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Cornelius Virginia Garcia clinic sits at epicenter of health care reform in Oregon

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A farm worker lay on his bunk, his workmates out on the job. The thin man had tried hard to go along, but staggered and stumbled uncontrollably because of a painful leg injury and serious infection.

Bereft, he stares at the plywood ceiling in his Cornelius bunk house. Not only does he have no money to see a doctor, but he feels he has no friends in Oregon.

Within a few days, a renovated recreational vehicle rolls into the camp. Out jumps a medical team who saw the man and linked him up with a local orthopedic surgeon, who fixed the leg gratis.

'He actually did have friends in Oregon. It was us,' says Chris Shine, a grant writer for Virginia Garcia Memorial Health Centers.

While Oregon officials have been wringing their hands over the state's 610,000 residents with no medical insurance, the pod of clinics west of Portland has been diligent, serving 30,000 people.

For each of the past four years, the clinics have added 5,000 patients to membership rolls.

'As it became clear that the Oregon Health Plan wasn't going to fulfill its potential, the board of Virginia Garcia stepped into the gap,' says Shine.

The first clinic opened in 1975 in a renovated Cornelius garage, inspired by the tragic death of its namesake, an eight-year-old girl who had a relatively simple foot infection. That first clinic offered walk-in care for those with urgent conditions.

But as the low-income population has become more established in Washington and Yamhill counties, the need for continuous medical care increased and Virginia Garcia has adapted and expanded. Now, only one in 10 patients here is a migrant worker.

'We've noticed that the community has become more rooted and people have begun to look to us for all of their medical care,' says Gil Muñoz, chief executive officer of the clinics, which are located in Cornelius, Hillsboro, Beaverton and most recently McMinnville.

'We're a critical piece of the delivery system. Without Virginia Garcia, there would be no access to health care except for the emergency room or an urgent care visit to a free clinic somewhere,' explains Muñoz.

From delivering babies to managing diabetes, from treating strep throat to working on depression, Virginia Garcia has become a provider of most kinds of health services for the very poor.

'We've come to the point that we can say to patients, 'Let's go down the hall,' instead of 'Make another appointment at some other place,'' says Shine.

The clinics have also begun preventive care, offering classes in diabetes care, weight loss, tooth decay and even parenting. The Cornelius building is fronted by a vegetable garden used to teach patients about healthful eating. Recently, mental health care has been added to the mix.

Virginia Garcia has even opened its own pharmacy system, including a site in a former Cornelius tavern. That helps patients avoid the high drug prices that can stymie the uninsured.

'You can have transportation, bilingual access to doctors - all kinds of systems in place - but it all falls apart if the patient can't fill a prescription,' Shine says.

The Virginia Garcia workforce has expanded apace. There were 47 employees in 1999. Now there are 250.

Staff members still answer the need to urgent care. The medical RV visits worker camps weekly, handling everything from injured limbs to respiratory infections.

Painted large on the side of the vehicle is an image of the smiling girl, Virginia Garcia.

In addition to medical and dental care, the van has a tiny pharmacy. Inside, it shows DVDs on preventive care and even has a box of donated clothes.

Though the clinic made its name working with Latino patients, it now serves many other immigrant populations, including Vietnamese and Somalis. Interpreters are a hot commodity here.

At the same time, the Latino population in the county has grown fast, tripling between 1990 and 2000.

The clinic, following the rules of federal grants plus the dictates of Catholic social teaching, does not ask patients about immigration status.

The Oregon Health Plan covers about half of the clinics' $20 million annual budget, with federal grants supplying about a third. Five years ago, the budget was about $7 million.

The Bush administration has increased funding for community health centers, with the president hoping to double the number of such clinics. That has helped power the Virginia Garcia expansion.

Patients pay for services - usually about $15 for an office visit. That helps with costs and is part of fostering dignity. But no one is turned away for failure to pay.

The co-pay still leaves a gap, however, and fund-raising is a vital part of the venture's survival.

The resources get used to help patients, not create plush offices. In the Cornelius clinic on any morning, a half dozen physicians and nurses scoot around each other in a small office that doubles as the record archive.

Physicians are not volunteers. They are paid staff. Patients embrace them as their doctors.

Once a patient gets established, he or she can make a phone call and get an appointment in a day or two. A triage nurse tends a round-the-clock advice and referral line.

'We are trying to provide the best care for the most people,' says Dr. Ann Turner, the clinic's medical director.

Health workers could get more money elsewhere, but turnover is surprisingly low here.

'The whole staff is committed to the mission of the health center,' says Turner, an internist who earned her medical degree from the University of Southern California. 'We are here because we want to be here. This isn't a job you take because you couldn't get a job anywhere else.'

Virginia Garcia's patients are mostly younger now, but Turner sees an increase in elderly patients, not only as people age, but as fewer and fewer providers accept Medicare.

Many volunteers help out, going to migrant camps, taking vital statistics, registering patients. Some volunteers have skills in nutrition or other aspects of health care.

Despite the increase in patients, staff members know there are many more patients in need. Washington and Yamhill counties have 90,000 uninsured.

Muñoz, while keeping the clinics going and expanding, still seeks a national change in the health system. Despite the uptick in the economy, employees are still not getting health coverage.

'We spend more than any other nation on health care, and still, access is abysmal,' he says.

This article is reprinted, with permission, from the Catholic Sentinel in Portland. To see other related articles, visit www.sentinel.org.