Soul providers

MIAMI- In the shadow of Miami's sprawling skyline, the famous Calle Ocho (8th Street) winds through the city's historic neighborhood of Little Havana, home to thousands of Cuban and Hispanic immigrants.

Middle-aged men in linen shirts roll cigars on thick tables in narrow storefronts. Old men in heavy sweaters hunch over chessboards and dominos in crowded Domino Park, smoking stogies and placing bets.

Cuban immigrant Carlos Knapp makes frequent trips to Little Havana, but not for cigars or dominos. Instead, Knapp visits poor families with no health insurance. The visits are part of Knapp's job as chaplain for the Good News Care Center, a free health-care clinic operated by the Miami Baptist Association (MBA).

The clinic is one of many free health-care centers in Miami and around the country that provide a dual benefit: treating the uninsured and driving down health-care costs for others. Knapp's work provides another benefit: caring for spiritual needs among populations often overlooked.

Despite a growing population of ultra-wealthy residents, Miami ranks as one of the poorest metropolitan areas in the nation. Researchers at Florida International University estimate that 25 percent of the area's residents are uninsured, a figure representing more than a half million people. Many of the uninsured are immigrants or migrant workers who harvest tomatoes and oranges in the fields outside the city.

Just a few miles from one migrant camp in nearby Florida City, eight Hispanic patients pore over clipboards in the Good News Care Center's packed waiting room in a modular building in the parking lot of Florida City Baptist Church. Several more wait outside on a bench at the top of a wooden wheelchair ramp.

Ana Alves-Daily, the clinic administrator, says the patient flow is steady: The center cares for 45-55 patients a day in five exam rooms off a narrow hall.

Alves-Daily's husband, Michael Daily, spearheaded efforts to open the clinic 12 years ago. Daily, director of church and community ministries for MBA, observed the need for health-care access while conducting two-day dental and medical clinics in migrant camps. Many of the laborers had never visited a doctor.

After years of raising funds and navigating red tape, the clinic opened in 1996. Today, the center is open five days a week and operates with two staff physicians and some 70 volunteer physicians each year, providing primary care to adults. To qualify for care, a patient must have no health insurance and an income that doesn't exceed twice the federal poverty level.

In a tiny break room near the back of the modular building, plastic display cases hold brochures about diabetes in Spanish and English. Alves-Daily says diabetes and hypertension are the most common illnesses among clinic patients.

Those ailments may be easily treated with primary care, but patients with no medical insurance often visit emergency rooms for treatment when their conditions grow serious. By providing primary care, Alves-Daily says the clinic keeps patients out of the emergency room, a benefit to hospitals that often pass the cost of caring for the uninsured to those who are insured.

Florida's sovereign immunity laws allow physicians to practice at free clinics without the threat of malpractice suits. And they allow free clinics to operate without costly malpractice insurance. Daily says that enables the center to conduct some 10,000 patient visits each year (including follow-up visits) on a budget of about $585,000. He estimates the same care is worth nearly $10 million in the health-care market.

The spiritual care is harder to value. Alves-Daily says the clinic makes its Christian mission clear: "We don't have anything to hide. We take care of the soul and the body." She often tells patients that receiving free care is like receiving grace: "Grace is getting something you don't deserve."

Knapp, the clinic chaplain, knows about that grace firsthand. Knapp first came to the clinic last year as an unpaid minister with heart problems and no insurance. "I couldn't walk a half a block," he told WORLD. "By grace I found this place."

After follow-up treatment at Baptist Hospital, a nonprofit hospital that provides free care for clinic patients, Knapp says he "feels like a new man." (The hospital's umbrella organization-Baptist Health South Florida-also provides a grant for the bulk of the clinic's operating budget.) Three months after visiting the clinic, Knapp joined the staff full-time.

As the clinic chaplain, Knapp follows up with every clinic patient, offering to visit with them in their homes. The work takes Knapp all over the greater Miami area, making hundreds of visits each year.

On home visits, Knapp takes Christian literature, as well as hygiene packets with items like toothpaste, toothbrushes, and soap. He makes sure that patients are taking medicine correctly and that they have basic provisions like food and electricity. Some families don't have basic supplies, and Knapp often makes trips to local grocery stores. Volunteer churches sometimes help with electric bills and other needs, and Knapp recruits church members to help make home visitations.

He also talks with patients and families about deeper needs. "I go there to show Jesus Christ," he says. Spiritual needs run deep, Knapp has discovered, and many people are depressed, especially immigrants away from home and family. "They're lonely," he says. "They need some attention."