Island Agencies Win U.S. Health Grant

Half a Million Dollars Will Address Doctor Shortage, Add Rural Clinic, Provide Brazilian Translators

By MANDY LOCKE

Three agencies on the Vineyard have won nearly half a million federal dollars to ease the Island's shortage of primary care physicians and break down language barriers for Brazilian residents seeking health care.

The Island Health Plan, the Vineyard Nursing Association and the Vineyard Health Care Access Program secured a competitive public health grant this month - paving the way for creation of the first rural health clinic in the state.

"This is something we're bringing to the Vineyard. It's for the community, and it's a clear gift," said Cynthia Mitchell, director of the Island Health Plan and administrator for the rural health outreach project.

The grant, championed by United States Cong. William Delahunt, will bring a full-time primary care provider into the Island's mix - alleviating a shortage that has left an estimated 3,000 Islanders without a primary care physician.

"It's quite clear that once you factor in the seasonal population and the full-time equivalent of the primary care providers - and not all of them are full-time - it doesn't add up," said Mrs. Mitchell. "If you are a well-insured person visiting the Island in the summer, there are stories after stories of them not being able to get a doctor. Practically all of the primary care offices are closed [to new patients]."

A full-time nurse practitioner, a bilingual assistant and a part-time overseeing physician could begin work as early as January. The vast majority of the $190,000 grant in the first year will go toward these salaries, in addition to rent for a facility, malpractice insurance and equipment. The Vineyard's designation as a health professional shortage area, Mrs. Mitchell said, boosted the grant application in the eyes of the federal Department of Public Health and enables the rural health clinic to receive cost-based reimbursements from state and federally subsidized insurance users. These reimbursements are expected to sustain the clinic in the years to come.

Along with serving summer residents or vacationers, the clinic will try to absorb some of the need within the Brazilian population - a year-round community estimated to exceed 2,000. In addition, the Vineyard Health Care Access Program, an organization which tries to link some of the 3,000 uninsured Islanders with medical care, will use some of the grant money to hire an interpreter for Brazilians using any health care services on the Island.

"Current interpreter services are minimal and informal. Very often, a Brazilian patient will take a relative who speaks some English with them to the doctor or hospital. But it's not the same as having a medical interpreter. No one will ever know what literally gets lost in the translation," said Sarah Kuh, director of the access program.

"It's easy to understand why we don't have an interpreter service, because they are a relatively recent immigrant community. If they can't communicate, they aren't getting the health care they need. Now's the time to address this," Ms. Kuh added.

This rural health outreach grant will enable the Vineyard Nursing Association, a home nursing and education/outreach organization, to expand its existing Women's Health Network. In this program, the nurses link women with clinics and physicians to perform preventive screening for breast and cervical cancer and cardiovascular blockages. Currently serving 350 low-income women, 40 per cent of whom are Brazilian, VNA pays for their screening and follows up with them based on the results.

"Women are sometimes reluctant, because of the fear of breast and cervical cancer, to seek services. Often they don't have the money to seek routine services, so their care is only emergency-based. We offer them preventive screening that's often lifesaving," said Kathleen Rose, president and CEO of VNA. Ms. Rose expects this grant will fund a part-time outreach position and offer the nurses a place to refer patients who might need care with other health issues.

The current gap in primary care physician access posed a potential hindrance for the Island Health Plan - a grassroots program that will join small Island employers to attain group buying power with a private insurer. The new clinic will remove this hurdle for the IHP, said Mrs. Mitchell.

In addition, a pool of volunteer doctors may find an operation base within the rural health clinic - sharing equipment and resources to aid the Vineyard through its busy season.

The clinic, Mrs. Mitchell said, completes the picture - nudging the Vineyard toward universal health care. The clinic will accept patients regardless of income level, and grant sponsors hope this nurse practitioner may take some of the load off the hospital's $3 million uncompensated care pool.

"It will hopefully relieve the people in the emergency room with non-emergency needs," Mrs. Mitchell said.

Striking the balance between too few primary care providers and too many is difficult, said Timothy Walsh, chief executive officer of the Martha's Vineyard Hospital.

"You have to be careful because it's a delicate financial balance. There's the potential that you could end up competing," Mr. Walsh said. "I always get nervous when you start playing with the system. Because if you hurt the system finances, you inevitably change what services get offered."

The hospital recruited another primary care physician last summer, bringing the number of general practitioners to 13. The hospital is now enjoying its second season with a full-time hospitalist - a doctor who completes in-patient rounds to assist the Island's primary care doctors. This year, the hospitalist is also performing twice-weekly clinics for follow-ups with emergency room visitors.

"To the extent that you compete, you take money away from the [emergency room]. We make money for three months, and you hope that it's enough to offset losses in the winter," Mr. Walsh said.

As many specialist referrals as possible will be handled on the Island, said Mrs. Mitchell - noting another concern for some in the medical community.

The recipient organizations are still nailing down the details of the program, they but feel excited about the Vineyard's opportunity to lead the way with the rural health clinic.

"We're thrilled to have this opportunity and challenge. This will not be the magic bullet. It's the beginning for us to start addressing some of the major shortages in primary care on the Island," Ms. Kuh said.