:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Monday, February 28, 2005  

Grassroots Medicine for the community -- the Just Healthcare Clinic

"People have such simple needs, yet we have such a complex system that benefits the insurance companies, the docs, the drug companies and HMOs. Our health care in this country is irrational. We need a rational system that offers affordable access for primary care."

That's a quote by Dr. Andru Ziwasimon, co-host of this blog, from an article in the Alibi, an Albuqerque, New Mexico weekly. Back in December (yes, finally posting on it now), the Alibi published a piece called Albuquerque All Stars 2004, and Andru was one of the top innovators featured! Below is the text of some of the Alibi feature:

During his family practice residency at UNM Hospital, Dr. Andru Ziwasimon said he became aware of the profound barriers and inflated costs of medical care for low-income and uninsured people, and he decided the best way to do his part to fix the problem was start a health clinic that offers primary care to uninsured patients.

"In a lot of ways our system of medicine is so corrupt in its values around money instead of taking care of patients." said Ziwasimon. "So I decided I wanted to practice medicine in a way that was respectful to my community and met the needs of the most vulnerable people."

After months of planning and while their humble stone and stucco office in a South Valley neighborhood was still undergoing renovations, Ziwasimon, along with Sylvia Ledesma, Alma Olivas and with the help of countless volunteers, opened the Just Healthcare clinic in September.

The clinic operates on the principle that health care should be affordable and accessible to anyone. The goal, Ziwasimon said, is to integrate indigenous medicine (Ledesma's specialty), homeopathic and standard allopathic (prescribed drugs, minor surgery) practices, as well as create a clinic where community leaders can have a voice in the way health care is managed (Olivas' specialty).

Nobody pays up front. After being seen, people are asked for a $25 visit fee, and additional small fees for labs or medication. The average visit costs around $35, compared to comparable service at an emergency room for $400 or more, which is the only option for the growing stream of uninsured residents in Albuquerque. Lab costs and pharmaceuticals are priced at cost, without profit motive. To meet his own financial demands (medical school loans aren't cheap), Ziwasimon moonlights on the weekends as an emergency doctor in rural New Mexico.

"There's so much inflated cost in health care: supplies, drugs, visit charges, inflation built in to pay salaries of administrators and insurance billers," he says. "At this clinic we don't deal with the hassle and it saves us a huge amount of money. There's a belief out there that poor people don't pay their bills. But 80 percent pay us because it's a fair and affordable service."

A perfect case study was a 50-year-old man who called with full body ache and back pain and thought he had a kidney stone, because a friend told him those were the symptoms. It was 4 p.m. and the emergency room would have been his only option. At Just Healthcare, Ziwasimon administered a urine test and physical exam, then diagnosed the flu. The man didn't have any money, but returned the next day and delivered $30, then went to the pharmacy for ibuprofen and home to rest. "He's the guy I went into business for, to keep him away from the ER and a $500 bill..."

For her part, Alma Olivas has become an expert of sorts on the intricacies of our modern health care system. When her uninsured grandmother needed hip surgery two years ago, Olivas was told she would have to pay $6,500 in advance. She and her mother only had $4,500 in savings, which was being drained to cover routine visits to the emergency room to pay for her grandmother's morphine shots. She finally pulled together enough credit cards to take out cash advances to qualify for the surgery and is now $50,000 in debt to UNM Hospital and $16,000 in debt to credit card companies. During her initial struggle, Olivas became involved with the Coalition for Healthcare Access—a consortium of nurses, doctors, lawyers, caseworkers, community advocates, health department workers—that has led her to work as a community health care advocate...

The Alibi story was picked up by a number of folks in the wide blog world, including a post by Plutonium Page on Daily Kos. Check out some of the SEVENTY-FIVE comments on that link if you can -- the sheer number and diversity of personal stories on healthcare that people bring to the table is amazing. These stories and people should be driving the heatlh care debate, not politicians far-removed from it all.

Saheli Datta also blogged about the clinic and the Alibi article, and brought to our attention the touching follow-up piece that the authors of the Alibi article wrote:

Since our piece on Dr. Andru Ziwasimon, Alma Olivas and Sylvia Ledesma appeared last week, I've received a steady flow of emails and phone calls from people wanting to learn more about the South Valley health clinic these folks founded in September. Although all other organizations mentioned in our “Heroes of 2004” feature included contact info, the number for Just Healthcare was conspicuously absent. Who knew that I'd receive calls from people with an eye infection, toe inflammation or colic-stricken baby wanting to make an appointment? And then there was a nurse who wanted to volunteer and an Albuquerque resident who posted the story on [Daily Kos] blog. The posting led to an out-of-state doctor wanting to volunteer at the clinic as well.

It was Dr. Ziwasimon's request that we not publish the clinic phone number, which I think is actually his cell phone, because he is attending a medical conference in California until Jan. 8. The clinic also did not want to turn any patients away, and I believe they are currently getting a full load of walk-ins just from word-of-mouth referrals.

The story further illuminates the point already touched upon in the article—that our American health care system is irrational and incompetent when it comes to offering primary care to the people that need it the most. We'll try to follow-up on the clinic's work in the next few months for more info.

Meanwhile, I felt sorry as hell listening to a crying baby in the background, as a young woman asked me if I could help her get an appointment.

On a fundraising note, the Just Healthcare clinic is raising some dough for an ultrasound machine (cost: $21,000). Check THIS -- currently, for profit companies charge $300-$500 per ultrasound exam. Once the clinic owns its own ultrasound machine, it can provide ultrasounds for $20-70 (including the professional radiologist read when indicated). The clinic has already received more than $5000 for this purchase!

For those interested, a tax-deductible donation can be sent to:
Kalpulli Izkalli
ultrasound machine
1028 Ann Avenue SW
Albuquerque, New Mexico 87105

If you have further questions about donations -- you can email one of us (info on the right sidebar of the blog).

As Andru says "If they're going to charge inflated prices, we're gonna get our own machine!"

posted by Anjali Taneja | 2/28/2005 05:03:00 PM | |


Re: "our American health care system is irrational and incompetent when it comes to offering primary care to the people that need it the most":

I suppose that's one take on it. Although I applaud those who prefer to be medical missionaries, it's rather arrogant to presume that all of medicine must be aproached this way.

Yes, medicine can be practiced on the cheap, charging less for an office visit than most women pay to get their hair or nails done, and begging for donations to pay for essential equipment.

Recognize however that your entire ability to practice this way is dependent on the kind of largesse only possible in a capitalist system. High tech ultrasounds and cash donations are not common in the third world.

Walter Russell Mead noted that only capitalism holds promise for greatly enhanced living standards over time, and said, [t]he poor need access to capitalism more than they need protection from it.Similarly, CL Schultze (Brookings, 1977) found that people who unduly denigrate markets harbor utopian fantasies about the ameliorative potential of government economic activity. On the contrary, he noted, that harnessing the "base" motive of material self-interest to promote the common good is perhaps the most important social invention mankind has yet achieved.So I am grateful you see fit to practice this way. but you should be grateful the rest of us are slogging it out, sending donations to our charities, trying to send our own kids to school without plunging them into debt, and to save enough for our retirement so as not to burden the working poor caring for these old bones.

In short, it would be more honorable if you wouldn't judge others this way, and it would be less arrogant if you refrained from making flawed summary judgements about health care simply because it doesn't run the way you think it should.

# posted by Blogger Pogo : 3/01/2005 4:54 AM  

"In a lot of ways our system of medicine is so corrupt in its values around money instead of taking care of patients." said Ziwasimon.

...um...I'm not sure what Ziwasimon means by the "system" being corrupt, since the "system" isn't really taking care of patients and I am. And I do it in exchange for money. If I didn't get money in exchange for taking care of patients, I couldn't really continue to do it. Certainly "the system" cares a lot about money - for example, I paid in the neighborhood of $120,000 out of pocket and with loans (not donations, I had to pay them back with interest) just to become educated enough to take care of sick people. (I'm going to leave aside the economic analysis of my postgraduate training years where I earned $7.85/hr while trying to pay back those loans).

To echo Pogo, bravo if you want to do charity. We live in a country that gives us the freedom to make those choices. But asserting that I have less of a right to profit from my expertise than any other person leads down a road where we don't have an American health care system, and instead of merely a problem with health care for the indigent, you end up with problematic health care for the majority.


# posted by Blogger Doctor Disgruntled : 3/01/2005 5:48 AM  

I was very inspired to read this post, and to look at the rest of this blog.

You might be interested in my post 'A charter for human caring in Nursing': http://thinkingnurse.blogspot.com/2004/12/charter-for-human-caring-in-nursing.html some of my other posts also deal with the need for social consciousness in nursing, which I argue is a form of human solidarity.

I have also published a short (and inadequate, compared to the quality of what you are doing) review of 'to the teeth' on my blog at http://thinkingnurse.blogspot.com/2005/03/to-teeth-social-justice-medical-blog.html

I intend to blogroll your site, as soon as I can! Keep up the good work.

# posted by Blogger Thinking Nurse : 3/02/2005 3:23 AM  

I am surprised at the number of docs I see on these blogs who don't seem to see anything wrong with the system we have in America right now. There is an interesting book that was just published called "Critical Condition: How healthcare in America became big business and bad medicine."

I found it in a library and I'm having trouble finding the specific quote I want, but I'll paraphase their arguments. There is a fundamental flaw inherent in medicine that makes it different from other commodities and sevices. In and ideal world a business is doing well if it can find that product that everybody needs and sell it at a profit. Look at Microsoft. Everyone needs Windows, and therefor Bill Gates is the richest man in the world. The fundamental flaw in medicine is that in ideal world, there would be NO medicine.

Medicine is a commodity that people want the absolute least amount they can get. An ideal medical system would have a healthy population getting healthier and staying healthier with shrinking profits for everyone involved. Unfortunately, this doesn't square with Wall Street. Wall Street demands that companies show earnings growth in order to keep their stock (and therefor their company) alive.

On a side note: I think it is morally wrong for some broker in New York to be earning a percentage of the money that a cancer patient is paying for their treatment. The only people who should profit from medicine are the people actually practicing it. Unfortunately, they are the ones getting squeezed...particularly nurses.

Back to Wall Street, This demand for growth has had an effect on medicine. Market-based medicine has not produced lower costs for patients as would be expected. Instead, medical costs have skyrocketed in the last decade. This is not because of medical malpractice or rising costs of doctors and nurses or even the rising costs of drugs (although those are contributing factors). It's because now there are people in New York who are seeking profit in medicine. This applies to all aspects of medicine from insurance companies to hospital chains.

There are many things we can do to lower the costs of medicine, but that fundamental flaw will always exist in a market based system. I don't know how to fix the problem, but it would be nice if more people recognized that that is the problem.

# posted by Anonymous Anonymous : 3/02/2005 9:22 PM  

I appreciate the comments posted. Let me respond to a few points.

The first is capitalism. ain't nothing wrong with capitalism if it were practiced with some kind of ethic. the reality is that it's attached to a structure of power run by people who want to maintain their power, along Race and Gender lines, which allows for certain abberant and sociopathic behaviors to be sanctioned as "business as usual." There are few healthcare systems that i know of which work to help their communities "access capital." Most just figure out creative ways to take it away from people. Job creation and skills building is something we are trying to do, on a small scale, within this new clinic enterprise. so i agree that access to capital is an important goal, but my friend, that is a political, highly political statement.

are you sure you aren't a radical naive idealist, believing that capital flows in some form of free market?

There is a powerful structure to U.S. society which bounds and limits the flow of capital in profound ways and many mechanisms in place, sanctioned by governmental policy over the years, to ensure that when some small gains are made amongst "certain" communities, those gains are eroded or stolen. read about red lining and the banking industry from the 1950's until today.

Finally, my comments were made in a certain context, i.e. a local newspaper, about the primary health care system in albuquerque, new mexico, not about the national picture, which has it's own problems. Come live or work here for a while and perhaps you will come to agree with my "judgement" that this primary healthcare system is broken. I have studied it now for six years from inside almost every clinic by doing locums work and from outside by working directly with community groups trying to get access for their members. My assessment is, unfortunately, accurate.

To the disgruntled doctor, let me respond about charity. I'm not doing charity, it's business with a significant dose of compassion. this isn't a free clinic. I'm charging a fair price and people are paying. When the clinic is up to speed and i'm seeing 10-15 patients a day, i'll be able to make about $75,000/yr with very few of the headaches that many of my peers are having working for clogged and overburdened health systems or in other poverty clinics, here in ALBUQUERQUE. Just Healthcare is an old time doctors office, it's the epitome of a conservative business model. It actually is "CONSERVATIVE." We conserve resources, capital, time, energy, minimal amount of governmental or corporate oversight, paper, etc.

In terms of donations, we appreciate the generous contributions of friends, family, patients, community, etc.. people share what they can, freely, and the money helps, but we aren't dependent on it. So far I haven't used a dime of money donated towards myself or the clinic, it's all in the bank for the ultrasound machine. We have made use of and appreciated the manual labor that many immigrant families and friends contributed to make the clinic wheelchair accessible and beautiful. That's the spirit of my community, working with and for each other, like an old fasioned barn raising and it's been alot of work and alot of fun. It's my guide to know that what i'm helping create is needed and important to others.

perhaps y'all should look at your own business models and see just how much profit you are making. money isn't the only form of profit out there. time, respect, joy, exercising creativity, sick leave, flexibility, it goes on and on.

my apologies for sounding judgemental, it's not my intent but this is a difficult medium to communicate in because we each come from and perform life in such different arenas and environments.



# posted by Blogger andru : 3/08/2005 10:59 PM  

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