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Clinic Provides Health Care for Uninsured

The Loudoun Community Free Clinic offers treatment for the 30,000 Loudoun residents without health insurance.

The Loudoun Community Free Clinic treats only adults, but in the small waiting room, it's a family affair.

Last week, Kimberly Holmes sat with her three children while her husband refilled his monthly prescription for hypertension. Since her husband suffered an aneurysm a year ago, Holmes has been the sole wage earner in the family. Her position at the Purcellville Child Development Center, however, doesn't include medical insurance. The Loudoun Community Free Clinic has made treatment for her husband possible.

"It helped us out tremendously because the medicine he's on we wouldn't be able to afford any other way," Holmes said.

HOLMES'S HUSBAND is one of the dozens of uninsured Loudoun residents who pass through the door of the old hospital at Cornwall Street in Leesburg every week. Since the clinic re-opened in 2002 — it had opened and closed in fits and starts since 1998 — it has seen more than 4,200 patient visits, and not charged any of them.

"Our budget last year was $391,000," said Lyle Werner, the clinic's executive director. "For that, we delivered $2 million in health care to the community."

So how does a volunteer clinic with two paid staffers squeeze five dollars' worth of care out of every one dollar?

"I do that by getting anything and everything I can donated and pay for very little," Werner said.

Since taking over as executive director in 2002, Werner has obtained free lab services, free prescriptions and even free transportation to free surgeries at the University of Virginia hospital in some cases.

Pharmaceuticals takes up the largest chunk of the clinic's funds, accounting for nearly a third of the 2003 budget.

"That's huge and we're drowning in it," Werner said. "That and salaries is keeping us from going full time right away."

UNTIL JULY, the clinic was open two evenings a week, from 5:30 to 9 p.m. on Wednesdays and Thursdays. Since the clinic operates on a first-come, first-serve basis, patients line up on the front porch sometimes hours in advance for a chance to see a doctor.

Since the majority of diagnoses were related to diabetes, the clinic began offering a diabetic-care clinic during the day on the first and third Thursdays of the month last September.

On a normal night, the clinic usually accommodates 25 to 30 patients, making for a "very organized kind of chaos" inside the 2,800-square-foot facility, as clinic coordinator Dena Willett put it.

"Because some nights we're so busy ... we have to actually turn patients away," Willett said.

Thanks to the availability of a volunteer retired doctor, however, the clinic was able to begin taking Monday appointments in July for patients who otherwise would have to wait another week.

"Free clinics mostly start out like this," Werner said. "They go full time eventually."

ON ONE RECENT Thursday night, 25 patients, three doctors and a handful of interpreters kept the four exam rooms full, treating everything from diabetes and hypertension — the clinic's most common diagnoses — to lupus and blindness. While the clinic only has the capacity to treat a limited number of disorders, only about one in 50 patients is referred to a specialist who will volunteer his services, according to Willett.

The vast majority of patients are Hispanic, accounting for 70 to 80 percent of visits. That's due to Loudoun's growing affluence, Werner asserts, bringing with it an increased demand for services — and it's those workers in the service industry that come to the clinic.

"They're not people who are bums who aren't working," she said.

And since the free clinic doesn't have to comply with federal requirements, anyone — providing he or she is an uninsured Loudoun resident between the ages of 18 and 64 — can receive treatment.

"We don't check their status," Werner said. "They could be illegal for all we know."

THE CLINIC RELIES on volunteers to keep things up and running, but with the growing influx of patients, the clinic itself is a little short-staffed.

Werner is seeking two new volunteer positions: a volunteer coordinator and a newsletter editor. And while a variety of volunteer specialists for referrals would be nice — the clinic has no neurologist or rheumatologist locally, for example — there's a need right inside the clinic as well.

With no volunteer pharmacist in the building, doctors find themselves leafing through massive physician's desk reference books to find the right dosage. Willett, who as clinic coordinator is responsible for day-to-day operations, often fills in as pharmacist.

As patients shuttle in and out of exam rooms and doctors and interpreters converge on the volunteer room, the clinic is a bright, busy place in the evening. Volunteers display a constant, cheery determination between patients, asking advice on diagnoses or swapping Spanish folk songs.

"I love it. It's my only job," said interpreter Michelle Engel, who learned the folk songs in question while at boarding school in Guatemala.

Dr. Rosalie Auster retired as a family physician four years ago, returning to volunteer at the clinic in October 2002. She just couldn't keep away from the business of saving lives.

"Like most doctors, we love what we do," she said. "It's deleterious not to do it."

WHEN WERNER came on board as executive director two years ago, the clinic operated in a single room on Catoctin Circle in Leesburg. Nothing was stored in the room, so doctors essentially worked out of Werner's truck.

This year, the clinic is on track to have a 22 percent increase in patient visits over 2003 — and Werner expects that number to grow since adding the Monday hours in July. Werner, a former planning commissioner whose contacts in the county have heightened the clinic's profile, and, likewise, the donations its receives, is hesitant to take credit for the clinic's success.

"It's a great story to tell," she said. "This place sells itself. It's not like I've done any magic."