By Clarissa Donnelly-DeRoven
In far western Macon County, U.S. 441 branches off and descends into downtown Franklin. Just before the interchange, a massive single-story beige and gray building sits empty on the east side of the rushing road. But on a sunny Friday morning in July, it wasn’t so. A pair of stray dogs meandered around the property’s three acres, while dozens of visitors carted in coffee, donuts, parfaits and plants.
Right now, the property doesn’t look like much: weeds spring up from breaks in the concrete outside, while inside, mysterious stains dot the ragged white carpet, and old security cameras poke out from the ceiling.
But soon — after a multi-million dollar renovation — it will be western North Carolina’s first bilingual one-stop-shop community health center, offering the region’s low-income residents everything from dental care to domestic violence support.
“I’m excited that y’all are seeing it as it is — dirty carpet, weeds in the parking lot — I mean, this is where we start from,” said Marianne Martinez, the executive director of the community health organization Vecinos (meaning “neighbors” in Spanish) which purchased the building, at the organization’s fundraising kick-off event.
“In a year and a half when we gather again to break a bottle of champagne over the ship, you can think back to what it looks like today. And we’ll all then take naps on the exam room tables.”
Expanding care to all
Since 2004 Vecinos has been the “medical home” for many of the region’s Latino farmworkers, providing them with medical care and health education. Their outreach first began using a mobile clinic. Later Western Carolina University donated space on its Cullowhee campus to Vecinos, where the organization operates an outpatient clinic twice a week.
At the moment, between the mobile clinic and the WCU office, staff and volunteers at Vecinos provide a total of 16 clinical hours per week to the community. In an average year, they see around 700 patients. In their first year in the new space, which will have seven permanent clinical exam rooms, the organization estimates they’ll serve at least 2,000 people, a reflection of the rapid growth of North Carolina’s Latino community and their unmet health needs.
The idea to create something like this began in earnest last year. Like other nonprofits, Vecinos creates a new strategic plan every few years and 2021 marked the start of a new planning cycle.
“With the pandemic and the emergency work that we started doing with COVID outreach and all of that, our board just kind of really took a step back and looked at what it is that we’re doing, and what did the community continue to need a year into the pandemic,” Martinez explained.
For years, Vecinos had been considering expanding its patients’ eligibility criteria from only being open to farmworkers, to being an income-based clinic — meaning, all people who could not afford care, anyone who was uninsured or underinsured, would be able to seek care with the organization.
Fanny Garcia, a phlebotomist at Vecinos, said the new community health hub (as the organization calls it) will make care much more accessible and comfortable for Spanish speakers in the region.
“Blue Ridge [Health] exists, but can’t always meet the needs,” Garcia said. Blue Ridge Health is another clinic for low-income people in the region, but the organization is often stretched to capacity. Garcia said she’s heard from patients that sometimes there are issues getting translators or a Spanish-speaking provider.
If ever there was a time to make this switch, Vecinos’ leadership thought, now would be it.
A fully-integrated model
The board and the organization’s leadership decided to move forward with the vision, but it would mean that they’d need a much bigger and permanent space.
Western North Carolina has lower overall proportions of Latinos than the eastern part of the state. Less than 5 percent of residents in far western Graham, Swain, Haywood, Cherokee and Clay counties are Latino, but that’s not the case for Macon and Jackson counties, where about 10 percent and 8 percent of residents, respectively, are Latino.
Moreover, nearly 40 percent of Vecinos’ patient population lives in Franklin, so they knew they wanted to find a location there. But they still didn’t like the idea that people would come to them for medical care, and then have to go elsewhere to get the rest of their non-medical health needs — such as support with an immigration case or help filing taxes — met.
“Every time somebody takes time off to come in to get health care or any other service, they’re not getting paid,” Martinez said. “That’s what we’re trying to reduce is all of those kinds of barriers to health care whether that’s social determinants of health or primary and mental health care.”
For about as long as the organization has existed, they’ve worked in tandem with other organizations that offer complementary services to the same patient population — El Centro Comunitario of Macon County, Blue Ridge Free Dental Clinic in Cashiers, Asheville-based Pisgah Legal Services which helps with immigration cases and is starting a new program to help people sign up for insurance coverage and file their taxes, and the Waynesville-based 30th Judicial District Domestic Violence-Sexual Assault Alliance, which helps Spanish-speaking survivors with therapy and navigating the criminal justice system.
Martinez began thinking: what if all of these operated under one roof? She posed the question to different nonprofit leaders and workers. Soon, people from all five organizations (and more) formed a leadership committee to begin working out the details.
There were similar models to this kind of work. In Charlotte, Camino Health Centers provides integrated physical and mental health care alongside a food pantry and health education classes. Behind the Buncombe County Courthouse sits the Family Justice Center, and there’s a similar facility in Alamance County.
In these multi-agency settings, there can be staff from the domestic violence shelter, rape crisis center, hospital, district attorney’s office, and law enforcement who all cooperate to help survivors of abuse or sexual violence navigate the criminal justice system.
What this community of organizations is trying to do would be something similar.
Ultimately, they decided that Vecinos would buy the building, and the other four organizations would lease space from them. There would also be additional, unoccupied rooms that other community organizations who work with this population could rent on a flexible basis or use for events.
And there would be child care. A lot of times people have to cancel their appointments either because their child care falls through at the last minute, or because the cost of a babysitter is more than they make in a day.
“With our dental clinic that we partner with, after two or three cancellations they can never come back, ever,” Martinez said. “And so if you have child care that’s been canceled two or three times, you basically have then, again, no dental care. So it’s really important to us to have a space where their children can come and safely play.”
How are they paying for it?
Dogwood Health Trust, the organization created with some of the profits from the sale of Mission Hospital to HCA, gave Vecinos a $1.6 million bridge loan to buy the building until they figure out their long-term financing. They will ultimately have to pay this back, and the construction costs are estimated to be $3 million.
“It is a big project, and it has to be done,” Martinez said. The building isn’t “health care ready.” It will need a new HVAC system, water will need to be run under the floors in the dental clinic, and the exam rooms and offices will need to be locked away from the publicly accessible parts of the building to ensure patient privacy.
Though counties can direct some of their pandemic relief money from the American Rescue Plan to nonprofit organizations to support projects such as these, Macon County has already designated all of its federal funds to go toward raises and bonuses for county employees, so that’s not an option.
Martinez said they’re pursuing grants and loans through the U.S. Department of Agriculture, along with money from foundations or, potentially, private loans.
“We have a lot of work to do, and that takes a lot of money,” she said. “But we have a fundraising and capital campaign plan that is solid. We’re not doing this alone.”
Part of the hope is that each organization that will work in this building can call on its networks to help fundraise for this project.
“I don’t think that we’re gonna raise five and a half million dollars over the next six months — it’d be nice — but, you know, it’ll take a while,” Martinez said, “And that’s fine, because it is a long-term investment in the community.”