Vehicles clustered near a Food Bank of the Rockies tractor-trailer in a parking lot near 60th Avenue and Quebec Street in Commerce City. Tables laden with non-perishable food items lined the front of the trailer and people queued up, waiting to fill bags and small carts. Others were busy unloading food into cars and trucks.
Behind the trailer on this cloudy mid-April Friday morning sat a short row of card tables staffed by a small group of people. Stenciled signs announced free services available to anyone who wanted them: pneumonia vaccination shots, smoking cessation counseling, blood-pressure tests, and general assistance with other medical questions and issues.
It might have seemed an unlikely place to find a lawyer, but Donnia Howell, Esq., a solo practitioner in Commerce City, stood near the tables helping to check people in. Howell isn’t there to drum up business. She is on the board of directors of the YHC Clinic, a nonprofit dedicated to medical outreach to those in need. Howell, secretary of the group, donated her attorney skills to set up YHC as a 501 (c) (3) non-profit in 2015.
In her professional life, Howell provides bread-and-butter legal services, like estate planning and probate. Why get involved in a free medical clinic? Howell gestured toward one of the card tables, where a woman spoke animatedly with a middle-aged man.
“It was Katy,” she said. “She’s very persuasive.”
Hospital to the streets
“Katy” is Katy Boyd-Trull, MD, founder and executive director of the YHC Clinic. Like Howell, Boyd wears another hat, although hers is a medical version. Boyd is inpatient director for the University of Colorado School of Medicine’s Department of Family Medicine. In that role, she devotes a good deal of her time working with other providers to help patients make a smooth transition from University of Colorado Hospital to outpatient and community care. The goal: help them to improve their overall health and avoid unnecessary hospital and emergency department visits.
To do so, the transitions-of-care team identifies and addresses barriers to care, such as finances, transportation, insurance, housing, and a host of other issues that for many patients complicate access. The work has been particularly successful at UCH’s A.F. Williams Family Medicine Clinic in Denver’s Stapleton neighborhood.
But the work touches only a fraction of patients facing serious medical problems with limited resources. Boyd, nurse practitioner Kara Palfy, NP-C – who serves as YHC vice president and treasurer – and a host of volunteers, both clinical and non-clinical, regularly take to the streets to deliver health care to the most vulnerable in Commerce City.
“There is tremendous need,” Howell said. “There is a lot of poverty in this city.”
The data back that up; roughly one in five Commerce City residents live below the poverty level. But Boyd sees more than cold statistics, having lived in the community the past nine years. As a resident, fellow, and attending physician at UCH, Boyd noticed the large number of patients from Commerce City’s 80022 zip code readmitted to the hospital as a result of poorly controlled blood pressure and cholesterol, diabetes, asthma, and other conditions that worsen health and drive up costs – unnecessarily, in her view.
“I’d see people in the hospital who’d had strokes because they had uncontrolled blood pressure but couldn’t afford their meds,” Boyd said.
She chafed at the notion that patients get sick because they don’t comply with their medication regimens. She noted that for an unemployed or homeless individual with kids, the $4 to buy a bottle of blood pressure pills, say, might mean an entire day of food. In that case, the challenge is not getting patients to take their medications, but rather getting them the medications without forcing a decision to eliminate something else.
“Most patients will take their meds once they get them,” Boyd said. “But we have to have a financially feasible system that keeps an eye on the needs of the population and provides them with consistent care.”
She’s not alone in that view. Boyd’s YHC work has the support of the Department of Family Medicine. “The department approves of and appreciates all of Katy’s work in the community,” A.F. Williams Medical Director Corey Lyon, DO, wrote in an email.
“They realize that improving access to care saves millions of dollars,” Boyd said. Identifying the “hot spots” of unmet need, like Commerce City, and sending in resources is the proper strategy for making that happen, she maintains. “The mission of YHC is basically to provide free health care to high-need communities.”
Back to the basics
Many times, the services people need aren’t complicated, Boyd said. They include regular screenings for diabetes, blood pressure, and cholesterol and checks of vital signs, weight, and oxygen levels. But social problems frequently make it difficult for people to access the help, and the list of resources to address them is “thin,” Boyd said. Salud Family Health Centers, Access Housing and Catholic Charities shoulder much of the load.
Boyd and her YHC colleagues work to bridge the gap. They spot the homeless on the outer edges of places like a Walmart parking lot, talk to them and see what they can provide to help them stay whole – like the truck driver unable to work because of his diabetes that Boyd found recently during one tour of the streets. She gave him a prescription for medications on the spot. They send nurses to the homes of people with high blood sugars for foot care – a key to preventing limb loss. They find low-price alternatives for medications like long-acting insulin and antibiotics and work with pharmacies to cover costs when patients can’t afford them.
The work depends on help from people like Melissa Clement, a nursing student and advanced care partner in UCH’s Oncology Unit. Clement, also a nine-year Commerce City resident, got involved in YHC through Palfy, who serves as her mentor. Clement goes to most of the Food Bank of the Rockies distributions to help with patient assessments, blood pressure and glucose readings, and other tasks.
“It’s helpful for me as a student to gain experience, watch other providers, and ask questions,” she said. “It boosts my education.”
Hidden needs
Her work benefits people like Sarah (not her real name), who had driven to Commerce City from Northglenn to pick up supplies from Food Bank of the Rockies. A 42-year-old mother of four, Sarah said she and her husband, an electrician, have Medicaid for their kids but make too much to qualify themselves and can’t afford private coverage, even with a large deductible.
“I couldn’t go to the doctor,” Sarah said, but YHC helped out. She got an exam that included a blood pressure check, a flu shot, lab work, and a prescription for needed medications.
It’s a typical situation, Boyd said. “People will get medical care for their kids but don’t prioritize themselves,” she said. “But we say a dead parent doesn’t help their kids, so we try to target adults.”
It all takes building relationships with businesses, service organizations and individuals in the community. During the food truck visit, for example, Palfy administered free pneumovax shots with vaccine a local Walgreens sold YHC at cost.
After the food truck crowd began to thin later that morning, Palfy and Boyd piled equipment, medical supplies, toys, towels, soap, water, books and candy into a van and headed for a dusty lot that is home to a “motel” – no more than a collection of shacks – in a poverty-stricken area of Commerce City south of 88th Avenue.
The bleak outpost is far from the landscape of competitive health care, a home to unemployment, drug abuse and crime, Boyd acknowledged. But the need for attention is precisely why she and Palfy go there.
“We keep coming through to develop trust,” Boyd said.
Palfy’s daughter Ivy carried a plastic jack-o-lantern holding candy and other supplies and volunteer Jill Dinneen acted as a Spanish language translator. The group split up, knocking on doors, and calling, “YHC. Do you need anything?” A young pregnant woman sleepily emerged from one. Boyd asked if she needed prenatal vitamins; the woman said, no, she got them from University.
Many doors remained closed or opened only a crack for people to offer curt answers. But the visit produced a tangible success. A heavyset man welcomed Palfy into his cluttered unit and accepted her offer of a pneumovax shot. He said he’d been to Salud’s Commerce City clinic and to National Jewish Health but had difficulty keeping his appointments because of transportation problems. Palfy and Boyd say that’s a common barrier for residents of areas like this one that are perceived as dangerous for drivers to enter.
The outreach work walks a fine line. The YHC team visits worlds where illicit drugs, spousal and child abuse, prostitution, and sex trafficking are present. They extend a helping hand but will not look the other way at illegal behavior. They try also to encourage positive behaviors and personal responsibility without moralizing.
Palfy summed it up as she watched a thin woman in her mid-20s pick through books and toys for her kids. The donations, she said, aren’t handouts, but rather a conduit to a longer conversation about better health.
“We’re trying to give people help without enabling them,” she said.
Clement, who has accompanied Palfy and Boyd on these “street medicine” trips, says her work with YHC has taught her that patient care calls for “teaching, educating, and understanding without judgment.” She said she’s carried the lesson to her work at UCH. “It’s my job and my duty to be an active listener to my patients, to understand what they need and not judge them on the basis of societal problems or issues,” she said.
Being the change
Boyd speaks freely of her belief in the power of the individual to effect change. “Kindness speaks volumes,” she said. “You don’t know what one act can do for a person in the world.” But she’s also acutely aware of the practical importance of building alliances if YHC is to help address the vast unmet need of the community.
Her long-range goals include working with other non-profits to open a drug treatment facility and a shelter for battered women and building partnerships with law enforcement. In addition, YHC has formed alliances with the public schools in Commerce City to identify kids with few resources, as well as with Community Uplift Partnership (CUP), a faith-based organization that provides both physical and spiritual help to people in need.
CUP’s Hope Family Resource Center offers basic help with food and clothing, but also gives people an opportunity to interact in a safe environment, share their experiences, and learn to manage their resources, said Executive Director Keely Thompson, as she stood near the YHC card tables during the Food Bank distribution. Like YHC, her organization strives to build trust among people wary of accepting help.
“That takes time and intimacy,” Thompson said. “YHC provides people in our community health care, which is a whole other piece. They are reaching more people.”
At the most basic level, that is what Boyd has been trying to do for much of her life. She grew up in Mead, Colo., where she says her family worked hard but went without health insurance – as did the migrant farmworker community that arrived each season. “I also grew up around addiction,” Boyd said, “and I hated all that.”
As she began her medical career, Boyd thought about finding an area of need. She found the answer simply by looking around her. “I saw that the needs are everywhere,” she said. “It’s just that people don’t know they are there.” She decided that her profession and her faith called her to stand up for “people without a voice.”
Boyd has done medical volunteer work in Rwanda, Honduras, and Mexico. But she said she has often found more hope in the ravaged communities of these countries than in the drug pockets of Commerce City.
Her motivation to restore hope is personal, but Boyd believes that society ignores the people YHC serves at its peril. The epidemic of addiction alone continues to sap spiritual and financial resources and will continue to do so without a reasoned, nonjudgmental response to medical and behavioral health needs.
“They are not living in the lap of luxury,” she said. “These are people who are barely making it and they are often doing it through socially unacceptable means. It’s costing us billions of dollars. We have to come up with a system that reaches the people who want recovery.”