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One mile away from outlaw Jesse James’ last home in St. Joseph, Missouri, sits a two-story, red brick building that was built a few years after his death in 1882. The Federally Qualified Health Center based in that building today, called Downtown Health Center, was built out in less than a month in 2017, for $42,000, cares for the community’s homeless population.
But now, during the Covid-19 pandemic, the clinic cares for all of the town’s residents, by keeping patients out of its one emergency room.
People experiencing homelessness are one of the most vulnerable populations facing the coronavirus, which has now claimed more than 93,000 lives in the United States. In addition to risks from co-morbidities, health directives related to Covid-19, including maintaining social distance, frequent handwashing and sheltering in place, are proving especially difficult for people without permanent housing.
In Missouri, the rate of chronic homelessness increased by 8% from 2014 to 2018. St. Joseph, a small town 55 miles northwest of Kansas City, Missouri, has seen tensions from the problem escalate such that the city government passed an ordinance last November which bans sleeping in public spaces.
Northwest Health Services, which runs Downtown Health Center, currently serves 1,915 homeless patients across its 19 clinics and pharmacies. Tiffani Bradbury, a nurse practitioner at the Downtown Health Center, said 80% of her patients are homeless, including some who are, what she called, “street homeless” and either unable to unwilling to stay in the local shelter.
“If we weren’t there, Mosaic [a local hospital] would be overrun right now,” Bradbury said in late March. “The patients are getting chronic care management here instead of having an emergency and going to the ER.”
The correlation between access to community health centers and reduced emergency department visits has been established in several studies, including one from 2010, which found that rural counties with community health centers had 33% fewer emergency departments visits compared to counties without a community health center.
In Missouri, 616 people have died and there have been at least 11,080 confirmed cases of Covid-19 as of May 19, according to the Missouri Department of Health and Senior Services. St. Joseph’s Buchanan County has had 562 confirmed cases and 2 deaths among its population of 87,300 people.
Though many visits are now via telemedicine, the clinic’s case managers are continuing to work, including meeting some patients in-person, from six feet away, as they help them obtain documents like birth certificates and IDs — documents Bradbury called the “first step in not being homeless anymore” since they are required to apply for work.
“People that work at a community health center, they believe in our mission. They believe in serving the underserved and going the extra mile to make sure people are healthy and safe,” said Rodney Hummer, a retired army medic and nurse who now serves as interim CEO for the Northwest Health Services.
Northwest Health has also been involved in Covid-19 testing. After conducting 766 tests across all its branches, 66 have come up positive, 625 were negative, 35 are pending. Earlier this month, the Downtown Health Center offered free testing for those experiencing homelessness.
One Clinic in Less Than One Month
For all the value it now provides, Downtown Health Center ‘s origin story began with an impulsive turn of the steering wheel. While taking a different route than usual into town, Hummer noticed a tiny for rent sign in a window.
“I had always dreamed that someday we could open a clinic there. Transportation is a huge barrier to care, and so if people could walk there, I knew it could be an ideal situation,” said Hummer. “I immediately investigated,” he recalls thinking, both because of the proximity to its primary clients and because NHS had to vacate a storage building nearby where they were storing medical equipment within 30 days.
NHS quickly closed on the space. Hummer drafted a blueprint by hand and then via a CAD program, which he submitted to the city on November 1, 2017. Thanks to support from the municipal government, by November 16, they had all the approvals they needed to start the work of converting what had been, variously, a pharmacy, bank, and church into a community health center.
Nineteen volunteers showed up on the first day. Among the tasks they had to accomplish were building weight-bearing walls, rewiring the whole unit, repairing the plumbing system, and installing handwashing sinks.
Hummer worked construction during college and has several family members in the industry as well. The team also benefited from contractors who pitched in, as did local construction firms.
“We were building this little homeless clinic and as far as you could see there were construction trucks lined up outside,” said Hummer.
The volunteer crews routinely worked past midnight and faced the expected pitfalls — cold nights, smashed thumbs — as well as the unexpected. One of the volunteers had his trailer stolen.
Despite the adversity, and sheer unlikelihood of bringing a medical clinic up to code in less than a month, after approximately 1,000 volunteer hours, according to Hummer, the Downtown Health Center and its pharmacy opened on December 15, 2017.
“We’re a Work-Together Community”
As the full brunt of the pandemic in Missouri lies ahead, the center’s six staff members are preparing to offer more services to their patients from a distance, such as video appointments.
“We’re trying to keep social distancing and trying to help them,” Bradbury said. “These are very big transitions, there are big changes coming down hourly in how we’re supposed to approach everything.”
Bradbury said she has seen how the pandemic and the attendant societal changes have led many in her community, homeless and not, to experience severe anxiety. She also sees the potential for recent events to trigger full-blown mental health crises.
“We’ve come together to really help get through this. I know the social distancing thing is a big deal, and people are organizing group prayers online, teleservices for churches, and organized groups for the elderly too,” she said.
“We’re a work-together community. Holding onto these community feelings, and taking it one day at a time, is going to help us get through it.”