Clinic fills gap for Patients

Latinos, poor find help at Lyon Park when Lincoln is unable to see them

BY MARK SCHULTZ mschultz@heraldsun.com; 419-6646

Beatriz Peña sat down in the waiting room just before noon. In her arms, her 2-year-old son William wailed, turning a tear-stained cheek to the wall.

"Pienso que es una infección [I think it's an infection]," she said, laying William across her lap and rocking gently. At her feet, William's twin brother, Wilbert, dressed in identical blue jeans and a green sweater, pushed Crayolas around the floor.

Peña had called Lincoln Community Health Center, she said. But her doctor wasn't there. So she drove her boys to Lincoln's new satellite clinic in the Lyon Park Community Family Life and Recreation Center, at 1313 Halley St. in Durham's West End.

An hour later, the visit was over. Peña headed for the door, William still in her arms but no longer crying, Wilbert sporting a shiny sticker on his hand.

"Es una ventaja muy grande [It's a very big advantage]," the Mexico City native said of the simple, two-exam-room health clinic. "Es un privilegio. [It's a privilege]."

Peña's visit is typical, clinic organizers and staff said. The young mother is one of more than 1,000 patients who have flocked to Lyon Park since the center opened a year ago this month. The program has been so successful -- exceeding patient projections and, with start-up funding from The Duke Endowment, already breaking even -- that Lincoln and its partner, Duke University's Division of Community Health, are planning a second satellite in Walltown.

Like Peña, most of the patients at Lyon Park are Lincoln Center regulars. They choose the clinic because it's closer to where they live or work or because they want to avoid Lincoln's crowded waiting rooms. Those who are new are automatically enrolled in the Lincoln computer system, giving them access to the same low-cost care that until a year ago had only been available at the health center's Fayetteville Street office.

The neighborhood clinic can't offer X-rays, advanced lab work or the pharmacy available at Lincoln. What it can offer is turnaround.

"They get, like, 300 calls right before 10 o'clock; there's only so much they can do," said office manager Geana Alexander. "We get calls every morning -- 'Lincoln says they can't see me.' "

Duke helps out

A health clinic was always part of the plan when Lyon Park neighborhood leaders decided to turn the 1920s brick elementary school into a community center.

But it took Duke's financial support to make it happen. The university helps fund the clinic as part of the Duke-Durham Neighborhood Partnership, the program under which the university works with the 12 neighborhoods and seven public schools closest to campus.

Even so, Duke didn't just come in and start planning the clinic, said Susan Yaggy, director of the Division of Community Health.

"We didn't sit down and say, 'We're from Duke and we'd like to set up a clinic,' " she said. "That's not how it works. We spent a lot of time talking with the neighborhood."

What they heard, Yaggy said, was that for many residents -- the poor, the elderly and immigrants -- "it's really hard to get care."

Money, transportation and language can all keep people from seeing a doctor. But not seeking medical help for minor, preventive and ongoing treatment often makes medical problems worse -- and raises costs when those patients show up in the emergency room.

"We have to look at where people are able to get in early enough to make a difference," said Evelyn Schmidt, director of Lincoln Community Health Center.

Even Lincoln -- with 35,000 different patients last year, 82 percent of them below the poverty level -- can't always see people as quickly as they need to be seen.

"No one likes to recognize it," Schmidt said. "North Carolina is still one of the 10 poorest states. We have great disparities."

High comfort level

Patricia Flores came to Lyon Park to get a physical for a janitor's job at Northern High School. A friend told the mother of five about the new clinic, and she came with her son Salvador, 18, who was on spring break from his college in Mexico.

It's more convenient, Flores said in Spanish. "Tardán más en Lincoln. Aquí es rápido servicio. [They take a long time at Lincoln. Here it's fast service.]"

About 60 percent of Lyon Park patients are Latino, even though the West End is not one of Durham's most heavily Latino neighborhoods. The clinic, which is open to all Durham residents, has even developed a new name in the Latino community: "la Halley," after the street it's on.

"I said, 'Oh, that's wonderful,' " Yaggy recalled. "That means folks feel so comfortable they have created a nickname. It's a wonderful sign."

If Spanish-speaking patients feel comfortable, the clinic's bilingual physician's assistant, Diane Davis, probably has a lot to do with it.

"La doctora es muy amable [The doctor is very friendly]," said Peña, the mother of the twins.

Davis honed her high school Spanish treating Mexican patients in Burlington. As she explained a consent form to Peña in the six-seat waiting room, she spoke as rapidly as a native speaker. (Later, when she spoke with a reporter, however, she spoke English just as fast.)

Lyon Park is "why I went into medicine," the 38-year-old said. "I believe everybody deserves equal health care regardless of insurance or language barriers. That's hard to do in private practice." Or at Lincoln, she added. "The reason we exist is because they're so overloaded."

No one denied care

Indeed, many Lyon Park patients could not get into a private doctor's office.

Two-thirds of the clinic's patients have no insurance, according to Yaggy. They pay $10 to $50 per visit on a sliding scale, though no one is denied care because of inability to pay. Another 22 percent of patients are on Medicaid, and the rest have private insurance.

That makes managing the new clinic's finances a balancing act. Lincoln pays Duke $35 per patient visit, which it must then make up primarily with Medicaid. As a community health center, Lincoln gets a higher reimbursement rate on its Medicaid patients than most private physicians get, Yaggy explained.

But to break even, especially when the start-up funding ends in June 2005, the clinic needs to keep overhead low and patient volume high.

"Right now we're really hampered by having only two exam rooms," Yaggy said. "We need at least four to keep a provider moving smoothly between patients, and not in her office waiting for folks to get changed [and have] their temps and blood pressure taken."

The clinic is currently waiting on the OK from Lyon Park to break down a wall and add the extra rooms in the space next door.

But two rooms or four, if the clinic can treat patients in the neighborhood, it can keep many of them out of the emergency room, Yaggy said. For her, it's all part of the same equation.

"It's the basic mission of Duke," she said. "We take care of patients. The question is, Can you take care of them close to home? This not a charitable goodwill gesture. This is our community."

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