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Al-Shifa Clinic | |
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M. Basheer Ahmed M.D., Arlington TexasAfia Mumtaz M.D. Fort Worth Texas |
Muhammad Khan M.D. Fort Worth Texas |
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Siraj Hussain M.D., Medical Coordinator |
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Al-Shifa Clinic - Article M.Basheer Ahmed M.D., Chairman In this country, 47 million Americans do not have health insurance.4 Twenty-five percent of Texas residents are neither covered under any insurance plan nor eligible for public medical services. Ninety-seven thousand illegal immigrants reside in Tarrant County, which includes Fort Worth and Arlington, and do not have insurance coverage.5 Unfortunately, people without health insurance are sicker and die at a relatively younger age. Due to lack of insurance, they delay physician visits and do not receive medical care for common medical problems such as hypertension and diabetes until they develop full blown symptoms or complications. Another sad fact is that hospitals and physicians agree to bill and receive negotiated discounted prices for their services from private and governmental third party payers but bill the full amount to individuals who do not have any insurance coverage. Many uninsured individuals in an emergency situation have to give their entire life’s savings for surgery or treatment in intensive care units. The number of uninsured Americans has been rising inexorably over the past eight years due to a variety of reasons.6 Families who have good insurance may lose it if the bread-winner loses his/her job. Individuals who are earning more than poverty level are not eligible to receive care at public hospitals and clinics. Visitors to the United States and illegal residents andare not eligible for care at the public hospitals or clinics. Regardless of age, legal status, or insurance coverage, immigrants receive much less health care than native born Americans. Based on data collected from 1996-1998, a high percentage of immigrants are uninsured and they consume 55% less services than non-immigrants. Financial, cultural, and language difficulties make it hard for immigrants to access care. Immigrant children had 74% lower per capita health care expenditures than U.S. born children. Charitable Medical Services - Al-Shifa ClinicIn view of the health care issues discussed above, the Al-Shifa Clinic was opened in October 1998. The clinic is a private not-for-profit agency providing culturally appropriate primary care to medically underserved populations. Indigent patients and visitors from overseas without insurance coverage also come to the clinic. The weekly clinic provides services for general medical problems such as diabetes, hypertension, high cholesterol and minor infections. If these problems are not treated at an early stage, they may lead to more serious problems such as heart disease, stroke, or kidney failure, which can result in more serious consequences for the patients and their families. All surgical and complicated medical cases are referred to public hospitals in this area. Fifteen area physicians come on rotation on Saturdays and donate their time. In addition to free consultation, generic or free medications (donated samples) are also prescribed or dispensed. In 2002, discounted rates were negotiated for lab work, and now laboratory services are also provided. Most of the physicians at the MCCHS clinic are internists and primary care physicians. Some area specialists see patients for free consultation in their own offices when referred by Al-Shifa. Students from local medical school also help at the clinic, getting credit for their work. Foreign medical graduates applying for residency program also attend the clinic as “observers” and work under supervision of the attending physicians. Initially the clinic was open every Saturday for four hours. Many Muslim women prefer to see female physicians due to religious and cultural modesty. Therefore, beginning in 2007, the clinic opened on Sundays for women and children only. Female physicians and a pediatrician volunteer their time at the women’s clinic. Eye Clinic and Dental ClinicIn July 2008, an eye clinic opened once a month for minor ophthalmologic problems and glasses for visual correction. MCCHS is also planning to open a dental clinic in the middle of 2009. Staffing the ClinicPrior to establishing the clinic several area physicians were contacted to discuss the feasibility of opening the charitable clinic. Fifty physicians expressed interest in volunteering. However, only 15 made the commitment to come to the clinic for three to four hours once in two months. The major question physicians had related to malpractice insurance. It was recommended that physicians who are in private practice must notify their insurance carrier about their work at the clinic and get appropriate malpractice insurance coverage. Physicians working at the United States Veterans Administration or other governmental institutions cannot get the coverage through their insurance company. MCCHS contacted the Texas Medical Association, and it provided extensive information on good Samaritan laws governing charitable medical clinics and the protection they offers to physicians. The Texas medical liability insurance provides coverage to retired physicians providing volunteer services at charitable clinics for the nominal charge of $250 per year. The federal government also offers malpractice coverage with no cost to physicians who are providing free services at charitable clinics. Recruiting and keeping physicians interested in the charitable clinic is a challenging task. Since the inception of the clinic MCCHS has lost a few physicians to family responsibilities and other commitments. MCCHS constantly recruits new physicians to replace them. OperationsA part-time officer manager is hired to make appointments, maintain medical records, supervise non-physician volunteers and arrange the lab work. The medical record contains the physician’s initial work up, progress notes, lab work and a list of prescribed medications. A pharmacist comes to the clinic periodically and sets up policies for recording the use of sample medications and disposal of expired medications. A physician dispenses the medication from the pharmacy, which is a locked room where the medications are stored. The clinic only accepts patients who have no insurance and are unable to pay the physician’s fee in private practice. It is difficult to do a financial assessment on every patient who comes to the clinic due to lack of staff and the high logistical costs. However, MCCHS believes that 90% of the patients meet its criteria for free medical care. Al-Shifa clinic served 1200 patients in year 2006, 1500 in 2007 and the number of patients has increased to 1800 in the year 2008. Ninety-five percent of the patients at the clinic are adults. The clinic sees a small number of children whenever the pediatrician is able to come to the clinic. Seventy percent of the patients at the clinic are female and 30% are male. The most common problems treated at the clinic are diabetes (30%), heart disease including hypertension and high cholesterol (40%), infections and other minor ailments (15%) and depression, anxiety and other psychiatric problems (15%). Al-Shifa refers patients with acute medical problems such as chest pain, acute infections, surgical problems and chronic medical conditions t o public hospitals. Most of the patients at the clinic have no other source of receiving treatment. The clinic does reduce the burden of public hospitals and emergency rooms. Patients also feel more comfortable with physicians who understand their culture, language and religious beliefs.
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Leveling the playing field - Al Shifa ClinicPublished Tarrant County Physician July 2009 Al-Shifa Clinic offers free preventative education and medical care for immigrants and indigent residents of Dallas Forth Worth area. by M. Basheer Ahmed MD and HujefaVora, MD We are all well aware of the playing field. Diseases such as diabetes, hypertension, coronary artery disease, and cancer, do not respect the lines created by race, color, nationality, financial status, or immigration status. Rather, just as the founding fathers expressed it so many years ago, all men are created equal. One in four Americans afflicted with hypertension are completely unaware of their illness. About one in four Americans with diabetes also are unaware of their disease. Obesity is reaching epidemic proportions, further contributing to diabetes, heart disease, and a host of other medical problems. Most of these can be predicted and prevented by the available tools for early diagnosis, and by the pursuit of lifestyle changes. When we speak of these issues, we must concern ourselves with two overriding issues, access to health care and education. While there are some minor differences in the incidence of these problems among different groups individually, collectively all groups are affected by them. The currentpresidential administration has brought these issues to bear most recently before the AMA. While access to affordable health care in America continues to be a challenge, the access to health information and education is not so difficult. Asking Americans to take charge of their own health and make healthy living a priority remains a bigger challenge. This aim requires resources many do not have. The escalating cost of health care delivery and increasing number of uninsured and underinsured remains a serious concern to all of us. The number of uninsured Americans has been rising inexorably over the past eight years due to a variety of reasons. Insurance premiums are ever on the rise. Many employers reduced their share of contribution to premiums. Many employees are unable to pay high deductibles. Uncovered employees are unable to purchase affordable insurance on their own. With unemployment on the rise, only one in ten workers chooses to sign up for COBRA coverage. And to compound these issues, the number of uninsured children has also jumped sharply, reaching over nine million, partially due to a decline in government funding. This burden is further exacerbated by a growing number of immigrants who remain uninsured. In Tarrant County, over ninety-seven thousand immigrants do not have insurance coverage. Regardless of age, legal status, or insurance coverage, immigrants receive far less health care than the average American. A high percentage of recent immigrants remain uninsured. Beyond the financial issues, language difficulties and cultural differences create further barriers to access to health care. A recent analysis showed that immigrants consume 55 percent less services than non-immigrants. Immigrant children had a 74 percent lower per capita health care expenditure when compared to U.S.-born children. In 1995, a group of concerned citizens founded the Muslim Community Center for Human Services (MCCHS), with the objective of providing education for health maintenance and disease prevention to the residents of the DFW Metroplex, focusing on immigrant residents who lack this fundamental access due to the above-mentioned language and cultural barriers. The MCCHS has actively participated in health fairs, providing health screenings for diabetes, cholesterol, hypertension, and numerous conditions. Initially, this delivery of education and services was met at the point of need, with screenings held at Islamic community centers, Christian churches, public libraries, and centers of higher education. Responding to ever-increasing barrier: to health care, the MCCHS opened the Al-Shifa Clinic in October of 1998 Our goal evolved to provide culturally appropriate primary care to this medically-underserved population. Today, weekend clinics serve Tarrant County's indigent population, immigrant residents, as well as visitors from overseas without insurance coverage. Our efforts center strongly around prevention. We provide services for general medical problems, focusing on diabetes, hypertension, dyslipidemia, and infections, conditions that when untreated can lead to more serious problems such as heart disease, stroke, or kidney failure. All complicated cases, specifically surgical patients, are referred to the public hospital system. Our staff of fifteen volunteer physicians comes on rotation on Saturdays and Sundays. The staff represents several primary care groups, including internal medicine, family practice, cardiology and emergency medicine. Additional support is provided by local medical students and premedical volunteers. Laboratory services are provided at a discounted rate in agreement with area labs. Generic medications are prescribed and pharmaceutical samples are dispensed routinely by the physicians. As our populations needs have evolved, the Al-Shifa Clinic and MCCHS have also evolved. In July of 2008, a monthly eye clinic was organized to address minor ophthalmologic problems and corrective lenses. There is a regular women's clinic which further addresses the cultural issues of our served population. Later this year, Al-Shifa plans to open a dental clinic as well. Service to our community should never be short-sighted. It should continue to evolve, with the fundamental goal of expanding the scope of our service to our community. In 2009, MCCHS would like to develop a network of physicians in the Dallas-Fort Worth area who can offer medical services to patients referred by the primary Al-Shifa Clinic for a flat fee in their own offices.
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