Soul providers

AUGUSTA, Ga.-Grant Scarborough doesn't mind using a second-hand desk. The 37-year-old physician licensed in both internal and pediatric medicine could enjoy a far fancier set-up than the modest, Christian clinic he helps run in Augusta, Ga. But a Bible verse inscribed on a thank-you note hanging near Scarborough's donated office chair explains the physician's perspective: "He who gives to the poor will lack nothing."

Robert Campbell's used desk sits next to Scarborough's station in a small office space in the Christ Community Health Services of Augusta. In the shadow of a used car lot advertising deals for buyers with "good or bad credit," the clinic's one-story building is situated in one of Augusta's impoverished, inner-city neighborhoods. Like many of the crumbling houses nearby, bars cover the renovated clinic's blue-shuttered windows.

Campbell, 38, worked in a private practice for four years in nearby Evans, an affluent suburb, before opening a nonprofit clinic with Scarborough to offer affordable health care to uninsured and poor populations. In Evans, a patient visit with Campbell cost at least $123. On a sliding scale here in Augusta, a visit usually costs between $20 and $30. It's less if a patient can't afford it, and free for the homeless.

That's a boon for this corner of Georgia: A study by the Brookings Institution reported last year that metro Augusta had the second-highest rate of working poor out of 58 large metropolitan areas. The clinic's zip code also represents one of thousands of federally designated Medically Underserved Areas-regions where residents have a shortage of health-care services. Many of those areas represent counties with high poverty rates.

The Augusta clinic is one of thousands of nonprofit clinics for the poor or uninsured, and one of hundreds of low-cost clinics with a distinctly Christian mission. Leaning back in his chair before patients start filing into the clinic on a crisp spring morning, Scarborough explains that mission: "There's more to people than just a body. They come to us for a pill, and the best thing we can do is to help them see Christ."

A difficult economy may bring more patients: As unemployment increases and the ranks of the uninsured swell, nonprofit clinics are bracing for a new influx of patients. And while legislators hammer out complex details of a ballooning health-care plan, nonprofit clinics are sacrificially taking care of the needy and hoping more physicians will join them.

Steve Noblett is executive director of the Memphis-based Christian Community Health Fellowship (CCHF), a national network for Christian physicians and clinics serving underserved and poor populations. (The Augusta clinic is a CCHF member.)

Noblett says the organization includes between 1,500 and 2,000 professional health-care workers at some 200 to 300 different organizations across the country. Some efforts are small: Members include lone doctors who offer free health care a couple of nights a week. Others are huge: Lawndale Christian Health Center in Chicago handled some 140,000 patient visits last year alone.

Health problems often fester in low-income communities, particularly for children without prenatal or primary care. For example, Noblett says health-care workers in three zip codes in Memphis report a higher infant mortality rate than in some developing countries. A 2002 federal report said Memphis had the highest infant mortality rate in the country: fifteen infant deaths out of every 1,000 births, twice the national average.

For Christians, such statistics should be a pro-life concern, says Noblett: "We're talking about girls and young women that have chosen not to abort their children, and yet their kids die within the first year. There's something wrong with that."

Translating that concern into low-cost care for the uninsured or poor isn't easy for nonprofit clinics: The cost of malpractice insurance alone dramatically impacts physicians' abilities to open clinics or offer a wide range of services.

Some clinics do get a boost from the federal government by earning recognition as a Federally Qualified Health Center. The government awards the qualified centers substantial grants and malpractice insurance, relieving a huge expense. The process for recognition is highly competitive, and only 7,000 clinics hold the federal status. Out of that number, Noblett estimates a few dozen are Christian clinics. He says the number of qualified centers significantly grew under the Bush administration, and he hopes President Barack Obama will expand the program even more.

For clinics that don't win the federally qualified status, the work is even harder: Clinic staff must raise funds to balance their budgets, and physicians typically earn far less than they could in private practice. Back in Augusta, Scarborough estimates he could make at least twice as much in private practice.

But the husband and father of four small children came to help Campbell start the clinic as soon as he finished his medical residency in 2007. "I realized there's a difference between the American dream and the Christian dream," he says. "The American dream says work hard and have all you can in this life. The Christian dream says lay down your life and pick up your cross."

Both doctors picked up their crosses by forgoing salaries at the clinic for over a year. The physicians moonlighted, working shifts at local hospitals to pay their personal bills so the clinic could survive. A large grant from a local hospital helps keep the clinic afloat. (A hospital also allowed the clinic to use its current location for the cost of renovating the space, and local organizations donated supplies and labor.)

Giving up some of the comforts a medical career can buy wasn't an easy decision, says Campbell, who also has a growing family, but a gospel-centered concern for the poor drives the men to think like missionaries: "We consider ourselves well-paid missionaries and poorly paid physicians."

Being a missionary-doctor to patients means entering into their spiritual as well as physical problems. "The No. 1 diagnosis here is despair," says Campbell. "And we don't have anything in our prescription pads for that." The doctors and nurses address spiritual needs by praying with patients, reading Scripture with them, and talking with them about Christ. Clinic staff recently threw a birthday party for a patient with a debilitating illness that had left her desperate before coming to the clinic. Campbell remembers her words: "This was my last hope. I was either going to get help or I was going to put a bullet in my head." The doctors helped relieve her physical suffering, offered spiritual hope, and watched her improve.

The physicians hope to improve their outreach by adding another doctor to the clinic, but first they need more space: The four exam rooms are barely enough space for the two doctors and four nurses that handled more than 3,000 patient visits last year. To that end, a local real estate developer donated a 120-year-old building-known as the "Widows Home"-that served first as a home for Confederate widows and then as a home for women in need until 2003.

Local volunteers-including many church groups-have donated hundreds of hours of volunteer labor to gut the existing structure, and clinic staff hope to raise some $3 million to renovate the historic building into a 15,000-square-foot space with 12 exam rooms and a pediatric physical therapy suite. The economic climate makes fundraising difficult, but the staff hopes to move into the building this fall.

Scarborough and Campbell also hope to continue to encourage medical students to work in the clinic and to consider working in similar groups as a career. CCHF's Noblett says his organization reaches out to Christian groups at medical schools, and he points out Christian organizations like Project MedSend that help medical students repay student loans so they can serve in Christian clinics for the needy. "We need Christians to think missionally," says Noblett. "The biggest thing is talking to [students] about living like the people you serve instead of like the doctors who trained you."

Campbell tells students the sacrifices are worth the rewards. "I've been driven into a deeper relationship with Christ, and that's the one thing I desire for me and my patients," he says. "It's always rewarding to bring down someone's cholesterol, but that's not nearly so good as union with Christ."