by Maia Tinder

Our week in Kilmarnock, VA at the Northern Neck Free Health Clinic began late on Sunday afternoon, when we met our community partner and her sweet dog in the parking lot outside of the clinic. As one of the site leaders of the trip, my co-leader and I had been told for months how warm and talkative our community partner would be and we saw this right away. After standing in the parking lot for about 10 minutes sharing stories about her dog and introducing each other, we headed inside for a tour of the clinic and the spaces we would be using to cook dinner, keep our things, and a brief tour of the other areas we would be working. We then went with our community partner to the place where we would be sleeping, which was actually the original site of the clinic at its establishment. We had planned that evening to drive over to a place on the Chesapeake Bay, which our community partner told us was beautiful, but after we had come into the clinic and put our things down, we looked outside the window and saw that the snow forecasted for the week was already beginning to come down in a wet sleet. We were warned by our community partner that the clinic may be closed the next day if there was too much snow, but that we would have to figure it out when the time came. We decided to go later in the week, said goodbye to our community partner, and settled down to have a team meeting to discuss logistics for the week.

The next day, we found out our community partner was not able to make it because of the snow, so that day became a great day of team-bonding, conversation, watching Forrest Gump, and some very resourceful team working to cook dinner for 12 with only a toaster and a microwave. Everyone in our group was still excited and curious of the day ahead as we headed off for the clinic the following day. After a brief orientation about the clinic, pairs of W&M students were broken up into different areas of the clinic to work on projects. This became the pattern throughout the week—each person started the day off working on a project, sometimes with a partner or two, and then whenever you finished, you found the next thing that needed to be worked on. In between these projects, pairs rotated in shadowing either the nurse practitioner or family medicine physician on staff at the clinic, or sat in on and assisted with eligibility screenings for new patients. It was an effective process as everyone got to work on multiple projects, we were able to get a lot of work done for the clinic, and we could come together at the end of the day and hear about others experiences.

A notable project we worked on throughout the week were cleansing their files kept in both their medical and dental central office of patients who were considered inactive because they had not come to the clinic in several years and clearing out the secondary storage area of dental patients who had not come in several years and were no longer considered patients. These two projects were some of the proudest work I saw my team complete. The purpose of this alternative break was to help this organization be able to fulfill their mission of providing healthcare to those that lack access in five counties of Virginia, and more importantly to indirectly help the citizens of Kilmarnock and the surrounding counties to have a place where they can receive healthcare, counseling, dental services, and care that they deserve so that they can live healthy lives and reap the benefits of all that comes with it. Our community partner mentioned numerous times that the work that we did on these two projects would have taken their staff months and months to complete, and that their operation would have stalled without its completion. While this may not have been the most inspiring work on its own, it was incredibly empowering and enthralling for me to see all that we had completed by the end of the week and feel that we had made a significant and concrete contribution to the clinic and thus the clinic’s patients and staff.

Another of my favorite projects, that I did not work on directly but observed several times, was a group of our team that worked with the person at the clinic in charge of giving presentations to potential donors and other members of the community. He showed us their current presentation during our orientation to the clinic, and mentioned immediately afterwards that he wanted our input on how to improve the presentation to make it more interesting and effective in communicating their mission, services, and statistical data to an audience. A group from our team began working on the presentation that day, and were able to create a dynamic, concise, but powerful presentation by the end of the week that they were able to make suitable for the purposes and requirements of the clinic. We all packed into the staff member’s office on the last day to see our group present the presentation to our community partner and it was a very powerful moment to see their appreciation and amazement at the presentation our group had created. Their work innovated what the clinic had been using and I hope will play a role in helping the people who operate the clinic gain the funding they need to continue its successful operation.

These projects were wonderful contributions to the clinic’s mission and service, and we also engaged in activities that helped our group to learn more about the social issue behind the clinic: access to health care and specifically the issues and difficulties that present themselves in rural settings. We observed and assisted with eligibility screenings, where individuals or families would come into the clinic with financial information and find out if they were eligible for the clinic’s services. One woman that we observed was in her mid-sixties and talked to me and my co-leader who were observing the screening about how she had hip and leg problems but that doctors at another site had refused to see her anymore because there was a disagreement in diagnosis between two physicians she had seen. She explained her entire story and was very talkative, to the point that the volunteer conducting the screening had to ask her to pause so that she could ask her the necessary questions on the screening form. As soon as the volunteer stopped asking her questions, she would resume telling us her story. After looking over the woman’s financial information, the volunteer asked her if she had ever been to the food bank, telling her they had a lot of great resources and the woman said she had not because she can’t get around very well. When asked if she had anyone that could take her there, she replied, “No, I don’t have anybody.” I was slightly overwhelmed by attempting to imagine what one’s life would be like when you felt you were completely alone, and how that was playing a role in her health, with limited access to public transportation in her area and difficulty moving around, she did not have access to even the sparse resources available to her in her area.

Other members in our group shared about their screenings, including a man who was the father of a family of three, and he brought his children with him to the screening. With a disabled wife who was unable to work and another baby on the way, his family was to living off of his salary, which he earned from working two different jobs. Another man that I observed while shadowing a volunteer family medicine physician worked in landscaping and doing other handiwork and had been suffering for nearly four years with what the doctor diagnosed as osteoporosis in his lower back. The patient had not been to seen a doctor in over five years, and the doctor discussed and planned for his return to the clinic so he could have blood work done in addition to providing him a medication for his osteoporosis, and discussing with the patient his rationale for choosing this medication and that they were starting with a low dose, but that he wanted to work with the patient to find what would work best for his pain, so for the patient to come back and see him if he had any concerns.

Throughout my time shadowing the physician, the doctor did fantastic work in having real conversations with his patients, asking thorough questions so he completely understood their situation, and being aware of the patient’s life outside of the clinic in order to apply the most appropriate and effective treatments. The doctor also treated the patients with the specific goal of making them feel welcome and cared for at the clinic to increase the chance that they would continue attending the clinic and receive consistent care.

One issue of the clinic that I discussed with the doctor after shadowing a patient was that one of the challenges the clinics’ patients face is a lack of continuity of care. Even if a patient attended the clinic every 6 months as was required to maintain their status as an active patient, oftentimes they would not see the same provider each visit. The clinic had semi-recently hired a full-time nurse practitioner that was one step towards improving this issue, but many of the providers still worked on a part-time, volunteer basis. Not seeing the same primary care provider during each visit limits the development of a doctor patient relationship which could lead the patient to become less invested in their own health and could limit the efficiency and effectiveness of a patient’s treatment because the provider will not know the patient’s case as well and each visit they will need to start fresh learning the patient’s history instead of being able to build up and move forward with finding the ideal treatment options for the patient. We had the chance to observe the benefits of continuous care when the doctor went in to see a patient who he, by chance, had seen on her last visit to the clinic. He took his time talking to her about her job working with adults who suffer from disability and mental illnesses. He remembered her last visit a few months ago in which she had a bad cough, and she brought with her records from a visit to the Emergency Room in which they had told her she had pneumonia. He was able to use his memory of her cough from two months ago, knowledge of her personal history, and careful informed discussion with the patient to come to his final diagnosis, which was that she had lung complications from her history of smoking. This sort of collaboration between the doctor and patient would be less likely to occur if the patient had come in and seen a provider who had known nothing about her or her relevant medical history.

A big topic that came up in many of our reflections was the emotional response of our team to witnessing and learning of the circumstances of the people who attended the clinic. As a free clinic with a eligibility requirement of having an income below 200% of the poverty level, compounded with the complications of limited resources and support in a rural environment, many of the people in our group felt they had previously had little exposure or acquaintance with people who lived with these conditions. However, I had a slightly different response. My family attended public health clinics throughout my childhood and I come from a socioeconomic background comparable to those who attend the clinic. Additionally, I have shadowed a pediatrician in a neighboring rural area in my home state so was acquainted with the conditions of the patients who were coming into the clinic.

One of the best responses I heard a member of my team make to the week and learning about the issue of access to healthcare and the complications of rural health care was, “yes, we gained a lot of new perspective this week, and with perspective, comes action. Once you have knowledge and understanding of an issue present in your community, or your country, it can lead to action.” This lead to a discussion about how we could encourage people to gain new perspectives more often. One of the simplest things that could be done is seeking open conversation and sharing of ideas and personal background and experiences.

Throughout my college career, I have realized that, for the most part, before people have the chance to experience many different backgrounds through service or by having a friend who has had very different experiences than them, people tend to assume that other people are like them—that they had a similar background and similar experiences and have the same norms. This is not surprising, because what each person knows best is their own life and in every day activity, their view of the world tends to be projected onto others when they don’t take the time to appreciate a diversity of backgrounds. Encouraging open conversation between individuals would increase understanding of the world and what life is like for people other than themselves, and furthermore, what they can do to work with others to attain the life each person wants to live.