Sept 4, 2019; The Atlantic
Yesterday, we published a newswire about community development corporations, and today we publish this paean to community health centers. Both stories illustrate the importance of certain legacy types of organizations in the lives of community all across this country.
Live in Eastport, Maine, and you are the first in the US to see the sun rise, among the fortunate few to watch whales or witness the largest whirlpool in the Western hemisphere, and—if you love mustard—able to savor a sample produced by the last remaining stoneground mustard mill in America. And Eastport’s harbor, the deepest natural one on the Eastern Seaboard, never freezes over.
Eastport’s people are hardy and resilient, some say. But they are not hale. Indeed, Washington County, where Eastport is situated, ranks the lowest of Maine’s 16 counties in health outcomes, from length of life to quality of life. Not surprisingly, the county also ranks lowest in the state in social and economic factors, including poverty, income inequality, and violent crime. Its population has declined from more than 5,000 in the early 1900s to 1,331 in 2010, mostly the result of the death of a once-burgeoning sardine processing industry.
But Eastport has a critical community asset: Eastport Health Care, a 40-year-old nonprofit community health center with the mission of providing access to high quality healthcare regardless of a person’s ability to pay. This clinic provides a true range of services to its nearly 6,000 patients, including primary, dental, psychiatric, and nephrology care. The clinic is able to make health care available to all because it is a Federally Qualified Health Center (FQHC), one of 1,400 in the country serving more than 28 million people.
FQHCs are a legacy of the 1960s War on Poverty, along with Job Corps, Head Start, and VISTA, and they are found in rural, urban, and suburban locales. The FQHC designation means a health center gets enhanced reimbursements for Medicaid and Medicare patients and can offer a sliding payment scale for people without health coverage. It means that its providers are covered by federal malpractice insurance and have access to critical medical school partnerships and specialists.
Despite these critical supports, however, rural health clinics are challenged with recruiting and retaining health care practitioners, an aging population, limited transportation options, inadequate exercise facilities, poor food choices—and, as we know, an opioid epidemic. Here’s where the creativity, persistence, longevity, and even flexibility of a true community-based institution like EHC comes in:
- Community Circles. Since 2011, Eastport’s clinics have convened nearly one hundred community circles, a model that honors and empowers the peer voice, demands attentive and responsive listening, and promotes community engagement. They cover a true range of conversations and topics in this far Down East Maine town: teens helping teens, understanding Alzheimer’s, palliative caregivers, food insecurity, and LGBT youth. According to EHC’s executive director, these circles begin with probing questions, allow for silence, honor all contributions, let the conversation flow where it needs to and, amazingly, “uncover the complexity of the system of problem being discussed.” The Integrated Behavioral Health Community Circle responded to a participant’s wish to improve the system of care for inmates with mental illness by developing a transitions-of-care program for inmates released from the local county jail. The Gay/Straight/Transgender Alliances Community Circle convened almost 100 educators and healthcare providers for an education workshop, focused on demystifying beliefs, raising awareness and building trust in a community unused to talking about and dealing with sexual differences. The Caregivers Community Circle developed and donated a set of books, articles, local resources, and music CDs to the local library.
- Making Access Easier. Transportation is a problem for many rural residents, and EHC has “patient-navigators” who manage the many pieces involved in accessing health care. They find specialists, arrange appointments, organize transportation, manage oversight stays and last-mile transit, and secure access to food and housing.
- Attracting Staff. EHC believes that an awareness of eastern Maine’s distinctive local culture is key to both attracting and retaining personnel. They’ve embedded a cultural-immersion component in local training programs at the community college, University of New England College of Pharmacy and College of Health Professionals. Doctoral students, for example, spend their spring break week with EHC. They say that two professionals, so far, have chosen to settle in the area because of it. The EHC Board has set up a scholarship program for local high school students to attend health-care professional tracks at the community college, providing more than $100,000 in financial aid over a decade.
- The median age in Eastport is 54, compared with 45 for Maine, which has the highest median age in the US. EHC installs grab bars and smoke detectors in homes with elderly residents, registers caregivers with the police and EMS to facilitate quick responses during emergencies, and has worked with the city to improve sidewalks, install street lighting, put safety rails along steep inclines and place benches for people to stop and rest.
These are not high-tech, complex responses to a rural community’s deep-seated challenges, but remedies that emerge from deep community engagement, cultural respect, longstanding partnerships, a viable business model and transparency—the marks of a respected and effective community-based institution like Eastport Health Care. As EHC CEO Holly Gartmayer-DeYoung compellingly asks, “How do we foster responsiveness in a healthcare system as massive as ours?”
How do we achieve real-life relationships in an industry steeped in tablets and smartphones? How do we combine the logical, evidence-based core of our current healthcare delivery system with mindful heart/spirit connections? How do we become still in the roaring river of change that seeks immediate solutions?
And let’s not forget—Eastport Health Care’s ability to effectively serve the uninsured and underserved is not a local aberration, but the result of a nearly 50-year-old federal program that continues to be funded and stays true to its mission of providing a patient-centered medical home for those of limited means.—Debby Warren