For Dr. Claire-Cecil Pierre, chief medical officer at Harbor Health in Massachusetts, health centers are closely tied to their roots in the civil rights era.
It makes sense. Harbor Health, Dr. Pierre explained, is the oldest community health center in the nation, founded at a time when activists and doctors realized that they could offer a new kind of health care to the country’s poorest and most vulnerable citizens.
Since their beginnings in the mid-20th century, health centers have fought both for their patients’ health and – operating on perpetually narrow margins – their own.
Their patients are frequently on public insurance, and in many cases are uninsured. Much of what they do – community outreach, education, and connecting patients to housing, food, and employment – can’t be billed or reimbursed.
With Covid-19, that struggle has intensified, and found new life.
“Covid-19 exposed some of the deepest and ugliest health care disparities in our country,” said Reuben Moore, CEO of Minnesota Community Care.
A majority of health centers’ patients belong to racial or ethnic minorities and live within 200% of the federal poverty line. Many have chronic conditions such as hypertension and diabetes, which put them particularly at risk during the pandemic.
Health centers, struggling to keep their doors open – and their patients out of hospitals – were also at risk, as revenue plummeted and staff members got sick.
On a recent webinar, three community health centers, each of which received a $500,000 grant as part of the $27.9 million that Direct Relief provided to health centers across the country, talked about how Covid-19 had affected them – and how they were fighting back.
“The Hardest-Working People”
Richard Veloz, CEO of South Central Family Health Center in Los Angeles, describes his patients as 95% Black or Latinx, and 95% living at the federal poverty level or below.
“These are the hardest-working people in our areas. They have multiple jobs…It’s a very difficult area to live,” he said. “Covid-19 exposed the problems we had in communities that we serve.”
When Covid-19 hit, the health center had only 20 test kits for its 25,000 patients. Although the area had a number of test sites, Veloz explained that many were drive-up, when a number of his health center’s patients didn’t have cars.
But testing was vital. Veloz described a family of eight people coming to a testing site that South Central Family Health Center established. They weren’t already patients, but they needed medical help: As it turned out, the entire family tested positive.
The health center explained the steps that the family needed to take to protect themselves and others; connected them to a local hospital, and arranged follow-up visits with behavioral health specialists to help them cope with the challenges of treatment and quarantine.
“This is just an example of what we do here as a community health center,” Veloz said.
“The Champions for Our Patients”
Part of what makes a community health center effective, the representatives said, is its close ties to the people it serves.
Moore explained that each of Minnesota Community Care’s centers is closely tied to other organizations – schools, homeless shelters, public housing – that allow staff members to offer care in a “customized, culturally and linguistically responsive way in their communities.”
Health center staff, often members of the surrounding community, are attuned to patient needs, Veloz said: “They’re really the champions for our patients. They bring the services linguistically as well as culturally.”
For Moore, those close ties to the community were acutely felt in the wake of George Floyd’s death in Minneapolis.
“I grew up on the block where George Floyd was murdered,” Moore said. “It strikes personally everyone in the community I know, but the ripple rippled across the world.”
It’s that tension between the local and the global where health centers really become essential, according to Dr. Pierre.
“When the cases are high, the biggest thing we need to realize is that every epidemic is local,” she said. “Even if it’s happening everywhere, you need a local response.”
Health centers – closely tied to and even staffed by their communities – are in an ideal position to provide that response.
As Direct Relief’s CEO and President Thomas Tighe pointed out, these organizations have spent the last half a century building the trust of the people they serve. “That great intangible ingredient of trust…that’s a rare currency these days,” he said.
But in the era of Covid-19, they’ve had to learn new techniques – quickly.
“Health centers were designed to be high-touch, high-presence, everything that Covid does not want,” Dr. Pierre said.
To continue meeting the needs of their patients – both coronavirus-related and not – health centers have swiftly adopted new technologies like telehealth, which have allowed them to continue providing services but present barriers to some patients.
“How do we make sure telemedicine is available to all of them?” Dr. Pierre asked.
“A Deep, Deep Return”
In addition, health centers are acutely aware that it’s the underlying disparities – in physical health, income, housing, and access to resources – that have contributed to making their patients so vulnerable to Covid-19.
Going forward, Dr. Pierre said, health centers need to focus on new kinds of community partnerships that will allow them to overcome these larger, systemic disparities.
“How do we go and connect all the areas that affect patients?” Dr. Pierre asked. In part, she explained, the answer is thinking outside the clinic, whether it’s forming a new partnership with a business school or developing on-site housing resources.
“We’ll stretch, we’ll bend, we’ll make it fit, we’ll make it work,” Dr. Pierre said. “And yet we’re at risk.”
However, the representatives said, the investments that donors have made in their futures will allow them what Moore called a “deep, deep return in the communities around you, and around us.”