Health Care for the Uninsured
Collaborative prizes treatment over profits but still struggles under debt
Sixteen-year-old Carlos Martinez sits in a bright green examination chair in the Topahkal Family Practice Office with a massive four-inch gash in his right index finger. There is a pool of blood beneath his hand as if someone had spilled Hawaiian Punch over a bed of gauze. A native of Juarez, Mexico, Martinez was visiting family in Albuquerque when he sliced his finger on a refrigerator that slipped as he was helping an uncle lift it out of his pickup truck. The wound required immediate medical care, as one could peel back the skin as if husking an ear of corn.
Usually under these circumstances, Martinez would have to be rushed to an emergency room at the nearest HMO-financed hospital, his bill running upwards of $1,500—exactly what happened to a friend of his who had a less serious injury.
“He probably has a Visa to come for a few days, but he doesn’t have any health care insurance,” says Dr. Andru Ziwasimon, the head practicioner at the Family Health Practice, a part of Kalpulli Izkalli’s Topahkal Health Collaborative at 1608 Isleta SW.
Thus, when wounded, Martinez was brought to Topahkal to see the soft-spoken Dr. Ziwasimon, who, wearing scrubs for a shirt, Carhartt khakis for pants and Teva flip-flops for shoes looks more like a guitarist than a doctor, and sounds exactly like Ira Glass, the host for NPR’s “This American Life.”
“There’s a certain sickness in our medical system that’s pretty evident. It doesn’t take much intelligence to see that. Health care bills are the leading cause of bankruptcy in the U.S.—that seems whacked to me, just wrong. I want to minimize my participation with the bad parts of medicine,” says Ziwasimon.
So in July 2004 he decided to join the Topahkal Casa de Nuestra Medicina (House of our Medicine) Collaborative [Re: Feature, “Just Healthcare,” Dec. 23-29, 2004]. He spearheaded the second of three branches of the collaborative, which started out in 1996 as Kalpulli Izkalli’s Promotoras Tradicionales Project, a donation-based indigenous traditional medicine clinic. Kalpulli Izkalli (Community House of Light) is a local grassroots nonprofit dedicated to the advocacy and improving of the community’s health condition with an emphasis on traditional healing.
With the addition of the family practice to the collaborative came the inclusion of modern mainstream medicine, open to the public as a walk-in health care resource. There also is a weekly ultrasound clinic that is offered for the flat rate of $120. But this practice was going to be different.
“The ER is $300 minimum to just be seen. It’s actually $80 to not be seen. If you walk into the ER, wait, and leave, you’ll get a bill of $80," says Ziwasimon, who did his residency in family practice at the University of New Mexico. "Come here and get health care three times for that amount of money. We don’t want to replicate those mechanisms that harm people."
The clinic's mission is ambitious, to say the least. It exists as a resource for the uninsured. The traditional medicine clinic is donation-based, and the Family Health Practice charges a flat rate of $25 per visit, plus material expenses, usually no more than another $10-$20. This is accomplished even after a December 2006 move into a new facility that caused their monthly rent to jump from $500 to $2,200.
“But we’ve kept our prices the same, and we’re very proud of that,” says Ziwasimon, who tends to Martinez’ finger with assistant Catherine Jones, a Tulane medical student doing a clinical rotation at Topahkal as part of her fourth year of medical school.
They joke with Martinez in Spanish, who masochistically laughs as the doctor instructs his understudy in the proper techniques of sewing up human flesh. They all laugh when someone suggests that Martinez should change his name from Carlos to Pedro, so he could be like the famed Mets ace Pedro Martinez, a unlikely proposition considering Martinez’ pitching hand was recently obliterated.
The Health Collaborative relies on volunteers and arrangements with universities in order to cut costs and keep overhead reasonably low. Work study programs with UNM and CNM pre-health students give aspiring doctors and nurses a firsthand look at what it is like to combine modern and traditional medicine through a holistic approach. The idea of Topahkal, however, attracts volunteers and students from all over the medical field.
“Andru’s an inspiring model. It’s definitely the kind of place I want to wind up in after medical school. It’s a perfect learning opportunity for someone who is interested in doing community health work,” says Jones, who is graduating in May.
While the fees at Topahkal save its patients somewhere between 90 and 95 percent on their health bills, if there are people who can’t afford that last 5 or 10 percent and are in need of care, they are still welcomed into the clinic with open arms.
“There’ll be a woman in some sort of a domestic violence situation who’ll come in, and she’ll be so clearly poor that out of the kindness of our hearts we just say, ‘Ma’am, please, this is on us,’” says Ziwasimon. “No one is turned away.”
Each patient is given a payment plan at the end of their visit to assist with the expenses. Martinez, who is no longer laughing about being stabbed repeatedly with a needle and is arguing against the 10th and final stitch in his near-repaired finger, will see a bill for $55, which subsidizes the local anesthesia and stitching used in his procedure.
While payment for the treatment received in the family practice is not optional, if someone refuses to pay on the payment plan, they are not pursued. Honesty and fairness is the name of the game, and even though the system can be manipulated by the common cheapskate, Ziwasimon says 97 percent of the treatments given by the clinic are paid in full.
“Most people we serve are in the South Valley and are low-income. But we have people who come from all over the city—even people with insurance come here just because they like it,” says Sylvia Ledesma, a healer at Topahkal, and founder and director of Kalpulli Izkalli and the Promotoras Tradicionales Project.
After a slow first year, the collaborative has been operating at capacity ever since. Open six days a week, 50 weeks a year, its staff tends to 20 patients a day on average and around 7,000 patients each year.
“Part of this place is a financial experiment," says Ziwasimon. "We’re experimenting with the price you need to charge to actually be sustainable and healthy, instead of profiteering. We’re finding the price—the minimum price—that we need to charge because we have to take care of ourselves, too."
Jones, now alone with Martinez to finish sewing up his finger while Dr. Ziwasimon steps out of the room to attend to another patient, has somehow managed to convince the defiant Martinez to allow her to insert the final, necessary stitch.
“You just never know what you’re gonna get in these donated packets,” she says, tearing open a plastic bag and pulling out a smaller needle than hoped for. A viscous drop of blood hangs from Martinez’ finger like droplets off the tip of a melting red Jello icecycle.
It is not uncommon at Topahkal to sacrifice financial stability in order to ensure that patients continue to recieve quality care at a extremely low price when compared with other clinics and hospitals. This fiscal year has left Topahkal some $10,000 in debt due to unforeseen expenses that often come up without warning, prompting the Center for Peace and Justice to hold a benefit for the collaborative, which will take place on Sunday, Aug. 26.
“There’s no way we’re going to let anyone stop us from doing what we love, so if we had to, we would eat that cost,” says Ziwasimon. “But if we could ask some support from our community to help us make up that deficit, that would really, really help us out. It would help us be a little more comfortable in the work we’re doing, instead of struggling to achieve a high level of quality in our care.”
As Ziwasimon and Jones exit the examination room, Martinez gives a sigh of relief. His finger is all sewed up—10 stiches in all—and he is ready to head back home. Topahkal will arrange with a clinic in Mexico to remove the stiches in a few days once the wound is sufficiently healed. After washing all of the blood from his arm and wrapping his finger in a utility Band-Aid, he hops down from the green chair and is instructed on the proper forms to be filled out before he leaves.
Now 3:30 in the afternoon, the waiting room is overflowing with people seeking medical treatment. Although the clinic closes at 7 p.m., Ziwasimon and his colleagues will be here until 9:30 or later tending to patients. Those who cannot be accommodated will have to come back tomorrow.
One can be sure, however, that this is where they will return, time and again. For those people whose lack of medical insurance does not permit them to seek care at any local hospital, Topahkal is their only option. Like Martinez, going to the emergency room isn’t financially feasible—and even if it were, why would they want to go anywhere else?