New Orleans just always has to do everything a little different. And since the storm, added to the usual roster of New Orleans' unique qualities — music, food, architecture, style, speech, dance — is an unexpected innovation: health care access for the uninsured. With the major public hospital still shuttered four years after Katrina, an innovative array of clinics have sprung up to fill the void. And for some, it's just what the doctor ordered.
"When I compare the treatment with my doctor on insurance and my experience at the 9th Ward clinic, I'm amazed. [Care at the clinic] is great. The community clinic is friendly. My doctor cares about me and what I think," applauds New Orleans native Michele Burton-Oatis. When she lost her job as a public school teacher after the storm, Michele also lost her insurance. "My previous job's coverage lasted til 2006, then I paid out of pocket. I didn't know about the clinics [in New Orleans], and my doctor didn't refer me... Because it's so expensive, I wasn't taking my insulin like I needed to. I was trying to stretch it. When I didn't feel my blood sugar was high, I didn't take it. I didn't have any other option."
But after Michele heard from friend about the Lower 9th Ward Health Clinic (5228 St. Claude Avenue), she decided to check it out. "I was amazed — it was only $25 co-pay to visit and $4 for my pharmaceuticals. It was so affordable I could even come back and bring in my aunt for treatment."
Before the storm, nearly all public health activity centered on Charity Hospital, from maternity to hospice, the historic building in the heart of downtown served as New Orleans' catch-all medical center. The second largest hospital in the U.S., Charity saw the birth of hundreds of thousands of New Orleanians. Ambulances picking up unknown victims automatically drove to Charity. It had one of the best gunshot wound facilities in the country (perhaps a dubious distinction), and the only Level Three trauma facility in the state. But as citizens of New Orleans can well attest, Charity's doors were closed after Katrina and have remained locked ever since. Though damage to the building's structure was minimal, LSU — the hospital's owner and operator has plans to build a new, larger medical complex in the nearby Mid-city neighborhood, a move that has sparked fierce debate through the city.
"New Orleanians have lived over four years without this critical medical institution, without construction on a possible replacement, and without even a basic business plan to obtain the money from the bond market necessary to finish the job," laments Eli Ackerman of SaveCharity.org. "As it stands ...it could be another five years or more before New Orleanians have the trauma center, mental health services, and basic hospital access they deserve." (Officials from LSU declined to comment for this story.) With the statewide system of free health care now forcibly closed, clinics in New Orleans have risen to the challenge of providing access to the city's uninsured.
Common Ground Health Clinic (1400 Teche St., Algiers) embodies the DIY spirit of post-Katrina New Orleans. Started as a first-aid station right after the storm, the clinic has since expanded with the help of activists, doctors, and community members. Since opening, it has logged over 60,000 patient visits, all at no charge to the patient. Today it offers primary care services, a Latino health outreach, health education, and prescription assistance. The clinic hosts regular street festivals, a community garden, and events with local cultural organizations to ensure that it remains an active, integrated part of the neighborhood landscape.
Other clinics are exploring alternative approaches to community medicine. St. Anna's Medical Mission (1313 Esplanade) offers acupuncture, massage, and Reiki, as well as drumming circles to reduce stress. They equip a full-sized mobile medical unit that travels throughout Orleans Parish and into parts of St. Bernard and Jefferson offering basic medical care, plus mental and spiritual counseling. Says Diana Meyers, RN at St. Anna's: "We offer these things because there is no one 'cure' for everyone. ...When talking about mental health issues such as depression, many people don't want traditional care because of the stigma it carries...These alternatives offer a 'safe' way to de-stress."
Taking advantage of New Orleans' unique subcultures, some clinics are targeting specific populations. "[Just] because you have a clinic does not mean those in need will come take advantage of it. That is the reality of a creative person... just because they can write a symphony doesn't mean they can stay on top of their health," explains Bethany Bultman of the New Orleans Musician's Clinic (2820 Napolean Avenue). Founded in 1998, NOMC offers free and reduced rate services to all New Orleans musicians, vocalists, Mardi Gras Indians and their families. Since the storm, it has expanded to include discounted prescriptions, patient assistance, lab work, and vaccinations. "Look at the principle diagnosis: hypertension, depression, diabetes. All these conditions can be maintained, but it takes a change in lifestyle."
However, as the nationwide recession continues and federal funding to clinics comes to an end, all clinics are feeling the pinch. NOMC has been forced to cut some of its most crucial services, such as its mental health program. "We realized that to keep people alive we would have to make serious budget cuts immediately. The biggest line item [for us] was paying private providers of mental health services. Mental health is not like some other services where you go once every 6 months. Often you have to go once or twice a week. Multiply that by 7-800 people. That adds up to some serious money," says Bultman. By reaching out to psychiatric partners, NOMC has been able to solicit enough donated services to cover its mental services — for now.
Dwindling funds are prompting some medical providers to seek creative ways to finance their services. ARTDOCS (artdocs.com) is a non-profit founded in 1999 to address the medical needs of artists in New Orleans. Each year, ARTDOCS pays for the medical care of its visual artists, writers, musicians and performing artists with funds from an annual art auction. "The goal at the end of the year is always to break even," explains Executive Director Greg Gremillion. "60+ national artists have donated works to the auction. All of the money we take in goes to finance the health care costs side of things."
Gremillion explains, "The way it works is, if you were an artist and went into Daughters of Charity, you explain that you're an ARTDOCS patient. They'll take your name and info and give you a check up. If you need surgery they'll recommend somewhere to go. Instead of you getting a bill, they'll send that to ARTDOCS... We're not a clinic, we form partnerships."
It is these partnerships that keep the system of clinics afloat. Dr. Robert Post of Daughters of Charity says that since Katrina, "There is a spirit of collaboration. Everybody has a sense that there's no way to fill all the needs or all the gaps left — geographically or service-wise." Partnerships strengthen the entire network because "different organizations have different strengths you can build on. There's certain things we can offer while others may have other strengths — better outreach, for example."
However, challenges abound. Federal money is coming to an end, and clinics are desperately searching for funds to keep themselves open. Many people are still consumed with rebuilding issues and prioritize healthcare last. Too few clinics often mean a long wait for appointments. Most clinics only handle primary services, making larger medical needs more of a problem. Bethany Bultman of NOMC points out: "Let's say you have diabetes and have to get your leg amputated. There's not a lot of resources [for that]. We can do a lot in a clinic setting, but if [patients] have glaucoma, carpel tunnel — where is the care for that? It's daunting. There's a point at which there's just nothing out there."
For now though, uninsured New Orleanians will continue to make do with what they've got. Thinking back on her medical experiences when she was insured, Michele Burton-Oatis ruminates: "I would prefer to go to a small community clinic. I think it's more positive. Before, I would have said that clinics were for 'those' people, that'd they'd have sub-par services and long lines. But I'm amazed at how comfortable I feel there. I never thought I'd be one of 'those' people, but now I'm glad I am."
For a full list of clinics throughout the Greater New Orleans area, please visit: gnocommunity.org.
Lily Keber is a contributing writer to The New Orleans Agenda.
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