When the Alma Illery Medical Center opened in Homewood in 1968, it was a godsend for people like Geneva Long. She had three children and appreciated the convenience of getting medical care and prescriptions at one spot.
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Donna McLain of Homewood recently visited the Alma Illery Medical Center in her neighborhood for an eye infection. She always must balance whether to seek care with what's in her wallet. (John Beale, Post-Gazette photos) |
She even carried a placard through the community to recruit people to the clinic.
"How good it is to have something in our neighborhood," she said. Now 62 and a widow, she's gone to the center regularly for more than 30 years.
That was the idea behind the center -- to bring a balm to impoverished neighborhoods ailing for quality health care.
Established with $1 million in federal funds and $600,000 in private donations, the center has grown into a network of 13 community clinics, including branches in the Hill District, Hazelwood, Manchester and McKeesport. Together, they make up the largest network of community-based, federally funded health clinics in the Pittsburgh area, offering basic medical, ob-gyn, psychiatric, pharmacy and dental services.
Patients pay on a sliding scale. Care is free for those who can't pay.
Among community-based health programs across the country, Alma Illery is a good model, said Jeannette South-Paul, chair of the department of family medicine at the University of Pittsburgh School of Medicine.
Such clinics are like having milk, eggs and flour in the kitchen, she said. "They provide people with the basics. You can live on that."
But resolving the health disparities that affect poor and minority populations is far more complicated than simply placing affordable care where it's needed.
Where poverty and racism meet mainstream health care, you get a train wreck, says Wilford Payne, the Alma Illery director for 25 years. A broad oak of a man who grew up poor, he's well aware of the cultural attitudes and perceptions that can add to the barriers of care.
"Black people don't go to the doctor until it hurts," Payne said. "When you grow up poor, you go to the doctor because of a sickness your mom can't cure. Or it's time to get your shots."
Once those habits get rooted in the culture, he said, they can be hard to break. It also means they're not getting regular checkups and preventive care, which can identify unhealthy lifestyle habits that can lead to chronic diseases.
"We sometimes see people coming into our center with diabetes and hypertension five, 10 and even 15 years in progress," said Dr. Paul Donegan, an internal medicine physician at Alma Illery Medical Center.
Payne's father, Walter, had high blood pressure and was diagnosed with diabetes at 57. Eventually, before he died at 83, diabetes complications forced the amputation of his right foot. Payne said his father couldn't afford regular visits to the doctor, so he got less timely and less solid medical care.
Statistics show these health disparities befall many minorities; causing many to end up disabled, with a diminished quality of life or to die prematurely.
The harsh reality is: poverty can make you sick.
A recent Pennsylvania report on the health status of minorities found that poor personal health is directly related to being poor and uneducated. More than a third of African Americans in Pennsylvania -- 39 percent -- are living in poverty. In Allegheny County, the percentage is more than half.
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The Homewood Alma Illery Medical Center at 7227 Hamilton Ave. |
To encourage people to seek care, Alma Illery must continually reach out to bring people in.
If people think they can't afford care, they will stay away.
If people remember a system as uncaring and racially and culturally insensitive, they will stay away.
That's what Donna McLain found on many days in the early 1960s when she had to go to Oakland for treatment. Often the Homewood widow refused to go and treated her migraines at home to save money. It turned out the headaches were a marker for high blood pressure, which she now treats with medication.
McLain, 57, who lives on Social Security, was in the Alma Illery waiting room a few weeks ago with her left eye bandaged with what she suspected was an infection. She has no health insurance.
"I already have bills," she said. "Without their sliding scale payments, my eye would have to be hurting worse than it is now to even think of coming here."
The doctor was able to easily treat the infection, and McLain didn't need to return.
What the poor can't afford
The lack of health insurance really drives racial and ethnic health disparities, said Lee Hargraves, a researcher with the Center for Studying Health System Change, a Washington D.C. group that monitors access-to-care issues.
"People without health insurance are more than likely in low-paying jobs, so they don't have coverage and they have fewer resources to pay bills," Hargraves said. Why is this a racial and ethnic disparity? "It's because one in five blacks lack insurance, compared to one in 10 for whites," said Hargraves.
People who lack health insurance are three times as likely to report not getting the care they needed as people with insurance, according to studies by the Washington center. And among people who lack health insurance, Latinos and African Americans are less likely to have a regular doctor, according to a center report released last week.
Neighborhood health centers that provide basic care try to address the problem, but they can't do it all.
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Wilford Payne, executive director of the Alma Illery Medical Center in Homewood. |
When patients have to go off-site for other tests, many just don't go, Payne said. Unless Alma Illery's physicians can steer them toward hospital programs that are lenient on billing or have services for the poor, they opt not to have the mammograms, psychiatric and other tests that could be critical to their care.
Left untreated, chronic diseases and other illnesses in the black community can quickly spiral to rates twice as high as those in the white community, according to reports released last year by the Urban League of Pittsburgh.
Some statistics:
In Allegheny County during the 1990s, three times as many black women between the ages of 44 and 54 and black men between the ages of 35 and 44 died of heart disease than white men and women in those age ranges.
Three times as many black men ages 65 to 74 died of prostate cancer than white men in the same age group.
The diabetes death rates for black women and men were about twice the rates for white people.
Black children are three times more likely to be hospitalized for asthma than white children, usually because of allergens carried by rodents and roaches that can thrive in densely populated, poorer communities.
Infant mortality, often a predictor of a community's health, is twice as high in Allegheny County's black population as in national rates.
Much of the mortality stems indirectly from economic factors, said Pitt's South-Paul.
Poverty forces people into a much narrower world and they don't realize they have other options. Adolescent pregnancies, substance abuse and smoking, for example, hit harder in neighborhoods where young girls can't afford early medical care and guidance when they're pregnant.
Taking care where it's needed
Alma Illery has outreach programs and social workers who go into neighborhoods with education programs and make home visits to the elderly.
The center also has day care and two transitional houses for women recovering from addiction. At each place, clients are encouraged to use the medical center. It's Alma Illery's way of trying to change habits. It also has an exercise studio across the street from the Homewood site.
In the past, a mobile unit has traveled to housing developments in Prospect, Fairywood and McKeesport. A doctor, nurse and physician's assistant would make the trip, offering health screenings and physicals. The unit is preparing now to offer service in other parts of Homewood.
For years, local ministers would recommend that congregation members with no health insurance go to Alma Illery's centers.
"They were always a feeder system," said Payne. However, with the discussion on using faith-based initiatives to address social ills, the medical center is looking for more formal links to address preventive health care.
Until a better system is developed, community health centers will continue to work to close the gap between the haves and the have nots, Payne said.
"It becomes a real issue because people who have to choose to buy medicine or buy food can't always choose medicine."
Post-Gazette Staff Writer Christopher Snowbeck contributed to this report.
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