Community health centers a safety net for urban populations


Shantray Hooks, who has asthma and diabetes, is a patient at Gary Community Health Center.

When Shantray Hooks, of Gary, lost her job as a restaurant cook in August, she didn’t know how she would pay for doctor visits.

“I had no health insurance and I couldn’t afford to pay a doctor,” said Hooks, 29, who was diagnosed with diabetes several years ago.

A doctor referred her to the Community Health Net of Gary, a federally qualified community health center that provides comprehensive primary care health services and charges on a sliding fee scale for services.

Their prices are reasonable,” said Hooks. “You can go in to get health care services and pay as low as $10,” explained Hooks, who said health center staff educated her to manage her condition. “They taught me to test my blood sugar levels, eat smaller meals more regularly and take my medicine at night and first thing in the morning.”

Because of her unemployment and income level, she also qualifies to receive her medicine free.

“It is a beautiful thing to be able to be treated when you’re sick,” said Hooks, who is also asthmatic and uses an inhaler daily. “I also go to the health center to see a gynecologist. They take good care of me.”

Hooks may also qualify to be among an estimated 530,000 Hoosiers expected to be covered under last year’s historic Accountable Care Act. The landmark health reform law is already making an impact on Gary residents and health care providers, even though some of the health insurance coverage provisions won’t kick in until 2014.

Dr. Janet Seabrook, executive director of the Gary-based Community Health Net, said the community health center has received an expanded services grant for $227,200 from the law to broaden health services it already provides at its current locations. That grant will also increase the number of health center providers.

Seabrook said the health center is also one of 1,000 applicants applying for 350 awards intended to promote expansions. “If we get it, we will open a school-based clinic at Hammond High School next year,” she said.

The center is also applying for a grant intended to expand services to HIV/AIDS patients, which would fund the hiring of an infectious diseases specialist and nurse coordinator.

And the additional $290 million funding for the National Health Services Corps, which offers student loan forgiveness to primary care physicians has enabled the health center to offer student loan forgiveness to two of its providers.

Seabrook said the center may be eligible to receive funding for its school-based clinics to compete for a grant to treat obesity in children.

More money for services

“Gary citizens will benefit from health reform in several ways,” she said, “By having more access points to receive care and better outcomes.” She said the health center sites will have electronic medical records starting in April. “And the community health center will receive a regular revenue stream when those eligible for insurance coverage begin receiving it. Instead of receiving $5 or $10 for services that might cost $100, we will be paid more for services provided.”

She said Community Health Net will become a Medicaid enrollment site, enabling the health center staff to electronically enroll those eligible for Medicaid.

Seabrook, a Gary native, wrote the original grant for the health center. The Meharry Medical School graduate has practiced in Gary since 1996 and was the first medical director of the health center when it opened in 1998.

In 1995 the U.S. Public Health Services designated Gary as the neediest community in the nation without a community health center. Federally qualified community health centers are safety-net clinics treating medically underserved urban and rural areas by offering preventive, prenatal, pediatric, family practice, obstetrics, dental and behavioral services. Because they treat large numbers of uninsured and Medicaid patients, the centers receive enhanced Medicaid reimbursement, making it possible for them to survive financially on a low-income clientele.

In 2004 Seabrook was promoted to executive director.

“We’ve evolved from basically a one-doc shop into a multispecialty organization with school clinics in Gary and a satellite clinic in Merrillville. “We now have two pediatricians, a nurse midwife, OB/GYN backup, several family nurse practitioners and a part-time family practice physician with an annual budget of almost $5 million employing around 40.”

She said the center, now called Community Health-Net, has partnered with the national Atlanta-based dental provider Kool Smiles to provide dental services.

“Studies have shown that you can provide good primary medical care services, but without good oral health, all of that could be at risk.”

Seabrook said though Gary’s population has decreased since the clinic opened, “I would say the need is even greater now because of our country and our city’s economic situation.  In urban depressed areas the need is even greater than among the general population,” she said. “Our health center is seeing an influx of people from other areas, especially from neighboring Illinois.”

“We’re making a difference, but the numbers are still daunting.”

Obesity a root problem

She said the incidence of heart disease, diabetes and hypertension are growing in Gary and Northwest Indiana, as well as something she didn’t witness as much growing up in Gary: obesity.

“It’s a combination of factors. The lack of grocery stores, the unavailability of fresh fruits and vegetables, the lack of education about salt in our diet and reliance on fast foods all contribute to growing obesity in our community. There is only so much one community health center can do in such a large community with so many needs.”

She said that Community HealthNet is trying to expand its influence and create a bigger impact by building partnerships with the Gary and Lake Ridge school corporations, the Boys and Girls Club and churches to try to educate youngsters about diet and exercise. 

Seabrook said because of the high rates of unemployment, poverty, crime and disease in Gary, many of the center’s patients demonstrate signs of depression.

“We have many grandparents raising grandkids, sometimes on a fixed income,” she said. “We treat a lot of depression at our center. It’s challenging to control diseases like hypertension and diabetes at the same time you’re treating their depression.”

She said the center launched an integrated model for bringing primary medical and behavioral health services under one roof, starting about 18 months ago.

She’s known patients whose mental health issues prevented them from complying with their medical treatments.

“You get numb after a while. The depression flattens your ability to respond to traumatic events. Some of our patients lost their jobs and owe so much money it’s overwhelming them.”  

 “The biggest problem we have now is colon cancer screening,” she said.  

 “We have three patients who hadn’t seen a doctor in many months and never had colonoscopies and all three ended up with colon cancers that are now too far advanced to treat,” she said. “We discovered them on their first visits and sent them for workups. But sometimes they don’t come to us until they are in the later stages of the disease.”

She said all three suffered weight loss had no insurance, even though two of them worked. “They just couldn’t afford the insurance.”

Seabrook said the center is seeing more uninsured patients since the recession began. “Local doctors are trying to provide services, but it’s hard for them to do in this economic climate. They don’t have the resources the health center has. We run a pharmaceutical assistance program and have a social worker who helps patients apply for public health and assistance programs.”

She said continuity of care remains a big problem for many Gary residents, particularly the uninsured. “People fall through the cracks. They need a medical home and that isn’t the ER. They don’t do colonoscopies or mammograms in the ER and they won’t screen for lead or do immunizations,” she said.

“The ER provides excellent trauma care, high quality services, but many of their patients’ health status is poor because of broken continuity of care.”  

Making a difference

Cindy Hoess, a pediatrician lured to Northwest Indiana from Chicago’s Rush University Medical Center to work at a Gary community health center, said she was attracted by Community HealthNet’s school-based clinics.

Hoess said when the clinic in Calumet High School in Calumet Township opened, it was primarily targeting students, but since has expanded services to treat adults as well. Students now comprise only 30 percent of the patients, while community members round out the other 70 percent.

“We want to extend access to care to them,” Hoess said. “Because their children go to school here, this offers them an easier way to see a doctor and improve continuity of care in an area that really needs it. When we opened and parents saw the care their children were receiving, many began coming for treatment.”

Hoess said the school clinic offers sports and other student physicals, as well as general primary care. “About 40 percent of our patients have asthma and allergies,” Hoess said. “Many also have diabetes.”

She said working in underserved urban areas is her calling.

“So many people in this area live without health insurance or are underinsured. Now they have a place to go,” she said. “And that’s why I’m here.

“We really do try to serve the community and provide good care. It’s an area that greatly needs it. Working with young mothers and seeing their children thriving is very gratifying. This is why I went into medicine.”

Seabrook said the center aims to become a medical home for its patients, providing primary care services in each cycle of life, from prenatal care to geriatric services.

The health center is the only medical link to a wide swath of diverse patients.

Freddie Galbreath, 63, a Gary native who returned to the city five years ago after living in Chicago, said he was diagnosed with high blood pressure years ago.

“It runs in my family,” said Galbreath, a retired marketing and transportation employee who said he’d been healthy all of his life. “It didn’t limit me from driving, but it did disqualify me for a job once. I ignored it because I didn’t feel any symptoms.”

When he lost his health insurance several years ago he visited the clinic and was again tested.

“They made me aware that it could make me very sick, I just didn’t want to own up to it,” he said. “But once they diagnosed high blood pressure they prescribed medicine and I started taking it. It brought my blood pressure down from 260 over 150 to 130 over 100. I go in about every three months now.”

Betty Campbell,  62, of Gary, moved from Chicago in 2007 and shortly after began seeking treatment at Community HealthNet. Campbell, a divorced mother and grandmother of one, discovered her high blood pressure while on her job as an administrative assistant in 2004.

“It was sky high at 200 something over 170 and I was feeling woozy,” she remembered. “I was all stressed out and near stroke level. I’d put on some weight and the stress got to me.”

She was diagnosed with hypertension, but also had to manage her Type II diabetes and high cholesterol.

“I was killing myself,” she said, noting that her doctor prescribed medications to control the cholesterol and hypertension.

After taking several falls, she moved in with her daughter and grandson at their Miller home and began visiting Community HealthNet. She said she lost the excess weight and changed her eating habits and monitors her blood sugar and blood pressure regularly.

“The health center staff are continuously helping me follow the treatment plan and have maintained me on a consistent care program that has enabled me to be as healthy as I am now. I’m doing fantastic and I haven’t had any problems, thank God.”