NEW YORK (AP) 鈥 Elisa Reyes has come to Plaza del Sol Family Health Center for doctor鈥檚 appointments for more than a decade. She moved away a while ago but keeps returning 鈥 even if it means a two-hour roundtrip bus ride.
That鈥檚 because her two children see the same doctor she does. Because when she鈥檚 sick, she can walk in without an appointment. Because the staff at the Queens clinic helped her apply for health insurance and food stamps.
鈥淚 feel at home. They also speak my language,鈥 Reyes, 33, said in Spanish. 鈥淚 feel comfortable.鈥
Plaza del Sol is one of two dozen sites run by Urban Health Plan Inc., which is one of nearly 1,400 federally designated community health centers. One in 11 Americans rely on these to get routine medical care, social services and, in some cases, fresh food.
The clinics serve as a critical safety net in every state and U.S. territory for low-income people of all ages. But it鈥檚 a safety net under stress.
Since 2012, community health centers have seen a 45% increase in the number of people seeking care 鈥 and they鈥檝e opened more and more service sites to expand their footprint to more than 15,000 locations.
Many centers are short-staffed and struggling to compete for doctors, mental health professionals, nurses and dentists. Leaders also told The Associated Press that funding is an ever-present concern, with the months-long making it all but impossible for them to plan and hire for the long term.
Community health centers have been around in some form for decades, and are largely what remains when urban and rural hospitals on services.
Dr. Matthew Kusher, Plaza del Sol鈥檚 clinical director, said there are things that prescriptions can鈥檛 change, like stopping the spread of flu and COVID-19 when people live in apartments with one family per room and it鈥檚 impossible to quarantine.
鈥淲hat we provide here is only 20% of what goes toward somebody鈥檚 health,鈥 Kusher said. 鈥淭heir health is more driven by the other factors, more driven by the poverty, and the lack of access to food or clean water or healthy air.鈥
Nine in 10 health center patients live at or below 200% of the federal poverty line, according to the U.S. Health Resources and Services Administration. Beyond that:
鈥 In 2022, nearly 1.4 million health center patients were homeless.
鈥 One in five was uninsured.
鈥 Half were on Medicaid.
鈥 One in four was best served in a language other than English; about 63% were racial or ethnic minorities.
Dr. Acklema Mohammad started 50 years ago as a medical assistant in Urban Health Plan鈥檚 first clinic, San Juan Health Center. She has cared for some families across three generations.
鈥淚t鈥檚 so gratifying to work in this community. I鈥檓 walking through the door, or I鈥檓 walking down the street, and I鈥檓 getting hugs,鈥 she said. 鈥淎ll along, 鈥極h, Dr. Mo! You鈥檙e still here!鈥欌
Staffing is Mohammad鈥檚 biggest worry. Many pediatricians retired or left for other jobs after the worst of the pandemic. It鈥檚 not just about money, either: She said job applicants tell her they want quality of life and flexibility.
鈥淚t鈥檚 a big job and it鈥檚 a big issue because we have so many sick children and so many sick patients,鈥 Mohammad said, 鈥渂ut we don鈥檛 have enough providers to take care of them.鈥
Former pediatricians are sometimes picking up virtual visits to provide relief, she said, and telehealth helps, too. But when telehealth is not a possibility, El Nuevo San Juan Health Center tries to bring care to people instead.
About 150 elders get at-home visits, said Dr. Manuel Vazquez, Urban Health Plan鈥檚 vice president of medical affairs who oversees the program. There are times when the care isn鈥檛 covered, but the team does it without pay.
鈥淲e said, 鈥楴o. We need to do this,鈥欌 he said.
Building community trust
One of the nation鈥檚 first community health centers opened in the rural Mississippi delta in 1967, in the wake of the Civil Rights Movement鈥檚 Freedom Summer.
Today, Delta Health Center in Mound Bayou, Mississippi, has 17 locations in five counties, including free-standing clinics and some in schools.
Access to preventive care is critical as area hospitals cut back on neonatal services and other specialty care, said Temika Simmons, Delta Health Center鈥檚 chief public affairs officer.
鈥淚f you鈥檙e in the middle of a heart attack, you鈥檙e going to have to be airlifted to Jackson or Memphis where they have the equipment to save your life, and so you might die along the way,鈥 she said. 鈥淪o, what we鈥檝e been doing in terms of primary care is trying to keep people away from that part.鈥
Another key to the centers鈥 ability to improve health disparities is understanding and being part of their communities. Plaza del Sol is located in the heavily immigrant, mostly Latino neighborhood of Corona, which was Staff are required to speak Spanish.
The Mississippi Delta staffers are trained to spot signs of abuse, Simmons said, or know that the patient 鈥渇ussing and fighting鈥 about filling out a form likely can鈥檛 read.
To continue to serve the communities in the way they want to, center leaders say they鈥檙e stretching dollars are far as they can 鈥 but need more.
Based on the rising number of patients and inflation in the health care sector, federal funding for centers would need to increase by $2.1 billion to match 2015 funding levels, according to an analysis sponsored
鈥淵ou can鈥檛 be overwhelmed with the problem,鈥 Simmons said. 鈥淵ou鈥檝e got to just simply take it one day at a time, one patient at a time.鈥
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Associated Press data journalist Kasturi Pananjady contributed to this report.
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