It's not what you expect.
If you thought that people who have to rely on free health care probably find it in weary, worn quarters, that the services they get aren't quite top drawer, then step into the Lackey Free Clinic. It's new, and it sparkles with up-to-date equipment and colors and an undeniably upbeat vibe. Sun pours through the high windows, flooding the interior with light. Staff are smiling, and there's hugging. It's like any family practice - only maybe more attractive, more welcoming, with a bigger measure of joy.
In the clinic's waiting room, what you find might not be what you expect. The clinic's patients aren't homeless or looking for a handout. Most - 70 percent or so - are employed or in households with an employed adult. They work largely in service jobs. They're the folks who work in retail shops, or as roofers, or in child care.
But where they work, health insurance isn't offered or is so expensive they can't afford it. The average cost for a family policy is more than $11,700 a year - more than a minimum-wage worker brings home.
And if you think social needs are corralled in inner cities, think again. The 1,000-plus patients who in 2008 will come to this clinic live in York and James City counties and Williamsburg, as well as Newport News.
They come to the Lackey Free Clinic because they're sick, or they couldn't afford the medicine for a chronic condition and it's getting worse. They come because a hospital referred them, or they learned about the clinic from word of mouth.
Many are embarrassed at finding themselves here because they've always worked and they're proud of taking care of themselves and their families. What they find is that just because they don't have insurance cards in their pockets, it doesn't mean they don't get good care in a great place, with their dignity intact.
The Lackey Free Clinic will upend your notions about what caring for the uninsured and the poor can look like and feel like. And that can be traced to James and Patricia "Cooka" Shaw.
From dozens of nominations from readers, the Daily Press Editorial Board has selected the Shaws as Citizens of the Year for 2007. The award comes with a $1,000 donation to the charity of their choice.
'LEAST OF THESE MY BRETHREN'
A glance around the clinic, or a little time spent here, will leave no doubt about why it was born or why it operates the way it does. Because it isn't just a provider of services, it's a calling, to the Shaws, who launched and still shepherd it, and to many of those whose efforts make it a success.
Painted on the wall on the multipurpose kitchen, workroom, breakroom and conference room are the words that sparked this medical ministry. They're from the part in the gospel of Matthew in which Christ says that, come the Judgment Day, the kingdom of heaven will be inherited by those who, in serving the hungry and thirsty, the stranger and the prisoner and the sick, served him: "Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me."
It was while Jim Shaw, a pulmonary specialist with the Intensive Care Unit at Riverside Regional Medical Center, was reading this passage that "a light bulb went off."
He asked himself, "How can I serve Christ?" and found the answer, "I can do it by serving the poor."
That proved easier vowed than done. Offers to help at a couple of clinics didn't even get a call back. Then a chaplain in training at Riverside suggested, "Look in Lackey," a part of York County with more than its share of poverty and pain, and sent him to the Rising Sun Baptist Church there.
Here Shaw's offer met fertile ground, but it was slow to grow. The clinic started in 1995, meeting one evening a week in a Sunday School room with a handful of volunteers serving a handful of patients. The next year, York County welcomed it to the new community center at Charles Brown Park. Then in 1997, cancer forced Shaw to close the clinic for a few months. He and Cooka contemplated giving it up, but gradually, more patients came, enough to add a second night - enough finally, that a full-time, fully equipped clinic was needed to care for them.
The fruits of the Shaws' perseverance now have an address: 1620 Old Williamsburg Road, not far from the Naval Weapons Station. The money to purchase the land was a gift from the York County Volunteer Association. Fundraisers brought in enough that when the new building opened in 2003, it did so debt-free.
What began as a Thursday-night clinic with equipment lugged around in a cardboard box is now a five-day-a-week operation. It has added dental care and critical specialties, including gynecology, ophthalmology, rheumatology, cardiology and pediatrics.
And the need keeps growing. The patient-visit count nearly doubled between 2004 and 2006 and rose another 27 percent in 2007 to 5,300. Every week brings 25 or 30 new patients, and Jim Shaw expects that trend to continue. There are, he estimates, 160,000 people in the greater Peninsula area who meet the qualifications for free care because they're uninsured and their incomes are less than 200 percent of the federal poverty level.
NOT JUST A BAND-AID
The Lackey Free Clinic is all about health, but not just physical health. Jim Shaw credits Cooka with an ingredient that defines and permeates and energizes the clinic. He's all "right brain," he says, suggesting his scientific training at work: Tell me your symptoms, and I'll solve the problems of diagnosis and treatment. She's the one, he says, who started going into the waiting area and talking to patients about their lives, about what's going, about all the dimensions - emotional, familial, spiritual - that a CT scan can't detect.
Cooka Shaw fleshed out what Jim's commitment to serving Christ by serving the poor looks and feels like. It must, she says, be about more than "putting a Band-Aid on a hurt." It must take care of the whole person.
So talk to people who work at the Free Clinic, and you'll hear about love, as well as lab tests; about prayers, as well as pharmaceuticals; about the spiritual health they gain by tending to the physical and emotional and spiritual health of their patients. The walls speak, too, with passages from scripture. They don't show up on prescription pads, but prayers and hugs are dispensed, too. It's no accident that the chaplain's door opens onto the waiting room, offering a spiritual resource and counseling.
The faith component is handled with a delicate, never forceful touch, but it's in the air and on the walls, ready for those who seek it. It's clearly the reason why many of those who work at the Lackey Clinic, volunteer or paid, are there, and why the clinic has the feel - bright, hopeful, affirming, loving - that it does.
MAKING IT WORK
The clinic may have a full-service building, but it operates on a shoestring. That works because of the Shaws' success at recruiting other people into their dream. An endeavor like this depends on volunteers, and the Lackey clinic needs specialized ones: doctors and dentists, nurses and people who can handle the pharmacy and the back-room operations that keep a busy clinic humming. Recruiting - through churches and word of mouth - and scheduling and managing the 200 volunteers is a big job, requiring a paid coordinator.
Many of the doctors are involved because Shaw, who has left Riverside and is volunteer medical director at the clinic, isn't shy about calling up old colleagues and asking them to help. Why do they agree? Ralph Robertson, whose regular job is as an emergency room physician, answers, "Because it's the right thing to do."
There are organizational supporters, too. Riverside Regional Medical Center furnishes generic medicines, lab testing and X-rays, at no cost to patients. The Bernardine Franciscan Sisters Foundation, Williamsburg Community Health Foundation, Riverside HealthCare Foundation, Virginia Peninsula United Way, Virginia Health Care Foundation and York County are among those who help with specific needs, from dental care to nurse practitioners.
A regular fundraiser, which features a dinner, auction and comedy entertainment, helps pay the bills.
All those donated hours, services, supplies and dollars support one efficient operation. Spending just $740,000 last year, the clinic delivered, Shaw figures, nearly $4 million worth of medical care. That's more than $5 of care for every $1 in its budget.
The patients aren't the only beneficiaries. By approaching patient care as it does - emphasizing prevention and management of chronic diseases - the Lackey Free Clinic keeps people out of hospitals. That reduces the drain on emergency rooms that results when uninsured people use them as primary care facilities for everything from toothaches to flu, because they can't be turned away.
And it cuts down on demands for inpatient care. Shaw says that patients who haven't received regular medical care are often sicker by the time they get to the hospital. They require more elaborate and expensive care, and they have higher rates of complications and even death. By keeping them well, the Lackey Free Clinic prevents admissions. And because hospitals have to absorb the cost of uninsured patients, or build them into the bills it hands insured patients, everyone benefits.
CODE FOR DIABETIC DINNER?
The Lackey Free Clinic works hard to be more than a drop-in, acute-care facility, although there are walk-in clinics twice a week. The bread and butter is in the three-day-a-week chronic care clinics.
Illnesses such as diabetes, high blood pressure and asthma are common among patients, so these clinics focus on the things that help them manage their diseases: education and support. And faith, as well, which patients experience as helping doses of acceptance and love.
Nurse practitioner Deborah Wilson believes that's all part of the reason she sees more success with diabetic patients at the Free Clinic than in other settings. Patients are educated, they're given the supplies and medicines they need, and they're empowered to take control.
The proof is in the numbers, specifically, the results of a test that reveals average blood sugar levels over the past few months. When patients come in, their typical reading is 10, which puts them in a dangerous range. Within a few months of working with the clinic, they're usually close to the goal of seven.
Nobody is billed for the services at the Lackey Free Clinic. And that's a good thing, because where on an insurance billing form would you find a code for the Diabetic Dinner?
By planning, preparing and enjoying a meal together, patients learn a lot about controlling their disease, about how to shop and eat, while enjoying the boost of support from fellow diabetics.
And how would you code the group some women patients formed, at their own initiative, that focuses on healthy eating and incorporates workouts and begins with devotions?
With uninsured patients, it's no good giving a slip of paper, with advice to take it to a drug store. Without insurance and much income, prescriptions go unfilled. So the Lackey Free Clinic has stitched together an umbrella of coverage to make sure that patients walk out with the medicine they need in their hands, at no cost.
It takes partners to make it work. Riverside stocks the on-site pharmacy with generics, and several pharmaceutical companies provide their expensive drugs. To make sure patients get regular refills by mail, the clinic works through a state program to hook them up with drug makers' own programs that provide medicine for low-income patients.
Since each has its own eligibility criteria, forms and procedures, this takes a well-run backroom operation. In a pinch, when a special medicine is needed right away, the clinic calls on another longtime partner, the Denbigh Pharmacy.
Still, there are needs that challenge the clinic and its patients. Shaw reckons that a large number are dealing with depression, and while the clinic can manage mild to moderate cases, it works with community services boards to serve those whose needs go beyond that, or who are struggling with substance abuse. He'd like to add more social work services. And the clinic wants to expand its dental capacity to bring in hygienists and add preventive care.
MORE TO COME
There's no way to read the numbers without coming to this conclusion: Absent some radical change in national policy, the number of uninsured, low-income people needing medical care will increase. So, likely, will a group that has come to represent one-fifth of the Lackey clinic's patients: Hispanics.
Shaw has a plan to meet that need. It involves moving administrative staff. A site next door, renovated or replaced, would be perfect. That would free up space to add another dental chair and more exam rooms. A $12 million capital and endowment campaign will try to make that plan a reality.
A more efficient way of connecting patients with the specialists they need is also in the future. Project Care, sponsored by Riverside HealthCare Foundation and modeled after a successful program in Roanoke, would offer the uninsured patients of the Lackey, Gloucester and Hampton free clinics and other programs the network of specialized care that people with insurance can count on. It will formalize the ad hoc system of medical availability that has, until now, depended on Jim Shaw's ability to tap the generosity of colleagues.
And there is, always, Shaw's dream of expanding the Lackey model to the area where he first tried to serve the poor, in downtown Newport News.
He explains why, in an area of great need, the Lackey Free Clinic model could work well: "We have a special and unique place here, a sanctuary for not just physical, but also emotional, psychological and spiritual health. We want to continue that ministry, to offer more than medical and dental care."Copyright © 2015, Los Angeles Times