by Matthew Olson, originally published in the July/August issue of the New Orleans Tribune
In broken mirror pieces reads a sign, “Common Ground Health Clinic,” above the door where nearly forty patients a day visit this converted convenience store on an Algiers street within two blocks of the Mississippi river. Up a ramp and inside is a pristine waiting room with twenty-five chairs and along the short hallway is the social workers’ office, then four patient rooms, and an herbalist station toward the back.
Anne Mulle, the clinic’s nurse practitioner, spoke with me from inside one of the patient rooms where flyers on the walls promoted reduced-cost eye exams, healthy eating and early breast cancer detection. She stressed the importance of integrative health, relieving stress, and understanding people in their environment. To this end, the clinic provides social work, acupuncture, herbalism, live Spanish language interpretation, and supports community organizing. Weekly “Mind Body Medicine” groups focus on breathing techniques, visualization and other methods of relaxation.
“People typically think of health as blood pressure, weight, and laboratory results,” explained Mulle (pronounced MOO-lay). “We believe their health includes the complete picture: What’s going on with their housing, with their kids and their schools? What’s their stress level? What’s going on with their work: are they working multiple jobs or not able to get a job at all? How is their over-all well-being impacted by their community and their environment?”
Earlier this year, Common Ground Health Clinic received the highest level of recognition for national health standards as a “Patient-Centered Medical Home” by the National Committee on Quality Assurance(NCQA). The standards for the primary care applicants can include the use of best-practices, the quality of medical records and following up with referrals. While thirty-seven applicants from the Greater New Orleans Area received recognition, only two practices earned the prestigious level three: Common Ground Health Clinic and St. Thomas Community Health Center.
Unlike peer institutions, these two clinics are explicit about their intention to be community-integrated and anti-racist as a means to long-term community health. As a means to those goals, both organizations work with the nearly thirty-year-young and locally-staffed People’s Institute for Survival and Beyond, which often facilitates weekend-long “Undoing Racism” workshops. The People’s Institute has worked with St. Thomas since 1991 and, in January 2006, the People’s Institute co-sponsored its first workshop since the storm with CGHC.
“They have incorporated anti-racism into their mission and vision,” said Dr. Kimberley Richards, CGHC board member and core trainer with the People’s Institute. “They recognize race in the health paradigm.” Part of this recognition is to turn the principles into practice beyond a single training. Accordingly, PISAB meets monthly with CGHC for strategy sessions and hosts quarterly trainings for patients, staff and community members.
“How do you incorporate anti-racist principles?” Richards continued. “You engage the community, establish partnerships, hire residents that fit, recognize the resource in the community, not just bringing in from the outside.”
“I think it made all the difference in the world,” said R. Noah Morris, a clinic co-founder and CGHC Board President, about the affect of anti-racist principles on getting the highest NCQA recognition. He added that the recognition should also convince the healthcare community that “free does not mean cheap.”
“There’s a notion that community clinics or free clinics provide a sub-standard quality of care. We’re here to show that doesn’t have to be the case,” added Mulle. The vast majority of people who come to CGHC, eighty-six percent, are without any form of healthcare coverage.
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Despite living only a few blocks away, Keith Jones’ first trip to the clinic came a full year after its opening. “What I had was simple,” Jones said of his knee injury. “I got advice beyond what I really needed: ‘Did I live by myself? Could I make it?’ I’m getting all this attention with a sore knee? And nobody knew me from the man on the moon.”
Soon after, he accepted the clinic’s invitation to attend an “Undoing Racism” workshop, which included staff and patients together. “It was on point,” said Jones, who began volunteering and is now on the clinic’s staff as a community organizer. “They recruited from the class and I’ve been there ever since.”
Several staff members were first patients, including Coleen Murphy. Murphy had lived in Algiers Point for four years when Katrina hit and hesitated to return after reading reports of vigilante violence. But with the news of a clinic, she found a clear reason to come back. “I have never had health insurance and had been a patient of various sliding scale clinics my entire adult life. Never had I been treated with such care and kindness,” wrote Coleen Murphy in an e-mail.
A few weeks later Murphy started volunteering at the front desk. Now, as the clinic’s Communications Coordinator, she assists in outreach and edits all of CGHC’s publications, including the coveted health resource guides—collated by geography, like the Central City Guide, or themes, like the Mental Health Guide. The overall guide, “New Orleans Community Resource Guide,” is so thorough that it is utilized by clinics, hospitals, and social service agencies city-wide, including the city’s health department.
On days when the clinic is open, Marie Romeo can spend up to five or six hours in conversations with patients about job searches to healthy eating to racism. “It’s revolutionary to have health care and racism in the same context. That’s not done anywhere. I think that utilizing anti-racist principles in social work is not only possible but it’s imperative to be effective,” said Romeo, the clinic’s social worker. The first crucial steps are to listen to “a person’s experience and understand them. What would be characterized as a pathology is a constant exposure to systemic oppression. People often come in saying, ‘can’t get a job. I’ve a got a bachelor’s and master’s degree and can’t get a job.’ There’s stress around making ends meet.”
Integrating social work and mental health services into the clinic in the fall of 2008 relieved a tremendous burden on the physicians and nurses to help patients with referrals, counseling, applications for other services and getting prescriptions filled properly. “A lot of that didn’t exist before, or it was falling on the primary care providers,” said Anne Mulle. ”In a healthcare system that is overwhelmed, having mental health and social work services in the clinic takes a huge burden off the patient visit and allows primary care providers more time for chronic disease management.”
At the Center for Mind Body Medicine training in January 2007, Anne Mulle met Antor Ndep, a public health doctorate student, and encouraged her to apply for the Executive Director opening. Ndep, who has lived in New Orleans since 1997, was hesitant, but committed to visiting before passing judgment.
“What hooked me is that it was almost a manifestation of everything that I’ve thought about establishing in a community health center back home,” said Ndep, who was born in Nigeria. “Here are a group of very young people on both sides of the race line saying we want to talk about racism because we feel that racism is what is making communities poor and ill. That is something that you just do not find anywhere. “Combating racism, gardening, monitoring the police. Pieces of the puzzle were all there, they just needed us to concentrate to put those pieces together.”
In two years as the clinic’s Executive Director, Ndep has overseen impressive growth through channeling the unique energy she felt on that first visit. Using her education in public health she formalized the organizational structure, revamped the clinic’s policies and procedures, and embraced the clinic’s non-traditional programs based in community organizing and engagement.
“Community engagement for us comes in many different forms,” said Ndep, who emphasizes consideration of patients as peers worthy of dignity and honesty. “It’s not sophisticated in any way at all. We talk, we make friends, look people in the eye and invite them to everything we do. It’s a way of providing healthcare that goes beyond sitting across from a provider and telling him what’s wrong and that’s the beauty of it..”
In contrast to its volunteer beginnings, the clinic now has an operating budget over one million dollars per year, a staff of more than fifteen, and a state-of-the-art electronic medical record system. While one co-founder of the clinic used to quip—“we’re building a plane while flying it”—the healthcare facility now seems to be a well-worn, thoughtful and precise collective.
Through the processing of those growing pains, the People’s Institute and the St. Thomas Community Health Center supported and guided CGHC. “St. Thomas Community Health Center has really been a model health clinic for us,” Mulle affirmed.
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In operation since 1987, the St. Thomas Community Health Center has been a model clinic of community inclusion and patient-centered health for CGHC. For instance, patients are a majority on St. Thomas’ board. Undoing Racism workshops have been a regular part of volunteering or working at the center since 1991. St. Thomas makes impactful partnerships with other health providers, including a unique cardiovascular surgery program for uninsured patients with Ochsner.
“At Charity, it’s just someone you don’t know. Here, you can talk directly to Mary,” said Barbara Jackson, a founding member of the St. Thomas CHC, of Dr. Mary Abell. Jackson said that after finding out why a patient came, Mary will ask, “‘But what else is bothering you?’ You could never do that anywhere else. It’s holistic problem solving.”
Executive Director Dr. Don Erwin, who chaired the Department of Medicine at Ochsner Hospital when he started volunteering at St. Thomas back in 1991, thinks the success in good health outcomes comes from an interdependence between the community and the center. “If you’re a patient of ours and we know that you’re sick and can’t make it, we’ll send a taxi for you. It’s not the clinic over here and community over here,” Erwin said, moving his hands from left to right.
Though St. Thomas is not free, but low-cost, they do have an open access policy to see a patient the same day they call. “The traditional appointment system has a forty percent no show rate,” explained Erwin. “If there’s no bus, you can’t come. If you can’t get a babysitter, you can’t come.” Switching to a walk-in or call-in system where patients can be seen the same day allows for flexibility in a patient’s environment—a crucial step to being patient-centered and anti-racist.
“Race is an independent risk factor,” Erwin firmly stated. It is a statement Antor Ndep repeated to me, and a lesson the Common Ground Health Clinic has taken to heart.
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CGHC has come a long way since setting up card tables to divide first aid stations inside the Masjid Bilal mosque in dry Algiers on September 9, 2005. Then, a few dozen volunteers saw one hundred patients per day and acted largely as an emergency first-aid location. Volunteers often drove people to the nearest open Jefferson Parish hospital or called ambulances when necessary.
Bay Love, a volunteer transplant who is now the clinic’s Financial Officer, remembered the intensity of those first few months. “It was inspiring, exciting, and thrilling, yet extremely humbling. I thought, ‘this is really bad, people are really sick, and there is nowhere for them to go,’” he recalled. What made the need for a permanent health clinic in Algiers urgent, at least for him, was the realization that people’s health and the healthcare in the city had been poor and broken due to systemic racism and poverty long before the storm.
On a recent April day, Algiers resident Ronald Ragas sat on the steps of Delille/Drexel Fellowship Center of All Saints Church on the opposite corner from the clinic. A middle-aged man, Ragas shook his head as he spoke deliberately about a bladder infection he had not long after Katrina hit. He paused between sentences. “I was short four units of blood. A walking dead man. They put me in the hospital. I wouldn’t have made it. A lot of people were saved by the clinic.”
The clinic might now need to be saved by the people. The clinic threw a fundraising kick-off dinner in April at their office, which is two doors down from the clinic. In the front yard, a DJ announced the event over loud speakers to passersby and added his own wisdom: “They were there for us, so now we’re here for them.”
The goal of the clinic’s fundraising campaign is guarantee the sustainability of the clinic and deepen the partnership with the patient community. They have set the bar high: the clinic wants to raise one million dollars by its fourth anniversary, September 9, 2009. For current operations the clinic relies heavily on a government grant that will end in December 2010. Without knowing how the Obama Administration’s will act, the conclusion of the grant could drastically alter the clinic’s structure. When community members heard that the clinic might have to reduce services, many enthusiastically brought up suggestions from church dinners to hosting a bazaar. “We’re trying to fundraise on three or four tiers, grassroots to the upper level to the internet,” said clinic community organizer Keith Jones.
Listening to the DJ, Bay Love danced on the porch and a young boy imitated him. An older girl laughed at them both. In the office’s first room, Anita Powell, wearing an impressive white straw hat with a black band, took money for the fundraising dinner. Powell shares her hat making skills in clinic-supported classes as a way for community members to relieve stress. In the kitchen, next to anti-racist principles written on the wall, Lanette Williams served up fried fish, potato salad, green salad and spaghetti. Everyone working at the fundraising dinner had volunteered their time.
“I got to get off my feet,” gasped Williams, who had been cooking for at least the past seven hours.
R. Noah Morris, a clinic founding member, pulled a cooler from under the dining table and put it in front of Williams as a makeshift footrest. He said, “I know how to take care of the caretakers.”
More than twenty people remained in the dining room and backyard sharing stories after dinner. Among them was Orissa Arend, who wrote about the clinic’s origins for this publication in 2007. She “gave somewhere between zero and a minus one to the chances” that the clinic would endure because of so many broken promises from other providers such as Red Cross, FEMA, and all levels of government in the fallout of Katrina.
But thankfully, as Ronald Ragas told me earlier in the day, “They hung with us. Didn’t show up for a week or two then leave.”
