Patients & partners

Zaarephath, N.J.-The line of patients usually forms long before the clinic doors are opened. This night is no different: Nearly 40 people are waiting for their turn with two volunteer doctors at a cottage turned clinic on the campus of a local church.

Once inside one of two examining rooms at the Zarephath Health Center, the patients, many of them repeat customers, frequently utter the same two words: I'm miserable.

There are Sabine, 51, who lost her job as manager of a craft store her first workday back from surgery, and Jessica, 22, who no longer can afford the $88 a month it costs to see her regular doctor, plus Brenda, 48, who winces and shakes as the staff pricks her finger to test her blood sugar.

"It's Halloween, so next time we can take it off your neck," jokes John Eck, a founding doctor of the clinic.

Eck's patients are black, white, Asian, and Hispanic. Some are homeless, others jobless, and many are luckless. But they all share one thing in common, and it's what brings them here tonight: no insurance.

As the declining economy erodes America's middle class, the nation's healthcare system continues to spiral out of control, sending even more patients to this free clinic: From 1,700 patient visits in 2007, the clinic is on track to see 3,000 this year.

"It's like Grand Central Station in there," says John Fasoli, 55, shaking his head as he waits outside for his turn. An uninsured electrician, Fasoli is making his fourth visit to the clinic to treat an infected foot. "But to run into people willing to help like this is a breath of fresh air."

Following the words of Matthew 11:28-30, which are painted on the waiting room wall, the volunteers at the center are trying to provide healing for those who are weary from disease, illness, and injuries but burdened by the inability to pay for treatment.

With the federal government closing in on a year-long push to spend nearly a trillion dollars to provide a safety net for people like John Fasoli, Zarephath stands as a modest reminder that places already exist for those who must walk life's high wire without insurance.

It is indeed a comforting place where hugs are doled out almost as much as free medicines. It is a place where one remembers why the word care is attached to the word health.

And that care comes cheap. While it currently costs the government between $110 to $120 per patient visit when the uninsured seek medical help, Alieta Eck, the clinic's other founding doctor and John's wife, says they have gotten costs down to between $10 to $20 a patient. The cost to the government: zero.

This clinic is tucked away in rural New Jersey, 214 miles from Washington, D.C. But the marathon healthcare debate that has enveloped the nation's capital this year seems thousands of miles away.

Still, John Eck has one message to the lawmakers he sees on television preaching about the best ways to cure the nation's healthcare ills: Come visit.

Zarephath is one of many clinics that serve those with low-paying jobs but no insurance. There are more than 1,200 free medical clinics around the country, serving more than 3 million patients each year. They are doing their part to keep patients from going to the nation's expensive emergency rooms-a practice that is a key driver behind the nation's escalating healthcare costs.

Sadly, the role of such clinics in a federally remade healthcare landscape has been ignored during the ongoing legislative debate: Several doctors associated with these clinics told me that they have not been given a seat at the negotiating table. Lawmakers are excluding insights from the very people who already are serving the uninsured population that any new law will try to reach.

So when I asked John Eck, while following him to the center's well-stocked pharmacy of entirely donated drugs, if he had any ideas for Obamacare, he quickly pulled from his pocket a green note card with the words "Goals of Healthcare Reform" printed at the top.

With $70,000, the Ecks started their clinic six years ago and now operate it on a shoestring $60,000 annual budget. Its formula for success depends on a platoon of volunteers, who know how to stretch a dollar and who desire to build relationships with their patients: all things John Eck is skeptical will occur if the government gets more involved in healthcare.

The Ecks have a vision of a nationwide network of similar clinics that would provide care to the needy while costing taxpayers very little. How to get enough doctors to staff the clinics? John Eck's plan is to have the government extend free medical malpractice coverage to the practice of professionals who donate 20 hours a month to free care for the poor.

With doctors avoiding lawsuits by performing "defensive medicine" practices costing up to $500 billion annually in unnecessary tests and treatments, Eck believes his plan would lower healthcare costs nationwide. "In exchange for compassion, give us medical malpractice," he says.

Similar innovations exist at other faith-based clinics where doctors are forced by resources to get creative when it comes to treating the poor. At the Church Health Center in Memphis, Tenn., doctors spend $1 on prevention for every $1 spent on treatment. Patients are ushered into the center's 80,000-square-foot wellness center on their first visit. There a health coach discusses exercise and diet plans before a patient even sees a doctor.

"We don't want to be a place for people to come and just get free drugs," says Scott Morris, the family physician who founded the center in 1987.

Morris believes that healing works best when patients and doctors enter into a partnership. He scoffs at modern medicine's mindset that you have to have a full body scan rather than be on an exercise plan to feel better: "We have a healthcare industrial complex that has developed an unholy belief in this country that technology can solve all of our medical problems."

To foster partnerships, the center conducts group accountability classes for diabetic patients and tackles childhood obesity by partnering with a local ballet company for lessons and hosting "snack attack" sessions where children learn how to prepare healthy treats.

The center focuses on dental work in the hopes of allowing patients to gain the confidence needed to move forward professionally. ("In this world, it's hard to go from a $7 an hour job to a $10 an hour job with broken teeth," says Morris.)

Flexibility is also a key at the center, whose network of volunteer medical professionals serve 70,000 working, uninsured patients annually. Morris says the working poor often skip doctor visits because they can't risk a day without pay. So the clinic follows an open access policy that allows patients to see a doctor without having to secure an appointment weeks in advance.

Thanks to quarterly seminars, 25 clinics have opened around the country using Morris' model, with another 20 due to open within the next year.

But John Bruchalski with Virginia's Divine Mercy Care worries that congressional efforts to increase the federal government's role in healthcare will undercut the practical, community-based answers such faith-based clinics bring to the nation's healthcare crisis.

What Memphis' Morris calls partnership, Bruchalski calls community. He says the importance of community is usually lost on government bureaucrats who focus on rules, regulations, and uniformity. "When you move the power to Washington, the relationships become blurred, people lose the reason for serving, and innovation dies," he says. "Policy can never replace relationships in medicine."

Bruchalski points to the government's current delays in distributing the H1N1 swine flu vaccination as just the most recent example of the government's poor track record.

Divine Mercy Care serves 20,000 patients each year, including 650 baby deliveries, and takes in $800,000 in donations. Volunteers who have a vested stake in and can better understand the needs of the community shepherd patients through medical issues by using personal contacts to secure help from area hospitals, labs, and social service agencies. Keeping the government at arm's length allows the center to pour more dollars directly into treatment rather than into deciphering the maze of regulations tied to federal funds.

John English, the director of the Bethesda Health Clinic in Tyler, Texas, wonders whether the government is stepping into the healthcare breach because too many churches have neglected to help their less fortunate neighbors: "We'd rather go overseas than across the street to serve, and it is kind of a shame that it has gotten that way."

At Bethesda, the dignity of the uninsured is respected by requiring some payment on a sliding scale that ranges from $10 to $20 a visit. This would not survive, English argues, under a system of healthcare handouts if the government becomes the nation's insurer.

Right now Bethesda has tapped into a robust network of retired doctors in the area, but English thinks people would be less inclined to volunteer if everyone expected the government to provide the services. He wonders whether all the reform talk is more about the insurance and pharmaceutical companies than the individual.

"Insurance can't fix everything," English told me. "I'm afraid we are going to get healthcare for all, but just because it is all equal doesn't mean it is all good."

What clinics like these provide that the federal government fails to provide is the personal touch. They are each striving to find local answers to local problems using local people. To them, healthcare is a ministry, and it's very personal.

That is made plain back in New Jersey as the clock ticks past the clinic's normal 9 p.m. closing time. The treatment list for the day has been long-­diabetes, heart disease, high blood pressure, infected bones, arthritis, glaucoma, asthma, and bronchitis, to name a few.

The Ecks say they each volunteer 12 hours a week, but you can tell it is probably more.

Why tonight's extended hours? The Ecks seem to enjoy talking to their patients. And most of them want to talk in the hopes of unloading some of life's anxieties, stresses, and fatigues. They want someone to hear their stories as much as they want medical treatment.

Mechanic Patrick Maylone, 52, has been coming here for two years after an accident left him with a herniated disk and no insurance. Since then he has been treated for diabetes and skin cancer. He says the clinic has become more crowded but that won't stop him from coming. He even one day dreams of making enough money so he can give a large donation to the place.

"You are not treated like an outcast here," he told me. "You are treated like a human being . . . not a patient. Hospitals should take lessons from this place."

At end of the day, Alieta Eck empties $136 from the optional cash box set up at the reception desk.

"When it is a government thing, people are not as thankful. They think they are entitled," Alieta Eck explains, thankful for the money. With 37 patients seen that night, it comes to $3.68 per patient.

It's half past 9 p.m. The clinic reopens tomorrow morning at 10.