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No-Cost Clinic Faces Hard Times, Uncertain Future

MUSCOY — Mark Thimmes has been coming to Al Shifa Free Clinic in this small community near San Bernardino for more than a year for treatment of heart disease and diabetes. Unable to afford health insurance after losing his house and business — a transmission shop in Menifee — Thimmes, 57, was referred to the clinic by a doctor who had seen Thimmes after he delayed getting treatment for a heart attack.

If the clinic didn’t exist, “I wouldn’t have anywhere to go,” Thimmes said.

Al Shifa Free Clinic, one of two no-cost clinics in Riverside and San Bernardino counties, is helping meet an ever-increasing need for a usual source of care for a growing number of the uninsured.

“Patient demand has jumped dramatically because of economic conditions,” said Shams Hasan, the clinic’s board chair. “Everyone knows someone who is uninsured or unemployed and needs some kind of medical assistance.”

Al Shifa clinic, which provides no-cost medical and dental services, is run by a skeletal staff of employees and a group of local medical professionals who volunteer their time to treat patients. The clinic specializes in cardiology, neurology, dermatology, endocrinology and obstetrics-gynecology. In March, a mobile facility launched to reach populations that cannot get to the clinic.

When a group of friends set out to open a no-cost clinic in 2000, they chose one of the most impoverished areas in San Bernardino County. Muscoy, an unincorporated area abutting San Bernardino, seems like it belongs in one of the county’s remote rural outposts, not part of an urban area with a population greater than 200,000. 

The ramshackle neighborhood has no sidewalks in front of sun-beaten stucco houses with dirt yards. It has earned an unfortunate reputation for cockfighting and as the dumping grounds for the occasional dead body. The motivation behind setting up the clinic was to serve people with the greatest need for medical services. “Al Shifa” means “to the one who gives health through divine help” in Arabic, Mohammad Aslam — the clinic’s volunteer medical director and chair of Arrowhead Regional Medical Center’s internal medicine department – said.

The clinic treats about 250 patients each month, said Hasan. Nearly 60% percent of those patients are Hispanic, though the clinic sees an incredibly diverse array of patients. Aslam likens it to an international community.

The clinic has taken steps to provide services and information in both English and Spanish. “Eighty percent of the time, we’re able to cope with the communication gap,” Aslam said, acknowledging that a patient’s family member sometimes must step in to interpret. The clinic’s future seems nebulous. The economic downturn has had repercussions for the clinic, which relies heavily on private donations to pay operating expenses. The clinic has had to cut back hours at the same time that demand has been increasing.

The clinic’s administration is looking into obtaining certification as a federally qualified health center to ensure its longevity. This would be a route similar to that taken by UMMA Community Clinic, which originally opened in Los Angeles in the early 1990s as a no-cost clinic for Muslims. The clinic became the first Muslim-American organization designated as a federally qualified health center in 2008.

In addition to grappling with funding challenges, Hasan is unsure what effect national health care reform will have on the clinic.

“The goal is to reduce the burden on emergency rooms, and that’s what we’ve been doing for the last 12 years,” Hasan said. “In a way, it complements what the new health care law says.”

Filling a Growing Need

Al Shifa clinic is part of a growing number of no-cost clinics with Muslim underpinnings. The number of no-cost Muslim clinics has doubled over the last 10 years and there are now about 35 such facilities across the nation, according to some estimates.

Faisal Qazi, a neurologist based in Upland who provides informal consulting services for free clinics, said he expects the number to double again in the next 10 years because Muslim medical professionals are channeling their passion for service into the clinics, where they see opportunities to test creative ideas and new approaches to providing care, he said.

“I consider it a movement,” he said. “We will see other free clinics springing up.”

The operation of these clinics dovetails with an integral part of the Muslim faith — community service.

“God gave me this skill,” said Makbul Patel, director of Al Shifa’s dental clinic. “I feel l need to use it. There is a severe, urgent need in this neighborhood.” Patel takes time out from running three dental offices in Riverside County to volunteer at the clinic.

It’s also becoming common for no-cost clinics to be run by partnerships, said Khizer Husain, president of the not-for-profit American Muslim Health Professionals. One example is a no-cost clinic in Champaign, Ill., which is run by a Christian group during the week and a mosque on the weekends, he said.

Also in the spirit of charitable care, Qazi and his colleague, Taif Kaissi, have launched an interfaith network called MiNDS to provide specialty medical services to low-income, uninsured patients. Kaissi triages the patients and finds specialists close to where the patients live who will treat them at no charge.

“The system is overwhelmed,” said Kaissi, citing backlogs at county-run clinics and hospitals. “Not many physicians are accepting Medi-Cal because of the paperwork that needs to be submitted. There is a large amount of people who are either undocumented or who have lost their jobs.” Medi-Cal is California’s Medicaid program.

Culturally Competent Care

Raul Ruiz, senior associate dean at UC-Riverside’s School of Medicine, helped open the other free clinic in Riverside and San Bernardino counties. Operated by the Coachella Valley Volunteers in Medicine, the clinic is in Indio, another impoverished area with a high number of uninsured.

Although the Coachella Valley suffers from a severe shortage of physicians, residents have identified a lack of understanding and communication by health care providers as one of the biggest barriers to care, Ruiz said.

“It’s not only a matter of language, but a matter of understanding where the patients are coming from,” said Ruiz, who also founded the Coachella Valley Healthcare Initiative to address access issues.

However, it is not realistic for a physician to be prepared for every patient he or she encounters, considering the wide variety of ethnicities, religions, socioeconomic statuses and communities in Riverside and San Bernardino counties.

“We’re trying to move away from learning a laundry list of cultural norms to a method of how to understand a patient’s perspective from a deeper dialogue,” Ruiz said.

Having physicians live in the communities where they work is one way to ensure that deeper understanding, he said.

The volunteers at Al Shifa clinic certainly fit that model. Kaneez Rizvi, who has been volunteering at the clinic since 2009, lives in Upland, a 20-minute drive from San Bernardino. She specializes in lifestyle medicine, an area of particular need at the clinic, where the most common chronic conditions are obesity, diabetes and heart disease. The American College of Lifestyle Medicine defines the discipline as “the use of lifestyle interventions in the treatment and management of disease.”

“The most important thing is that I know the community,” she said.

Rizvi, who is applying to residency programs, plans to remain in the Inland Empire after she becomes a physician.

“I want to be involved in the same community where I have experience and practice,” she said.

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