Against a backdrop of healthcare policy upheaval, there’s been a quiet resistance movement brewing in our own backyard – one that promises to preserve a spirit of community, celebrate diversity, and deliver high-quality healthcare to vulnerable populations.

Clínica Esperanza / Hope Clinic (CEHC) in Olneyville provides free Spanish-language care and educational programming to thousands of patients – many of whom are immigrants – in Providence. In the process, the clinic has proved that the fight over the future of America does not take place exclusively in the White House; that it is waged most powerfully at the local level, in our own towns and in our neighborhoods; and that anyone with the will to make a difference can.  

“A Place to be Healthy”

CEHC was founded in 2007 by a group of volunteer healthcare providers, including Fadi Mansourati, Joe Diaz, Annie De Groot, who still volunteer at the clinic today. Dr. De Groot – the founder and chief executive officer of EpiVax, a company specializing in computational vaccinology – serves as the volunteer medical director. She has received $26 million in federal funding since 1989, and, in 2009, was awarded $13 million from the National Institutes of Health to establish the University of Rhode Island’s Institute for Immunology and Informatics.

According to Dr. De Groot, CEHC’s founding physicians “felt that there was a need for comprehensive care for people in their own language.”

“The fundamental precept for this clinic was that people have differences,” she said. “It’s okay to be different.”

At its inception, CEHC did not have a permanent home; it operated out of churches throughout Providence. In 2010, the founders and board of the clinic were able to obtain an interest-free loan from the City of Providence and the Local Initiative Support Corporation to build its current space. CEHC has since fully paid off the loan.

Today, CEHC operates with an annual budget of $400,000, sees more than 2,500 patients a year, and has developed community-oriented educational programming to teach patients about pervasive ailments, such as diabetes, high cholesterol, hypertension, and obesity. And the clinic’s guiding philosophy is prevention.

“There’s a lot of holistic care,” Natasha Kumar, a fourth-year medical student at the Warren Alpert School of Medicine who volunteers at the clinic, said. “They recognize that medicine alone doesn’t fix chronic disease. It’s about changing people’s behaviors as much as it is about giving them medicine.”

In this vein, the clinic offers a range of programs to help patients make productive changes to their lifestyles. One class, Vida Sana (“Healthy Living”) teaches participants how to incorporate exercise into their daily routines and prepare healthier meals. Another, the Diabetes Prevention Program, encourages pre-diabetic patients to avert the onset of diabetes with targeted lifestyle interventions. Both programs are taught in Spanish, and the principal instructors are navigantes – bilingual community health workers who manage individual cases, help patients deal with the healthcare system, and serve as medical interpreters.

There is ample evidence that this sort of culturally-attuned educational programming is effective. A study in the Journal of Community Health found that 90 percent of Vida Sana graduates leave with a higher level of health literacy, and 60 percent actually enjoy a reduced risk of cardiovascular disease and diabetes.

In addition to its clinics tailored to diabetes and nutrition, CEHC also offers a Women’s Clinic, which started in May 2016.

“At CEHC, we found that there was a huge need for routine gynecological care, specifically cancer screenings like pap smears and mammograms that we weren’t yet providing,” Kumar, one of several students who helped organize the Women’s Clinic, said. The clinic now provides a whole range of services, from pap smears and mammograms to contraceptive care and counseling.

“CEHC has tried to make itself part of the community and bring the community in, so the clinic is a reflection of the community around it,” Kumar said. “It’s not ‘Come to us and here we are as a separate entity.’ It’s ‘We’re in the community.’”

A culture of volunteering

CEHC has a full-time staff of 12, and relies on nearly 300 volunteers – doctors, nurses, undergraduates, and medical students – to perform a wide range of functions, from administrative work to check-ups.

For medical students, clinics are a meaningful way to get experience with primary care. Students are responsible for noting down patient histories, conducting physicals, and determining diagnoses – all under the careful supervision of attending physicians.  

“At CEHC, the benefit to the student-run clinic is that students are able to spend a lot of time counseling and listening to patients, and I think that makes CEHC a unique experience for its patients too,” Kumar said. “We can have conversations with our patients that are just longer and listen to them more.”

Kumar started out as a volunteer at CEHC. Over the course of her medical studies, she became a volunteer coordinator, staffed the student-run clinic, and, last year, along with Gabi Duvernois, a fellow medical student, worked to set up the Women’s Clinic. Altogether, her time as a volunteer has indelibly affected her own approach to the practice of medicine.

“CEHC has shaped the kind of provider I want to be,” Kumar said, “because it’s taught me that when I approach my patients, I first have to learn from them what they need and what the community needs.”

Erik Simpanen, a research assistant at the Warren Alpert School of Medicine and Clínica Esperanza’s current volunteer coordinator, feels the same way. “Every time I came in, I felt like I was coming home, like I was with my family – just helping people,” he said.

Bridging the gap

Dr. De Groot hopes that, in the long run, CEHC’s preventative approach to healthcare can be a model of cost-saving and efficiency for community health programs.

“People who have their pre-diabetes identified – the value of that can be calculated in the millions of dollars. One person, millions of dollars saved,” Dr. De Groot said. “Why? Because you keep them from becoming diabetic and avoid all the problems that are associated with diabetes. Same thing with heart disease. Same thing with being overweight.”

Dr. De Groot estimates that CEHC’s preventive interventions save patients about $600,000 a year in medical expenses. And these savings can also accrue to government healthcare programs that eventually provide coverage to older patients.  

“Our concept is if you get people into care before they transition to healthcare, to insured care, then you can actually improve their health and reduce the cost of providing that care,” Dr. De Groot said. “And obviously there’s a benefit to the patient, to the community, to the country if we do that.” 

The clinic’s latest initiative – “Bridging the Gap,” an umbrella project that encompasses all of the clinic’s preventative work – is an attempt to measure the amount of money the clinic’s early interventions save.

“If we can show that getting uninsured patients into care, and engaging them in ‘self-management’ of their chronic diseases such as diabetes and hypertension will reduce costs in the long term when these same patients are insured, then we hope to get insurers to ‘invest’ in prevention at our clinic,” she said.

The clinic started tracking a group of 600 patients starting in March 2016; Dr. De Groot hopes to bump that number up to 1,500 in the next year. Every quarter, the clinic checks in on these patients – both when they are still receiving care from the Clinic and when they have transitioned to government-provided healthcare – and measures the costs associated with their medication and clinical care.

But the data-collection process is not easy. “The problem is it’s extremely labor-intensive to track all these patients. It takes many volunteer hours,” Dr. De Groot said. Ideally, the end result of this work is hard proof that CEHC saves the healthcare system money and ought to be reimbursed “for pre-insured care, with the money that’s saved by avoiding expensive complications that are associated with untreated chronic diseases.”

Standing up to D.C.

CEHC’s commitment to multiculturalism is not without detractors. In fact, the clinic’s core values clash directly with the priorities of the Trump administration, which has promised to build a wall on the Mexican border and clamp down on immigration. These measures could have a negative impact on the lives of people involved with Clínica Esperanza; the clinic’s patients and volunteers hail from a diverse array of countries, including Mexico, Syria, Egypt, Morocco, Tunisia, Afghanistan, Pakistan, and Palestine.

As such, Dr. De Groot finds the nationalism stoked by leaders in Washington deeply troubling. “We feel as if the country has gone backwards, rather than forwards,” she said.

In the meantime, while the political situation in Washington evolves, Dr. De Groot asserted that the clinic is “going to remain a place where everyone is welcome, whether their ethnicity is different, their country of origin is different, their sexual preference is different.”

“If we can provide free healthcare to those people, since they don’t have access to healthcare,” she said, “then obviously that’s good for them, it’s good for the community, it’s good for the country, it’s good for the future.”

More broadly, Dr. De Groot is frustrated by how little the federal government has done to reduce barriers to healthcare. “I feel that there should be universal access to healthcare, that healthcare is a human right,” she said. “For some reason, in this country we have decided not to provide universal healthcare. It doesn’t make any sense.”

The commodification of healthcare is to blame, Dr. De Groot said. The current model has made profitability the overarching goal of the healthcare system, as opposed to the quality of care.

“I don’t think health follows the same rules as everything else,” she said. “It’s quite clear that having universal access to healthcare makes people’s lives better. Those people can continue working instead of becoming sick. So there’s value to the economy, to the country. It’s taking a long time for people to understand that.”