It's been a few months since i last posted. i entered a vortex of personal growth, clinic expansion, and political upheaval. when it rains, it pours.

:>

The Topahkal Clinic Coolaborative is growing beautifully. We have four part time practitioners and have expanded our hours to six half days a week. with an average of about 8 patients per half day, we are financially solid and our patient bas is expanding rapidly, folks can actually find the place now and we are receiving alot less phone calls as people trust that we really are there. The clinic is stocked with every tool and toy for practicing medicine that one could want, short of an x-ray and mri machine. we have EKG, ultrasound, microscope, autoclave, slit lamp exam, woods lamp for flouro eye exams, all the procedure instruments necessary for gynecology, biopsy, suturing wounds, and all the CLEA waived labs that an office can have.

And most importantly, we now have two wonderful volunteers who come three days a week to help welcome patients and answer the phone. Claudia is a phsychology student and health promoter who wants to build a preventative health education component to do with patients while they are waiting for their visit with the practitioner. Ledis is a physician from Colombia and a health promoter who will ultimately go thru the lengthy process of getting her lisence here in the U.S. She studied system administration in Colombia and will help us with patient satisfaction data collection as well as linking more strongly to the various other health safetynet resources nearby.

Final note on the clinic - we passed two major milestones!!! the first is fairly meanigless, i suspect, to the general public, but for some reason it really hit me. i had to replace the soap container in the bathroom last week. :> it's sometimes the smallest of things that alerts you to the passage of time and the texture of success. we've washed alot of hands in that bathroom. the second milestone is much more substantive and touching. WE HAD OUR FIRST BABY! we reluctantly started a prenatal care arm of the clinic after a number of pregnant women showed up on our doorstep, sent from the clinics (UNM M and I, First Choice) that are supposedly funded to care for pregnant women. It's still not clear to me exactly why they couldn't get care at those clinics. we have followed one lady, who needed a c-section, thru her prenatal course, and were able to link to the family practice department at UNMH so that her entry into the hospital, her hospital course, and her reentry into "clinic" life were smooth. She had a great experience, no complications, baby boy, 7 pounds 3 ounces. she came to the clinic unannounced this past saturday with her whole family and her new 5 day old baby, just to visit and show off her son. This was the first time as a doctor, after helping catch over 200 babies, that this very personal experience happened. I realized that it would have been impossible for her to do that if i worked in another system, because the front desk likely would have required her to have an appointment and the wait time would have been prohibitive to sit there with a brand new baby. it was a beautiful and touching experience for me to be so honored that the whole family wanted me to see the baby i helped care for. Of course, since i had never happened before, i didn't realize they were coming for a social visit so i started doing the doctor thing, checking the belly button and listening to the lungs... DORK!

I can't leave this email without an update on the political work at UNMH. things are shifting fast now. The governor (Richardson) weighed in on the issue a month ago, and he came down on the side of UNMH being a public hospital. he wrote a letter to the regents of the hospital demanding that they put on a summit within 90 days to rectify the problems at UNMH and stated clearly that it is wron to put financial considerations ahead of patient care. We are very pleased with this turn of events. It has sparked a healthy debate at the highest levels on what the mission of the hospital is. Folks have articulated three different major missions so far - a public hospital caring for county and/or state residents, a private hospital caring for privately insured patients, and an academic research institution. Everyone agrees that it is the major teaching hospital for the state, that isn' really a question in anyone's mind, perhaps except the students and residents. :>

So we have asked the next question - is UNMH administration using public tax money to subsidize the construction (physically of new buildings and by policies which exclude the uninsured) of a private hospital that is competing for private patients with the other hospital systems? Or are they constructing private parts of the hospital (which is happening at a fast pace) to help subsidize care for poor and uninsured patients? Our stance at the summit is clear - this is a public hospital first and it must meet the basic tertiary care (is that an oxy-moron?) medically necessary health needs of the uninsured before it takes on the burden of caring for insured patients. From many insider testimonials, and my personal experience, i do not believe that any funds from private patients are being used to subsidize care for the poor. as it is, more policies of exclusion are being created.

Admin has argued something very interesting lately. they say they are serving the "new underserved." these new underserved are people from around the state and in albuquerque who have insurance but apparently cannot access key specialized medical services offered only at an academic research facility. i have no idea what services they are talking about. it's all more double-speak to me. either you strive for equity in society, and a public hospital is the key tool for doing that in our healthcare system, by meeting everyone's basic healthcare needs first, or you set up a scenario where a class of people are deemed "a burden" to elite society and are shunned and excluded from dignified access to health services. Entry into the ER as the only access point, with a 12 hour wait, is not dignified nor appropriate, nor healthy health care. I know from personal conversations with high level administrators that they believe poor people are a burden to "their" system, a dead weight holding the hospital back from being "great" and being able to serve those who really need it, the insured. It is disquieting for me because, even though it is much less profound, it brings back a deep cellular memory of the type of social thinking exhibited in Nazi Germany. The energy and attitude, combined with the power of decision-making of this narrow minded group, is wrong from a humanist perspective. it is degrading, disrespectful and unjust.

So the discussion will now rise to a new level of the MISSION of the hospital. until that is clear, there is no road forward. the public believes it is a public hospital. the board of regents seems to believe it is an academic research institution with a public hospital function that is underfunded. the administration clearly believes it is a private hospital with an udue burden of uncompensated care.

andale pues. democracy in action is a beautiful thing, even if everyone doesn't like it.

andru