Guerrilla health care

In April 2007, Teleen Santillán showed up at the Shalom Free Clinic. She knew she was sick, but she was nevertheless surprised when a doctor, after conducting a simple urine test, told her to go to the hospital without delay.

“No, I can’t go, I can’t pay,” she told Shalom staffers. “They said, ‘Just go, and figure out what to do about the bill later.’” That visit, said 40-year-old Santillán, saved her life—over the next several years, she would suffer with pancreatitis and out-of-control diabetes—even though the Enloe Medical Center bills would set her on the road to financial ruin.

Like many of the people who visit the no-cost, volunteer-run Shalom Clinic, held on Sunday afternoons at the Congregational Church of Chico on East First Avenue, Santillán has a college degree. But when a temporary teaching job ended, she lost her health insurance and stopped taking diabetes and thyroid medications that she could no longer afford.

Every Sunday, some 20 people have lined up by the time the Shalom Clinic opens at 1 p.m. in the church’s annex. Some of the people look stunned that they’ve found themselves at a free clinic; some have driven from as far as Tehama, Red Bluff or Yuba City.

Shalom is at the epicenter of a guerrilla health-care movement under way nationwide. Throughout the country, a loosely woven network of volunteers and nonprofits offer “battlefield” medicine as they serve thousands of middle-class and poor people falling through the cracks of the American health-care system.

In Chico and other American cities, volunteers have converted church meeting rooms to doctors’ offices, hoarded prescription-drug samples that can be used at faith-based clinics, and are coaching patients on how to advocate for themselves in a complex, often unfriendly system. Citizen-run clinics can’t offer surgery or x-rays, but in some cities, local hospitals back free clinics by performing lab work for them at no charge. In other words, free clinics have become a component of the health-care system that large institutions depend on to help provide so-called “charity” care.

This is what it’s come to in the United States: Affordable and free health care is considered “charity.” But guerrilla health care doesn’t protect credit ratings or retirement accounts.

After several hospital stays, Santillán said she owes more than a half-million dollars in medical costs. Increasingly, underinsured residents of Butte County undergo financial ruin because of medical bills. They often show up at Legal Services of Northern California’s credit-card-debt seminars, bankrupted because of an illness or accident.

“We’re seeing a new clientele, more middle-class people,” said Laurel Yorks, a local public-benefits paralegal. “Most employers can’t afford plans with low deductibles. That’s where the slide to desperation and poverty often starts—with huge deductibles and co-pays.”

Santillán said that a social worker tried to help her enroll in Medi-Cal. But she couldn’t meet the tough eligibility criteria, even after cashing out a $20,000 retirement fund. Her health problems continued for the next several years as her unpaid bills mounted. Her debt was turned over to a collection agency, and Santillán said her inability to pay if off has “made me sick literally and figuratively.”

Over in Oroville, Thomas Lewry and Scott Marshall had stopped for a free blood-pressure check on a November Thursday at the Fire House Certified Farmer’s Market in the city’s Southside neighborhood.

Marshall, 61, has stage-4 bone cancer. He’s homeless. As Marshall explained his problems to a pair of volunteer student nurses, the screening began to seem inconsequential.

Observe the nursing students at work for a little while, and you see that the blood-pressure screening produces more than just a measure of a heartbeat. In this neighborhood of broken sidewalks and boarded-up businesses, the students were here to listen, and for a few hours every week during school semesters, when they take their place on the fringe of the grass-roots health-care movement.

During a March 31 shift, Chico State seniors Whitney Salis and Stacy Moon provided information and encouragement to about 20 Southside residents.

“People are tired, overwhelmed and don’t feel well. Then they have to battle the system,” said Chico State public-health nursing professor Kristine Warner, who oversees student-run booths at the Southside and Chapmantown cChaos farmers’ markets. “We’re really providing health education and referrals. People feel very comfortable getting their blood pressure checked, and it gives us a chance to talk to them.”

The blood-pressure screenings are also a learning experience for Warner’s students. “Students see some of the struggles a marginalized population has,” Warner said, “and learn how to talk to people without being off-putting. From our standpoint, they see how they can impact a community.”

Shalom Free Clinic makes an impact to the tune of 60 to 70 people a week. Its most immediate problem, said co-founder Nancy Morgans-Ferguson, is that it’s “too successful.” Clinic organizers are looking for a larger space that could offer examination rooms for five medical providers, and for a range of other services they offer, including legal consultation.

The clinic is a stunning example of what can happen in health care when the profit motive is absent. A mix of traditional and nontraditional medicine is practiced; patients sometimes wait several hours, but say they don’t feel hurried when they’re seen; check-in is simple. No one asks about insurance coverage or citizenship; Spanish and Hmong translators are often available.

Since it opened four years ago, Shalom has become a magnet for volunteers. Often, former patients who have been helped in moments of desperation want to repay the clinic. Some volunteer at Shalom’s downtown Chico thrift store that helps provide the funding the clinic needs.

Morgans-Ferguson said organizing some 500 volunteers is a full-time job in itself. The project is close to her heart; she poured the money she received as a wedding gift into its founding.

But Shalom volunteer Dr. Ken Logan noted there are too many things the clinic can’t do in a health-care system that he calls “helter-skelter.”

“I would love to not need the Band-Aid of Shalom,” Logan said.