Health & dignity

A 6-year-old boy sits on an examining table in a clinic near Houston, waiting to receive his school immunizations. He's nervous. Volunteer nurses say, "We're going to crisscross his arms and give him a big hug." One volunteer leans over to hold him still, while two others give him shots, one in each thigh, at exactly the same time. Before the boy knows what's happening, they repeat the procedure-four shots in all.

"Oh, my goodness. You are all finished. You did absolutely fabulous." The boy looks proudly at his mom as a nurse applies a Peanuts and a Scooby Doo bandage. Then she leads him out to pick a toy.

Some 45 minutes later the phone at TOMAGWA HealthCare Ministries rings. It's the school nurse from the 6-year-old's public school. She says his shots aren't up to date so he needs to go home. But TOMAGWA nurse Dottie Hardy says: We know he's behind on his shots, but we only give four shots at a time. [More than that, she tells me, and you can't tell what caused a negative reaction.] We told the mom to bring him back in a month. Today he received the shots he should have gotten when he was 4 months old. The school nurse relents, and the boy is able to stay at school.

TOMAGWA-the name is an acronym from Tomball, Magnolia, and Waller, three small cities northwest of Houston-is a Christian, nominal-fee, family practice clinic that provides care to those who don't have insurance and aren't eligible for Medicare or Medicaid. Last year TOMAGWA saw 4,000 patients for a total of 27,000 patient visits. But with Obamacare due to take effect in 2014, will charity clinics like TOMAGWA still have a role to fill?

Executive director Judy Deyo says yes, regardless of whether the healthcare transformation survives Supreme Court review. Deductibles and copays will still exist, and a large group of people will still not have insurance. She says government-run or state-financed clinics will not have the freedom that TOMAGWA and similar clinics have to offer healthcare in the name of Christ: "Our foundation is Jesus. The things we do, the way we treat, the attitude we have is because we know His love for us, and we want to share that love with others."

Many of TOMAGWA's patients are like the mom of the 6-year-old boy. They've slipped through the cracks of available healthcare. She didn't send her son to kindergarten last year because she said she couldn't afford his required vaccinations. The long waits and impersonal care typical at government clinics also deterred her. The staff at TOMAGWA works hard to set a different tone, starting with the clinic's sun-lit waiting room. A marble tile floor and cushioned office chairs in a neutral palette say professional office, not second-class clinic. Deyo says, "Patients come and feel, 'Wow! It's nice, not rundown.' That's by design to help restore dignity."

Because it takes no government money, TOMAGWA doesn't operate under government constraints. As R.N. Dottie Hardy hurries down the hallway and spots a woman with a cast-down expression, she stops to talk and learns that health issues are only one of the woman's concerns: She is facing foreclosure and needs a job. Hardy refers her to a counselor who works on a sliding scale basis, but she also prays with her: "Faith is part of healing, and we get no resistance among patients."

TOMAGWA began in 1989 after two tragedies shook the three communities. A little girl from Tomball lost her hearing because her parents couldn't afford medical care, and a father died from an infection after refusing to go to the emergency room because he couldn't afford it. Christians in the community rallied. A church set aside a room, which volunteers divided in half with a curtain. On one side was the examining room, staffed by volunteer doctors on their lunch hours. On the other side, reception. A line of waiting patients snaked out the door. Several years later, TOMAGWA moved into a larger space with three examining rooms.

In 2008 the clinic bought and finished out its own space in a new medical park. The spacious office has seven exam rooms and room for a dental clinic, eye clinic, and small pharmacy. A combination of paid and volunteer staff allows it to stay open five days a week from 8:30 to 5:00. Patients pay $15 for a first visit and $10 for follow-ups. Judy Deyo says, "We help restore dignity by allowing them to help pay for care."

Sometimes even a little money is too much. Nurse Lisa Goodeau explained to one new patient, "Don't not come because you don't have the money. We'll start you an account. We don't report it to the credit bureau. It's an honor system." Dottie Hardy explained further, "We never bill. We never chase them down. If they remember to pay it, that's fine. Their account is in their head."

While I was visiting, a middle-aged man poked his head through the door, looking for someone who had taken care of him a while back. He wanted to tell her, "I'm doing good." A trucker, he lost his job when he developed eye trouble. No longer able to make payments, he lost his truck. Then he lost his house. Finally he came to TOMAGWA, where a doctor discovered cataracts on both eyes. A sympathetic eye surgeon performed surgery, and the trucker is back at work.

Susan Browning is a nurse who has been volunteering 25 hours a week for the past 16 months. She says appreciative patients like the truck driver make volunteering easy, but she also enjoys "the freedom to practice medicine freely." Nurses don't have to worry about "the things you have to do to be reimbursed." As Judy Deyo explains, "We spend money on patient care, not on paperwork."