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"We rode out the storm in our
car in a parking lot behind a Starbucks. There were lots
of other people there, too. My boyfriend moved the car when
the wind direction changed so that if one of the buildings
blew down it wouldn't blow down on us. We hadn't eaten in
about 12 hours, but we were too scared to be hungry."
In the next few days, Avis and her
family were helped by people like the convenience store
owner who opened his doors and said, "Take what you
need."
As the community moved into recovery mode, individuals
like Avis were offered beds in an emergency shelter—although
Avis wouldn't sleep in one because she refused to leave
her dog alone in the car. As the days passed, she, like
so many other people, had to accept the fact that she wasn't
going home anytime soon. But like everyone's story, Avis's
is unique. Avis is HIV-positive. She needed an HIV clinic.
And when she opened the Yellow Pages to find one, the HIV
clinic she needed was there.
A Call…
Today, the main site of the Southeast
Mississippi Rural Health Initiative, Inc., is just a few
miles south of downtown Hattiesburg, a Deep South college
town of about 45,000—at least before Katrina. Since
the hurricane, the population has grown by about 40 percent. "And
it's still growing," says Kaye Ray, the clinic's CEO—an
observation not lost on anyone trying to drive through
the tree-lined streets of this now very crowded community.
The Southeast Mississippi Rural
Health Initiative, Inc., clinics are available to hurricane
evacuees like Avis, and to underserved residents throughout
the southeast Mississippi region because of actions taken
almost three decades ago by people who saw the frontlines
in their own backyard. They weren't on the frontlines of
AIDS—at least, not
yet—but the frontlines of something else: the battle
for health care for people without health insurance.
"People in many of the small,
rural communities around Hattiesburg realized that ambulances
were making runs to meet basic health needs," says Ray.
"Patients were being taken by ambulances—in some
cases, even by air ambulances—into the large hospital here
in Hattiesburg. If the uninsured had basic health care in
their community, most of these runs would have never been
necessary."
Some of the individuals who took
note of the problem coalesced into a united force. A diverse
group of people—a doctor, elected officials, ordinary
citizens—did far more than bear witness to a chronic
shortage of health care services. They decided to act.
In doing so, they spread a message that still rings loud
and clear. As Ray says, "If you get like-minded people
together, you can do this work—you can do something about
a shortage of heath care in your community."
The individuals who built what is
today the Southeast Mississippi Rural Health Initiative, Inc.
realized that, first, they needed funding. And like most successful
clinics, they became very good, very fast, at grappling with
this issue. Through the Federal Rural Health Initiative, they
received a planning grant, and built a consortium to evaluate
need. Two years later, they applied for and received full
funding. With it, they established what Ray describes as "our
first three little clinics, in the small towns of Sumrall,
Seminary, and New Augusta." Today, they have nine more,
plus a pharmacy.
The frontlines in any battle for
health care equity are constantly changing. By the mid-1990s
the battle for primary care for the underserved in southeast
Mississippi could not be fought outside the context of HIV/AIDS. "When
we opened our Hattiesburg site in 1995, we knew that we
would be the safety net provider for HIV," explains
Ray. "There
had been a private physician providing the care, but she
moved to Jackson. By the time we applied for Ryan White
[the Comprehensive AIDS Resources Emergency (CARE) Act]
funding in 1999, we already had 69 patients. By the end
of 2005, we had 424 HIV-positive clients—and an infant
whose status is still indeterminate."
The growth rate continues. There
were 14 new HIV-positive patients in January 2006 alone.
All this and, Ray says, "We didn't know beans about
HIV when we started."
Today, the poverty rate and insurance
status among the Initiative's clients reflect the national
epidemic and its ongoing march into minority and historically
underserved communities. Of the Initiative's total clients,
37.0 percent are female and 73.4 percent are African-American,
"a significant change from 10 years ago," notes
Ray.
The similarities between the Initiative's
clients and those seen nationwide do not stop with race,
ethnicity, and gender. Poverty and lack of health insurance,
whether they exist in southeastern Mississippi or on the
south side of Chicago, bring with them a whole set of problems
that must be addressed if sustained HIV/AIDS treatment is
going to be a viable option. These problems often encompass
previously unaddressed chronic health issues. They include
mental health diagnoses that, in many cases, are a direct
result of living a life in constant financial peril. In short, they create
a hard-to-reach profile that, one might think, would cause
staff burnout. But there seems to be none here.
…And a Calling
Almost every person on staff at the
clinic said that they knew what they were getting into when
they committed to this work and that their expectations were
realistic. "You start anew each day," says Julie
Trotter, a social worker, "and hope that you can help
one person."
There's also a palpable level of
team spirit and camaraderie at the clinic. It is clear
that the staff members support each other and they love to
do their work—even the patient advocate wading his way
through level after level of bureaucracy to resolve why a
patient has been refused his medicine.
For almost everyone at the clinic,
working for severely underserved people is a passion. And
for some, it's a mission. This includes Dr. Robert Moore,
a brilliant man who has spent time at Yale and New York University,
who first studied computer science but then went into medicine
because he said he wanted a "people factor" in his
work.
Moore is the program's clinical director,
but he also has a second job. He's a Baptist minister. When
asked if he sees any tension in his role as a clinician, treating
people who engage in behaviors he might not approve of as
a minister, Moore replies, "Tension? There is no
tension." When asked what other pastors think of his
work with people whom some call "sinful," he replies,
"I don't know, and it doesn't matter." And
when asked how to cope with those patients who don't take
full advantage of what the Southeast Mississippi Rural Health
Initiative, Inc. has to offer, he smiles and says, "The
Bible commands us to be long-suffering. This is an opportunity
for us to learn how to do that."
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