Bill Grimes was working at a primary care center. But, he remarks wryly, “I was no longer practicing medicine. I was practicing insurance company compliance.”

NewHope Clinic, a storefront located on the main square in Owingsville, Ky., avoids the red tape of corporate medicine by offering free medical service to anyone without health insurance whose income is less than 200 percent of the poverty line. Supported by private donations from individuals and businesses and by small grants from local foundations, the clinic typically treats patients who see a doctor infrequently and come to the clinic with chronic illnesses.

Bill points out that free clinics decrease morbidity and increase life expectancy because these chronically ill people finally get consistent care. They get their blood pressure checked, their sugar tested and leave with medications in hand. 

“Free clinics increase the overall well being of the community,” he says.

An ordained deacon, Bill Grimes came to this Glenmary area because he wanted to combine health care and church ministry. He serves the local Glenmary parish, St. Julie, with liturgical ministry and lectures as a faculty member at the University of Kentucky’s College of Health Sciences. He sees his two days a week at NewHope as an expression of the Church’s preferential option for the poor. 
“It’s an issue of justice,” he insists. “Everyone, because of his or her dignity as a human being, deserves the basic right of health care.”

A second goal of NewHope Clinic focuses on education for healthy living and prevention by encouraging exercise and proper eating. This holistic approach recognizes everyone’s responsibility to care for the health God has given them.

“The greatest thing we do for patients is to show them that they are loved,” says Bill. “And it’s an honor to reach into people’s lives to help them better themselves. That’s the caring part of being a health-care provider.”

Health Wagon Clinic
Sister Bernie Kenney needs to change the oil in her clinic every 3,000 miles. For over a dozen years, she has driven an RV outfitted as a mobile medical unit serving seven isolated communities in Dickenson and Buchanan counties in Southwest Virginia. 

Driving to the patients “insures that folks get health care,” she says. “The advantage of going to the people shows that you really care.”

Sister Bernie, a Medical Missionary of Mary, came to this Glenmary mission area in 1978 and started her ministry with home visits to the sick. In 1992 St. Mary’s Hospital in Norton, Va., contracted with her to do rural health care and furnished her Health Wagon.

Parishioners from Glenmary’s mission in Clintwood volunteer to change the oil and maintain the electrical system to keep the Health Wagon traveling the winding mountain roads and offering the only health care for isolated communities.

The distinction between healing and curing can get lost in the high-tech world of medicine, Sister Bernie points out. But she sees illness as a teachable moment about our humanity. She cannot cure cancer, she says, but she can help heal the spirit.

The atmosphere she creates with the Health Wagon promotes the values of caring and compassion. Patients mingle among friends; they laugh together; they affirm one another with a gentle touch. Her holistic nursing emphasizes “the therapeutic use of self,” combining stress reduction, self-care and spirituality. Though the Health Wagon offers limited medical technology, the holistic healing deepens the meaning of each patient’s life.

Yet the future of the Health Wagon is uncertain. The Catholic hospital that had sponsored the Health Wagon was recently purchased by a for-profit hospital system which has given the Health Wagon until February 2006 to find alternative funding—or go out of business.

I once brought a group of seminarians to visit the Health Wagon around 2 p.m. Sister Bernie had already seen 34 patients—but pointed to two sacks of vegetables as her total revenue so far for the day. The Health Wagon’s new owners want to make money not eat vegetables.

Sister Bernie, like so many rural health-care providers, laments the complicated confusion of medical insurance, the number of people without insurance and the market-driven cost-cutting that affects the care of patients.

“People need universal health care,” she says. “Health care needs to be a right like education. You need to be able to access it regardless of your income.”

As Sister Bernie drives the Health Wagon out of its parking spot and on to the next town, the Virginia vanity license plate she displays summarizes the work of the free clinics, like hers, that serve the rural uninsured. It simply reads “HEALERS.”