MIAMI | A free health clinic sponsored by a Florida-based religious community is bracing for a wave of new patients resulting from the COVID-19 pandemic and the associated economic and unemployment fallout.
The St. John Bosco Clinic also has been making a rapid transition toward telephone-based and telemedicine (video) consultations, which will continue even as it explores re-opening for in-office consultations sometime next month.
“We stopped seeing patients in person around March 19 and we have been following our patients telephonically — and then of course we are planning for when we do return what that will look like, as we will slowly return to seeing patients in person,” said Berta Cabrera, executive director of the clinic and a social worker.
Located adjacent to Corpus Christi Parish in Miami and about a mile and a half north of Jackson Memorial Hospital, the clinic has been meeting the medical needs of the uninsured through volunteer physicians and support staff for some 26 years.
St. John Bosco Clinic, sponsored by the Sisters of St. Joseph of St. Augustine, is also a member of the Florida Association of Free and Charitable Clinics. It normally sees up to 1,400 cases annually (or 5,000 office visits) and is open Monday through Saturday. It is solely funded through the generosity of community partners, philanthropic individuals, corporations and foundations.
Federal regulations previously made telemedicine operations costly and complicated for small or non-profit medical clinics. But many of those regulations have been scaled back during the pandemic. As a result, St. John Bosco Clinic has trained its small staff of nurse practitioners and a network of some 25 volunteer physicians to use both telephone and video-based telemedicine tools to consult with patients remotely.
Cabrera said the clinic has received a grant to allow implementation of telemedicine, which will help patients manage routine chronic illnesses such as hypertension, diabetes, high cholesterol, asthma and respiratory issues.
“There is a lot that the health care provider can observe by seeing the person (through video) and people like to see that face on the other side,” Cabrera said.
She added that some of the clinic services are on hold during the office closure, including cervical cancer screenings. A lot of routine lab testing also is on hold given the currently heavy demands on independent labs.
“Medication management is one of the most important things we are doing: diabetics are checking their blood sugar levels and we do a lot of listening; listening to their anxiety and making that follow-up appointment so everybody will be seen again in person when we open the office again,” she said.
But as the numbers of unemployed skyrocket, many will lose their health insurance. Where will they go? To the free clinics, Cabrera said, noting that there is network of free medical clinics through the state, including in Monroe and Broward counties.
But free clinics do not get reimbursements based on the number of patients seen.
“We have to raise the funds through grants, foundations and individual donors. We will need our community to support us because we expect an increase of patients,” Cabrera said. “I know this is a struggle for many people but if people can give toward keeping people healthy at this time it keeps them out of the hospital. We don’t need people going to the emergency room for blood pressure or their diabetes.”
The clinic’s medical director, Dr. Rheinchard Reyes, is a Guatemalan American who grew up in St. John Bosco Parish. A general practitioner with 20 years’ experience and a private practice in Miami, he said the pandemic has hastened a move toward technology enhanced doctor-patient consultations.
“The computer and the internet have revolutionized everything about life, and I think it was moving toward something like this anyway — but the pandemic has definitely accelerated the rate of changes,” he said.
Going from a phone call to both audio and video during a patient visit makes a considerable difference, he noted.
“There is so much more information you get when you are actually interacting with a person through video: their mood, the way they are moving. You get a lot more information from a video call than you do with just a phone call but even just a phone call goes a long way.”
Telemedicine saves the healthcare system a lot of unnecessary use and time. It also reduces the burden on patients who won’t have to go to hospitals, potentially exposing themselves to infection while seeking routing care.
“As far as my private patients and the clinic, I feel very confident that their needs are being met for routine care even if we can’t see them face to face just yet,” he said.
But he also thinks there are limits to the effectiveness of telemedicine as the weeks and months pass.
“We are pushing it now, six and eight weeks in; by the third month, I think that it is much harder to maintain control of chronic conditions when you really can’t draw blood and when you can’t get an x-ray done — the third month becomes critical,” Dr. Reyes said.
He added he only wishes that community-based COVID-19 testing would ramp up much faster to keep pace with the pandemic’s likely spread.
“Being a high tourist area, we receive people from people all over the world and that will continue to expose us I think,” he said. “There is a lot of fear in the community and a lot of insecurity in this marginalized population and so we do talk a lot about how not to get sick and where to get food if it comes to that.”