What keeps me awake: one doctor's worry about America's essential workers
In the midst of the COVID-19 pandemic, which worries us all, I am also concerned about the consequences of rapidly diminishing access to health care for those who can least afford to lose it. The vulnerable population to which I refer is not the group of 60 and older who are at greater risk of severe COVID-19 disease, but rather those who were marginalized even before this virus. Many of these people are now considered essential workers, who harvest fruits and vegetables, deliver goods and provide the many other services one cannot do without.
As medical director of a free clinic, I am acutely aware that they, in particular, are at grave risk of missing out on lifesaving care. I work at Clackamas Volunteers in Medicine (CVIM), a clinic in Oregon City that provides medical care at no cost for the most underserved of the region. The clinic offers a safety-net of desperately needed health care provided by volunteer doctors and other dedicated health care workers, who all believe in good medical care that is provided with compassion and dignity for every patient, regardless of background.
Most of our patients have jobs, but without access to a free clinic they would have to choose between life's necessities, such as food or rent, and health care. Our patients often live in poverty, are ineligible for various health plans, and may have limited language skills. We diagnose and treat, keep patients out of emergency rooms, help avoid homelessness, prevent the spread of communicable diseases through vaccinations, and empower our patients on their journey to better health and wellbeing. Clinics such as ours provide medical care with minimal barriers and, as such, create a bridge from hardship to healing.
CVIM is just one clinic in the Volunteers in Medicine America network, a collection of 90 clinics in 29 states that are all locally managed and responsible for their own funding. What unites these clinics is that none of them charge for the care that they provide. Nationwide, there are about 1,400 free and charitable clinics and pharmacies. Most of these receive no state or federal funding but largely depend on donations, just like CVIM does.
With the current epidemic, free clinics operate with scaled-back service, which is widely implemented in general health care as well. CVIM has decided to not treat patients with COVID-19 symptoms, but rather to focus on other pressing health issues, such as diabetes, high blood pressure and heart disease that each can have severe or deadly outcomes when left untreated. We thus meet the urgent medical needs of our patients while minimizing the burden on hospitals. We, too, are shifting to telehealth where possible as one of a variety of changes meant to maximize everyone's safety. This is a very different environment in which to practice medicine, but for the time being it is our new normal.
Our work may take place behind the scenes of the pandemic, but it improves and saves lives that otherwise would be negatively impacted or lost by a lack of access to care. And once the influx of patients into emergency rooms, hospitals and intensive care units abates, the influx into free clinics will remain and surge. Disparities are almost certain to become deeper before things get better. Poverty is likely to rise and hit home hard, especially in those families who do not benefit (enough) from government aid in the first place.
Free clinics may have scaled back for now, but that will need to change once the lockdowns are over. Even as live fundraisers had to be canceled and donations are uncertain, we must keep our doors open for patients who have nowhere else to go. Patients who need free clinics already have less of a voice. Their suffering frequently remains invisible and they are at risk of becoming silent victims of the pandemic, whether they ever contract the virus or not.
Some people already lost their jobs, while others are suddenly considered essential workers. We need them. But will our gratitude for their increased exposure to the virus and for their continued efforts to keep life going extend beyond the immediate crisis? Will they be able to escape negative health consequences once COVID-19 has come and gone? We can all make a difference today by supporting a free clinic.
Iris Schrijver is a physician and serves as medical director of the Clackamas Volunteers in Medicine clinic in Oregon City. She is an adjunct professor at the Stanford University School of Medicine. An online auction is taking place through May 10 at clackamasvim.org. Resources: nafcclinics.org; volunteersinmedicine.org/volunteers-in-medicine-clinic-directory.
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