Dr. Dimitri Sirakoff, the founder and medical director of Serve the People Health Center, rushed around his small, bright clinic tucked into an office complex in Santa Ana one recent afternoon. In one of the nine exam rooms, a man was suffering from back pain. In another, a woman was diagnosed with high blood pressure, and in another, a patient complained of dizziness. Dr. Sirakoff, a board certified general medicine doctor, opened the clinic in 2009*. He offers the gamut of clinic services from pap smears to diabetes screening to mammograms — all for about $15.
Whipping around in his white-coat and clutching charts in hand, the doctor has the demeanor of a man on a mission. Sirakoff started this clinic with a skeleton staff because he saw in his own private practice a great need to serve the community of poor, low-income, and primarily Latino patients in Santa Ana who could not afford health care. He set up the clinic in the modest building he owns and where he also maintains his regular practice.
He works for free, relying on grants to pay for his small clinic staff.
On one recent Saturday more than 40 women came in to get mammograms. In the cheery waiting room, an educational video broadcast a health message about the importance of regular screenings. There were refreshments and educational materials, and the staff gave each patient a pink polka dot makeup bag as a goodbye gift. Women of Mexican descent have higher incidence of late stage breast cancer, according to the Susan G. Komen Foundation, which gave Serve the People Health Center a small grant for the screening program.
As an evangelical Christian, Dr. Sirakoff sees serving this most vulnerable community as his moral obligation. “Most doctors don’t want to treat them because it’s not a moneymaker,” said Sirakoff, who serves 6, 000 patients annually. “We are pretty much trying to do what we can in the community.”
The clinic isn’t all that Serve the People does. The center also has a food pantry that serves 1,600 families a month, a legal aid service for those who can’t afford representation, and even parenting classes.
Serve the People Health Center is gearing up to do a lot more. The Orange County Community Clinic Coalition recently chose the center as one of five clinics in Orange County to receive support under a pilot program to help clinics become Patient Centered Medical Homes — a term for doctor’s offices that track all of a patient’s health issues and needs.
Under the Affordable Care Act, which seeks to improve the standard of care for patients, clinics who win certification as Patient Centered Medical Homes would be in line to receive more patients once health care reform is implemented. California supports setting up models for more comprehensive and coordinated care for some of state’s most vulnerable residents in order to prep for the higher numbers of people who will have access to expanded services once health care reform is fully implemented.
“Once we are certified, we are going to see how feasible it is to get up to speed,” Dr. Sirakoff said. “It’s a whole different ballgame.”
Certification will put the clinic ahead of the curve, but the requirements are substantial. The clinic, for example, has to invest in electronic medical records because every medical treatment, lab test, and procedure has to be measured and tracked to ensure efficiency and quality.
With such a large caseload and limited time with patients, Dr. Sirakoff has to glean information and diagnose ailments quickly. On a recent day, one woman, an assembly line worker at an electronics company that serves the local aerospace industry, had come in complaining of back pain. Her work involves repetitive motion and Dr. Sirakoff had given her non-steroidal medication. Now, she says she is feeling better. But, Dr. Sirakoff doesn’t let her leave without giving her a little nutritional take-away. More fruit, more fish, and continue on those Omega 3 supplements, too, he told her.
Sometimes, his patient’s ailments can’t be gleaned from tests, though, because the cause of the discomfort is hidden.
Magdelena Ortuno sits hunched over on a table in another exam room. The 44-year-old had complained of dizziness and bronchitis and was at the clinic as a follow up to get her lab results back. Dr. Sirakoff told the woman in Spanish that the labs were normal. He has ruled out lupus, an autoimmune disorder, which he’d suspected. But, now he thinks her symptoms are stress-related.
“She is out of job, has pain, and no insurance,” Dr. Sirakoff. “She is stressing herself out and that is manifesting in physical symptoms.” He has seen cases of rashes, swelling, and itching — all from stress.
Ortuno, after Dr. Sirakoff leaves the exam room, said she likes her doctor’s demeanor.
“The doctor is amiable and fast and answers you quickly,” Ortuno said. “He really does care about his patients and asks them how they are doing, and make the person feel comfortable.”
A few minutes later, Dr. Sirakoff went into an adjacent exam room to see Arturo Galindo, 52. The man said he is still losing his hair even though Dr. Sirakoff gave him a gel to apply to his scalp. It might take a while, Dr. Sirakoff said, and Galindo promised to be patient. “And no more hats,” said the doctor, “because you don’t want your scalp to sweat so much.”
Then, Dr. Sirakoff pivots to another of Galindo’s problem: blood sugar that’s a little too high. For that, the man is told to reduce his intake of starches and go easy on the pastas, and breads. “Oh, I eat a lot of rice. Oh, my goodness and breads,” said Galindo. “Just a little bit less,” Dr. Sirakoff gently, “because you are right on the border line of diabetes so we want to make sure you don’t develop that.”
Melissa Marchand, a 21-year-old college student who wants to become a doctor, volunteers at the clinic Thursdays and Saturdays. She takes patients’ vital signs (weight, height, blood pressure, blood sugar, and urine tests) and says the hours fly by.
“We see tons of patients, we’re always packed, and so many patients are so grateful,” she said, noting that the legal assistance and twice-a-month food drives are another reason for that. “This is the most profound organization I have ever seen.”
*This story has been updated. An earlier version of the story said the clinic opened in 2010.