HOW ONE PHYSICIAN SUSTAINS CARE FOR THE POOR

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When Jasmine Sulaiman, M.D., moved to Texas 11 years ago to become the medical director and practicing physician for a rural health clinic, the Health Center of Southeast Texas, she didn’t know exactly what she was getting herself into. “I was interviewed by about 10 people, all community members,” she says. “The hospital was losing money through emergency room visits, and they wanted to create a clinic to help keep patients out of the ER.”

In Cleveland, Texas, a rural town about 45 miles northeast of Houston, many people live below the federal poverty level and lack access to preventive health care. Several years ago, the hospital closed. The community desperately needed better access to care.

The beginnings were humble: The health center bought a two-room flower shop and converted it to a clinic, with donated furniture and a computer contributed by the local Walmart. News of the health clinic spread by word of mouth. Sulaiman, the only physician, saw 4,000 patients the first year — some for free, some for $5 or whatever they could afford to pay. Though exhausting, “it was actually very rewarding,” says Sulaiman. “I was doing exactly what I was trained to do, and in a good way.”

Steve Racciato, CEO of the Health Center of Southeast Texas, recalls that when he and his colleagues were recruiting for a physician for the health center and read her curriculum vitae, “I couldn’t believe what I was looking at. She was obviously very qualified, and she could have a job making a lot more money in a large group practice. But this is the kind of work she wanted to do.”

After the first year, they applied for a federal grant, and were pleased to be one of the few clinics awarded it on the first application. Becoming a Federally Qualified Health Center, or FQHC, was an important next step, allowing them to hire more staff. A few years later, they were granted a USDA loan to build their own clinic, which opened in 2013.

In the past few years, Sulaiman and her team have opened additional satellite clinics, and now have a total of four spread across three rural counties in Texas, all in areas high in poverty and considered medically underserved, with a shortage of health professionals. Their service area covers more than 3,000 square miles. Seventy percent of the patients Sulaiman sees are uninsured, down from 92 percent when she first opened her clinic. As part of her work, she and her team screen all patients for health insurance programs for which they may be eligible.

As the operation expanded, Sulaiman hired and trained her own staff. She is still the only physician, but now supervises seven midlevel practitioners, either physician assistants or nurse practitioners. “Most of them had clinical rotations with us,” she explains, “and after training here, ended up taking the position.” It’s still very difficult to find physicians, she says.

It’s also challenging to provide all the care some patients need. “We have a lot of patients who require chronic care, who have diabetes, COPD, or heart disease,” Sulaiman says. “One of the biggest challenges we face is getting them specialized care if they need it. We also see a lot of acute cases because we don’t have a hospital here.”

At times, it is hard for patients to get to the clinic. “Dr. Sulaiman makes home visits, often driving 30 to 45 minutes to get to one person’s house, way out in the boondocks, just to make sure the person is doing what they need to do to stay healthy,” Racciato says.

Sulaiman works with churches and other community organizations to help provide patients with transportation to medical appointments. She also reaches out to specialists, negotiating reduced-payment rates for uninsured patients. “I’m constantly looking for good partners in care,” she says.

Despite the challenges, the clinics provide much-needed care, from minor outpatient procedures to medications through their own pharmacy. With a grant from the Susan G. Komen foundation, they provide mammograms via a mobile unit that comes once a month. The clinics also recently hired two behavioral health counselors, both of whom are substance abuse specialists.

Racciato says Sulaiman’s compassion and willingness to serve make her stand out among care providers. “We all do whatever we have to do to help patients get the care they need, and Dr. Sulaiman is no exception,” he says. “If someone shows up at the end of the day and needs care, she sees them. We’re so proud to have her. She’s been a real asset to our organization.” He says he’s well aware that “she could go to any number of other places and make more money, but she’s stayed with us all these years.”

Sulaiman, who was recently named Staff Care 2016 Country Doctor of the Year, says she finds the challenges of providing rural health care to yield great rewards. “I wish more doctors would come work in rural health settings,” she says. “I feel I’m a key part of my patients’ well-being. I don’t see them as patients, really. I treat them as though they were one of my family members. I teach all my staff that — you make fewer mistakes
that way.”

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