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When Loretta Hillmon, a 52-year-old beauty salon owner,
noticed a lump under her left arm, she asked her sister,
an RN, to examine it. Her sister advised her to have
it checked out by a doctor right away. But the uninsured
mother of six procrastinated, in part because of financial
limitations.
When she finally saw a doctor months later, she was
told she had the "Jackie Kennedy kind of cancer"-lymphoma.
Hillmon died a little more than a year later, having
endured surgery, chemotherapy and radiation treatment.
She left behind two daughters, aged 17 and 11.
Cases like this are all too familiar for nurses who
work in hospitals that care for the uninsured, and the
demand for programs that treat this patient population
is increasing.
Last year, an estimated 2 million Americans lost their
insurance, the largest one-year rise in nearly a decade,
according to statistics released in February by Covering
the Uninsured, a new partnership of national organizations,
including the American Nurses Association and the American
Federation of Labor and Congress of Industrial Organizations.
The rise in the number of uninsured Americans can be
attributed in part to the large number of people that
earns too much to qualify for public health care coverage,
but cannot afford private insurance, said John Sweeney,
president of the AFL-CIO.
To tackle the problem, the government is creating programs
such as the Depart-ment of Health and Human Service's
Healthy Families mandate to benefit children who live
in poverty. Nurses also have proved a critical part
of the solution.
Nurses throughout the country are bridging health care
gaps to provide services to the uninsured and indigent
through nurse-run clinics, university- and hospital-based
programs, public health services and community service
organizations.
One of the nurses who heads up some of these programs
is Roxane Spitzer, Ph.D., MBA, MA, CEO of Metropolitan
Nashville (Tenn.) General Hospital. Spitzer said one
of the most common ways that nurses interact with the
uninsured is through hospital-based maternal/infant/child
health programs, which are primarily staffed by nurse
practitioners or certified nurse-midwives working under
the direction of physicians.
Chris Taylor, FNP, RN, pediatric coordinator at Metropolitan,
said he loves having the chance to affect the lives
of children and families. "I get to be the first
teacher many families have as they wade through the
intricacies of raising their child," he said. "I
am the person they look to for advice and support for
a whole range of problems, from teething to asthma management."
Taylor acknowledges that along with the enjoyable parts
of his job comes a high degree of responsibility. "I
have to be conscientious about my guidance because if
I give the wrong advice or make a poor decision, it
can result in complications," he said.
Spitzer is especially proud of Metropolitan's nurse
practitioner-run sexual assault and rape program, which
serves a large number of uninsured patients.
"Nurses there are doing a phenomenal job, not
only spending time with victims and lending important
emotional support, but also serving as trial witnesses,"
Spitzer said.
AmeriCares Free Clinics Inc. in Connecticut is another
program geared toward serving the medical needs of the
uninsured and underinsured working poor.
Its executive director, Karen Gottlieb, MBA, started
as a volunteer at AmeriCares and later was hired to
start the organization's first free clinic. About one-third
of the clinic's patients are treated for episodic ailments,
but the majority are seen for chronic life-threatening
illnesses, such as hypertension, cardiovascular disease
and asthma.
"The uninsured population is a wonderful group
to work with," Gottlieb said. "They are the
forgotten segment of our population who do not demand
or expect anything, and are extremely grateful when
they receive care."
The program has grown to include three clinics, which
are staffed by more than 500 volunteer doctors, nurses
and nonclinical volunteers who assist with screening,
translating, outreach and various administrative duties.
The Clearwater (Fla.) Free Clinic also depends largely
on volunteerism to keep its doors open. With a staff
of about 120 nurses, doctors, pharmacists and clerks,
the clinic provides free medical treatment to any north
Pinellas County resident without health insurance.
Patients are asked to pay $1 for prescription medications.
The clinic does not receive government or United Way
funding; instead, it is sustained by fund-raisers, private
donations and grants. The clinic operates on an annual
budget of $165,000 and sees 10,000 patients a year.
Connie Bahrey, RN, the clinic's nurse manager and volunteer
coordinator, said, "We are family here. Not only
do our volunteers provide care and support to our patients,
but they are here for one another.
"We come from diverse cultures and professional
backgrounds that somehow fit together and make this
place perfect. Our patients like the personal touch
we provide here," she said.
The former LPN became involved with the clinic after
volunteering there, and has seen the patient load triple
since she started working at the facility four years
ago. She said there is an increasing demand for more
clinics like this.
Parish nursing presents yet another avenue for nurses
to provide care for uninsured patients. Parish nurses
primarily serve their own church members and work in
roles ranging from educator to counselor to referral
agent.
According to the College of Nursing at Marquette University,
more than 6,000 parish nurses work in the United States,
and receive several weeks of special training before
they begin working with parish patients.
Becky Anton, MSN, RN, vice president of the Health
Ministries Association, is a practicing parish nurse
in Sacramento, Calif. The retired nurse manager is a
facilitator for the uninsured in her parish, and works
largely with Marshall Islanders from the South Pacific.
She helps them navigate Medi-Cal and Medicare insurance
programs, and also finds community resources for those
who do not qualify for either program.
"The church becomes family to those without family,"
she said. "Some people are on medications they
can't really afford. They are often unaware that there
are resources out there for them."
Although many clinics are working to reach the uninsured
before these patients face catastrophic illnesses, some
nurses encounter this patient population only after
a health crisis has occurred.
Gwendolyn Snell, RN, PHN, is an HIV/AIDS case manager
for San Joaquin County in Stockton, Calif. She sees
a large number of immigrants, including Hmong, Vietnamese
and Cambodian immigrants-many of whom are HIV-positive.
Snell's duties include helping HIV-positive people
as they make the transition out of prison, and working
with the early-intervention program. Although she often
has an interpreter on her rounds, she's learned that
some forms of language are universal.
"A hug goes a long way in the art of communicating,"
she said.
"Some of the patients are undocumented, and most
have no family or friends. These people don't have a
lot of choices about whether they get what they need
or not.
"Even if my clients don't say thank you, I can
see it in their eyes."
Contact Alicia Hugg
at rosewind09@earthlink.net.
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