Where can Columbia’s uninsured find health care? Free clinic open amid COVID-19 crisis

Nina Deason doesn’t seem scared, even though she has every reason to be. She bursts through the clinic door, wearing a white mask on her face and blue latex gloves on her hands — increasingly common attire during the COVID-19 pandemic.

Deason needs her mask more than most. She has chronic obstructive pulmonary disease and can only use 30 percent of her lungs. Every moment she spends in public, around people, around potential COVID-19 carriers, is a moment she puts her life at risk.

“I have respiratory problems, so I’ve been cautious as heck because I’d be one of the first ones to die,” she says, laughing as though she just told a hilarious joke. “I really would.”

No, she doesn’t seem scared, and maybe that’s because she feels safe here, at The Free Medical Clinic on Harden Street. It’s a small office, tucked behind the Columbia Fire Department’s logistics building. If not for a large sign pointing in its direction at the end of the street, it would be easy to miss.

For patients like Deason, it’s a hidden treasure.

A retired nurse, Deason started coming to the Free Clinic nine months ago, when her medication was running low and she was struggling to breathe. Though she receives disability benefits, she’s in the midst of a two-year waiting period for Medicare coverage, and inhalers for COPD can cost up to $500 a month. Deason gets hers from the clinic — for free.

“We’ve got to stop meeting like this,” jokes Freddie Strange as he wraps a blood-pressure cuff around Deason’s arm and sifts through her paperwork. She cracks up again, her laugh reverberating under the bright fluorescent lights.

After checking her vitals, Strange leads Deason toward exam room 3, one of six in the facility. There, Deason talks with nurse practitioner Maggie Selph over a computer monitor. A few minutes later, Strange emerges from the room and asks for someone to roll in an EKG machine.

Executive director of the clinic for the last six years, Strange is about as hands-on as they come. On this day — Tuesday, April 7 — the 61-year-old is a ball of energy, zig-zagging around the office while wearing a neon orange mask under his thick black-framed glasses. He jokes that he looks like something out of “The Andy Griffith Show.”

Normally, there’d be a medical assistant here checking in patients, along with multiple student volunteers. But the medical assistant resigned a couple of weeks ago, and the students are staying home for their own safety. The nurse practitioner, Selph, is seeing patients virtually because she’s a mother and COVID-19 has made finding childcare a near impossibility. So Strange is running the show today, and that’s OK by him.

A lifelong health care worker, Strange spent most of his career on the administrative side, but since he joined the clinic he’s made an effort to interact with patients like Deason every day. He says he believes God put him in this role for a reason, and in the last six years, he’s gained a deeper appreciation of the plight of this particular patient population.

These are the working poor, people who don’t have Medicaid, Medicare or private health insurance and whose income falls at or below 175 percent of the federal poverty line. These are people like 35-year-old James Hollingsworth, who works as a server at Red Robin but can’t afford his $400-per-month blood pressure medication, or 53-year-old David Lightbourne, who was homeless when he first came to the clinic but now works in produce and needs help managing a seizure disorder. These are people who work at many of the essential businesses that remain open in South Carolina, people who are risking their health to keep grocery shelves stocked during a pandemic yet can’t afford their own medical treatment.

“The majority of our folks have a residence of some sort, either renting or some own a home living with someone who accommodates them,” Strange said. “And the vast majority of our patients are working — or at least they were until this COVID crisis hit.”

With more than 22 million Americans filing for unemployment since mid-March, including over 268,000 South Carolinians, nonprofit health services like The Free Medical Clinic could become crucial lifelines to larger and larger segments of the population. Strange said he expects patient volume to increase as more people lose jobs and the health insurance tied to them.

For safety, the clinic’s volunteers check for COVID-19 symptoms at the door, taking temperatures and asking the screening questions recommended by the Centers for Disease Control and Prevention. On five separate occasions, the clinic has isolated patients, examined them, then sent them to a hospital for COVID testing.

The pandemic threatens to wreak havoc in other ways. With four single mothers working at the clinic, it has already created scheduling issues. The clinic isn’t government funded, other than a small yearly grant from the S.C. Department of Health and Human Services, and it could see a decline in the donations it relies on to stay afloat.

But today Strange isn’t dwelling on any of that uncertainty. He doesn’t have time to. He’s in the moment, turning over exam rooms, checking temperatures and blood pressures, cracking jokes with patients.

“The worst thing you can do is panic,” Strange said. “And I’m not apt to hit the panic button.”

’This is real health care’

The Free Clinic has existed in some shape or form for 36 years. Todd Crump has volunteered as its medical director for the last 19. There are patients he’s known for a decade or more. He’s seen them rebuild their lives, get their blood sugars in check, find jobs. He’s seen their children graduate. He’s met their grandchildren.

An emergency physician by trade, Crump is also one of the many health care workers on the COVID-19 frontlines. When he’s not at the clinic, Crump works full-time at the Saluda Pointe Urgent Care Center, which in recent weeks has become a hub for coronavirus testing.

The urgent care center holds drive-thru testing in multiple time slots throughout the day, typically churning through about 17 patients in 20 minutes.

“You don’t even get out of the car,” Crump said. “You roll down your window, we confirm your identity, we ask you to repeat your date of birth, we swab your nose, you sniffle and then you drive on, and we send your swab off for testing. We’re doing a lot of that at my urgent care center.”

But it’s still an urgent care center, which means patients are still coming in with kidney stones, broken bones and appendicitis. Between working at Saluda Pointe and fulfilling his duties as medical director at the Free Clinic, Crump’s schedule couldn’t be more hectic. He’s seen firsthand the toll that COVID-19 has had on both places. He worries about the safety of his elderly parents in Atlanta. He worries about his colleagues.

“The big thing is trying to keep my staff raised up over here at the clinic and over at Saluda Pointe,” Crump said. “They’re on the frontlines (at Saluda Pointe). They’re swabbing people. We’re treating people with COVID-19. We’re seeing a lot of it. Our patients are getting sicker. And our staff is going home to little ones. And they’re worried about, ‘Am I carrying the stuff on my scrubs?’

“Same thing here. We’re constantly exposed to people.”

Oftentimes, Crump can’t get to the Free Clinic until after his daytime shift at urgent care ends. He’s spent many lonely nights reviewing charts and signing off on prescriptions in a quiet office. But he knows how important it is, even during this time of turmoil, to keep the clinic lights on.

With emergency departments and urgent care centers like Saluda Pointe already slammed with coronavirus patients, a facility like The Free Medical Clinic becomes all the more essential in preventing unneeded E.R. visits — one of the clinic’s vital functions. It also ensures that a vulnerable patient population doesn’t slip through the cracks.

Last year alone, the Free Clinic served 1,590 unique patients from 13 S.C. counties, with 44 percent of those patients using the clinic in lieu of a primary care physician. The clinic’s in-house pharmacy, stocked with donated drugs, dispensed 42,139 prescriptions last year for free — a wholesale value of $4.5 million.

Those patients and their needs aren’t going away, and neither are the doctors, pharmacists and nurse practitioners who treat them — most on a volunteer basis.

Jessica Ballouli is one of a handful of paid staff members, sharing a full-time position with two other nurse practitioners to guarantee one is available in person or via telehealth each day of the week. In recent weeks, she’s had many patients come to her afraid that they might have the virus. Some have chronic conditions so severe that they’re scared to come into the office. She’s seen other patients who hadn’t even heard of COVID-19, patients who don’t have computers, phones or access to the news.

“The clinic is always an interesting place to work because we have such a varied demographic that we see,” Ballouli said. “We see homeless immigrants who just lost their jobs, or we see long-term unemployed. Some patients didn’t graduate high school, and others are doctors from other countries … The spread is so huge, it’s just for some reason they don’t have insurance or income. We have patients who are so educated and were employed weeks ago. We serve such a vast group of people, because everybody is really on the verge of being without insurance.

“I mean, really, everybody could be a month away from losing insurance.”

A mother of four young children, Ballouli is of course concerned about catching and spreading the virus herself, but that fear doesn’t stop her from coming to the office. Every evening on her way home, she calls her husband and tells him to isolate their kids so she can take off her scrubs in the garage, throw them in the washing machine and shower.

Dr. Bill Logan, a one-day-per-week volunteer, follows a similar routine with his wife, Victoria. He said she’s expressed concern about him working at the clinic during the pandemic, but he insists he isn’t afraid, and he has a track record to prove it. Earlier in his career, when he worked at the Mayo Clinic in Minnesota, Logan treated patients with military tuberculosis from Asia. In the mid-80s, he treated some of the very first AIDS patients in North Carolina while working as a nursing assistant.

These days, Logan serves as the chief medical director at Centene, one of four companies that manages Medicaid in South Carolina. He’s a firm believer in building up safety nets for the less fortunate, volunteering at two other free clinics throughout his career. He calls it an honor to work with Strange, Crump and the rest of the clinic. Throughout all of his stops in the medical world, this work is the kind that resonates with him most.

“This is real health care,” Logan said. “This is stuff that actually really matters … I wish that we had free health care available for everybody. I grew up in South Carolina. I hate the disparities we have in this state that still exist in the year 2020. I love people, and I love all people equally. But all people are not equally blessed, and I wish they could be. Medicine to me is not a business. To have health care try to act like a business is ridiculous.

“As long as we’re not taking care of the least of these in society, our society is not going to be well.”

Keeping the lights on

It’s nearly lunchtime, and Strange hasn’t eaten yet. He’s running on a cup of coffee, half a Gatorade and a sweet tea from Chick-fil-A. After checking in a steady slew of patients, he’s finally able to take a seat in his office.

Now, it’s time to handle the administrative aspects of his job. He’s got a vacant medical assistant position he needs to fill and interviews to arrange. In a few minutes, he’s going to log onto his computer and apply to the federal Paycheck Protection Program.

The clinic may run on volunteer work, but it still has bills and staff to pay.

“My No. 1 concern is my staff and the stress level and keeping them safe, and I think we’re doing a pretty good job of that,” Strange says. “The second concern is the disruption in the revenue stream, and that’s not going to happen now. That’s going to happen in the not-too-distant future.”

This time of year, Strange and development director Caryn Little would normally be planning for the clinic’s annual November fundraiser, called The Doctors Lounge, which netted $73,000 last year. But those plans have stalled, at least for now, due to the COVID-fueled economic downturn. The bulk of the Free Clinic’s revenue — 37 percent — stems from donations from foundations, and it’s too early to tell just how much those contributions could be affected.

The clinic continues to receive support from its partner agency, The United Way of the Midlands, and from the local hospital systems. Direct Relief recently donated 250 N95 masks. Other companies have contributed hand sanitizer and paper products. Individuals can donate on the clinic’s website.

Despite the financial uncertainty, there’s been no talk of reducing hours or any other sort of reduction in services. The clinic remains open four-and-a-half days a week, and Little said she expects the clinic to be able to handle the increased volume that could come with surging unemployment, thanks in large part to the staff’s all-hands-on-deck approach. Little herself has helped out in a variety of ways outside of her role as a development director.

“I couldn’t have pulled it off this morning without Caryn out there being my scribe basically, and that kept us moving,” Strange says from his office desk. “The attitude of our whole staff, you see our admin turning the room over, our girls up front, the guys in the pharmacy. I think that’s been the best part of this (COVID crisis) is seeing the employees and the way they’ve adapted to it. Even in a stressful situation they’ve maintained a positive attitude and been good to our patients.

“We have some patients who come here very stressed out, very scared, and they tend to get a little anxious, and our staff has done a very good job of saying, ‘Calm down. We’re going to try to help you out. This is what we’ve got to do.’”

Nina Deason was once one of those patients — terrified that she wouldn’t be able to afford the medicine she so desperately needed for her COPD. Nine months ago, her breathing had become so labored she was afraid to leave her home.

“I didn’t know what I was going to do,” Deason said. “I was really scared. And then I came here.”

She doesn’t seem scared anymore. Not here.

Here, she feels safe. Here, she’s laughing.

This story was originally published April 20, 2020 at 5:00 AM.