Thursday, October 18, 2007
For several years, I worked with a partner in my prior practice in a group called the Christian Medical Response Team. This team served as a volunteer medical team for the Washington Department of Emergency Management, and we "trained" by providing medical care at large group events. We did many, many events, including several years of EndFest, Bumbershoot, Creation Festival, local rock concerts (some as a part of Rock Medicine, including the last five Grateful Dead concerts in Seattle), and large national Youth for Christ events in DC and LA. We provided safety for well over 1M people.
I've also had a few truly life-changing experiences as a missionary. In 1998, I spent seven weeks on four different trips to Latin America. I participated in El Nino flood relief in Peru with Mac Med, worked with families in Mexico with Northwest Medical Teams (now Medical Teams International), and lead a team in response to Hurricane Mitch in Honduras with World Vision.
My wife and I are preparing for a mission trip to Peru - we leave in ~24 hours. We are traveling to northern coastal Peru with Mac Med, working with the same pastors that I met nearly ten years ago on my first mission trip. In the past couple of weeks, I have revealed to a few patients that we are planning this trip. And, most of them have said something that indicated that they were somewhat, well, impressed by my plans to serve in a developing country. But one longtime patient of mine responded, “What, there aren’t enough poor people in Bremerton for you?”
There it is! My work is a mission. I work with a missionary team of 137 other people, the employees of my Health Center.
I certainly have reason to be impressed with missionaries who serve for years, like my old Doctors Clinic partner Perry Jansen and his family (http://sim.org/index.php/project/96555) who have been working in Malawi for the past few years. And, we have a nurse practicioner who works with us for a few weeks each year, during her "break" from her and her family's work during the rest of the year in Nepal.
And, I'm impressed with my partners (providers and support staff) who have been dedicated to this longterm mission for nearly twenty years. And proud to be a part of that.
Friday, October 5, 2007
I must admit that I had no idea what a Community Health Center really was until I started having lunch with Dr. Bob Rozendal, our previous Medical Director. At that time, I had been working in the community for a few years, and thought I had a good understanding of the health status and needs of our community; I couldn't have been more wrong.
A Community Health Center is a practice which is partially funded by the Federal government as a grantee of the Bureau of Primary Care, one of four bureaus of the Health Resources and Services Administration. Other names which might be applied to this practice model include:
- Federally-qualified Health Center ("FQHC")
- "Safety Net Provider"
- Federal 330 Clinic - named for the section of the Public Health Service Act which authorizes funding for this program.
To quote the Bureau of Primary Health Care's website:
"Health Centers are community-based providers of comprehensive primary and preventive health care and enabling services to medically underserved populations. Many Health Centers also offer comprehensive dental care and mental health and substance abuse services."
What we are NOT as a Health Center:
- We are not "owned/run by the government." - We are an independant, nonprofit agency, which is "owned" by the community and run by an all-volunteer Board of Directors, the majority of which must be patients whom we serve.
- We are not one national system. - There are ~1,000 different Community Health Center systems across the country, with about ~6,000 delivery sites. Because of local ownership and patient-driven Boards, each Center works to meet it's own community's needs, and may offer markedly different services.
- We are not a "free clinic" - There are wonderful people doing remarkable work in Free Clinics across the country, as seen at the website for the National Association of Free Clinics. We charge patients on a sliding fee scale based upon their ability to pay.
Thursday, October 4, 2007
I recall during my application for medical school that I, like many of my competitors in the interview process, responded to that expected question by saying, "Of course, I want to be a family physician, so I can serve the community, the needy, relieve suffering,..." But, perhaps unlike many of my colleagues, after enjoying each of my rotations, I did decide on family medicine. And, I had no idea that it would lead me here.
I took my two-month anesthesiology elective rotation first, so that I could force myself to get over my fear of poking people with needles. I achieved that goal, and enjoyed the intellectual stimulation of the daily physiology experiments, and considered that as a great option for a career.
I took rotations in cardiology, and pediatric oncology, and psychiatry. Each with the excitement of learning from remarkable men and women, becoming part of a truly noble profession. And, imagining myself as wise and compassionate as these mentors. But, ultimately, it was family medicine that kept me. I completed my residency, as Chief Resident, at the University of Kansas School of Medicine in 1992. With much of my education still to come...
I am the Chief Medical Officer for Peninsula Community Health Services, a "safety net" provider in Kitsap County, Washington. And, despite my father's repeated advice, I now know that I have since specialized in "diseases of the poor." I'm starting this blog so that I have a place to tell the stories of my daily work. It is named for the book "Health Care Meltdown: Confronting the Myths and Fixing Our Failing System", by Robert LeBow, MD. Dr. LeBow was a Peace Corps doctor in Bolivia, the Medical Director for the Terry Reilly Health Services in Southwest Idaho, and a past President of Physicians for a National Health Program. As described in this USA Today article, Dr. LeBow came to know about the Health Care Meltdown from "both sides of the bed", having suffered a head injury from a bicycle accident which ultimately resulted in his death. I had the great privilege of getting to know him and his wife Gail via email after his accident, and consider his book an excellent primer on the issues of our failing health care system.