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In medically underserved areas of the United States, finding an available physician to treat healthcare needs can be difficult.
Cochise County, Arizona, designated medically underserved population by the Health Resources and Services Administration, is just 12 miles from the U.S.-Mexico border. The county has a shortage of primary care health services for its population, which is facing economic, cultural, and language barriers to health care.
When Dr. Darlene Melk of Chiricahua Community Health Centers, located in Cochise County, was told her neighboring hospital in Tucson was no longer participating in free consultations with local physicians, she needed another avenue of support for her staff. Rural healthcare options were limited before the pandemic, and even moreso after. Issues like physician burnout and retention were exacerbated, creating a greater need for medical support.
“Sometimes we have to be the rheumatologist, the endocrinologist, and the psychiatrist because our patients either don’t have insurance or they have transportation barriers,” said Melk, chief medical officer at CCHC.
Melk reached out to the MAVEN Project, which stands for Medical Alumni Volunteer Expert Network, a nonprofit that provides support for clinicians. The nonprofit hosts medical consultations through email and Zoom conferencing, medical education webinars, and clinical and leadership mentoring from retired volunteer physicians. MAVEN has over 300 clinic partnerships within 21 states and Puerto Rico.
Melk said every staff member at CCHS now has access to MAVEN, which she uses for mentorship and consultations.
“It’s pretty incredible to be able to tap into this resource,” she said. “It’s been a wonderful blessing, and I’m just so grateful for it, and hopefully, we’ll be able to keep it for years.”
Connecting through SHARED EXPERIENCE
While hundreds of clinic sites have access to Maven, CCHC has its own unique set of challenges.
Dennis Walto, chief of external affairs and foundation executive director, said that CCHC serves a transnational community given its proximity to the border. In addition to patients moving back and forth across the border, some employees frequently cross the border to see loved ones and friends. Walto said many CCH employees have chosen to work at the health centers because of their connection to the populations they serve and their belief that everyone deserves access to quality care.
In Cochise County, nearly 13% of the population was born outside of the United States, and about 36% of the county’s population is Hispanic, according to census data. While just 15% of CCHC patients are best served in a language other than English, cultural competency and language access are a top priority, but with limited funds, recruiting and retaining top medical professionals can be challenging.
Melk is the daughter of a political refugee from Cuba; her Maven mentor, Dr. Lo-Ann Nguyen, was a refugee from Vietnam and relied on Medicaid in the 1970s for health care. The pair have met virtually for a year and a half, mostly on organizational vision regarding conceptual problems, recruitment, retention, and how to maintain a highly functional team. Nguyen said that it was important to Melk that CCHC employees feel like they are part of a solution and they have a consistent workflow as a team. Nguyen, an internist, also worked for Kaiser Permanente until she retired in January 2020 and began volunteering for Maven. She’s one of 170 volunteers.
“I grew up in a place where medical care was very, very unavailable, and it is an opportunity for me to participate in some solution to help the population who doesn’t get full access to medical care,” she said. “It just, it just grabbed my heart.”
Maven tries to connect clinics to physicians based on mentor availability, skills and shared interests, according to Dr. Jill Einstein, Maven’s senior director of physician engagement.
“Everything that Maven does (is through) this holistic approach to prevent or alleviate burnout,” Einstein said. “So, if a provider develops more skills and increases their confidence in caring for a patient, it won’t be as overwhelming. And if they have a system, an organized system and an immediate access to getting answers, that’s going to decrease their stress.”
In 2021, CCHC reported to the Health Resources and Services Administration that 83% of their patients live at or below 200% of the federal poverty line. While Arizona adopted and implanted the expansion of Medicaid in 2014, almost 20% of CCHC patients were without health insurance in 2021. At that time, 41% were enrolled in Medicaid or CHIP.
Nguyen became eligible for Medicaid as a student, but she didn’t always have access to care. During a case of pneumonia, she was unable to see a private practice physician who had filled their Medicaid quota for the month, and she was forced to go to the emergency room, and her condition worsened. In another instance, Nguyen had a molar toothache for a week while waiting for an appointment. She said that she pleaded on the phone for a root canal, but was offered a cheaper, more consequential extraction instead.
“I knew exactly what people have to go through with that program, and a lot of bad things happened [when I was enrolled],” Nguyen said. “So I have always felt that we needed to do more for people who do not have good health insurance.”
CCHC hired its first psychologist in 2021, and since the clinic has had access to MAVEN they have hired two more. Melk said that mental health was and continues to be a high priority during the pandemic. Now, the biggest request from physicians and nurse practitioners is consultations from endocrinologists.
According to HRSA data, 16% of CCHC’s patients are diabetic, 36% have hypertension, nearly 58% go to CCHC to control high blood pressure and 72% seek out CCHC for prevention and treatment of cardiovascular disease.
Melk said it has been helpful to have access to experienced clinicians who give reassurance and resources. She described the Maven partnership as a “beautiful concept,” given she can get a response for a consultation in as little as a few hours. She’d rather not ask a patient to travel to Tucson to see a specialist if it’s not necessary. Some patients experience transportation barriers and often have conflicting work schedules so making the appointment would be difficult.
“I think as clinicians, your ultimate goal is to alleviate suffering and make that patient’s health journey lighter somehow,” she said. “And so we’re here to help, and when you feel like your hands are tied because they either can’t go or they don’t have insurance, or whatever reason, there are too many barriers to getting there, this helps.”
Direct Relief and the MAVEN Project have worked together to connect community health centers and free and charitable clinics with medical expertise in underserved communities across the United States.