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Chronic Disease

Struggling to Meet Neighbors’ Needs In a Rural Community

A small church on the outskirts of town in a rural area becomes a free clinic once each month. But being in a small town hasn’t protected the clinic from larger forces that threaten its survival.

By Rose Hoban

One Thursday each month, a group of people meet at the Saint’s Delight Baptist Church in rural Franklin County and sit quietly in the pews.

Though the event may be the answer to a prayer for many of the people who attend, it’s not a prayer meeting. Those Thursday nights are when the staff from the Franklin County Volunteers in Mission free clinic in Louisburg set aside time for a mobile clinic session on the very edge of town.

People drive from as far as an hour away to walk through the white double doors, wait inside the little brick church and be seen by a doctor who treats people in a small room behind the altar.

Patients sit in the pews as they wait to be seen in the VIM clinic held at the Saints Delight Church on the outskirts of Louisburg once a month.

Patients sit in the pews as they wait to be seen in the VIM clinic held at the Saints Delight Church on the outskirts of Louisburg once a month.

“They’ve helped me out a lot,” said Kay Beasley, a painfully thin woman who drove almost 40 miles from Zebulon to attend a recent clinic on a cool, clear evening.

Beasley has been cobbling together health care since she quit work to care for her ex-husband as he was dying in 2004. Then she had back surgery, and that kept her from returning to work. Her father helps out the 49-year-old, who has emphysema and takes three different inhaled medications.

“I haven’t been to the doctor in six years, except these folks,” Beasley recounted.

“I had to go to the hospital last year when I had pneumonia because I thought I was gonna die. I’ve had it twice, and they told me, ‘Don’t get it again; you won’t make it through the next one,’” she said.

But Beasley said she was put off by the way she was treated at the hospital. “I thought, they’re gonna just let me lay in this room to die because I didn’t have health coverage.”

She went home from the emergency department, afraid of the bills that would follow if she allowed herself to be admitted. But before she went, the doctors at the emergency room told her about the Volunteers in Mission (VIM) free clinic.

“Thank goodness for these people, dedicating their time.… They’re good folks,” Beasley said.

But state budget cuts, lagging donations, a lost grant and North Carolina’s decision not to expand the Medicaid program have put the VIM clinic in jeopardy.

“I just had the talk with my staff yesterday to say I don’t know if we’ll be here beyond the end of the year,” clinic director Beverly Kegley said on Friday.

A need, a calling, a response

According to family practitioner Phillip Stover, the idea of the clinic was born out of a desire to respond to the need made apparent by Hurricane Floyd in 1999. It took years to get the project organized and off the ground; it launched in 2004.

“When we first started, we decided that we would concentrate on chronic disease,” said Stover, who runs his own practice in Louisburg, as well as consulting with the local prison and a local hospice. “A lot of clinics start out the opposite; they start by treating acute disease.

“Where you have the biggest bang for your dollar is treating chronic diseases, high blood pressure, diabetes, and for relatively low cost you can control most people’s diabetes and blood pressure and cholesterol.

“And that saves the system money down the road.”

At the outset, VIM got a grant from the state that allowed it to hire a fulltime provider. Other grants followed from state-based foundations.

One important grant was on the result of Franklin County being classified as a Tier 2 distressed county.

According to the state Department of Commerce website, “The law calls for the 40 most distressed counties to be Tier 1 counties, the next 40 counties to be designated as Tier 2 and the 20 most prosperous counties to become Tier 3 counties.”

Dr Phillip Stover

Dr. Phillip Stover as he finished up seeing patients at the church clinic. Stover has been involved with the Volunteers in Medicine free clinic since before it started in 2004.

But last year, the Department of Commerce re-classified Franklin County as one of the state’s 20 most prosperous counties, based largely on the new concentration of wealth in North Raleigh suburbs in the southern part of the county.

“If anyone knows Franklin County, you know that we’re pretty rural and pretty poor,” said Kegley.

While the county had an unemployment rate of 7.6 percent in August, she said she sees many of the longtime unemployed and low-wage workers from the less prosperous north and northeastern parts of the county.

“And we know that 95 percent of our patients are in working homes,” Kegley added.

“We estimate – nobody knows for sure – but that between 7,000 and 10,000 people in this county don’t have adequate health insurance,” said Stover, who disparages the idea that free clinics could have enough capacity to pick up the slack for people who lack insurance.

Time to make the donuts

One of those working poor without insurance is Evelyn Harris, 49, who had just gotten a job making donuts from 2 a.m. to 7 a.m., seven days a week. She came into the mobile church clinic for a check-up and to see how her blood pressure and blood sugar were doing.

“It’s doing better since I got on blood pressure medication a year ago,” Harris said. And she said her blood sugar readings show she’s no longer borderline diabetic.

“I lost some weight. I’d gotten up to 217, but this morning when I got up it was 188,” she said.

Evelyn Harris, patient

Patient Evelyn Harris works making donuts on the night shift, and was getting her blood pressure and blood sugar checked at the church clinic.

“We do more baking, grilling, boiling, broiling; once a week, we have a fried pork chop. [We’re] eating a lot more greens, a lot more fruit,” Harris said. And she drinks more water than soda, although she admits she has not completely cut out her favorite, Sprite.

“I may have four or five Sprites a week. Used to be, I’d drink six in two days.”

But Harris said her new job has created one problem: Her right arm has developed muscle pain from the repetition of making the donuts. Stover gave her a prescription for a non-narcotic painkiller and taught her some exercises.

“The fact that I don’t have insurance, I don’t like that. But the fact that they’re here is a great thing,” Harris said. “I won’t get paid until the week after next and I need medication now.”

In the front pew, pharmacist Frank Schneck explained that much of what he does is help patients get onto assistance programs sponsored by pharmaceutical companies. He said that last year the clinic helped patients get access to well over a million dollars of medications through the programs.

Schneck described a complicated procedure of gathering information, faxing it to the pharmaceutical company and then waiting for the company to determine if a person qualifies.

“It usually takes four or five weeks because people are applying from all over the country,” he said.

Schneck said one of the issues the clinic has with patients is that they have no coordination of their care. Patients come in with medications given by different clinics and it’s up to him to sort it all out.

“We tell them to bring all of their medicines in a brown bag,” Schneck said, and he then examines them to ensure that one drug won’t cause a negative reaction to another.

Hard to recruit

Kegley said that last year her clinic was hoping that with an expansion of Medicaid they would be able to grow to meet more of the county’s needs. The clinic invested in electronic medical records in anticipation of accepting Medicaid, and was planning where it would expand.

But the General Assembly’s decision to reject the expansion threw a wrench into Kegley’s plans.

Saints' Delight Baptist Church on the outskirts of Louisburg has provided a welcoming venue for a monthly free clinic for more than 5 years.

Saints’ Delight Baptist Church on the outskirts of Louisburg has provided a welcoming venue for a monthly free clinic for more than 5 years.

Then the clinic lost the grant due to the county redesignation. Kegley’s budget went from $400,000 last year to about $250,000 this year.

In the spring, she had to lay off their one fulltime practitioner. Everyone at the clinic took a pay cut, including Kegley, who cut her salary by $10,000. They’re changing the hours of their main clinic in Louisburg from five days a week to four longer days to save on utilities.

Many free clinics depend on volunteer labor from doctors and other practitioners, but Stover said it’s been a challenge to recruit people from their community. For one thing, it’s extra work, and that work can be tough.

“We have lost providers because they get so frustrated because they can’t do what they feel like the patient needs,” he said. “I don’t agree with this, and obviously I’m still here, but I understand their frustration.”

“When you finish at a clinic like this, you feel like you’re all washed out and you feel like, yes, you’ve done some good but there’s a whole heck of a lot more you could do,” Stover said.

Kegley said she’s amping up the drive for volunteers and money. She admits she’s lagged when it comes to fundraising from the local community, and not enough people in Franklin County with money know about the Volunteers in Medicine clinic.

“It’s hard to fund one of these in small rural communities,” Kegley said. “There’s not a lot of money floating around out there.”

But she’s been making the rounds of local churches and the chamber of commerce, and she’s planning a fundraising skeet-shooting tournament on Dec. 7.

“Already, the local police department challenged the sheriff’s department,” said Kegley, who admits she’s depending on the tournament to raise enough to keep the clinic afloat into the new year.

“I was saying that it’s dire, and I’m now saying that it’s precarious,” she said. “I hope we don’t get to where it’s imminent.

“I’m praying we don’t get to imminent.”

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