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Building the bridge to healthcare with the Blue Ridge Free Clinic

Patient receiving care from a Free clinic provider
Blue Ridge Free Clinic
Patient receiving care from a Free clinic provider

The Blue Ridge Free Clinic has been providing free healthcare services to Rockingham County residents since 2020, after the Harrisonburg Rockingham Free Clinic closed last year. An upcoming benefit for the clinic will take place on Saturday. WMRA's Chris Boros recently spoke to Susan Adamson, the Free clinic's Chairwoman and Nurse Practitioner. Chris asked Susan about the original free clinic closing.

Susan Adamson: In 2020, it was a really hard time for nonprofits in general to raise funding. You couldn't have fundraisers at that point. A lot of our volunteers were elderly. And so when COVID first hit, we weren't sure exactly how that was going to play out, especially for the elderly or older individuals. So it became very difficult all of a sudden to raise enough funding to continue the free clinic and also to have the staffing that we needed. So the board decided that it, you know, it was probably a better idea to go ahead and close at that point. And we're hopeful that Medicaid had been expanded, that that would catch the great majority of patients that were in need.

Susan Adamson, NP and Chairwoman to clinic
Blue Ridge Free Clinic
Susan Adamson, NP and Chairwoman to clinic

We noticed there were quite a few, 240 or the 400 patients that we were worried they may not plug in somewhere because they were either over income for Medicaid, but they weren't making enough money to be able to buy insurance. or people who had immigrated here that were not eligible for Medicaid. So there were about 45 of us who had been volunteering at the Harrisburg Rockingham free clinic for many years, who said, you know, if we can incorporate as a new free clinic, maybe with a different model and reopen, we were going to try it. And amazingly, we found some traction. We were able to start literally with no dollars. We started as a grassroots effort. We were not trying to reopen. The Harrisburg Rocking Free Clinic, we were opening as the Blue Ridge Free Clinic. And our model is quite different than pretty much any other free clinic that I've ever been associated with, but it's based on having donors, community volunteers, and basically letting the community support the free clinic and so that we can adapt and adjust to whatever the needs of the community were. And at that point, we didn't even know exactly what the needs were going to be, but we have certainly found out since then.

WMRA: And what have you found out?

SA: When we first opened, we expected we might have as many as 400 patients in our whole surrounding counties. But since we opened, not even three years ago, it was two and a half years ago, we have seen well over 2,000 patients
And the demographics are changing. Shortly after we opened in April of 2021, there was an Afghani refugee crisis. And Church World Service, another local non profit, was resettling refugees. And so 200 Afghanis were brought to the Harrisonburg area. Many of them were sick. And so that was where we saw our first surge in patients that we had not anticipated.

The other thing that we found is that people in the community were going through tough times with COVID. There were people that were between jobs. They lost their job. There were people that were depressed. People got divorced. There was a whole lot of turmoil in families and businesses and employment. And so a lot of people just fell through the cracks. They were not eligible for Medicaid or they didn't know if they were. There was a lot more support that was needed by people that were already living here. And then on the heels of that, there's just been a real surge in immigration to this area.

Blue Ridge Free Clinic logo
Blue Ridge Free Clinic
Blue Ridge Free Clinic logo

Harrisonburg is known as a friendly city and we are a city of immigrants. We have lots and lots of immigration. Been happening here for decades, but in the last two years, the number of immigrants has just soared a lot of the, you know, political strife that's happening in Central and South America. People are finding their way here. And then, as I said, church World Service has a large presence here, and they bring in refugees from all over the world. So suddenly this tiny little Blue Ridge free clinic that opened on a very small space. We found that every single clinic has been full to capacity, and we started recognizing we needed some things that were different than other free clinics.

For example, when we opened, about a quarter of our patients were non English speaking. Well, less than two years later, 85 percent of our patients are non English speakers, new immigrants. And their needs are very different.

WMRA: How do you deal with that on a language barrier? I mean, do you have people working at the clinic who can speak all these languages?

SA: Well, we're always looking for in person interpreters. And certainly, after English, Spanish is our next most common language, and then Arabic, and then Kurdish, and Swahili. We deal with many, many languages. So we're always seeking volunteers who can come in and help us with that. But we've actually had to contract with some other interpreters because just the sheer number of people in our office at one time that need interpretation is so great.

We have contracted with some local interpreters to come in. So we have a Spanish speaker at every clinic that we're open, just for safety because the phone's ringing with people in Spanish. People are walking in speaking Spanish. The volunteers can do their job. We have to provide interpretation. But then we have contracted with a service that's on the internet. We pay for a service called Voice Global. We can access 250 languages. And it is a video interpretation. We have rolling iPads and we roll the iPads into the room. And it's like FaceTiming with an interpreter. And that's a service that we found through the Virginia Association of Free and Charitable Clinic.

But just this morning, I saw patients in four different languages within the last three hours. And one with an in person interpreter, the other's using the rolling iPad.

WMRA: How did you get involved with the free clinic and what's your background?

SA: So, I've been a nurse practitioner for 31 years now. And I was in private practice for about 7 years. And saw so many patients that I would diagnose, for example, with diabetes or hypertension that could not afford their medicine. And this was, you know, in private practice, it was really hard to figure out how we were going to help them. And so I became exposed to the free clinic movement and was affiliated with a free clinic down in Roanoke, the Bradley Free Clinic. First, while I was still in private practice, I volunteered once a month down there and just loved it. So when I came to Harrisonburg in 1998, I found out about the free clinic that was downtown and began working there as a nurse practitioner, volunteering there for 22 years until it closed. And then just could not abide the idea that there wouldn't be a safety net free clinic in my town because I knew there'd be people in need.

The Blue Ridge Free Clinic
Blue Ridge Free Clinic
The Blue Ridge Free Clinic

So for me, it's a beautiful place to practice because we don't have to worry about insurances. We don't have to worry about preauthorizations. It's the pure practice of medicine and nursing with people who want to be there. The volunteers all want to be there working together. And we are able to give comprehensive care. One of the things that I think is missing in a lot of healthcare is looking at the whole patient. So when patients come to us, we do an assessment of what's called the social determinants of health. Do they have housing? Do they have transportation? Are they food insecure? Is there a history of violence in the home? Do they have immigration issues and they don't know where to turn? Some people have lost an ID. They don't know how to get one. And so we're able to offer social services as well as medical care. And then just recently we've opened an on site pharmacy so that we can actually provide most of the medications right out of our office before the patients leave the building.

I love it because I get to love my neighbor and my neighbors are coming from all over the world. I don't have to go out of the country to provide international care and I'm learning about so many cultures. I was going to say it probably has enriched your life too. The cultural aspects of medicine is something that I did not appreciate until just recently.

You know, whether somebody believes that antibiotics work, whether they're afraid of our medicines because they can't read the label, all that plays into it. So with so many new cultures coming to the area, even at my age, I'm learning about cultural medicine. all the time. Remembering if somebody takes insulin, if it's Ramadan, are they going to be fasting? Oh my goodness, if you give someone insulin and they're fasting, you could do some serious damage. Those are the kinds of things that I get to think about on a daily basis at the free clinic here.

WMRA: Can someone come to the clinic if it's an emergency, like they break their arm?

SA: We are not in urgent care. We don't have x ray and we would prefer, and we pretty much insist that patients make appointments because that allows us to plan to have enough volunteers. We are not in urgent care. We want to make sure that people know if you're having chest pain or if you think you broke your arm, going to an urgent care or an emergency room is an appropriate place. However, if you don't have insurance for your follow up, you can certainly come and follow up with us. But we don't want people just walking in who may really need an emergency room or urgent care center.

WMRA: How do you handle mental health issues?

SA: We are so fortunate. We have two nurse practitioners who were psychiatric nurse practitioners. And so they volunteer one clinic a week and they care for our patients who have serious mental illnesses, people who are struggling with substance use disorders, alcoholism, people who are trying to get off of drugs. So, they handle the patients that have more higher level mental health needs. And beyond that, we have, we have an agreement with two other counseling offices here in town that take our patients for free. If somebody is willing to go for counseling or they want counseling, we're able to refer to two different organizations here in town.

WMRA: There's a benefit coming up pretty soon here for the free clinic. Can we talk about the benefit?

SA: Yes, we only do one big benefit a year and this is sort of our gala night of musical medicine. And it's very exciting. It's going to be held on March 16th at seven o'clock, and it's in a beautiful new venue on the upper level of the Mercantile building, which is across from Magpie. It's called the Loft at Liberty, just opened recently, and it's gorgeous. It's just going to be a perfect night for showcasing musical talent. We have Scott Miller, who's going to provide folk rock guitar. We have a silent auction and some of the auction items have been donated by our physician volunteers.
Very interesting, exciting things to come look at. So it should be a really fun night. So we're really trying to encourage people to come out. It's the beginning of spring. It should be a really fun time.

WMRA: How do you see the clinic evolving from, from this point? Like, do you see it growing? What, what, what do you hope the future is for the clinic?

SA: Well, our tagline, we are the Blue Ridge Free Clinic with the tagline, Your Bridge to Health. We are not growing a practice, we're not trying to get bigger, bigger, bigger. We want to provide a bridge for anybody who doesn't have their health care needs met so that we can, in three to twelve months, find a place for them in the community to go for long term, sustainable, affordable, accessible health care.

And so when someone comes into our services, we tell them up front, we're not planning to keep you in our care. forever. We're hoping to help you find primary care ongoing. And for most patients, we can do that. We work in partnership with the Harrisonburg Community Health Center. We work with Sentara, outpatient primary care offices. And so our social worker meets with people and finds out, are they eligible for Medicaid? And about 15 percent of people that come to us are eligible, but they didn't know it. or they didn't know how to fill out the application or just seemed overwhelming. And so we help them get Medicaid and we can plug them in in a local practice.

For patients that come to us that are not eligible for any government assistance or insurance, then we will take care of whatever their healthcare needs are, including their healthcare maintenance, whatever they need in addition to treating their hypertension, diabetes or whatever. So most of our patients we call it crossing the bridge within a year, but we don't let anybody go until they are solidly in care somewhere else. And we continue to provide all the service that we can, including dental. We even have dental, we have five dental offices that volunteer for us. I mean, it's amazing how this community has responded. so yeah, dental, mental health, primary care, internal medicine care, social services and needs navigation.

That's what we do for anybody that walks in. We're a no barrier free clinic.

WMRA: Susan Adamson is a nurse practitioner for the Blue Ridge Free Clinic and their benefit a Night of Musical Medicine is this Saturday and we have details about the event and the clinic at our website, WMRA.org. Susan thanks again.

SA: Thank you so much.

Chris Boros is WMRA’s Program Director and local host from 10am-4pm Monday-Friday.