CrossOver appeal

RICHMOND, Va.-By noon on a Thursday this summer, whites, Hispanics, African-Americans, and a woman with bubblegum pink hair packed the waiting room at the CrossOver health clinic here. Despite the high traffic, the clinic did not feel like a warehouse of sick people-everything was orderly and clean, as in a good private practice.

That sensibility is intentional, because clinic founders wanted patients to sense that they are receiving the best care, not something second rate because it's free. CrossOver is evidence that not everything in U.S. medical care for the poor is dysfunctional. While doctors at CrossOver agree reform is needed, their ministry has succeeded in using parts of the system that work: They serve 4,300 uninsured patients a year on a $2.5 million budget.

The clinic opened in 1983 in an old furniture store turned church in downtown Richmond: One Saturday founder Dr. Cullen Rivers and local pastor Buddy Childress put a sign in a storefront window announcing "Free health care." In the dark emptiness of the store at their first clinic, they had a single light bulb, an old examination table, a stethoscope, a blood pressure cuff, and some chairs they borrowed from a bank. People walked in off the street.

Rivers, Childress, and other local Christians originally intended to address all sorts of urban needs, including legal services, but they soon saw medical help as the most prominent need. Then others came to help. Dr. Daniel Jannuzzi moved to Richmond 20 years ago after his wife noticed an ad in a medical journal seeking a doctor for the fledgling CrossOver. He inquired about the position-and it turned out that he was the only person who had responded to the ad.

At that point Jannuzzi had to decide whether to take a risk. He thought about sticking with his bustling private practice in Baltimore, Md., but he had recurring dreams about working with the poor and uninsured. "It just started eating away at me," he recalls. "We took a leap of faith."

It's rare for nonprofit clinics to have fulltime physicians, but Jannuzzi has worked full-time for CrossOver ever since and helped it build a reputation for doing whatever it takes to help people. His colleagues told me about a snowy day when the city health department called Jannuzzi and nurse Myrna McLaughlin to help homeless people-one with pneumonia, one with an infection-who were standing around a fire in a barrel. Later, when social workers couldn't get another homeless man out of a tree in a park, McLaughlin coaxed the person down to earth.

Jannuzzi said it's hard for doctors to stay committed to poverty medicine year after year: "A physician can find a job overnight. . . . It's sort of the siren's call." But the work itself is engaging from a clinical perspective, he said, because of the complex health issues common among the uninsured. It's also personally fulfilling and challenging: "To grow in my own faith in terms of living out the gospel for healthcare for the poor has been very rewarding spiritually."

Today, the clinic sits on a highway within view of downtown skyscrapers but across the James River, on a side of town that has discarded shells of factories and delivery trucks suffocated by vines. Across the street at a soul food joint, locals sip sweet tea that is less tea and more sweet-they know CrossOver because they have gone to the dentist there.

The dental area is busy. When I visited, a mother was in one of the two dental chairs in the clinic under the uncomfortable whirr of a drill. Dental assistant Kerri Reed helped the dentist, a volunteer who has his own practice, but kept her eye on the woman's four children playing in an adjacent exam room. "Our makeshift nursery," she said, smiling.

But most of the clients come because of medical problems, with primary care sometimes leading to larger fixes. When CrossOver's Dr. Richard Lower-one of the country's pioneers in heart transplants-noticed that a patient seeking birth control pills had blue lips, signs of a heart defect, he called a heart surgeon at the local hospital who agreed to operate on the woman for free.

CrossOver gives the uninsured regular check-ups to keep them on medications for chronic illnesses, and that protects against more costly medical services down the road. "It costs pennies to save hundreds of dollars," says Steve Lindsey, a former administrator at a local hospital who is now on the CrossOver board. CrossOver makes use of philanthropy from hospitals, backed up by charitable donations and a host of volunteers, to provide first-class care for free.

For example, Jannuzzi and director Julie Bilodeau helped to organize an in-house community pharmacy for $3,000 when a consultant told them they would need $400,000 to do it. Richmond's other free clinics now use CrossOver's pharmacy. Bon Secours, one of the major Richmond hospital groups, bought the building for CrossOver's clinic, and Chippenham, another local hospital, does the organization's lab work at no charge-which has added up to about $800,000 worth of work a year, "more than they bargained for," said founder Rivers.

"When I hear that the healthcare system is broken, it disturbs me that they use that term," he added. "All we've had to do over the years is to say I've got a patient who needs help and people have been willing to open the doors and let them in."

CrossOver enjoys generosity not just from prosperous hospitals (which get tax write-offs), but also from some of its clients. The clinic asks patients to give a donation when they visit, and in 2007 received that way a total of $80,000. Patients may make a donation years after their visits-one former patient who got a job as a security guard sent the clinic $100 from his first paycheck. Another, Jerome Runner, who received treatment for HIV at the clinic, left all of his money to CrossOver when he died-$87. The ministry named one of its clinics after him.

The ministry administers a thorough financial screening process that, among other things, requires each patient to have a household income at or below 200 percent of the poverty level. In years past, most of the clinic's patients have been immigrants, but now doctors are seeing more U.S. citizens. In this recession, director Bilodeau said, doctors are seeing "people who a year ago thought they were doing OK."

Patient visits have gone up 25 percent this year, "testing the limits," Jannuzzi said, and CrossOver has opened two other clinics in the city. It now relies on 30 full-time and part-time employees and a network of volunteers to serve not only its 4,300 regular patients but thousands more through a training program it has developed for inter-community health care (see sidebar).

A report by the Virginia Health Care Foundation showed about 15 percent of adults in Virginia to be uninsured: That was in 2007, before job losses from the recession kicked in. That's similar to the national percentage, though some say the number is inflated because it includes illegal immigrants. Virginia has the second-most free clinics of any state in the country.

Though CrossOver doctors don't sit down and present the gospel to patients, Jannuzzi said they offer what is missing in much of the healthcare system, compassion born of faith: "I think a lot of what we do is sort of pre-evangelism, you know, by seeing people for free, telling them that God loves them." Patients, Rivers said, want "to be dealt with in more than just medical ways." Physicians will pray with patients if they ask for it, and Christian reading materials sit out in clinics.

Local churches from many denominations both in Richmond and in its suburbs are involved with CrossOver, which hosts "mission trips": Local churches send their medical professionals and other volunteers to run the clinic on Saturday mornings. It's a popular way to do medical missions without taking physicians away from demanding schedules: One church on a Saturday last fall sent 17 medical personnel.

Rivers, reflecting on his quarter-century of CrossOver experience, said, "If it were not for this ministry, I would not have been able to go out and meet people from all over the city and take care of them. I would have been in my practice. . . . God's using it as a platform for a lot of people to get involved with other people. That's probably the best thing that it's done for the city." For more information on this year's Hope Award for Effective Compassion and to read profiles of other nominated organizations from this year and previous years, click here.

Sharing knowledge

Conseulo Segura, 46, from El Salvador, works for the U.S. Postal Service at night. During the day she volunteers for CrossOver, sometimes as a Spanish interpreter. On one Saturday this summer she chatted with me and threw out directions in Spanish as prepared dishes arrived for a special CrossOver celebration.

The dinner was to celebrate the graduation of 25 Spanish speakers from the organization's lay healthcare promoter program, a 10-week evening course that has made them fluent in nutrition, hygiene, prenatal care, recognizing signs of abuse, and doing basic check-ups. The program, designed by a nurse who experienced a similar program in African villages, requires graduates to share what they've learned with their neighbors, making them viruses of health information.

Spanish-speaking teacher Karen Bunn told me that she began the course by telling students, "The key to health is that God is the center of your life." Over the 10 weeks class members made 2,700 health visits in their neighborhoods, invading supermarkets and drugstores to check blood pressures and talk about what smoking does to lungs. One of the graduates, Maira Ortiz, decided to give up a lifetime of smoking after the class.

As we spoke, the fellowship hall in a Spanish-speaking Catholic church filled with husbands in suits, wives in high heels with their hair done up, and antsy children. The program has produced 161 graduates in three years, and they know lives will be saved: "It will be an honor for me to share this knowledge," graduate Jhoni Brocos said solemnly.

Everyone dug into dishes from South America and Mexico paired with lime green punch. Segura graduated several years ago and takes opportunities to instruct diabetics-she tells them to "keep food in their pockets"-and those with high blood pressure: "You need potassium-eat a banana."

Some insured Americans may be hypochondriacs, but doctors find the opposite problem in Hispanic communities, where people generally don't seek help until they have very serious health problems. Basic care becomes that much more important. The male graduates of the program said when they use the restroom they tell other men to "lavese las manos" (wash your hands) and get odd looks, but they also have the reputation now as people who know what they're talking about.

CrossOver

• Mission: "We are called to provide health care, promote wellness, and connect community talents and resources with people in need in the name of Jesus Christ."

• Vision: "A healthy, vibrant community where every person is restored by the compassionate, healing love of God."

• Thirty full-time and part-time employees, and more than 350 volunteers.

• CrossOver does not accept federal funds. Its broad base of donors, according to Dr. Jannuzzi, makes the ministry "a private sector solution to treating the uninsured."