From Before Birth, Health Care for a Diverse Community

May 2, 2018

The Harrisonburg Community Health Center serves a diverse community – and now also offers prenatal care for women, including those who are undocumented and uninsured. WMRA’s Christopher Clymer Kurtz visited the Center, and filed this report.

According to Ann Schaeffer –

ANN SCHAEFFER: How are you?

– about four out of every ten babies born at Sentara RMH Medical Center in Harrisonburg receive their pediatric care here at the Harrisonburg Community Health Center. And so it makes sense that the Center has added prenatal care to its services.

[Sounds of pediatric care: baby crying]

Not to be confused with the Health Department or the Free Clinic, the not-for-profit Health Center is one of about 1,400 federally qualified health centers across the country that deliver care “in areas where economic, geographic, or cultural barriers limit access to affordable health care services.” The appointment numbers here in Harrisonburg?

ANN SCHAEFFER: It’s just gone through the roof. I think we saw 16,000 patient appointments in 2016, we saw over 30,000 in 2017, and I think we are on track to totally shoot right past that for 2018.

Schaeffer is a certified nurse midwife who has worked for nearly two decades in private and public health settings, including for the last year and a half at the Health Center, which serves anyone who needs their help.

SCHAEFFER: I thought I knew my community really well before I came to work here, but I’m realizing that even as open as I felt like my eyes might have been, that I have become so much more amazed by and proud of the diversity we have here, but also very much more aware of the challenges people face.

The Center’s main site is on Port Republic Road, but it also has clinics at the Virginia Mennonite Retirement Community and in Elkton. It offers family, pediatric and women’s health care, dental and behavioral health services, and more to anyone at all – with or without insurance, with or without documented immigration status, English-speaking or not. Its staff interpreters speak Spanish, Arabic, Kurdish, Tigrinya, and Russian, and its sliding fee scale for medical care goes as low as $10 per visit. Schaeffer said that patients range from attorneys to new refugees – and her own family and mother.

Federal grants cover $1.6 million of the Center’s annual $8.3 million budget, with the balance coming from patient revenue and donations.

Side note, here: Schaeffer is hopeful that Medicaid expansion will pass in Virginia – because it would help people who now fall in the gap, and because for each Medicaid patient a federally qualified health center sees, it receives an extra subsidy. More Medicaid patients means more funding for the Health Center’s services.

SCHAEFFER: Any time we take care of somebody with Medicaid or with private health insurance, that’s probably funding one or two or three other patients who are on our sliding fee scale to be able to get care. If we have a population that reflects our community here in Harrisonburg, that is kind of the best-case scenario.

And now, that scenario can include women seeking prenatal care. That’s a big deal, Schaeffer said.

SCHAEFFER: There are very few things that affect the well-being of a family as much as the care they receive around childbearing.

The Harrisonburg Community Health Center is not the only – or first – federally qualified health center in the region to provide prenatal care. Other similar health centers in Lexington, Farmville, and Winchester also offer such services.

But until now in the Harrisonburg area, access to conventional prenatal care for women without insurance or who are undocumented has been less than ideal. They would go to the health department for a single intake appointment and a referral to a participating obstetrics provider for prenatal visits and hospital birth services. Then, after the birth, they could return to the health department for a single postpartum visit – and to be, as Schaeffer put it, “released back into the wild to hopefully find their way back to their primary care provider.”

That system, with its many opportunities for missed care, is replaced by the Health Center’s prenatal services. The Health Center is partnering with Harrisonburg OBGYN, a private practice that will provide in-hospital services at the time of delivery at Sentara RMH, with the Health Center providing care before and after birth.

SCHAEFFER: We will really be doing newborn care for that baby in utero all the way through. So then we will actually have a really good feel for the mother’s history and the family’s history. We will already know about that baby before the actual physical baby is carried back through our doors. So it’ll be really good care for people in our community who were often falling through the cracks.

That includes new mothers. Schaeffer said that the continuity of the Health Center’s services will make it more likely that women’s postpartum needs will be addressed.

The Health Center’s prenatal care will soon include bringing together women who are due around the same time for centering and topical discussions – in a deliberately relaxed, non-exam-room setting, with fun and snacks.

SCHAEFFER: Prenatal care is a state of wellness, so we don’t need to treat every woman like she’s sick when she’s pregnant.

Those groups, Schaeffer said, will build important community among expectant mothers.