Replacing despair with Harmony

By Matt Perry
California Health Report

Just north of Sacramento, Yuba County is home to crushing poverty, homelessness and hunger. It also has some of the poorest health outcomes in the state, ranking 52nd out of 58 counties in the state’s 2011 County Health Status Profiles; it ranks the worst in deaths from lung cancer.

So it might be surprising that in the tiny village of Linda, just outside the county seat of Marysville, Harmony Health Medical Clinic offers something rare even for much larger cities. On a street shared with 14 liquor stores, the community clinic provides integrated healthcare that spans physical, mental, and reproductive health, along with extensive social services.

Indicative of its progressive philosophy, in October the clinic opened Baby Buddies Birth Center for women committed to experiencing natural childbirth outside a hospital setting.

Harmony Health dominates a tawdry strip mall formerly home to an Asian market and sewing shop. Today, in addition to the clinic, the mall features its Family Resource Center and medical laboratory, the birthing center, and the Eating Well Café, which provides wholesome food in a community overwhelmed by fast food restaurants.

“They’re the only clinic in the area that approaches health from a holistic perspective,” says Mary Jane Griego, a Yuba County supervisor. “They not only deal with health in the traditional sense, but nutrition, mental health, community outreach, even job training.”

Many residents of this impoverished county feel the same as patient Rebecca Comarsh, a clinic devotee who also manages the café.

“These people wouldn’t have a chance without them,” smiles Comarsh, wryly.

Returning to her childhood home after 20 years to escape an abusive relationship in Utah, Comarsh credits Harmony Health clinical director Rachel Farrell for rescuing her life.

“She changed my life, she really did,” says Comarsh. “I think I’d be back in Utah getting beat up some more.”

Farrell is a fierce advocate of holistic health and social justice for low-income residents in an area many have turned their backs on.

“There’s abject poverty (in the county) that I’ve only seen in the Third World,” sighs Farrell, whose vision of health is expansive.

Farrell employs a lactation consultant to help new mothers breastfeed. She gives free evening clinic space for the Western Farm Workers Association to provide healthcare for field workers, many of them undocumented. The clinic’s R-Spot Youth program offers a wide variety of activities for typically bored children 8-17, including camping trips, film festivals, family nights and mentoring.

“The services we offer are very unique in many areas,” says nurse Elizabeth Beltran, the clinic’s lactation consultant. “I’m the only breastfeeding specialist in the county.”

A midwife and Physician Assistant, Farrell recently bought a house nearby to allow her 24-hour access to the clinic.

Farrell’s goal is to fulfill Harmony Health’s lofty mission statement: “Our vision is that Yuba County will become an active, healthy, sustainable community that individuals and families are proud to call home.”

This vision has not gone unnoticed. In May, Farrell won the 2011 Physician Assistant Service to the Underserved Award from the American Academy of Physician Assistants. She smiles, recalling receipt of the award in front of 1,500 conference attendees at a ritzy Las Vegas hotel, following invitation-only cocktails in the hotel’s “Elvis Room.”

In typical fashion, Farrell donated the $2,500 in prize money to Comarsh, who volunteers 30 hours a week to run the cafe.

Together, the combined Harmony Health health services support 60,000 appointments a year in its eight exam rooms.

Besides four Physician Assistants – who conduct most of the same activities as doctors – the clinic is also staffed by midwives, marriage counselors, social workers, a dietitian, laboratory technician, and mental health specialists. A surgeon and specialist in internal medicine are also on staff.

Approximately one-third of Harmony Health’s patients are Latino, one-third Caucasian, one-quarter Hmong, and about 5% African-American.

Besides accepting various insurance payments, the clinic has a sliding scale for those who lack health insurance.

“We never send anyone to collections,” admits Farrell.

For the past five years, Harmony Health has also provided medical services to students at nearby Yuba College.

“They’ve been a great partner with us,” says Miriam Root, public information officer for the college. “They’ve done a lot of preventative care.”

This year, administrators saw further need to add mental health services for students stressed out in a county riddled by poverty.

Already providing healthcare services for eight hours a week, in October the college added mental health services at four times that number – 35 hours a week.

Yuba College students often return to school seeking new careers in business, computer science, healthcare, or psychiatry, as well as vocational fields such as automotive repair, welding, or the culinary arts. But Farrell says juggling family, school and work – or unemployment – creates anxiety, depression and insomnia.

“Now we can move them over to the wellness center and have them treated,” says Connie Hoglund, a counselor and learning disabilities specialist who negotiated the contract with Harmony Health.

“Our mental health program at the college is bursting at the seams,” admits Farrell.

Harmony Health Medical Clinic gets by on a shoestring budget of $1.3 million, much of that going to salaries and benefits, which include complete healthcare benefits and a 401(k) retirement plan. Farrell says she conducts a high-wire balancing act to cover expenses, even using an American Express credit card for emergencies.

“I rob Peter to pay Paul,” says Farrell. “We struggle financially so much.”

Yet she insists that the model used by the clinic – allowing healthcare providers to spend as much time as needed with patients – is crucial to proper healthcare delivery.

“We try to really encourage that relationship so people want to get healthy,” she says.

“A lot of the community would be worse off without them here,” agrees patient Patrick Crowder, a long-distance trucker forced off the job by high blood pressure and severe intestinal diverticulitis.

Crowder, who has worked since the age of 12, has gone without a paycheck since July, and is now reduced to collecting cans and bottles just to buy food. He’s been a patient at Harmony Health for 12 years.

“They have a good, friendly reputation,” he adds. “They take care of everybody they can, however they can.”

Medical assistant Gloria Garcia echoes Crowder’s sentiments. A county without Harmony Health?

“I can’t even put words to it,” she sighs.

Despite the clinic’s financial challenges, Farrell is committed to further expansion.

On the drawing board is a new facility behind the existing strip mall that would put all the clinic’s services – including a health club — under one roof.

Farrell says her biggest health struggle is not treating her patients, but a lack of vision by health executives. She cites the failure of Yuba County officials to recognize and solve rampant health problems in the county, including high blood pressure, diabetes, and obesity.

Most county officials are either “two years away from retirement,” says Farrell, or throw their hands up in hopelessness.

Still, she soldiers on and to many is the guiding light for the county’s future.

“Her clinic and community involvement also force other care providers to up their game in order to compete,” says Griego. “Her presence in Yuba County is a win for all of us.”