Increasing Access to Health Care for the Medically Underserved through Faith

(Pamela Leong, Center for Religion and Civic Culture at the University of Southern California, 2004.)

Vincent, a Latino male in his 50s, expressed dissatisfaction with public health care clinics in Los Angeles County. He noted that one clinic refused to provide him with medication and that the little service received was poor, and given in a manner that was cold and impersonal.  By contrast, he enthusiastically endorsed the medical services he received at a faith-based (Muslim) freestanding medical clinic, where he is now a regular patient.  “Their personality is different, you know?” he said.  “That’s good, you know.” 

Public hospitals and clinics in California are the health-service-providers-of-last resort for the state’s indigent residents. Confronted with severe budget cuts, these hospitals and clinics are under stress. Cut-backs in their services are part of what everyone concedes is a burgeoning crisis.

The fact that the faith-based clinic where Vincent has found a home is surviving—and even thriving—should be carefully noted.  To be sure, because of its location in one of Los Angeles’s most medically underserved neighborhoods, the clinic has been exempted from some of the most severe cutbacks that have been imposed within the county’s network of “public/private partnerships.”  But something more has been going on here. In the midst of widespread stresses in California’s health care system, this faith-based clinic continues to be regarded as a model for demonstrating how high-quality, welcoming, culturally-sensitive medical services can be sustained in low-income neighborhoods.

Lessons Learned

This clinic, of course, is unique to the Los Angelesenvironment.  But universally-applicable lessons can undoubtedly be derived from its success.  In interviews with representatives from the clinic’s administrators, staff members, volunteers, collaborating organizations, and participants, a number of these lessons were repeatedly cited: 

*       A faith-based medical clinic should be located in a central area where marginalized populations can easily access it.  The organization needs to be situated within the area where poor and racial/ethnic minorities are heavily concentrated.  Founders of the Muslim medical clinic established the clinic at the epicenter of a racially-tinged uprising—an area notorious for racial and economic deprivation.

*      The clinic needs to be stationary.  The founders of the medical clinic originally proposed a mobile medical clinic, in which they could drive through the entire community and provide health care services to the needy at their place of residency.  However, it later dawned on the founders that South Los Angelesneeded a more permanent fixture, something they could claim as their own.  They were used to businesses and organizations establishing themselves in their neighborhoods, but their tenure tended to be so fleeting.  The stationary nature of the medical clinic, hence, provided some stability to an otherwise unstable neighborhood.

*     A faith-based medical clinic requires political backing.  Having political support opens the doors to funding opportunities.  The Muslim medical clinic, for example, received considerable support from a city councilwoman, who donated a number of city resources to the clinic, including the physical site, the building, financial donations to clean out hazardous waste underneath the property, and money for building reconstruction. 

*      Medical services can be expanded through the use of volunteer physicians and staff.  The clinic provides physician volunteers with direct, on-site, hands-on clinical interactions with patients in exchange for their labor.  This is a win-win situation for all. The physicians benefit from the experience educationally and career-wise. The clinic is spared heavy expenditures associated with labor costs. And the patients receive high-quality medical services.

*       The clinic benefits from ties with local medical schools, universities, and medical centers.  The clinic exchanges information and resources with local institutions in order to improve and constantly update medical services and clinical operations. 

*      The clinic repeatedly applies for grants.  Operating a medical clinic is very expensive, and donations are not enough.  The program administrator at the Muslim medical clinic noted that finding grants in itself is a “full-time job,” which requires a full-time staff person whose function is solely to write grants. 

*      The clinic controls service utilization by restricting patients to only those who are uninsured.  This prevents unnecessary waste and over-utilization of both medical resources and labor. 

*      The clinic’s leadership nurtures cultural sensitivity in the delivery of services.  The clinic’s leadership urges staff members and volunteers to become familiar with the identity and the values of the surrounding community and cultures.  They need to understand the plight of marginalized populations and the obstacles that that they face.  “You’re working against…generations and generations of negative…factors,” one clinic administrator noted, referring to the cumulative effects of deprivation, poverty, and racism that the clinic patients have faced.  At this clinic, a large proportion of patients are immigrants from Latin American countries and the administrators and clinicians understand the importance of providing a Spanish-language interpreter.  Clinicians also acknowledge that cultural beliefs, norms, and values might affect clinical interaction.  A staff physician noted several examples:  female Muslim patients prefer female health care providers, while male Muslim patients tend to avoid physical contact with female providers, even as an expression of greeting (e.g., shaking hands).  Similarly, around holy days, Muslim patients will also avoid laboratory tests. 

The success of the clinic’s strategies is affirmed by returning patients.  As one administrator observed, “We have an amazing response from our patients.  They really feel connected, that this is their place….Even when they finally get their insurance, they still want to come back to the clinic…. We tell them we can’t bill their insurance; that it’s better for them to go to private health facilities because there are more services when you have insurance. But they still come back here.”

This kind of loyalty is an achievement. The decisions that were made along the way in the clinic’s development deserve our reflection. They have worked in creating a model health care institution within a neighborhood where medical services are scarce.

Several broad recommendations can be derived from the clinic’s experience:

*       Choose a site that announces, loudly and clearly, the neighborhood with which the clinic intends to identify.  Work with religious and political leaders who serve this neighborhood.  They will legitimate your enterprise in the neighborhood.  They will have access to local sources of financial support.

*       Recruit volunteer physicians who will supplement the services of paid professional staff.  These volunteers will quickly expand the range of specialized services that can be offered.

*       Clearly identify the population you intend to serve, then stick with the decisions you make.  Draw boundaries, because free clinics can easily be overwhelmed.

*      Seek affiliations with local medical schools.  They can be valuable sources of student interns and volunteers, whose services are supervised by highly qualified faculty members.

*       Be aggressive in offering training opportunities for staff members and volunteers—especially training opportunities in which the objective is to expand the cultural sensitivity of persons who deliver medical services.

*       Diversify funding sources.

*       Clearly identify your religious affiliations, even when the services you offer may be experienced by participants as secular.

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This is part of a series of Thumbnail Case Studiesauthored by the FASTEN research team and released by Baylor University School of Social Work as part of a 30-month research project funded by the Pew Charitable Trusts.  This project is designed to identify the factors that contribute to the effectiveness of faith-based organizations (FBOs) in addressing challenges of urban poverty.  The Baylor School of Social Work is leading this research team with members from BaylorUniversity’s business school, the schools of social work at the Universityof Pittsburghand VirginiaCommonwealthUniversity, and the Center for Religion and Civic Culture at the Universityof Southern California.

This essay represents some of the findings from the FASTEN research project that are relevant to the planning and delivery of services by faith-based organizations.  The piece was authored by Pamela Leong (with the Center for Religion and Civic Culture at the Universityof Southern California) with the FASTEN Research Team.  She can be reached at pamelale@usc.edu.