A Phoenix health clinic offers hope for people with no insurance, no access to care

Show Caption Hide Caption A clinic for those with nowhere to go Phoenix Allies For Community Health staff regularly make house calls to check on patients and deliver medication.

She had canceled one appointment, then another, and now Jason Odhner was starting to worry about Maria. Her world, she said, had grown darker. Her phone was disconnected. She stopped taking care of herself, so Jason filled the prescriptions she couldn’t afford, packed a medical bag and prepared to bring the clinic to her.

“I was just checking to see if she needs any more pills,” he asked Maria’s daughter over the phone. “Does she have everything she needs?”

His patients never had everything they needed.

At the clinic's front desk, he scrolled through medical files to find Maria’s. Each file flashed similar sets of complaints and chronic illnesses. Mercedes had a prescription that made her sicker than the disease. Yessica’s blood sugar was too high, and she ignored it. Patrick still hadn’t recovered from a stroke. Maria had a jumble of pills she couldn’t keep organized and diabetes that stole her sight.

But health care had become a product to be purchased, and patients at Phoenix Allies for Community Health were shut out of the market. “Medically marginalized,” Jason called them.

Almost all of the clinic's 400 patients were immigrants. Most lacked legal status. None could afford health insurance, prescriptions or a trip to the doctor. Nobody else seemed to care.

“These are people who could live a normal life,” Jason said, and so he spent whatever time he could at the clinic, inside an old office building surrounded by a barbed-wire fence.

He and the clinic’s co-founders built a makeshift pharmacy in the back, filled tiny exam rooms with donated equipment and transformed a kitchen into the main office. They crammed desks in every corner and covered the bright-orange walls with posters and mission statements: Stop separation of our families. Together we can.

Jason, 40, arrived before breakfast for a day full of house calls. It had been two days since President Donald Trump took office, capping a campaign that promised to deport millions of people and roll back the government’s involvement in health care.

PACH felt its patients retreat. There were more missed appointments, fewer answered phone calls, and more patients checking in with anxiety attacks.

“I’ve been worried about her for a while now,” Jason said, packing Maria’s charts into his medical bag. He dialed her number one more time, to be sure.

The line screeched back at him. Dead.

When there's no access to health care

So much pain, so many patients, but for now they decided it was safer to stay at home. The schedule was full. The waiting room was empty.

A decade of health-care reform had filtered more people than ever into hospitals and doctor’s offices, but preventive care stayed out of reach for most of the 11 million people in the country without legal status.

Government programs like Medicaid and Medicare required patients to be “lawfully present.” The Affordable Care Act blocked those without legal status from discounted insurance plans. Anybody could buy health insurance from private companies but, as the ACA pulled low-income Americans into its system, the price of private plans spiked. Hospitals were required to provide only emergency care, and then could send people home.

The health of 11 million people was left to a patchwork of charity and community clinics. It was a safety net full of holes: The UCLA Center for Health Policy Research found that undocumented immigrants are significantly less likely than legal immigrants to see a doctor, visit the emergency room or report themselves in good health. Just 21 percent of them said they were in "very good" or "excellent" health.

As a nurse at a Phoenix hospital, Jason was forced to discharge patients after ensuring they wouldn’t immediately die. Their symptoms faded and returned, cycling them back through the ER, never treating their long-term health.

That was before PACH, when all Jason could do was never enough. He believed in treating the whole person, in reminding people they were important, in hope and love and in the wondrous power of healing. He saw medicine twist the humanity out of people. Nurses scribbled charts and notes. Doctors wrote prescriptions. Surgeons clipped out malfunctioning parts. Who handled the rest? Why did his hospital colleagues stare back blankly when he talked of hope and healing?

These seemed to be unanswerable questions, so Jason made house calls with a doctor from his hospital. He loaded medical supplies in the back of the doctor’s Buick Skylark, and they visited a few patients on their days off. They brought medicine outside the hospital, pushing back a health crisis a few days at a time.

Then in 2010, protests filled the streets. Jason brought together a loose collection of street medics. They pulled on blood-red shirts and trailed the crowds, brought water to heat-stricken marchers and washed out eyes filled with pepper spray.

That year, Bob and Amy McMullen started to slip into the crowds.

Amy had never protested before Gov. Jan Brewer signed Senate Bill 1070, which required immigrants to carry their residency paperwork at all times. The activist community erupted. Notice of a rally against SB 1070 appeared on Amy’s Facebook page. “I’m attending,” she clicked and, within an hour, she had become an activist. The protests grew larger. The McMullens kept showing up.

They showed up again when neo-Nazis marched toward the Capitol. In November, the National Socialist Movement received a permit to rally in support of SB 1070, and activists planned a counter-protest. The two groups met underneath a haze of tear gas.

Amy, a former EMT, carried a sign into the masses. Bob, a physician’s assistant for 30 years, tried to blend in to take photos of the protests. He watched the people in red T-shirts duck in and out of the crowd, pouring milk and water into people’s eyes and sending them back toward the chaos. He weaved through the crowd and found Jason.

“What are you guys doing here?” Bob asked.

“We’re street medics,” Jason replied.

“I’m a P.A.,” Bob said. “My wife was an EMT. We’d like to help you out.”

Later that afternoon, they met at a Mexican restaurant and laid out their overlapping ideals. Jason wanted a wider reach, a way to bring medicine to the people who needed it. Bob and Amy wanted a release for their newfound activism. Together, they set up booths at health fairs and in parks, checking blood pressure and testing for diabetes. Bob held after-hours appointments at an urgent-care center.

As their stopgap health care took shape, Amy searched for her next project. She had found an empty house downtown and considered flipping it into a bed-and-breakfast. But as they drove back to their home in Gold Canyon that day, doubts crept in.

“I don’t think I want to do this,” she told Bob. “I want to do something that gives back to the community.”

“Why don’t you open a clinic?” Bob asked. He had opened health centers and hospitals before, and had once been sent to rural Texas to start a health-care system there.

Amy wavered. A health clinic would come with a pile of paperwork and licensing. “I don’t want to deal with insurance,” Amy said. “I don’t want to have to do all that.”

“OK,” Bob said. “Why don’t we open a free clinic?”

'I have no will to live'

The diabetes clouded her vision, so Maria barely noticed as Jason pulled into her driveway for a February house call. She sat at a table outside, eating lime-flavored noodles out of a paper cup. When Jason was close enough to recognize, she stood on unsteady legs and shuffled inside.

They had met years before, when Maria tried to heal an infected wound that had torn through her foot and couldn’t afford the antibiotics. She walked into a pharmacy, looking at the shelves full of medicine behind the counter, so many thousands of pills locked inside hundreds of bottles.

“Do you have insurance?” the pharmacist asked her then.

“Please,” Maria said, looking at the shelves full of medicine behind the counter. There was so much back there, she would later tell Jason, so many thousands of pills locked inside hundreds of bottles. “I just need a little bit.”

But she had no insurance and no money. The pharmacist turned her away.

“What can we do for you?” Jason asked now in Spanish, settling into a patched leather couch. “Are you depressed?”

Maria said nothing and stared at the floor. Her granddaughter placed a tiny hand on her shoulder, and Maria’s darkening eyes filled with tears. “I’m worried about the children,” she said.

Everything in her cramped home faced one corner, where Maria had filled the walls with framed photos of her daughter, Perla. There she was, smiling with her sister, her friends, her children. A painting of the Virgin Mary, hands folded in prayer, watched over them. On a shelf sat a box of ashes.

It had been just over a year since Perla missed an immigration court date and was deported to Mexico. No one told the family. For two months they searched, finding nothing, until Perla sent a Facebook message. She wrote that she was in Sonoyta, then stopped responding. A few months later, a stranger online asked Perla’s family to call him.

“I haven’t seen your sister in a while,” he told them. The family went to the Mexican consulate in Phoenix for help and was told there was nothing they could do. Then the consulate called back, asking for a physical description. When Perla’s body was found on the street, only bones remained.

Nobody knew who killed her. The family held a small funeral in Maria’s house.

Her husband died soon after, and in Mexico her mother was dying. Maria wanted to go home to see her but didn’t have paperwork to cross back into the United States.

“I have no will to live,” she told Jason. She stopped checking her blood sugar. Her pillboxes were full of medicine she wasn’t taking.

“Maria, this is very important,” Jason said, lowering his voice to little more than a whisper. So much of his work was a careful nudge, a small push to convince people to help themselves. “Your health is important. Your family needs you.”

For a moment, everything fell silent. Jason waited. There were other patients to see and other sacks of medicine to deliver, but many of his patients just needed somebody to care. He gave them phone numbers for immigration attorneys, gave driving lessons, and set them up with free therapists. A home visit could take 10 minutes, but most lasted over an hour.

Finally Maria looked up. “I know,” she said. It was all important. “I know.”

Jason emptied her pillboxes onto a table and tried to sort through them. Her morning pills went into a blue box, nighttime medicine into a purple one. If she held them close enough to her face, she could make out the difference.

A tearful hug, another promise to take care of herself. Jason pulled open her refrigerator and checked for food, to make sure she was eating.

“All right, let’s clean up our mess,” he told an intern. “Our work here is done.” They packed the medical bag and pointed the car to their next appointment.

The sun fell behind the mountains. Jason had dinner plans and a reminder from his girlfriend to pick up acorn squash, but this was everything.

He worked flexible shifts at the hospital, filling the rest of his time with protests and PACH appointments. He seemed to know every activist in Phoenix. Refugees slept in his house. His summer plan was a medical trip to a remote village in El Salvador. Once, a stranger called from Honduras, just because she heard he could help.

With so many good people left helpless, he asked himself, how could he possibly take a day off?

Yessica, the next patient, once made regular trips to PACH but had since stopped scheduling appointments. She lived in a single-wide trailer that had started to fall apart, but spent most of her time at her sister’s house. Her phone number changed, and then changed again. Jason eventually tracked her down on Facebook.

He walked into her sister’s house just after dinnertime. Smoke floated near the ceiling and a stack of beef cooled on a plate, a pot of oily rice hardening next to it. Bags and bags of hot-dog buns were piled on top of the refrigerator. Empty Coke bottles covered the kitchen table.

Yessica cleared a place for Jason, and he handed her three stacks of diabetes pills: one to take in the morning, one at night, and one to take twice a day. The prescriptions cost $72.88 at Walmart, well beyond what Yessica could make selling flowers on a street corner. So she had just gone without.

Jason motioned to the intern, who opened her pack and checked Yessica’s blood sugar. The machine beeped. Jason leaned over to see the result: 504, high enough to send most diabetics to the emergency room.

“I just ate,” Yessica said, trying to explain.

“It doesn’t matter,” Jason said. “It should never be 504.”

He shook his head and checked the number again, to make sure he’d read it correctly. Still 504, but she showed no symptoms. Somehow her body had figured out a way to survive. He reminded her to take the medicine, which would make her urinate out some of the sugar running through her veins. The emergency room could wait.

As Jason turned to leave, Yessica’s sister screwed the cap on a Coke bottle and grabbed his arm. She had diabetes, too, she explained, and didn't think she could afford a doctor.

“How do I get your services?” she asked, tugging at his shirt.

Never enough of anything

But there were never enough services. There was too much need, too many patients with a friend or a relative or a neighbor who needed a checkup, and PACH didn’t have the money or the volunteers to help them all.

“He missed his 9 a.m.,” an interpreter told the staff one morning, covering the phone with her hand. On the other end, a man named Rodrigo apologized in Spanish. “He said something happened. He wants to come in later today.”

“We don’t have any openings today,” said an intern at the front desk, clicking through the day’s schedule.

“All day?” a nurse asked.

“We’re triple-booked,” the intern said, but they tried to fit him in anyway.

The clinic runs on $50,000 and dollar bills stuffed into a donation jar at the front desk. Every doctor, nurse, intern and interpreter is an unpaid volunteer. A team of naturopaths comes once a week for free acupuncture and alternative medicine. Bob recruits student interns from classes he teaches at A.T. Still University in Mesa.

A sporadic stream of supplies comes from hospitals and Jason's friends. There are never enough catheters or glucose test strips or non-latex gloves. Blood samples are shipped all the way to Florida for testing, because that’s where the cheapest lab is. They memorize which pharmacies have the best prices on each drug and sign up for every discount program available. Jason often pays for patients’ prescriptions himself.

Money is always a concern. But now, as Congress worked out a health-care bill that is expected to cause millions of people to lose their insurance, PACH's defining question drew nearer. Which is the greater good: To help 400 people as much as they need or to give basic care to a thousand?

Around them, minority communities fell quiet. More undocumented immigrants stayed close to home, afraid of straying too far and being swept up. Fewer crimes were reported, because people didn’t trust the police. Patients stopped going to hospitals and health clinics.

PACH's staff tried to make the clinic feel as safe as possible, but there was only so much they could do. They filled the courtyard with flowers and potted plants, but the converted office building was set away from the street, surrounded by warehouses and empty lots. The parking lot was enclosed in a barbed-wire cage.

So the clinic bought a set of walkie-talkies, just in case. A laminated tag hung around each one, listing a series of warnings. "Code white" signaled a white-supremacist protest outside the building. "Code green" meant law enforcement had arrived.

'This doesn't have to happen to you'

When Jason brought Maria’s new prescriptions three weeks later, a birthday party had taken over the driveway. Her relatives took turns grilling hot dogs outside, and a dozen kids played on a bounce house, taking turns sliding into the inflatable pool at the bottom. Inside, Maria wiped away the water that dripped from their swimsuits and moved a gift bag so Jason could sit on the couch. A thin layer of dust coated everything but, in the corner, Perla’s photos had been wiped clean.

Maria had started checking her blood sugar again, she told Jason, but couldn’t see well enough to read the numbers. Her chest hurt, just a bit. A cough lingered.

“We’ve got lots of new medicines,” Jason said, opening a plastic sack and pulling out boxes of pills. “They’re more powerful.”

Once again Jason emptied her pillboxes and re-filled them with new medicine he had bought himself. He clicked them shut and took the last vial of insulin from her refrigerator: One fewer vial they’d have to buy for somebody else. Zipping the bag shut, he hugged Maria's daughter Marbella. The stress had started to eat at her nerves, and she finally saw a doctor.

“When you went to the doctor, did they take your blood work?” Jason asked.

“I’m supposed to go this week,” Marbella said.

“You need to get it.”

“I know,” she said, eyes locked on her mother.

“Because you’re important.”

“I know,” she repeated.

“By the time we got to her,” Jason said, waving toward Maria, “bad things had happened. That doesn’t have to happen to you.”

Back into the driveway he went, stepping around the bounce house, turning away hot dogs and declining invitations to stay for the party. The day’s last patient was waiting.

The Congo’s never-ending civil war forced Patrick and his family from their home and into South Africa, where it was always difficult for refugees to find work. They applied to the U.S. Diversity Visa Lottery and were selected to receive five of the 50,000 green cards the lottery gave out each year. Once again, they packed everything and moved.

A month after they landed in the United States, Patrick had a stroke. Immigrants are required to have green cards for five years before they are eligible for Medicaid. Patrick had nothing until he had PACH.

“Jason, I have been waiting to see you,” Patrick said now, sitting on the leather couch where he spent most of his days. It had been weeks since somebody from PACH stopped by, and Patrick worried they had forgotten about him.

Around him, his three young children practiced somersaults, competing for his attention. His wife stayed in the bedroom. For over a year she had done everything: raised the children, earned their income, pushed Patrick to go to physical therapy. Patrick tried, hoping to force the movement back into the left side of his body, but he made little progress.

“Are you going for walks every day?” Jason asked, setting $135 of medicine on the kitchen table.

Patrick shook his head. Once a week, he said. Sometimes twice. The physical therapy was too expensive. It was easier to wait out his days alone on the couch.

“Come on, let’s go for a walk,” Jason said. “Right now.”

Slowly, Patrick pulled himself off the couch and trudged to the bedroom to change. Each step was its own task, to find enough balance on his left leg to swing his right forward, and then drag along the rest of his body. He shut the bedroom door behind him, and 15 minutes later came out in a tank top, sliding into the flip-flops his son carried over.

Jason stood by the door, waiting.

“Come on, my brother!” he said.

The two men linked arms, nurse and patient holding each other up, and together they stepped into the sunlight.

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