"Inside each of us is a sense of decency and goodness and if we listen to it and act on it, we will give the world much of that which the world most needs. It is not difficult but it takes courage to listen to your goodness and act on it."
Made possible through a grant from The Robert Wood Johnson Foundation
Photograph Usage Permission has been received from The Island Packet and Hilton Head Monthly
Cover Design by Barbara Lisenby and Todd Hirshman
Printed in the United States of America by Data Reproductions Corporation
Published by The Estes Park Institute 3669 S. Huron Street, Suite 202 Englewood, Colorado 80110 303-761-7709
Dedication
To my wife, Mary Ellen, without whose support The Volunteers in Medicine Clinic, and this book about it, would not have been possible.
Fore\Vord
It happened on Hilton Head Island, South Carolina. It could have happened anywhere, but it did not. The spirit of possibility roamed the land looking for someone, somewhere , who could hear its voice and volunteer for its incarnation. The person who felt this gentle stirring of spirit was Jack B. McConnell , M.D. The place was Hilton Head Island. The time - a few years ago.
This little book is about the power of an unusual man and the passionate intensity of his purpose. It is about a group of people caught up with him in a vision of possibility. It is about changing the world and creating a better reality. Jack saw something he could not acceptwealth and poverty side by side - the haves and the have nots as neighbors, and the have nots without medical care. Many other people witnessed the same thing. They accepted it as "the way things are." Jack did not accept the obvious. He knew there had to be a better way. Furthermore, he was willing to commit himself to making a difference. This is the mark of a true visionary, and it opens the doors of heaven.
Dr. McConnell is a world changer. He is too modest to admit it, but under his unassuming, friendly, folksy manner is a loving heart and a very clever head. Without this winning combination of gifts, the Volunteers in Medicine Clinic would not be a reality for Jack's friends and neighbors.
It is not often a visionary shares his faith, hope , frus-
tration, anger, joy and euphoria. Such is the power of this book. It takes you ''backstage" where you can see what goes on behind the curtains. Move by move you will witness the play of Spirit through human vehicles and devices. You will sense the difficulty in moving a great idea from the subtle ethers to hard-rock reality. This book is full of the stuff it takes to make a difference. It is written with humor, but behind that humor is steel. Doing good is not easy in a world comfortable with social injustice, poverty, and apathy.
I have visited the Volunteers in Medicine Clinic. I can personally attest to its culture of caring. The mission statement and vision statement are living realities that greet you when you walk through the door. My first reaction was - it's amazing what you can do if money does not get in the way of compassion. This is an important lesson yet to be learned by many of the for-profit and not-for-profit healthcare facilities in America. I view the Volunteers in Medicine Clinic as a national destination and training site. Here the future is already happening. The spiritual and material dimensions are perfectly reconciled. It is a living example of the power of community to change people's lives .
The goods news is - the culture of caring can also manifest in your community. If you are willing to volunteer yourself to this spirit of possibility, it will move through you and take up residence in your place. Read this book to gain inspiration and resolve; then obtain the Clinic Start-Up Guide and receive practical guidance for implementing a similar vision in your community.
Leland R. Kaiser, Ph.D.
Ackno\Nledgernents
It would be impossible to mention all those who made a contribution to the creation of The Volunteers in Medicine Clinic. There are just too many. But I must thank the initial organizers who accepted the idea as their own and gave their full resources to making the "dream " become a reality. Included in that group are: Thomas C. Barnwell , Jr. who served as Founding Trustee and whose endorsement gave me all the encouragement I needed ; Ken Anderson whose organizational skills quickly brought order to a rough-cut idea ; John Clarke whose wisdom and gentle nature still stands us in good stead ; Mary Doughty who is the unsung hero of the clinic but whose modesty prevents her from claiming her reward ; Linda Silver whose advice kept us on a steady course; Kirk Glenn who still adds confidence and quality to the organization ; Dr. Jack Catlett who continues to provide steady and experienced guidance in the examination rooms ; Steve Caywood whose early support and protection allowed us to get underway and survive even in the face of enormous pressure; Buzz Carota who provided us with valuable insights into the local political scene ; Bill Stubblefield who brought experience and common sense to the decision making and Dr. K. C. Kunze whose support at critical times in our development was much appreciated . Dr. Diane Montella, our first Medical Director, transformed the retired physicians into a first-rate delivery team . Diana Maria Koncul , RN, our Director of Nursing, is the sort of person who causes one to believe in angels . Dr. Bret Williams , our present Medical Director, is the role model for what a true physician should be . The early effort
of Dr. George De Young and the continuing effort of Dr. Sherman Gans, along with the help of Una Jackson, have created a first class dental clinic .
Eileen Goulden, Kay Clark Nelson, Mary Hall and now Bill Haberman have all made a significant contribution to the lay volunteer program . Every day I am reminded of the splendid job Bill Fishburne did in constructing the facility.
Without the help of physician Representative Billy Houck, along with Sen. Holly Cork and Rep. Scott Richardson we might still be nothing but an idea. Cal Stewart, Dr. Bart Barone and Bill Mahon occupy a special place of honor and gratitude in my heart. Former Governor Carroll Campbell showed why he deserves to rank as one of the best governors South Carolina has ever had.
The leadership donations of Opal Duke Abbink, Edith and Henry Everett and Kathleen and Brock Rowley gave us the assurance we could consider a permanent facility for the VIM Clinic. The support of the citizens of this town , especially those of Bear Creek Golf Club, help to keep the clinic viable and dynamic.
The support of the island churches and the synagogue as well as the local newspaper, The Island Packet , especially Fran Smith Marscher, was critical in our development.
My thanks to Annette Brokaw for reading and correcting the manuscript and to Barbara Lisenby and Libbet Watson for their splendid graphic and editorial assistance . The suggestion of Dr. Joe Black, that we consider the retired community, and the support and encouragement of Kaye Black have been enormously helpful.
Last but by no means least I would like to thank the Robert Wood Johnson Foundation for their support of my dream of health care for all.
If I have left out anyone I should have mentioned I am truly sorry. Please chalk it up to a "senior moment ."
Following is an editorial from The Island Packet, dated Monday, March 8, 1993 . It is reprinted with permission .
Loo k Wh a t Cooper atio n I s Achi ev i ng He r e
Warm sunlight powered through the breezy air Friday as a crowd gathered to mark the groundbreaking for the future Volunteers in Medicine Clinic.
The non-profit , volunteer-operated free medical clinic has been established to provide health and wellness services to the medically underserved who live or work on Hilton Head or Daufuskie islands. It is a concept that has moved rapidly from an idea on New Year's Day 1992 to the point of constructing a $450,000 clinic on 1.1 acres of prime Hilton Head Island land .
The march has been well chronicled in The Island Packet. It has been led by the phenomenal Dr. Jack McConnell.
But a key point in the ceremony Friday in a lot across from the north-end Huddle House restaurant, was that the clinic has already involved the work of many, many volunteers. The media was given a list of the official committees, and we will share it here. This is by no means a complete list of all who have given significantly to the project
For example, it does not include Deep Well Project founder Charlotte Heinrichs, whose bright spirit defied her frail and tiny body as she sat perched on the front row of folding chairs Friday. Her presence signified her early and eager involvement , and it provided a link between the dreams of tomorrow and the island' s heritage as a haven for energetic retirees who find ways to help those who need it most.
The list does not include William Vitto, father of "Baby Brigette," who has designed the clinic building as a way of saying thanks to a community that reached out to help when his baby girl was ill. And it does not include the group of builders who will construct the clinic at cost, or the 138 professionals who have volunteered so far to work in the clinic .
And it doesn't include the government officials - both those elected, such as Mayor Harvey Ewing, state Sen . Holly Cork and state Rep . Scott Richardson , and adminis
trators such as town manager Mike O'Neill - who have pushed the idea forward.
But the list does give a glimpse at the width and breadth of volunteer support it has taken to transform an idea into a reality that already is capturing imaginations nationwide.
This is the board of trustees, chaired by Jack McConnell : Thomas C. Barnwell Jr., Kenneth Barick (secretary), Dr. Jack Catlett, Steve Caywood, John Clarke, Kirk Glenn (treasurer), Sandra Norvell, Brock Rowley, Ross Rutherford, Linda Silver, William P . Stevens Jr . and Bill Stubblefield.
This is the honorary board: Dr. Bart Barone, president, S. C. Medical Association; John Curry, chairman, Heritage Foundation; former Gov. James Edwards, president, Medical University of South Carolina; Creighton Likes Jr., chairman, S. C. Hospital Association; former Gov. John West, former ambassador to Saudi Arabia; and the Rev. Ben Williams, pastor, Mt. Calvary Missionary Baptist Church .
The following is the voluntary staff: Ross Rutherford, clinic director; Dr Jack Catlett, acting medical director; Dr. George DeYoung, dental director; Jean Bowen, director of nursing education; Mary Ellen Shephard, chief of nursing; and Mary Doughty, office manager.
The following served on the start-up committee: Ken Anderson, Bill Bennett, Ken Barick, "Buzz" Carota, Jack Catlett, John Clarke, George DeYoung, Kirk Glenn, Paul Glick, Lynn King, Jack McConnell, Sandra Norvell, Ross Rutherford, Linda Silver, Ron Seamon, Bill Stubblefield and Susan Wiener.
These did their work through the fund-drive committee: Ross Rutherford and Bill Stubblefield, co-chairmen; John Curry, Carla Gyetvan, Charles Johnson, Lynn King, John and Joann McCreight, Sandra Norvell, Dick Patrick, Rick Schmid, Joe Short, John Gettys Smith , Charles and Ellen Taylor, Mike Wyman.
Preface
Afte r food and shelter there is no more pressing need than access to health care. Yet, 45 million of our fellow citizens are left outside the system. The United States is one of the few developed countries in which all of their citizens do not have an easy access to health care. That need not be. In this book I have shown how it can be different. Everyone can and should have access to health care. It is entirely possible that all the towns in the nation can provide health care for their citizens . Every town has all the resources it needs to provide health care to all of its citizens .
This is the story of how our town , Hilton Head Island , South Carolina , solved the problem . A ctually, it is more than that . It is my story, the personal story of my journey in following my dream . Sr. Jennie Lechtenberg tells me that an idea without action is nothing but an empty thought. But an idea with action makes a dream come true .
I have followed my dream and it is one of the most meaningful and fulfilling things I have eve r done . Someone asked me how it compared to the achievements in my work career and I answered , without hesitating, all of that together doesn't compare to following my dream and creating The Volunteers in Medicine Clinic!
I urge each of you to find your dream - follow it - and enjoy the journey.
"James"
Ho\M It Began
The storm of the night had not quite finished. It was continuing to pelt the Low Country with a soft but constant rain, reminding us who was in charge of the weather. It turned the dirt roads and the paths into mud. As I drove out the back gate from the development where Mary Ellen and I had built our retirement home, I noticed a native islander striding down the path alongside the road. I was not surprised to see he had no umbrella, for that would have been uncommon and unmanly. He did not have a raincoat either. But he did have a mission . He was a man going somewhere with a purpose.
I slowed down as I approached him and asked if he would like a ride. He peered in and hesitated for a moment or two and then looked at the sky as if he were reading the weather. Apparently having come to an unsatisfactory evaluation of the climate and a satisfactory evaluation of me , he said, ''Yes, I would," and got in . After he settled in and we were underway, I suggested he fasten his seat belt . But then we rode along without speaking for a mile or so. I wondered who would break the silence.
"Where are you going?" I asked finally, unable to keep the silence any longer.
"To look for a job," he replied, staring straight ahead.
"Any particular place I can drop you off?"
"No," he answered, apparently leaving the choice to me .
"Do you live around here?"
''Yes, I live just back down the road."
"What kind of a job are you looking for?"
HOW IT BEGAN
''Any kind I can get," he said, followed by a long pause. I somehow knew he wanted to say more and gave him a moment to gather his thoughts.
"I have a wife and two children and we are expecting another and I just got laid off from a construction job."
I could not resist asking, "Does she have access to medical care?"
"No," he replied. "Ain't none of us does."
"Have you ever had access to medical care?"
''Yeah, when I was in the Army."
"Is that the only time?"
''Yeah. We have to take care of ourselves. Ain't no one else goin ' to help us."
About that time I turned down the main road on Hilton Head Island and headed south with no particular destination in mind . We soon passed a construction site and he wondered out loud if he might be able to get a job there. I suggested we wouldn't know if we didn't stop, so I pulled in the parking lot where the on-site trailer was located. Before entering, I asked my rider his name - James - and together we climbed the stairs to the manager's office. He told the manager he needed work. The man eyed James for a while then said that someone had failed to show up and if he could stay he could have some work for the next few days. They settled on a wage and he accepted the offer.
We shook hands and James turned to go but stopped in mid-turn. My new friend looked me in the eye for the first time and reached out and gave me a bone-crushing hug while he whispered into my ear, "I thank God for you, brother." We held each other by the shoulders for a moment and as he started to pull away he said, ''You have
HOW IT BEGAN
been a big help to me. Why did you do it?"
The question stopped me in my tracks. I could not immediately reply. It was a simple but very powerful question . Possibly the power lay in the simplicity. I had no ready answer, so I said slowly, "I don't know."
In fact, I did know. Over time I realized that the answer, in one respect, was that I could not do otherwise. My faith gives me an unconscious desire and need to understand and help others. But in truth I expect it was, at a deeper level, my desire and need to understand and help myself.
Throughout the whole of my life I have learned and relearned that it is only in service to others that we find and begin to understand ourselves. Until everyone is healthy and whole, none of us can obtain health and wholeness. In medicine it is that pursuit of health and wholeness for everyone which drives more of our decisions than we understand or like to admit.
Robert Frost tells us that every poem starts with a lump in the throat. I might add that is also the way to start a clinic for the medically under-served. Or at least that is how the Volunteers in Medicine (''VIM") Clinic on Hilton Head Island, SC, began - with a serendipitous meeting on a rainy day that transformed a rather routine retirement into one of the most exciting and rewarding experiences of my life.
HOW IT BEGAN
Building A Concept
INTRODUCTION TO THE PROBLEM
My wife, Mary Ellen, and I retired to Hilton Head Island and looked forward to the usual retirement activities: golf, good restaurants, travel and visits with family and friends. Despite knowing better, we somehow believed the Chamber of Commerce when they suggested that everyone on Hilton Head Island was beautiful , rich, played golf and tennis and dined each night in a different restaurant. How could anyone beat that?
We built our home in a comfortable, gated community, but were surprised when we drove out the back gate straight into actual poverty. The juxtaposition of relative wealth and such poverty was so striking and disturbing that I could not ignore it.
I soon made a habit of picking up native-island hitchhikers going to work or just strolling along the paths. In each case I would ask them where they received their medical care . To my surprise and shock, essentially every person said they had little or no access to health care. Applying my limited survey to the total population of the poor people on Hilton Head Island, I realized the problem must be quite large .
I asked others, professional and lay, if they were concerned about the lack of medical care for the indigent and if they had any interest in doing something about it. Only Dr. Joe Black, the pathologist at the Hilton Head Hospital, evidenced an interest and concern. In a discussion
BUILDING A CONCEPT
Dr. Joe Black
with him during the 1991-92 Christmas/New Year's holidays, he advanced an idea to which I had given some thought earlier - using the retired physicians on the Island as a resource for care giving. His reinforcement and encouragement of the idea was very important in starting me on the right path.
PRELIMINARY SURVEY OF CARE GIVERS
In early 1992, Dr. Cliff Tichenor and I assembled a group of 29 retired physicians and introduced the concept of providing health care to the medically under-served. Thirteen had good and valid reasons why they could not join in the effort . The other 16 said enthusiastically, "yes," but they gave me two formidable caveats. First, they did not want to put their life savings at risk to the possibility of a malpractice lawsuit; second, they did not want to pay
Dr. Cliff Tichenor
$1 ,000 and spend 6-8 hours taking the South Carolina state test for re-licensing when they had just finished practicing medicine for 30-35 years in another state.
I told them not to worry - that I would get to work on these two issues and be back in touch with them as soon as I had something to report. I left to attend another meet-
BUILDING A CONCEPT
ing thinking I had their whole-hearted support. But after I exited, they all agreed that it was a good idea but nothing would ever come of it. None of them mentioned their skepticism to me until the day we opened the clinic. Thank goodness.
GETTING OTHERS ON BOARD
Before I could tackle the two problems brought up by the retired physicians , I needed to know more about the size and scope of the target population as well as the problems and opportunities we were about to face. In mid 1992, I gathered a group of people who were willing to help and created an Organizing Committee . They were "troopers," every one of them . In fact many of them are still involved with the clinic five years later.
One of the group was Thomas C. Barnwell , Jr. I specifically sought him out as my first contact because of his experience in creating the first health clinics for the medically under-served in the Low Country of South Carolina. I wanted to learn as much as I could from him and to take advantage of his sage advice and expertise to keep focused on the proper solution . His input was invaluable . He and I were also the Founding Trustees of the organization . Dr. Robin Roark dropped in one morning and asked quietly, even shyly, if I thought he might be of help . On inquiring I learned he had a Ph.D. in "Listening". On the surface it seemed a rather limited expertise but in time he had a sigDr. Rob in Roark nificant impact on the cha r acter
BUILDING A CONCEPT
Thomas Barnwell and his marsh pony, Pat.
and culture of the clinic . He taught us anew that a caring heart and a listening ear are as therapeutic as a visit to a physician and much more difficult to obtain. "Listening" is what we do when we are at our most canng.
Another early member of the group was Ken Anderson , a very bright and energetic fellow with a most fertile mind.
K i rk Glenn He was one of the first people I contacted. I biked over to his house one morning and, working at the counter in his kitchen, we came up with Buzz Carota the name for the clinic - Volunteers in Medicine - and the Mission Statement (more about that later) . There was also , Ken Barick, an attorney who helped us
BUILDING A CONCEPT
incorporate and obtain a 501(c)(3) designation as a not-forprofit organization; Kirk Glenn, CPA, who provided invaluable financial advice; Buzz Carota, whose knowledge of local politics was very important to us; John Clarke, an engineer who , in addition to his wisdom, gave us advice on the practicalities of building a facility; Mary Doughty, a jack-of-all-trades and one of the most wonderful people I have h d 'll • Ross Rutherford, Mary ever met, w o was, an sti 1s, Doughty and Dr. McConnell one of the stabilizing forces of the inspecting the building site. clinic; and Ross Rutherford , a former foundation executive, whose management talents were called on frequently. Linda Silver was the Director of the Volunteer Center for the Island . Her knowledge of the Island and experience in the field of volunteering was invaluable.
We met every Friday morning at 7:00 a.m. for an hour in a suite of rooms located at the Volunteer Center and made available through the generosity of Bud Bright. Our meetings were primarily reporting and assignment sessions. During the first 40 minutes , members of the group would report on their assignment of the previous Friday and then the last 20 minutes was spent assigning new tasks. It was a pretty heady time for all of us.
I still remember with great joy those initial meetings and the contributions the members made. We had triumphs and disappointments , but at no time was there ever a sense that we had been "defeated." We were involved in a creative process and intended to see it through to realization. The dedication and commitment of the group to
BUILDING A CONC EPT
the idea of creating a free health clinic for the medically under-served was essential for the completion of the dream . The members of the Organizing Committee held true to the course . They were, and still are, among the people I most admire .
We faced a number of hurdles (we took the position that there were no barriers , only hurdle s to jump over, go around or scoot under) many of which were new to us but which we were managing at an alarming pace. The two biggest ones, malpractice insurance and easy access to relicensing, were much more difficult , and will be discussed in detail later on .
We developed a process for visualizing and understanding the issues by using charts, mottoes , overhead slides and other aids. It was our position that if we didn't know what the issue was , we couldn't discuss it and come to grips with a solution. We organized the work , made assignments and scheduled a timetable for response.
It was a process with which I was familiar but it was Ken Anderson (the project engineer on one of the radars for the Atlas Missile used to launch John Glenn) who transformed our program management into a Decision Tree suited to our particular purpose. For those who may not be acquainted with a Decision Tree, it is a chart , several feet long, which presents all the major activities and issues , and the order in which they must be addressed. It is an enormously effective tool in directing a group , clarifying issues , use of resources (personnel , time , money, etc.) and introducing new members into a group, giving them a clear picture of what has gone before , what is to come and the part they will be expected to play. Ken's contribution boosted our effort into orbit.
BUILDING A CONCEPT
SIZING THE PROBLEM
One of the first tasks we needed to work on was conducting a demographics survey of the target population. To do this we obtained the addresses and phone numbers of many of the businesses on the Island and wrote each one a letter explaining who we were and what we were trying to achieve. Then we borrowed a set of phones from the local phone company, Hargray Telephone, and made follow-up calls to inquire about the number of people they employed who were without medical insurance. The merchants were surprisingly cooperative - we obtained information from well over 85% of the businesses on the Island. We discovered that one out of three of our fellow citizens (8,000-10,000) had little or no access to health care and that over 98% of them would welcome a clinic where they could obtain treatment for themselves and their families. These data were extremely important. Essentially every decision we made from this point forward was determined or shaped by the needs of the target population. These decisions included the type and scope of the services, the size and qualifications of the group of care providers, the equipment and furnishings needed, materials and supplies, and size and shape of the facility.
DISCOVERING WHO WAS FOR, AND WHO WAS AGAINST, A FREE-CARE CLINIC
Possibly I shouldn't have been, but I was surprised at the resistance, and at times outrage , of some of the Board members and one or two physicians at the Hilton Head Hospital toward the concept of a free-care clinic. Giving these contrarians the benefit of the doubt, I feel that they obviously had not thought the concept through. We were
BUILDING A CONCEPT
preparing a facility which would - and did - take most of their non-paying patients out of the emergency room and restore them to good health so they were less apt to need hospitalization .
Opposition was widely scattered throughout the hospital's Board of Trustees. I heard on several occasions of Board members who did not think very highly of the project . It was very frustrating because not a single one of them had the courage to come to me and tell me faceto-face how they felt. But that did not keep them from trying to sabotage the project by rumor, innuendo and occasional behind-the-back strong criticism.
Some of those who recounted the unkind remarks asked if I wanted to know who the critics were , and I said, "No! They will probably do more harm to themselves than they will ever do to me or the project by their devious attacks. And I hope you don 't put any more credence in what they say than I do. The next time you see them please tell them to bring their criticisms to me . I would love to meet them face-to-face to discuss their concerns and hopefully learn how we can work together productively for the medically under-served ." Not one detractor has shown up yet and I'm not holding my breath waiting for them to appear. I am too busy enjoying life and my new-found career.
After we were well into the planning period, I also remember hearing from several sources that one or two of the physicians in town criticized me and the project rather harshly, apparently believing that we would be a competitor. I tried several times , without success, to reach these people by phone to discuss their concerns. A few months later I was asked to speak to a group of practicing physicians. One of them took this opportunity to openly criticize
BUILDING A CONCEPT
the project. I heard him out, and when he was finished I said , "I am surprised you feel the Volunteers in Medicine Clinic will take patients away from you . Just tell me how many of our non-paying patients you want and I will see that you get every one of them ." The other physi cians nearly laughed
Dr. David Baehrans him out of the room. He not only stopped complaining about our project but, to his credit , became one of our strongest supporters . Fortunately, we did have s ome strong supporters at Hilton Head Hospital. These were: Director of the Emergency DeDr. K C. Kunze partment , Dr. David Baehrans; President of the Medical Staff, Dr. K.C. Kunze; and CEO of the hospital, Steve Caywood. They were wise enough and experienced enough to see the potential benefits for all segments of society involved in the projectthe care recipients , the retired care providers , the hospital and the hospitality, landscaping and construction industries on the
Steve Caywood
BUILDING A CONCEPT
Fran Smith Marscher
Island . Without their help and support, developing the clinic would have been a much more difficult task . Another important and indispensable ally was the local newspaper, The Island Packet . Then-editor Fran Smith understood exactly what we were trying to achieve and the potential benefit to the community. The articles and the editorials which followed were very supportive and helpful in acquainting the community with the idea.
While I am sure all the churches supported us philosophically, only a handful of them, and the local synagogue, spoke out strongly in favor of the idea . Being "a child of the parsonage," this lack of total response bewildered me. My father would never have stood by silently when support was needed for a struggling project which held out promise for the poor or needy.
VALERIE
During the early planning stages of the clinic, in 1992, I met President-elect Bill Clinton and spoke to him about the benefits of a free clinic for the poor and suggested that this concept might be a partial answer to the problem of the medically uninsured. He took notes but I heard nothing from him, in spite of the fact that I tried several times to contact the person whose name he gave me. It is possible I would have had a better relationship with the President and the First Lady, Hillary Clinton, if
BUILDING A CONCEPT
Dr. McConnell, Hillary ''Valerie" Clinton and Kate McConnell. I had not called her "Valerie." For the life of me I can't figure out why I did it. I know only one person named Valerie and she is definitely not the wife of the President of the United States. I was terribly embarrassed and told her so. She handled it beautifully by saying, while pointing her finger gently at me, "Never mind what you call me. But I am very interested in what you have to say."
I thanked her for the rescue and continued the conversation ... only to make the same mistake at the end of the conversation when she asked:
"You will keep me and Bill informed as you progress with this, won't you?"
"I certainly will, Valerie." She threw up her hands and said with a bit of a laugh, "There you go again."
She may not have thought much about my idea, but she never forgot who I was. I saw her the next year at Hilton Head and, as we approached each other, she pointed to herself and said with a good -hearted laugh , "Hillary,
BUILDING A CONCEPT
Hillary." Even though I was one among hundreds she met that day, she remembered my name ... even though I had forgotten hers. I loved her for the forgiving way she handled the situation.
The ''Drea111''
OUR MISSION AND VISION STATEMENTS
One of the fun things in life is to develop a concept which is inspiring to those we respect and admire. The idea of a free clinic seemed to have great appeal for people of all walks of life - retirees, young people, the target population, the practicing community, the local newspaper and the national television news.
I think the appeal of the idea came from both its power and simplicity. It did not take long to explain it to others ; however, it had enormous depth as well as the capacity to transform lives . Selling the dream was not difficult . Once understood , the concept of a free clinic for the poor was readily accepted and embraced.
As committed to the idea as I was, I was still surprised by the interest expressed here and elsewhere. We did not seek publicity, but it certainly sought us. Hardly a week went by when we did not receive a request for an interview or an invitation to speak to a group about the clinic. In some ways the requests and calls were an "interruption, " but in reality I expect they were part of what our work was all about. I supposed I wasn't given the idea of creating a free clinic to hide it under a bushel.
I spoke to virtually every organized group on the Island . I had no difficulty speaking at any time about how much joy I felt helping those in need. When is comes to speaking about the VIM Clinic or asking for money for it, I am shameless. Others in the clinic did the same. They made
THE "DREAM"
themselves available to speak for and about the VIM Clinic on many occasions.
Two things which made the dream easier to sell were the Mission Statement and the Vision Statement. People could quickly and easily understand what we were trying to do and how we were going about it.
Our Mission Statement says what we planned to do, where and with whom. It was quite clear and specific. It was developed primarily by Ken Anderson, with a thought or two thrown in by me, one morning at his kitchen counter very early in the development stages of the clinic. He cap- Ken Anderson tured immediately what I was trying to do and how I wanted to do it . His words have not been changed except to enlarge the Mission Statement to include, "and their households" .
I love the clear, concise nature of our Mission Statement . No one can have any doubt about what it is we wish to do. It goes like this:
MISSION STATEMENT
Our mission is to understand and serve the health and wellness needs of the medically under-served and their households, who live or work on Hilton Head and Daufuskie Island.
Our Vision Statement, on the other hand, was created by an entirely different approach. Each morning Mary
THE "DREAM"
Ellen and I take time for reading, meditating and prayer. It is a very special time and so enriching that neither of us would want to start the day without it. One morning I read a short prayer by The Rev. Thomas Hawkins, a theologian on the faculty of McCormick Seminary in Chicago. I was so impressed by it that I added a line or two at the end. It is not only the Vision Statement of the VIM Clinic but the guide by which I live my life.
VISION STATEMENT
May we have eyes to see those rendered invisible and excluded, open arms and hearts to reach out and include them, healing hands to touch their lives with love, and in the process, heal ourselves.
If you find merit and value i n either of these statements, please know how welcome you are to accept them and use them for your own benefit. As with love, words of wisdom are good only if shared.
SCALING THE DREAM
Toward the middle of 1992 , we turned our attention to putting some practical limits around our "dream." What could we do? Who would do the work? Where should it be done? In what sort of facility? How should we perceive ourselves and those we would serve? How did we want to be perceived by our patients and the community? Even though I did not realize it at the time, this last issue was the most important element of the development phase. The answer to it and all of these questions would define us for years to come. Such analysis could either limit the
THE " DREAM "
"dream " or provide a beacon to guide and drive us to an increase in excellence . It is the latter, an increase in excellence , which I feel should be the ultimate goal of every operation , but especially a health clinic for the poor. The survey of our tar, get population would necessarily come
Dr. McConnell "sta n ding by" the in to play in Vision Statement. many, if not most, of our decisions. I cannot emphasize too much how we relied on the survey results to guide us in our decision making.
It was decided that we needed to "scale the dream"that is, to compare what we wanted to do with what was appropriate , possible and practical. After our success with the Robert Wood Johnson Foundation (described in the next chapter), we had to believe in our ability to obtain funds not only for the program but also for a facility.
First, a staff sufficient to satisfy the demand for care was mandatory. The worst thing we could possibly do was to encourage this group of individuals , who had never had care, to come to the clinic and then not be able to accommodate them. Not only would their immediate needs not be met , but such lack of organization could have been construed as another failed effort by a bunch of "do-gooders" with more heart than common sense . I did not want that to happen!
THE "DREAM"
This much we knew:
There were 8,000 to 10,000 patients to whom we would be providing health care, most of whom ( ~85-90%) lived on the Island. The rest commuted to work here;
• They had had little or no access to health care their entire lives;
• We had 16 physicians and probably an equal number of nurses to deliver the care;
• We had no place in which to deliver the care;
• The Hilton Head Hospital Board and Administration, with the exception of the CEO , Steve Caywood and two or three others, were, at best, only partially supportive of us;
• The Chairman of the Board of the hospital was becoming less supportive as he moved to sell our local (and only) hospital on the Island to an HMO;
• We could not expect the support of the hospital;
• We needed our own facility;
• We needed to be able to survive as an independent entity.
SELLING THE DREAM
I found it very helpful to cooperate with the media. They can validate a person or project quicker than almost any other group I know. Fran Smith Marscher, then editor of our local newspaper, The Island Packet, knew of our work and gave us coverage whenever it seemed appropriate. The paper's support helped enormously in selling the idea of the clinic and helping us raise sufficient funds for the program .
Support was also needed, and forthcoming, from the churches of the African-American community. Our native-
THE "DREAM"
islander churches are much more than houses of worship - they are also community centers , gathering places, and forums for ideas. We knew that , without their endorsement, we would have a very difficult time reaching church members who needed our services. Obtaining their cooperation was one of the most rewarding experiences of my life.
I recall an occasion when we wanted to get the word out about our immunization activity - which we started in 1993, before we opened for full-service medical care in 1994. I called the pastor of the largest church on the Island for the African-American community, The Rev. Ben Williams, and asked him if he would please distribute flyers about the immunization clinic. He readily agreed to help us.
I asked when it would be convenient to bring the flyers by.
"Saturday," he replied. "What time Saturday"? "High tide."
A bit taken aback by his answer, I asked him , "Why high tide, Reverend?" He explained that was when they were going to baptize some children . I asked if he would mind if my wife and I came along. He said, ''You will be most welcome, doctor."
At high tide on Saturday morning my wife and I appeared all dressed up and met with the Rev. Williams and discussed the immunization program . He was clothed in a long white robe. Nearby were four precious children, all wrapped in white from the tops of their heads to the tips of their shoes.
We set out from the church toward the creek, with Dea-
THE "DREAM"
con Bryan leading the way. He was carrying a tall shepherd's staff approximately eight feet long. Behind him was a collection of about 20 church members with the four little ones in tow. My wife and I and the pastor brought up the rear. Some of the women up front began singing softly and the rest responded in kind. It was a beautiful scene. The sun was shining, and except for the birds singing, all we could hear was the rich, soft singing of those
of us headed to the creek for the baptismal. When wearrived on the bank, Deacon Bryan marched straight into the water and found what he determined to be the correct spot and, with great certainty, set the pole in the creek bottom and declared the baptizing could now begin.
At this point Rev. Williams, who had been carrying a very large Bible, said he was going to read from the Bible and asked if I would hold it for him while he waded into
Rev. Ben Williams and Deacon Bryan perform baptism.
THE " DREAM "
the water. I agreed. Then he asked, ''Will you please lead us in prayer after I reach the spot for baptizing?" Without knowing what I was going to say, I agreed.
He began to read in his wonderful deep baritone voice. I thought for a moment I was listening to John the Baptist himself as we stood at the water's edge preparing to baptize the little children. The dock workers , preparing their boat for shrimping, stopped what they were doing , took off their hats , flicked their cigarettes into the water and leaned silently on the railing of the boat throughout the whole of the ceremony. They understood the importance and the beauty of the event which was occurring.
It came time for me to pray. I walked to the water's edge to be as close to the Rev. Williams as po s sible. I wanted to draw strength from him for the prayer - his presence was that inspiring. Just as I was getting ready to pray, I looked up and noticed the beauty and grandeur of the sky, marsh and creek. Out loud , I thanked God for this special place and special people, especially the children. I reminded each of us of our responsibility in the raising of these children , pledged myself to the task and prayed that the others present would do the same. I prayed fo r The Rev. Ben Williams and recognized that he was not only the pasto r of this congregation , but of the Island. I prayed for his health and longevity and that his spirit of love might become the s tandard for all of us. I closed by recognizing that God came to us in many ways, but never more than in the children he gave us. I prayed for their safety, health and deep spiritual growth that they might fulfill their potential and be a joy forever to their families and to God.
The little children were marched into the water one by one . After the last one was baptized, the shrimpers put
THE "DREAM"
their caps back on and returned to work. We all took pictures, hugged each other and started to file back to the church. Then we really sang. It was no soft, tentative singing. I am sure God heard us all the way to heaven.
THE "DREAM"
THE "DREAM"
their caps back on and returned to work. We all took pictures, hugged each other and started to file back to the church. Then we really sang. It was no soft, tentative singing. I am sure God heard us all the way to heaven.
THE "DREAM"
T1No Large Hurdles
MALPRACTICE INSURANCE
Sooner or later I knew I had to face the issues of malpractice and re-licensing, so I chose to pursue malpractice first because I thought it would be the more difficult of the two. I called the President of the South Carolina Medical Association, Dr. Bart Barone , a very wise and caring surgeon in Charleston, and asked him if he knew who provided malpractice insurance for most of the physicians in the state. He told me it was the Joint Under- Bart Barone writing Association (JUA) and that I should contact Cal Stewart. Dr. Barone's advice was among the best I received during the entire start-up process of the clinic.
Mr. Stewart turned out to be one of the wisest, most concerned, compassionate and solid businessmen I have ever met. I shared with him my need for very low-cost malpracCal Stewart tice insurance to enable retired physicians to treat the poor free of charge. He did not then
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set out to find out what was wrong with the idea , as most people I contacted did. Instead he approached this ''hurdle" by trying to determine how he and the JUA could be the most help to us. After a thorough discussion of our idea, the JUA agreed to provide unlimited malpractice insurance, with a 21-year "tail" for everyone, professional and lay, involved in the clinic, for a total annual cost of slightly less than $5,000 . That was not per person, but for everyone! And , as we had no malpractice lawsuits filed against the clinic during the first year of operation, I asked the JUA to cut the annual premium in half the next yearand they agreed!
Not only have I enjoyed the benefit of the generosity of the JUA for the VIM clinic , but in Cal Stewart I sense I have one of the best friends I have ever had or ever hope to have. I admire enormously his wisdom and common sense, and still seek his advice.
RE -LICENSING THE NURSES AND DENTISTS
The nurses were, and still are, a joy to work with. The
D r. Jean Bowen task was made much easier for me when Dr. Jean Bowen appeared on the scene . She came to the office and rather hesitantly said, "I am a nurse and I wondered if you would have use of someone with my background ." I asked is she had a resume and she produced a package fully one quarter an inch thick. I learned she was not only an RN but also had her Masters and Doctorate
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Degree in nurse education . She had created a nursing school for the disadvantaged and the students were the disadvantaged. They came from "the projects " of Hartford , Connecticut. When Dr. Bowen retired the Governor honored her by declaring it "Dr. Jean Bowen Day" throughout the State of Connecticut. And she asked if we could use her. You bet we could! She made our life much easier and organized a first rate nursing group.We had a few initial concerns about their licensing process . There was a sixmonth window in which any nurse could receive a South Carolina license just by applying for it based on reciprocity with another state. Dozens of them signed up . Licensing of nurses is more difficult now. They have to have 900 hours of experience in order to apply. Fortunately, work in the clinic is accepted.
The Dental Board of Licensure adopted some stiff requirements for re-licensing our dentists. The applicants have to pass a "practicum" on a dummy set-up. The test is given in Charleston, 100 miles away, only three or four times a year. For a dentist to practice in the clinic , they have to be dedicated . We are grateful so many of them have demonstrated that dedication.
At one point in this process, the Dental Board was going to request that there be a dentist with a valid South Carolina license on site at all times . I finally convinced the Board that there were no dentists who wanted to stand around watching others work . They accepted my reasoning and gave up on that particular requirement . The Dental Board finally accepted our counter-proposal, which included language that required practicing dentists to review the charts of our dentists on a regular basis and pass judgment on the quality of care delivered. Fortunately we have
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several practicing dentists who donate their time on a fairly regular basis.
RE-LICENSING THE RETIRED PROFESSIONALS
Obtaining re-licensing for the volunteer physicians was an entirely different experience. I went from joy and exhilaration regarding our successes with the JUA and relicensing the nurses and dentists, to frustration and disappointment at my initial inability to deal effectively with the South Carolina Board of Medical Licensure, (SCBML).
As I recall , the SCBML was composed of twelve members, eleven of whom were voting members, with the twelfth serving as a non-voting President of the Board . At the time, I was 64 years of age and all of the voting members were my age or older, with one or more in their eighties. They seemed, for the most part, to me to be a rather unhappy and joyless group and, unfortunately, not at all open to new or creative ideas, particularly when the idea was offered by someone who had just moved to South Carolina from the North - of all places. This was certainly my impression, as related below.
I made an appointment with the Board, and acquainted myself with their names and faces and , to the extent possible, some pertinent background information. Except for the President, a personable and well trained 45-year-old radiologist from Charleston, they were mostly general practitioners working in smaller towns scattered around the state. There was one lay member who, unlike most of the others, gave evidence of a bright and inquisitive mind.
I arrived in Columbia at the appointed hour and place and noted they had given my petition only 15 minutes in the late morning - not a good sign. As I was about to en-
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ter the meeting room, a young man in his mid-thirties came out looking so pale I thought he might be ill. I approached him and asked if he needed help. He did not answer but it was obvious he was becoming increasingly unsteady on his feet. I walked him to a reception area where we could sit down. Without looking at me he began to tell me how he had come to South Carolina from the Philippines where he had graduated from medical school near the top of his class and trained in cardiology. Shortly thereafter, a group of physicians in South Carolina had offered him the opportunity to practice medicine with them in this state. The offer was a chance of a lifetime, he explained. He could provide for his family and raise his children in a safe environment, one which respected the rights and dignity of everyone.
"But," he said, "I have just gone through the worst experience of my life. I have been grilled and treated as if I have come to the United States to 'steal' something from the members of the Board. All I want to do is just practice my profession and be a good citizen of the United States. What can I do?"
I listened to him for a few minutes more but, except for getting him a cup of water, had to leave in order to keep my appointment with the same Board that had left this poor man shaking in his shoes. I told him I would be back to look after him.
When I entered the room I noticed a stream of petitioners waiting, each with a thick sheaf of official looking documents in their hands and a look of deep anguish on their faces. Recalling the comments of the young man from the Philippines, I could understand their concern.
The Board was seated on a dais behind a long table
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which curved gently, so each member of the Board could see the others seated at the table . Between the grilling of the terrified petitioners, there was no small chatter or conversation. The room was eerily quiet except for the shuffling of papers and the sound of Board members gulping swallows of water. The temperature of the room was higher than necessary for a mild April day in South Carolina. Afterwards I wondered if they purposely kept the room warm so they could gauge the anxiety level of the petitioners by watching them perspire.
When the time came I introduced myself and told them what I was seeking -a waiver of all fees and tests for those physicians who wished to practice without compensation in a free health clinic for the medically underserved.
I had expected some questions and discussion, but instead there were none , only negative comments. One of the older members had been chosen, or rather, I expect, volunteered , to be spokesperson or "leader" on this issue. He proceeded to tell me that although a free health clinic might seem like a good idea to me , this Board would not allow it . No reason or explanation was given. They simply would not allow it!
Each time this man spoke , a cur i ous thing occurred . After he made his comments , there followed a series of echoes from many of the other members of the Board: They mumbled the last few spoken words while at the same time firmly pounding the table, as if the idea I had proposed was dangerous and needed to be dealt with forcefully and pounded out of existence. The echoing seemed to be a chain reaction that flowed from the center out to the edges of the group . I was so fascinated by this phenom-
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enon that I paused in my presentation to study it. I had never experienced anything quite like it.
The idea of retired physicians providing care to the medically under-served seemed to me to be rather straightforward and to have great merit, so I asked, "Can you please explain to me why you cannot allow the idea to be discussed and pursued?"
I don't think the leader had expected or welcomed questions, so he hesitated before responding. "We cannot allow it because we have to treat everyone the same in South Carolina ." And again I heard a low rumbling and mumbling from the rest of the group echoing, as best as I could make out , "... treat everyone the same," thump, thump.
I replied, "There are 8,000 to 10,000 people in my part of the State who are not receiving any treatment at all." I had intended to continue but the leader grew a little red in the face and said with great emphasis, "Doctor, you have taken my words and distorted them." Again there followed an echo, "... distorted them," and a resounding pound on the table. I agreed that I had, indeed, taken his words and turned them around; however, I was just trying to understand the logic of his position.
Quick as a flash he said, "We have to require the fee and the test of everyone in order to assure high-quality medical practice in South Carolina." I asked if they had had this policy in place in South Carolina for a long time and he responded, "For several years." Again the echo , "... several years," thump, thump.
I continued to press my point. "If that has been a policy you have had in place for several years and it is the way you attempt to assure high quality medical practice in South Carolina, then why is South Carolina in the bottom
TWO LARGE HURDLES
three states of the nation by any medical parameter you can measure? I respectfully suggest, sir, that what you have been doing is either not enough or the wrong thing. Possibly a new approach along the lines I have suggested might be worth a try."
Well, one might have thought I lit a bomb under the man - he stood up half-way and, hovering above the table, condescended: "Son, I think we have heard enough of this and we ain't going to he'p you . Thank you and good day, son." "Good day, son ," accompanied by fists pounding the table, echoed in my ears.
I don't know whether I was more fascinated by being called "son" at my age or the abrupt turn-down. I paused, dropped my head and while rubbing my forehead thought to myself - you have now got yourself in a fine mess. The project is going down the drain and there appears to be little, if anything, you can do about it. I then sent out a quiet prayer: "Lord, you got me into this. Now what do I do?"
While I still had my head in my hands trying to sort out what had just happened, the lay member of the Board spoke up, much to my relief "I don't know why these physicians don't want to take the exam. I took it and almost passed it."
I was shocked by this remark, but recovered quickly. "ls this the way you assure high-quality medical care in South Carolina , by demanding a test which a lay person can almost pass? And yet you won't give a license to physicians who have practiced for 30 to 35 years on the other side of our state border and who want only to treat the medically under-served?"
The leader jumped to his feet and, sputtering with rage,
TWO LARGE HURDLES
growled, "This part of the meeting has been concluded. We ain't goin' to he'p you and we have told you so. If you want anything done in this state you gotta go through the legislature. You might as well get your hat and coat and get outta heya. Good day, son."
I was so stunned I don't remember if there was another echo or not. I thanked them for their time and said I hoped to come back and continue the discussion when we both could think the idea through a bit more. I then went to the bench and shook the hands of many of the members. But there was no doubt they did not like the idea , or, possibly, the way I presented it.
I left the room wondering how I could have been so ineffective in presenting such a good idea . Once outside the room I looked for the fellow from the Philippines to see if I could be of help to him, but he was nowhere to be seen. I left hoping he would have better luck at his next appearance before this intimidating Board. It was well into the lunch hour but, for the moment , all I wanted to do was get in my car and get as far away from the SCBML as possible.
The long, three-hour drive home was one of the lowest points of my life. It seemed that during my brief audience before the SCBML , all the work I and my volunteer staff had completed may have been for naught - our precious idea was shot down. After about an hour of feeling sorry for myself, I said myself: That's enough of that. Now let 's review the facts and events and try to figure out how a simple request for regulatory relief from the Board turned out so badly and what we can make of this predicament. Before too long, I remembered the words: If you want anything done in this state you have to go through the leg-
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islature. "There's the solution!" I shouted out loud. "That nice man who served as leader told me how to solve the issue. Go to the legislature!" I even echoed it a time or two and pounded my fist on the steering wheel in gratitude to the Board and its spokesman.
That night I called a friend close to the political scene in Columbia and asked him if there were any physicians in the General Assembly. He said there was a feisty fellow from Florence, Rep. Billy Houck, who was a physician serving in the House. I got his phone number and called him the next day.
I introduced myself and told Rep. Billy Houck him what I was trying to do and wondered if he would be willing to help me . He declared he was not surprised at the treatment I had received at the SCBML. He confessed he had once been a member also, but had resigned because they were some of the "most stubborn and pig-headed people" he had ever seen.
I asked if he would help me get a one-sentence amendment attached to any bill currently under review in the legislature which no one was going to read and everyone was going to vote for. He assured me , in no uncertain terms, that such a bill did not exist. Desperately seeking a solution, I tried to reason that since the General Assembly would be adjourning in less than six weeks , the pressure on legislators to pass bills would be as frantic as feeding time at a piranha tank . Rep. Houck liked the metaphor and agreed to try my approach, but first he wanted to
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know what the amendment should say.
At my suggestion, he contacted Senator Holly Cork and Rep . Scott Richardson, both from the Hilton Head district. The three of them worked together very effectively. A few days later I received a call from Rep. Houck letting me know he had found an appropriate bill and that I should "keep quiet and out of sight" for a while. The day before the closing of the General Assembly, he phoned to tell me to drive up to Columbia next weekand bring my pen. We were going to have a signing party with Governor Carroll Campbell. It Re v. Ben Williams, Rep. Scott Richardson and Sen. was only Holly Cork attend the dedication ceremony. then that I learned of the strong support Gov. Campbell had given to our project, working quietly behind the scenes.
Incidentally, the final draft of the amendment read:
"The South Carolina Board of Medical Licensure shall, by November the first, develop regulations leading to the creation of a Special Volunteer License, with a waiver of all fees and tests, for those physicians who wish to practice without compensation in a health clinic providing care to the medically under-served."
It was appended to a bill that advocated creating a computer database for all injured South Carolina veterans.
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Billy Houck was confident no one would study it too closely and that everyone would vote for it.
The passage of the bill with the attached amendment creating a "Special Volunteer License" would solve my problems with SCBML - or so I thought. I was destined to have additional discussions with them regarding the creation of a Special Volunteer License.
I waited forty days and forty nights (something biblical about that, it seemed to me) to hear from the SCBML. Finally, on the morning of the 41st day, I called and asked them when they would like to get together to discuss the "Special Volunteer License" bill that had recently been passed by the South Carolina General Assembly and signed by the Governor.
The poor fellow who answered the phone, obviously caught off guard, shouted back, "WHAT BILL?" Being as helpful as I could, I explained that I had taken the Board's suggestion and gone through the legislature to effect the re-licensing changes I had proposed. In a panic he shouted, ''WE DID NO SUCH THING!" I then confessed I was so uninformed of the proper procedure to follow in South Carolina that I could not have learned it any other wayand that I was certainly grateful. He asked for my phone number and a faxed copy of the bill. The Board would study it and call me back, he said .
They did call three weeks later and declared they had no intention of following the instructions in the bill . I asked if the Board had read the bill and, if so, were there any questions I could answer. They told me they did not need my "hep" and hung up.
The SCBML notified me they had scheduled a meeting to discuss the re-licensing amendment on October 28,
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1992, three days before the deadline to have regulations drafted as directed by the General Assembly. I called to ask if I might appear and if I might bring others with me. They said that would be "within the law." The reply was so dry I felt I could have blown dust off the receiver.
I assembled a group consisting of State Representative Billy Houck, MD, who wrote the amendment to the Bill; Margaret Key, Legislative Assistant to the Governor regarding Health Care Affairs; Dr. Bart Barone, President of the South Carolina Medical Association; the Executive Director of DHEC; a representative of the President of the Medical University of South Carolina; Creighton Likes , Chairman of the South Carolina Hospital Association; Steve Caywood, CEO of our local hospital, as well as the Medical Director, Dr. Hal Hunter; Dr. K. C. Kunze, President of the clinic's Medical Staff; my associate, Mr. Ross Rutherford; and Mr. Thomas C. Barnwell , Jr., Founding Trustee of our Board . This was a formidable team of proponents willing to speak in favor of the amendment.
In addition, there was a large audience present to hear the outcome of our petition. Among them was Cal Stewart of the JUA. His attendance was further tangible evidence of his deep support for our project.
To support their opposition, the SCBML had obtained a letter from Dr. Sidney Wolfe, the "medical expert" for Ralph Nader, which warned , "There is a renegade doctor loose in South Carolina trying to create a two-level healthcare system with a good one for those who can pay and a poor one for those who cannot."
Dr. Wolfe was well known among the medical community as an "expert witness " for virtually any and all malpractice suits around the world. He claimed to be an "au-
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thority" in essentially every facet of health care. Although I didn't mind that he had written the letter, which was read at the hearing, I was darn well aggravated when I learned that he, or someone at the SCBML, had sent a copy to The Robert Wood Johnson Foundation , our financial underwriters!!
(As might well be expected , the RWJ Foundation asked for a detailed rebuttal to Dr. Wolfe's charges , with the implication that if our explanation was not satisfactory, funding for the clinic would be cut off. I wrote a four-page reply putting the episode in perspective and closed by saying that Dr. Wolfe promoted himself as an expert in everything, which by definition made him an expert in nothing. I asked that they give no more credit to his remarks than I did . I didn't hear any more from the foundation about it.)
All of the speakers we brought along were excellent, but
Thomas C. Barnwell, Jr.
none as effective as Thomas C. Barnwell , Jr. - a handsome, low country native-islander African-American with a wonderful baritone voice. He began his speech by saying, "I am Thomas C. Barnwell, Jr. I was born and raised on Hilton Head, as were my parents. While my grandparents lived on Hilton Head I do not know where they were born. They were slaves. I hope you have read my remarks made on the six occasions when I was invited to address the House and Senate Health Committees in Washington on the wretched state of health of
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the poor in the Low Country of South Carolina." All the SCBML members at the table dropped their heads and acted as if they were otherwise occupied.
Thomas continued, "I will accept the vertical drop of your heads as a 'yes ' reply." He then went on to underscore the wretched state of health of the native islanders in South Carolina and particularly those on Hilton Head Island. He spoke in great detail, without using a note, for about 10 minutes. He closed by saying, "I am not here to 'ask' that you create these regulations, but rather to DEMAND it with the full knowledge that it is owed to us and is a debt which has been overdue for the last hundred and fifty years or more."
He walked away from the microphone with enormous dignity and pride. I resisted my immediate urge to stand and applaud, knowing it would disturb the atmosphere he had created. The President of the Board asked rather meekly if anyone else had something they would like to say.
I rose and walked to the microphone with a sheaf of papers - letters, I explained to the Board, which I wished to send to their hometown newspapers telling their fellow citizens how proud they should be of the SCBML for its instrumental role in creating an entirely new kind of care for the medically under-served in South Carolina . I hoped to submit them as soon as I heard the Board members had written the regulations as called for in the bill creating the Special Volunteer License.
However, I advised, "I stopped by our attorney's office this morning and he instructed me to tell you that if you continue to obstruct the instructions of the General Assembly of South Carolina, you will each be in contempt of the
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General Assembly and subject to a fine of $10,000 and one year in jail." I told them that I didn't want that to happen , but if they chose that option I would personally nail the notice of non-compliance to the door of their office at 9:00 A.M. on November the 2nd . I thanked them for their interest and moved away without further comment.
The Board was stunned into a prolonged and somewhat embarrassed silence. Finally the President struck the gavel on the table and declared the meeting closed . They quickly gathered their papers together and walked out looking straight ahead , avoiding every attempt by the press to question them .
On the evening of October 31st , the attorney for the SCBML called to say that the Board had drafted the regulations!! Now they will never know if I really intended to nail the notice to the door myself. But they might have been interested to know that I did purchase a new hammer.
Funding
FEASIBILITY FUNDS
Early in 1992, at the urging of The Rev. Lee Kenney, The First Presbyterian Church gave us our first financial support in the amount of $2,000. It couldn't possibly have come at a better time. I was still supporting the project out of my own funds and welcomed the relief, but more importantly this was tangible evidence of others ' moral support. Their donation gave us the opportunity to obtain phones and a fax machine , stationery, business cards , and two folding tables along with twelve chairs from SAMS . These last two items cost us $284 and were essentially the only furniture or equipment we have ever purchased . Everything else was donated or purchased with donated funds!
We approached the Robert Wood Johnson Foundation (RWJF) in the middle of 1992 for a $50 ,000 grant to fund a feasibility study. I had originally asked for more, but I can understand why they set limitations: they did not know me ; we did not have the backing of a strong institution; and it was a new concept. So naturally, before they put more funds behind the project, they wanted to observe our work and progress for a period of time.
The RWJF grant allowed us to manage our resources wisely. We could pay for supplies, materials , and limited salaries for some of the people , and purchase a computer, pay the utility bills , prepare and pr int public relations brochures for further fund raising, conduct surveys and generally concentrate for a few months on the tasks at hand
FUNDING
without worrying about money. While we knew these funds would run out in a few months, the monies did give us time and the opportunity to think clearly about our future and to plot our course for the long haul.
RAI S IN G FUNDS F OR THE LONG HAUL
In the late summer of 1992 , after we had successfully addressed the issues of licensure and malpractice insurance , and obtained feasibility funds from RWJF, we could turn our attention to creating the clinic . It was obvious our first grant of $50 ,000 would not carry us much further, so I directed my energies toward raising sufficient funds to : (a) support the program for three years or more; and (b) build a facility appropriate for the size of our target population.
The local library provided two references published by The Foundation Center - The Foundation Directory and The National Directory of Corporate Giving. The books described , in detail , each foundation's structure, purpose , charter, its total endowment and the usual size of the grant approved. In addition, both sources directed us to those foundations most likely to fund start-up efforts for a medical clinic.
To sort through this information we were fortunate to have the help of Mr. Ross Rutherford, who had worked for a foundation in Canada. He prepared and submitted applications to 40 foundations on behalf of our clinic. We are, five years later, still benefiting from those initial contacts .
It is my impression that obtaining a grant is a "stalking" operation . I have learned not to expect immediate or early results. The foundations are in charge of the funds, and many worthy civic groups , programs and institutions
FUNDING
are continuously applying for grants. The key to success in this area is persistence.
We received grants for as "little" as $2 , 000 and as "much" as $350,000. Each was fully appreciated. The larger grant from Robert Wood Johnson Foundation was especially appreciated. They gave us an additional $300,000 on top of the $50,000 we had already received. This new grant was for the program only - no building or equipment. Wisely, it was dis tri bu ted over a three- Alex and Brigette Vitto sitting on an examining year period table provided by the Hasbro Foundation. and sustained us until we could develop long-term funding sources to support the program well into the future .
One of the most unexpected and delightful grants came from the Hasbro Foundation. A letter arrived in May 1994, a few weeks before we were to open, and asked what equipment we needed in the range of $5,000 to $8,000. I wrote back immediately that we needed a cystoscopic table, a set of cystoscopes and six wall mounted ophthalmoscopes and otoscopes. Three days later I received a call from a representative of the Hasbro Foundation saying they had received my letter but they could neither pronounce nor understand what it was we needed. If I would chose one of the three, he said, they would be delighted to
FUNDING
provide it for us.
I chose the wall-mounted ophthalmoscopes and otoscopes so the physicians would always have at their ready these instruments to examine the patients eyes, ears, nose and throat. I hope the Hasbro Foundation enjoyed the experience of giving the gift as much as we did receiving it.
In addition, we continued to seek funds in the community and around the country. That was, and continues to be, a never-ending process.
Jill Briggs was our first Director of Development. It was a delight working with her. Not only was she gifted and
talented she is one who is blessed with an intuitive sense of style and class in her work and elevated all of us who worked with her. She represented the clinic in such a way that our image was improved by the manner in which she presented our message. She established a style and pattern of Jill Briggs fund-raising and public relations which is still practiced. Her leaving was a great loss to the clinic.
The Clinic Facility
RENT, LEASE OR BUILD
There came a point in late 1992 when we realized that the clinic was going to be a reality. It was then that we had to face the issue of a facility. Should we rent, lease or build? It was Mr. John Clarke , a forme r corporate executive and a member of the original Start-Up Team , who helped spearhead this part of the project . He was one on whom I always relied for solid advice and judgment . He totally relieved me of the responsibility of overseeing construction of the facility. With him, we were able to keep to the schedule and end up with a first-class facility.
Renting had almost no appeal. It was highly unlikely there would be a facility which had , or could be adapted to comply with, the state and federal regulations for a health care clinic. In addition, I did not like the idea of paying to renovate someone else's facility and then be subject to the possibility of their selling it out from under us. Leasing had only slightly more appeal. We would still be using our funds to support someone else's facility. And we still had to resolve the issue of compliance with state and federal regulations .
Buying an existing structure and refurbishing it had similar drawbacks, but we decided to study some of the possibilities anyway. We looked at buildings that were in the early stages of completion, early stages of deterioration, too large for our needs and too small even for our care givers, much less the care recipients. But mostly we
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looked at buildings that were too expensive. It appeared to me that the wisest course was to obtain a piece of property and custom-build a facility that was appropriate for the needs of our patients and care givers. I felt that since we already had funds for the support of the program for the first three years, we could more easily raise funds to build the facility.
Ross Rutherford, Mary Doughty and I put our heads together and decided to invite Mayor Harvey Ewing and Town Manager Mike O'Neill to our temporary quarters in the Volunteer Center to ask them to donate a piece of land for our new facility. They accepted our invitation, albeit somewhat reluctantly, and, over the next few weeks, we prepared a presentation which was very thorough.
Knowing we could expect Mayor Ewing to ask some very penetrating questions, we had a dry run with me taking the part of the Mayor. Although we knew no one could take the place of the Mayor, I did my best. When we completed this exercise, I think it was a draw as to whether we felt we were sufficiently prepared and would get the land.
January of 1993 Mayor Ewing and Town Manager Mike O'Neill arrived. I think they were surprised by a lot of things: how well prepared we were; how much we had achieved; the extent of our planning process; our Decision Tree - which Ken Anderson prepared for us, how well others, especially Robert Wood Johnson Foundation, thought of us and our commitment and dedication. I doubt if they had any idea, before they came, just how far along we had come.
After the presentation , which was interspersed with plenty of good common-sense questions by Mayor Ewing,
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our two guests got up to go without giving us a hint as to what they thought . I walked them to the door, which was so old it seemed to take forever to close , listening carefully for any piece of information . It was a cold, miserab le day and Mr. O'Neill paused to put on his topcoat. As the door was swinging shut - more slowly than he probably realized -I heard him say, "Harvey, we had better get involved with this activity while we can still get some credit for it."
A few days later the Mayor Harvey Ewing Mayor called to say he wanted to see me . As soon as I walked into his office , I knew we were going to get the land - he had one of his daughters with him. It seemed unlikely he would turn me down, in front of his daughter, for a piece of land for a free health clinic for the poor. I was right. He instructed Mr. O'Neill to get together with me to see where the Town had land that would serve our purposes. The Town agreed to lease us the land for $1.00 per year for 30 and a half years. Not a bad bargain, for both of us.
On a very cold and rainy February day in 1993 , Mr. O'Neill and I sat at a table in a fast-food eatery on Northridge Drive near Highway 278. I chose a 1.1-acre plot opposite the restaurant - near public transportation , accessible to the main highway, and only 3/4 of a mile (as the crow flies) from the hospital.
THE CLINIC FACILITY
BUILDING THE FACILITY - OUR BENEFACTORS
I am a social liberal but a fiscal conservative. I am not prepared to spend money I don't have in hand or know where I can get it. I don't like to go deep into debt or be associated with an organization which does. So, that set the policy I followed. We had the money for the program from the RWJ Foundation and the land from the Town. Now we needed the plans and the money for the facility.
)The citizens of Hilton Head Island have done some very wonderful things. One that is memorable is the time we raised funds for a small child who needed heart surgery. Her father, Bill Vitto, is a talented and
John Clarke, Bill Vitto, Bill's daughter, gifted young archiBrigette and Ralph Lynes. tect who was just getting started and did not have ready cash or insurance to pay for the surgery. The operation was a success thanks to the generosity of our community.
When I first met Bill, he mentioned how impressed he was with the idea of a free health clinic for the poor. He explained that, because of medical expenses for his daughter, he did not have extra funds to donate, but would be delighted to help if there were any other way he could be of service. He was clearly anxious to give something back to the community. So, when the time came to draw up
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plans for the facility, I called Bill to see if he would like to design the clinic , and he readily accepted .
Using our survey of the number of patients and the different types of practices by the physicians, he created a superbly designed clinic facility. It incorporated all the elements we requested, plus some he knew we would want later on. We are still enjoying and appreciating his genius as an architect. It not only meets our current needs, but is designed for easy expansion .
At the Groundbreaking: John Clarke, Hen ry Driessen, Donna Ma rtin, Russ Condit, Rep. Sco tt Richardson, Mayo r Harvey Ewing, Dr. Jack McConnell, Sen . Holly Cork, Ross Rutherford, Bill Stubblefield and Rev. Charles Hous ton.
Once we had committed ourselves to constructing a building, we needed to raise funds to pay for it. I do believe that this is one of the things I most enjoyed. My father was a Methodist minister and was never sent to a church which was out of debt. Nor did he ever leave a church in debt , except for one at which he served only two years - a rather enviable record , all in all. I watched him
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and tried to learn as much as possible. Never in my wildest thoughts did I think I would need his expertise as a fund raiser.
It was my father's philosophy that when asking someone for money for a worthy cause, he was giving the person an opportunity to do something good not only for the recipient but also for themselves. I had always thought it was the other way around, but not so. It is an example of one of the paradoxes of life which says there is more joy in giving than in receiving. Surprising, but true!! Mary Ellen and I enjoy the symphony and the theater on the Island. I noticed that the program for each performance had a list of the donors. So, I made a list of those who gave generously to these valuable organizations, thinking they might also think well of what we were trying to do, and called on some of them. I was surprised how well the idea of the clinic was received. Looking back, I suppose I was so immersed working to create the clinic that I did not know how truly interested the residents of the Island were in its success. I contacted many of the major donors to the other organizations and was almost never turned down! Some truly surprised me with their generosity.
I visited Opal Abbink, a great lady in every sense of the word, and shared with her what I was in the process of doing and asked if she would consider suporting the effort. She thought for a rather long time and then looked up and said I will support you and mentioned a figure which, for the first time gave me reason to think we might possibly be able to raise adequate funds to build a facility. Her leadership grant was the most affirming thing that happened to me in the early stages of creating the clinic for the poor.
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Opal not only donated funds but joined the Board of Trustees and continues to contribute in many ways with her common sense and solid business acumen.
Not only did Opal contribute to the facility but her daughters also supported the project by donating the equipment for our dental clinics, a very insightful and perceptive gift. Our patients will, on rare occasions, spend money for health care but never for dental care. Like mother, like daughters, certainly applies in this instance.
This contribution was followed Opal Duke Abbink by another major leadership gift from Kathleen and Brock Rowley. It was their decision to make their donation in in-
crements over a period of time. I had rather hoped to have access to the funds earlier, but I fully understood their reasoning. Over time, it proved to be a blessing in disguise - we were able to use their contribution to create our first endowment funds for the clinic . A very wise and mature approach by them.
Both of the above donations were from the residents on the Island. A third came from New York City residents
The daughters of Opal Duke Abbink: Lisa Bates, Leslie Sanders and Lynne Conboy.
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Edith and Henry Everett - supporters of good works not only in the United States but around the world. The opportunity and the need to help our clinic came to their attention in a curious fashion.
We met Mr. and Mrs. Everett in January 1992 at a meeting on Hilton Head , and shared the raw concept with them at dinner one night, knowing nothing of their interest in supporting good works.
I met again the following year. Right away the Everetts mentioned an article about the clinic which had appeared in the New York Times on Christmas Day, 1993 . They expressed an interest in the concept of a health care facility for the poor, and the approach I was taking, so I invited them to come out and see where we were engaged in the immunization program and planned to build a new facility. They spent an hour and a half at the site asking excellent questions.
That night, Mr. and Mrs. Everett indicated they would like to make a gift to the clinic, and wondered : "Would something in the six-figures range be considered significant?" I was so excited that I hardly knew what to say. Jokingly I asked, "How big do you want the letters on the front of the building?" Mr. and Mrs. Everett not only contributed their financial resources but agreed to serve on the Board . They have faithfully attended our annual Board of Trustees meeting and enriched it with their observations and suggestions. In demonstrating by their actions how one can wisely invest their resources in the improvement of our communities, they are serving as a role model for many of us who have had the opportunity of knowing them.
I called a hasty meeting of the Board of Directors to tell
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them of the potential gift , and we decided upon the name , "THE DUKE - EVERETT FACILITY," with good reason. Their gifts assured our ability to build the clinic. When
The Duke-Everett Building Plaque coupled with the donation of the Rowleys, we had support for both the facility and long-term endowment. Three incredible gifts to the clinic by three incredible families. While I have expressed my gratitude to them directly, and often, I hope this mention will let them know once again just how important they and their gifts were to the completion of a "dream."
Some of the local merchants went to exceptional lengths to help us. One that comes to mind is Mr. Lou Perella, who obtained commercial grade carpet for us for the cost of transportation only - an incredible savings for us! An incredible person!
On another occasion Mr. John Clarke and I were meet -
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ing at the building site late one afternoon with the supervisor, Mr. Ralph Lynes, to discuss exterior finishes. As if
Hispanics stuccoing the VIM Clinic free-of-charge . on cue, a pickup t r u c k filled with Hispanics pulled into the parkmg lot , and one got out and asked if the exterior of the building was going to be stucco or wood. I said that we had not yet decided. Well, if it was to be stucco, he stated, he and his co-workers were the best in the area, and since all of them would probably be using the clinic, they would finish the exterior for free. I exclaimed happily, "I think you just made up our minds."
Mr. Lynes asked them what we should order and from whom. They gave us the information and a few days later the distributor from Charlotte happened to be on the Island and came by to inspect our fledgling operation. He must have been satisfied with what he saw - he gave us the material for free. That episode was a good example of what happened time and time again in building the facility. Essentially everything was donated for the clinic - materials, supplies, equipment and "sweat equity."
Ross Rutherford , a stanch friend and steady influence while we were developing the clinic, helped us sort out the
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approximate cost of the rooms or areas. He suggested naming each for those who donated sufficient funds to build and/or equip it. Several individuals jumped at the oppor-
1::1 VOLUNT'EERS IN MEDICINE
VIM COMMUNITY PROJECT -
The H8A/HHI in co.!;>pera1i on Wilh """Y t, ui l de t< 011 d dl dtvi<lu;,ls •r~ prnud w p iny • 1'0!~ i n the con struction of th<l VOLUN TEERS lN Mf.DIC:INE p roject Th~nk you to th¢ following fo r lh ¢i r• torn\\, labor r-i'l> l<>f,>I & serv,<c e f<i r ,his con11nunity projo,c t.
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GENERAL CONTAACTO!t foh!rur nc & Com pa1'1J' JOB StTE SUPERINTEN DA NUl.lifph ly1>1,s AR(HITECT:W,lflamVitto.A,-cJ1itcc1 DONATION OF LAND :Tow" e! H i1m11 H e o<l
The- Em plo~). Vf1-'lt l e~,_, CoJ_1, E~r.rn.i r i C;-,rp~tt i:t' llfls ul :-" r.0 1, Or y~"',t. G,rd• Supply Sow lh.e :.n<!rrn FiJ'Q P.tol<?U-10f.l • F1Jbc<ll'An tn1u1l :n.-~" C&C C <!fi,n1< .IT1tc N~tiona~Gttilr4Qn A¢'1'.ai 1l ccd ,K !t:r.;he-, D4'.!~igi T,im T<Ch S.....,1rn
Sign listing the Hilton Head Island businesses who contributed to the construction of the VIM Clinic.
tunity and chose a particular room or activity to sponsor. One of the most interesting contributions came from the Leadership Hilton Head Class of 1994. As some of you know, Leadership Hilton Head is a yearly program run by the local Chamber of Commerce to teach individual residents how the town functions and how they can contribute ideas on town management and administration. The candidates are in training for one year. As a part of the program, they select a final project which must be conducted and funded by the class.
THE CLINIC FACILITY
Th e Class of 1993-94 chose the children's reading room of the clinic as their project. To prepare, they spent time researching the needs of the children, creating the design, determining the expense of the project and how to raise the necessary funds. The final design was put together by Donovan Schmidt, a Disney World consultant , who designed an underwater scene involving the entire surface of the room. It gives the appearance and feeling of being inside an aquarium .
As a fund raiser, they decided to have a "BachelorBachelorette Auction." Eight handsome bachelors and eight beautiful bachelorettes volunteered to be auctioned off for an evening of dinner and fun with the highest bidder. In addition, they had assembled an incredible assortment of gifts to auction. One was a computer which I obtained at a very good price for the clinic .
The night of the auction, in spring of 1994, the members of the Class of 1993-94 were very anxious and uncertain they could raise the $5,000 that was needed to complete the class project. When I walked in, I was astounded at the size of the crowd. It was standing-room-only. To everyone's joy, the auction was a huge success. There was some very spirited bidding for an evening with the Bachelors and Bachelorettes , and almost $20,000 was raised .
It was an incredible sight the following week seeing some of the most important and influential people in town dressed in dirty shorts and T-shirts, up to their elbows in paint and having the time of their lives . They are very proud of the room , and whenever they are at the clinic volunteering, they visit the beautiful room and take a look at the accomplishment of The Leadership Hilton Head Class of 1993-94.
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By the way, during the auction a man came up to me and asked if I was the Dr. McConnell who was creating the free health clinic. I said I was. He introduced himself and said he was a painter. If we purchased the paint, he offered, he would have his crew paint the entire interior of the VIM Clinic free-of-charge! (Unfortunately, I don't remember his name . I hope he reads this so he will know how grateful I am for his support .)
The day we were to open our immunization clinic , our refrigerator went on the blink. Since the vaccines need to be kept under refrigeration, it was a rather difficult situation. I called Billy Wood , a local appliance-store operator, and told him of our troubles. Without a moment 's hesitation he asked , "How big a refrigerator do you want and do you want a right-hand or left-hand door?" Before we hung up he assured us the refrigerator would be there within the hou r . Billy is one of those people who make Hi l ton Head Island such a special place in which to live.
We obtained our complete eye examination room equipment from Lombart Instrument Co. of Newport News, VA. They sell medical equipment and take used equipment in trade, passing it on to groups who will put it to good use . We were able to get in touch with them through a fortuitous encounter - one of the company's principals was on the Island for a wedding , and in conversation with the minister, The Rev. John McCreight , mentioned what he did. Rev. McCreight immediately shared with him our efforts at The Volunteers in Medicine Clinic and obtained the man's business card and the commitment of Mr. Lombart to help too . This encounter lead to a fullyequipped eye clinic.
A Georgia firm t r ied unsuccessfully for two years to sell
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us an x-ray machine. As much as I wanted one, I did not want to spend money for that which we could get along without, at least for the time being. Even though I did not buy anything from them, they agreed to help us design our x-ray room, in hopes of selling us something in the future.
About a year after we were open I received a call from the Georgia firm saying they had a good used x-ray they had taken in trade and wanted to give it to us. I asked how old it was and they said 21 years. I told them I did not want a 21-year-old x-ray. The tube and the wiring would be no good. They assured me they had replaced both the wiring and the tube.
Sensing we might finally obtain an x-ray machine, I asked what they expected in return. They said they wanted a free three-day weekend of golf for four. I asked if this was a one-time request or if they wanted it every year.
"Every year," was the reply.
"Then, I want a free service contract."
We both ended up satisfied.
Our Xerox copying machine came to us in a similar fashion. I learned that a good friend, Bill Buehler, had recently been made Chief of Staff of Xerox. I wrote telling him what I was up to and requested a donation of $25,000 and a new $11,000 copying system. After a few days I received a letter in which he said, "Thanks for keeping me up to date on what you are up to, Jack. I am very impressed with your program. We at Xerox are unable to give money and a system to the same organization but to let you know we support you, I am enclosing a check for $5,000." I was pleased with the donation, but we really needed a good copier and $5,000 wouldn't do it for us.
THE CLINIC FACILITY
After thinking about this exchange for a few days and re-reading the part where he wrote that they were unable to give money and a system to the same organization, I wrote him saying how good it was to receive the check, but I did not know until reading his letter that I had a choice between a new system and the check for $5,000. So, I was returning his $5 ,000 check and would prefer a $11,000 copying system.
In about the time it took for the letter to arrive I received a call from him asking, in feigned anger, "What in the world are you trying to do to me? I've been on the job only a few months and your letter has been seen by all the secretaries on the executive floor. They were so taken by it that they circulated it around the whole of the executive floor." I detected laughter in his voice and we were both enjoying the joke. But what he didn't know was that I was in earnest. I congratulated him on his new position and the efficiency of their internal mail service and claimed not to understand what the problem was.
He said they really could not give a grant and a system to the same group. I repeated, "In that case, I would take the new system." He said that would not be possible but he would return the $5,000 check to me with warmest congratulations and best wishes.
I gave up. We then began inquiring about each other's children and what they were up to. But before we got very far into the conversation he said,
"Our house and cars are filled with the music of your son's band, PHISH."
"Is your son going to the concert in New York City next week?" I asked.
"We tried to get tickets, but the concert was sold out. "
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I purposely allowed a long pause to hang in the air and then said, "Oooh?"
"I know what you are thinking, Jack," he jumped in , "but I still can't give you a new system."
I haggled, "How much would you give us for two tickets and a couple of backstage passes for your son?"
He relented. "OK, I'll send the $5,000 check back and see if I can locate a good used system with plenty of mileage still on it. OK?"
I recognized when I had reached the limit of his generosity and thanked him before he could change his mind. I was reminded of a statement which I heard often as a child and which has a special meaning for Mary Ellen and me: "The Lord works in mysterious ways, His wonders to perform." Amen!!
The general contractor, Mr. Bill Fishburne, not only did the job at cost, but also donated his profit to the clinic. How many other builders do you know who would have done that? There is a special place in heaven for Bill and others like him. But one of his greatest contributions was the careful crafting of the clinic for our particular use. It still shows after three years of occupation.
As for some of John Clarke and Bill Fishburne at VIM the other needs, we obconstruction site. tained examination tables from the hospital and other practicing physicians, used furniture from offices that were being renovated, and
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instruments from instrument dealers who gave us good used equipment which had been traded in.
All of this generosity allowed us to design and build a 7,000 sq. ft. facility without a dime of federal, state or local money. I know former Mayor Harvey Ewing will dispute that. He will claim the Town gave us the land, but that is not entirely correct . On the day we broke ground for the clinic, March 5, 1993 , in a fit of reckless fiscal abandon, I paid off the entire cost of the lease , all $30.50 of it. Now it belongs to us, fair and square. Harvey asked if he needed to hold the check until Monday. It is a running joke between the two of us.
Clockwise: The Rev. Ben Williams and Deacon Bryan perform baptism; Dr. McConnell, Hillary Clinton and Kate McConnell; Thomas C. Barnwell, Jr.
Clockwise: Mayor Harvey Ewing and Dr. McConnell at the groundbreaking; Dr. McConnell and surveyor; audience holding hands during recitation of the Vision Statement; the Rev. Greg Kronz; and Mr. and Mrs. Everett receive recognition.
Top: Dr. McConnell speaks at the groundbreaking
Right: Dr. Jack Catlett
Below: Erwin Faulkner, member of Governor's staff; Governor Carroll Campbell and Chairman of Beaufort County Council Thomas C. Taylor congratulate Dr. McConnell
Bill
OpalAbbink
Stubblefi e ld addresses crowd at groundbreaking.
Left to right: Bill Stubblefield, Susan and Kirk Glenn, Linda Silver and Opal Abbink
Dr. McConnell and Gov. Campbell at ribbon cutting ceremony. Charlie Harry (in wheelchair in background)
IDr. McConnell addresses volunteers before the dedication.
Below: John Clarke, Tim Singleton (our 10,000th patient) and Dr. McConnell
Dr. Bart Barone and Dr. Chuck Hiles
Members of the Boys and Girls Club
Dr. Harry Nelson, a volunteer surgeon
Above: Dr. Sherman Gans with Dr. McConnell in the dental clinic
Jean Morehouse, RN
Sue Sheridan, RN and patient
Dr. Brooks Poley, a "good Samaritan"
Volunteer Hanna Swimmer and Bonnie Haroff, RN
Kay Clark Nelson
Ann Conner, a greeter/receptionist
Director of Nursing, Peg Oswald, and friends
Some of our first immunization patients - June, 1993
Some of our Hispanic "friends" enjoying the childrens' reading room.
Nurse Ellie Duke, RN in the background
The Organization
BOARD(S) OF DIRECTORS
Several months prior to opening the clinic for full care in July of 1994, we discussed and decided how we wanted the clinic organized operationally. Because we were an experiment we decided to organize it by creating a strong Board, which would oversee the clinic, and have the employees - Medical Director, Director of Nursing, Office Manager and Director of Development - report directly to the Board .
I knew this particular system had its pluses and minuses. On the plus side, the Board was able to monitor the progress of the clinic easily and frequently, make adjustments quickly and try out different approaches until we got it right, while keeping the clinic moving as a smoothly functioning unit.
On the minus side, we faced: too much tinkering by me and other members of the Board; disturbing employees more than we should, keeping them off stride and uncertain; and not allowing employees to "adopt" the problems of the clinic and work them out for themselves.
In retrospect, the clinic did not do badly using the system (initially) of strong Board involvement. In fact we grew rapidly and gained the respect and participation of our patients and the community - no mean feat for a new, untried approach to the delivery of medical care.
Having said that, there were probably more reasons to let the clinic operate on its own without Board interference
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earlier than we did. The issue of "strong vs. weak" Board involvement was resolved after I interfered unnecessarily in a question that should have been left to the Clinic Director, Angie Greenfield, to handle.
In 1995 we had been three years into the planning and creation of the clinic. We were now ready to recruit new and younger members of the community to become involved in management . Many of the initiating founders, Angie Greenfield including myself, were retired; therefore, by the laws of nature, we had a limited number of productive years left. The clinic's Charter allowed expansion from a total of 8 members of the original Start-Up Committee to between 12-21 members of the Board. In that way, a broader and more diverse representation of Island residents in the management process was assured .
To our dismay (although, understandably), we were turned down by some of the people we had hoped to have on the Board. However, we were able to persuade many of them to be members of our "Honorary" Board of Directors. While they have no responsibility for day-to-day operations, they are able to serve as vital spokespersons for, and contributors to , the clinic. Their participation has allowed us to affiliate with some of the most prestigious institutions in the state , including the Medical University of South Carolina and the South Carolina Medical and Hospital Associations.
Our Board had almost daily oversight of the clinic operations. Not only has this system proven to be effective ,
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but it also saved our operation from a potential disaster. Our first Clinic Director, Angie Greenfield, had left. The Human Resources Committee unfortunately recommended, and the Board hired, a Clinic Director who darned near sank the clinic by his erratic behavior. He seemed intent on getting rid of essentially everyone involved in starting the clinic - including me! I must say, I took a rather dim view of that idea , as did the other founding members. His erratic behavior prompted me to inquire, on behalf of the Board, about his background , which he refused to share. Rather, he abruptly resigned leaving as much dust and disturbance as possible in his wake.
ORGANIZING AND ENERGIZING THE CARE GIVERS
The clinic needed a self-sufficient out-patient unit to deliver the care our target population needed. To accomplish this goal, we needed sufficient funds, a delivery staff and lay volunteers . By delivery staff, we included physicians, nurses, dentists, chiropractors, social workers and all other medical care givers licensed in South Carolina to practice their profession. With the funding question well in hand, I addressed the issue of recruiting an adequate number of physicians. I assembled the initial group of 16 physicians and encouraged them to enlist the cooperation and participation of at least one more physician. This chain-reaction tactic worked . All public relations experts know that the best way to advertise is for one person to tell a second person about a third person's product. That was what we did. One physician was telling another physician about the Volunteers In Medicine Clinic. We soon had 35-40 medical professionals who expressed a general interest in the idea.
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I knew that several of them would not last more than a few months unless we got them involved in the process of developing the clinic. Our new Medical Director, Dr. Diane Montella, very smoothly started an immunization clinic and a weekly Continuing Medical Education Program (CME). The immunization program appealed enormously to the nurses while the CME attracted both the nurses and the physicians. We invited the physicians from the local hospital to provide the lectures on issues we might face in an out patient experience. In no time at all we had 60 to 75 professionals attending the weekly CME courses. The staff brought their own sandwiches and we provided the iced tea, cookies and the lecture. We named the sessions "Sandwich Seminars" and videotaped each lecture.
• We soon established rules which required that, when available , participants were expected to attend the Friday "Sandwich SemiDr. Diane Montella lecturing to the lay volunteers. nars." If anyone missed two or three classes in a row, I called saying, "I'm sorry you've been sick." If they said they had not been ill, then we had a discussion about their level of interest in the clinic. I let them know I understood if they were not interested, but that, if they wanted to be involved, we ex-
THE ORGANIZATION
pected them there every Friday they were on the Island unless they had a good and valid reason to be absent. I explained it was not so much for the benefit of the clinic, or even the patients, but for their own benefit; I wanted them to feel that, when they walked in the clinic on any given day, they could handle anything the patients presented. If they wished to continue their participation, they were invited to check out the videos of the lecture they had missed, take the tests, and please come back. This method worked because it gave the doctors a sense of esprit de corps to be associated with an organization which demanded optimum and ongoing preparedness of its professionals.
At our first Sandwich Seminar after the clinic opened, we had over 100 physicians, dentists and nurses in attendance. They were proud to be giving their services to those in need. There was an enormous sense of excitement. During the early days of organizing the clinic, we made elaborate plans to entice physicians, nurses and dentists to work with us. As it turned out, the plans were unnecessary. We did not have to recruit any of them. As soon as they learned of the opportunity, they volunteered. Not all at once, mind you, but in a nice flow that allowed us to assimilate each one.
We should not have been surprised at the willingness of the retirees to join in support of a program to provide care to the poor. Our retired medical personnel practiced at a time when there was an ethic of caring for everyone. Sadly, that is not true today. Even if they wanted to, HM Os often will not allow physicians to provide free care for the medically under-served. I have heard of several clinics such as ours which have been severally restricted after the
THE ORGANIZATION
not-for-profit hospital became a for-profit hospital as a result of being sold. The emphasis appears to be more on efficiency and increasing profit instead of effectiveness and making sure everyone receives care. Those who manage the HMOs don't seem to understand that physicians, by law, are the only ones who can deliver medical care to our fellow citizens. If, for whatever reason, they don't or can't, then no one else can.
We presently have 44 physicians, 64 nurses and 15 dentists actively engaged in providing care to the medically under-served in our town. A great many of them tell me they are now doing what they have always most wanted to do, just practice their professions in a hassle-free environment without having to worry about the bureaucracy or finances involved in running a business.
We even have physicians, nurses, dentists and social workers who have retired to Hilton Head because the Volunteers in Medicine Clinic is here. Several learned of our operation via a National Public Radio special feature on the VIM Clinic which aired sometime in the middle of 1994. From the calls I received, the piece must have been broadcast rather widely.
One call was from a social worker, Susan Hudgins, who was on her way home from work in the Washington, D.C. area, when she tuned in the program. At the time, she was trying to sort out where she should retire and this program helped her make up her mind. She is here and has a private practice in addition to helping out at the VIM Clinic.
A truly unique recruiting experience occurred near the time we were starting to build the clinic. About 6:30 one morning the phone rang and a woman, in a rather de-
THE ORGANIZATION
mantling manner, asked if I was the doctor who was creating the health clinic for the poor.
"Yes," I replied .
"Are you sure the clinic will open in six months?"
"At this hour of the morning I cannot assure you of much of anything."
"Do you have any reason to think it will not open by then?" she then snapped through the phone.
"I do not."
Susan Hudgins
"That's good enough for me. I have an appointment with a real estate agent at 8:00 this morning and I'm going to put a down payment on a house. My husband and I are moving here in six months. He's a physician and I don't want him hanging around the house all day!" They did move to Hilton Head and he has made a significant contribution to the clinic.
I think one of the big reasons we had such an easy time recruiting the professional staff was because of our Medical Director, Dr. Diane Montella. She cared deeply about those in our target population as well as those who delivered the care. She deserves the credit for organizing and energizing the physicians. She not only oversaw the medical care but also wrote the policies and procedures, handled the referrals, presided at the medical committee meetings, directed the weekly CME program , and generally served as a cheerleader for the physicians and nurses. Her efforts allowed us to be successful much earlier than we might otherwise have been .
THE ORGANIZATIO N
As for the dentists , Dr. George De Young walked into the office early in 1992 while we were still in the process of developing the clinic and mentioned he had been a Professor of Dentistry in New Jersey School of Dentistry and would be willing to - organize the dental activity. It was an area I knew almost nothing about and his offer could not have been more welcome. He deserves a lot of credit for doing for the dentists what Dr. Montella Dr. George De Young did for the physicians. I am eternally grateful to him for his contribution . Later, Dr. Sherman Gans took over the operation of the dental services and , under his guidance , we have a firstclass dental program. With the addition of Una Jackson, as dental coordinator of the Dental Department, we now have one of the smoothest functioning dental programs in the area .
Dr. S h e rman Ga ns in den t a l clin ic.
LAY V OLUNTEE R S
Early on i n the development of the clinic Eileen Goulden contacted us looking for and needing something to do . She has a delightful English accent and the manners to go with it . With no prior experience, she took
THE ORGANIZATION
charge of organizing the lay volunteers and in no time at all they all fell in line with her style and quality of work. It was a delight to see how she quietly moved among them, giving encouragement and suggestions which they all accepted immediately. We are all better for having worked with her.
Before we opened the clinic for full service in July of 1994, Eileen organized a series of training sessions for all of the lay volunteers. The sessions included lectures, simulated role playing, and walk-through exercises. We began with the position of receptionist, and continued with the "greeters," eligibility screeners and other positions. I wanted our lay volunteers to know that the image of the clinic was communicated immediately by how we answered and responded to a phone call; the way we greeted patients; and how we handled the initial interview. We Eileen Goulden struggled a bit through the role playing but it gave us a sense of what we were trying to achieve. It prepared us for opening day.
Much of the clinic's operational success is because of our lay volunteers and the early work Eileen did in preparing them. The lay volunteers are a delight and joy to work with. Indeed, they are essential to the success of the clinic. They do more things and do them better than I had ever expected of them . Our record room is in their charge. They handle the scheduling - do the screening - handle the desk in a way that brings credit to the Clinic - help with
THE ORGANIZATION
the office work - are in charge of the nurses' desk - and dozens of other tasks.
Make no mistake about it, our clinic would be enormously diminished without the daily support of the lay volunteers who give of themselves unstintingly. We are a success because of our volunteers.
Eileen Goulden and Mary Ann Van Auken at volunteer lecture.
Opening The Doors
We opened our doors twice. The first time was for immunizations, only, in a facility which the local hospital provided. There were several reasons to do this. First we needed to give the retired medical personnel a chance to move gently back into practice. They and we felt a gradual reentry would be most helpful. Our target population badly needed to be immunized. Very few of the infants and children had any of the routine immunizations. It allowed us to develop policies and procedures while we were still in the development stage. It was tangible evidence to our community we were, even at this
Front entrance to the early stage, Volunteers In Medicine Clinic. providing medical services to the community. And it gave all of us involved a boost to see the parents and children come in the door. It suggested we were being accepted by them.
The opening was planned for the first Tuesday in June , 1993 at 1 p.m. We had planned almost no fanfare or big
OPEN ING THE DOORS
celebration. But the Hilton Head Women's Business Association had decorated the reception room and were on hand to greet the patients. A photographer and reporter from The Island Packet was there. We waited for our first patient . The reporter became restless and inquired when
our patients would be there. I assured him they would come but one could not produce patients on demand . It was 1:45 when I looked out the door and saw a mother carrying a small child and leading another by the hand. I hurried to the door to greet her. I
reached out to take the child in her arms but she wanted to walk in by herself So, I opened the door and a precious child about three years of age walked in and ushered in a new approach to the delivery of health care to the medically unde rserved on Hilton Head Island.
At a dinner held for
D r. McConnell greets the first patient, Malikah Housey.
Kaye Black and Missy Santorum we lc ome Malikah Housey.
OPENING THE DOORS
the benefit of the clinic, someone asked me what were my feelings seeing the first patient walk in the clinic. With only a short pause I said, "It was as if we had Dr. Jean Audet, Dr. Bill Henken and Dr. Sam wired the clinic Atkinson waiting for the arrival of our fi r st for electricity and patient. the little child turned the lights on."
She walked to me and I held her in my lap, I entertained her with the stethoscope around my neck. The photographer took a picture of this scene and it is , by far, my favorite picture. It speaks volumes about those who created the clinic and those who come there. It was the beginning of tens of thousands of patient visits. All of our patients are special but none more so than our first patient .
DEDICATION
We planned for a big celebration to dedicate the facility on June 9 , 1994. The road in front of the clinic was blocked off and a tent erected . It was a glorious day, and Jill Briggs, our Director of Development, had planned a splendid program of activities. I gave a short speech, dedicated brass plaques to Opal Duke Abbink , Edith and Henry Everett and Kathleen and Brock Rowley, and introduced our keynote speaker, Governor Carroll Campbell. Gov. Campbell told a wonderful story that granted us a new perspective. He related how his father had been a
OPENING THE DOORS
general practitioner in a small town in South Carolina . He charged for his services but never tried to collect what he was owed. Gov. Campbell said that his father probably had more money on the books than he had collected in his entire life. However, they were never hungry or lacking for food or clothes. They had a wonderful home and all were taught, at an early age, the Edith and Henry Everett at the value of service to others. dedication of the plaqu e being recognized for their leadership He said it was a lesson he gift to the VIM Cl i nic. hoped he had learned and by which he lived his life. As anyone can imagine, it was well received by all those present, especially those of us working in the clinic who were embarking on a glorious experience of service to others .
Linda Lader, wife of Phil Lader, former candidate for Governor of South Carolina and , at the time, a member of President Bill Clinton's Cabinet, read a splendid letter signed by the President. It read :
"It is extraordinary what a Linda Lader gifted individual with great vision , high energy, and uncommon persistence can accomplish in our country.
"The dedication of Hilton Head's Volunteers in Medicine Clinic is testimony to this phenomenon. And it is a tribute
OPENING THE DOORS
to you, personally, as well as to your fellow residents and friends who have demonstrated commitment to understand and serve the health needs of the medically under-served individuals living and working in your beautiful part of the world .
"From our conversations about this concept over the years, I know something of the obstacles that have had to be overcome for this day to come. Congratulations to you , Mary Ellen, the many volunteers, those who have contributed in so many other ways, The Joint Underwriting Association, and the Town of Hilton Head for establishing this model of public service to the community and fellow citizens in need .
"Your dream, Jack , is an inspiration to us all . Hillary joins me in wishing you and all those involved in the Volunteers in Medicine Clinic every continued success."
Sincerely, Bill Clinton (signed)
All of us involved in developing the clinic were enormously grateful to Linda Lader and her effort in making the letter possible.
The event ,----- -....,, was capped off by an outstanding presentation by the Island Singers group and the wonderful experience of in-
Dr. McConnell with keynote speaker, Governor Carroll Campbell.
OPENING THE DOORS
eluding the members of The Boys and Girls Club in the ribbon-cutting ceremony. Many of the boys and girls who
The Island Singers perform. come to the VIM Clinic for their care still remind me that they helped cut the ribbon. After the celebration was finished a small collection of us were reviewing and reliving the joy of the day and one of them said , "This is the most diverse collection of people I have ever seen on this Island in the 17 years I have lived here. I have never seen the native islanders, the business community, the politicians and the retirees come together in a common cause. This clinic may be the beginning of transforming our Island town into a community."
That was a very insightful observation. It suggested the wonderful healing power that occurs when one does the right things, in the right way, for the right group. It draws the community together.
PROVIDING CARE
We opened the clinic for full patient care Monday, July 5 , 1994 . It was none too soon. We were working early Saturday morning July the third to get the clinic ready when a patient knocked on the door and asked to receive care. She introduced herself as Elizabeth Taylor and wanted to be our first patient. She was elegantly dressed and was
OPENING THE DOORS
wearing a very attractive hat at a jaunty angle. I told her we would not be open to see patients until 9:00 a.m. Monday morning. I suggested she come early and I would see that she was one of our first patients. At 8:00 a.m. I heard a knock on the door and looked up to see Elizabeth Taylor, again , dressed in her elegant outfit. She still comes to the clinic and never hesitates to tell anyone who will listen that she Dr. McConnell and Gov. Campbell help Boys & was our first Girls Club members cut the ribbon. patient.
Angie Greenfield was our Clinic Director. She did a splendid job for us. Fortunately, she is back with us as a member of the Board . The opening of the clinic went very smoothly, thanks, in
Van Auken at the podium. large part, to the work of Dr. Diane Montella. She whipped our group of retirees into a first-class delivery team. They
Bob
OPENING THE DOORS
knew what they had to do and they approached the task with vim and vigor. No pun intended. We saw only eight patients that first half day and while it took us the entire time they were "well seen."
We have had several Directors of Nursing. The Diane Montella, M.D., Medical Director first one, and Mary Ellen Shephard, R.N. Mary Ellen Shephard, left before we opened, and Peg Oswald stepped in with good experience and good humor to help us over the "hump." The present Director of Nursing, Maria Koncul, is wonderfully suited to the task. She cares deeply about both the patients and the clinic. She is in fact, if not in title, in charge of patient care. She reminds me of the Chief Nurses of the Operating Room or Intensive Care Units
Peg Oswald, R.N. and when I was in training. We phy"friend." sicians thought we were in charge but in truth the nurses kept a stable platform for us to come in to do our tap dance and leave while they cleaned up after us and prepared the place for the next batch of "tap dancers."
OPENING THE DOORS
While everyone was busy patting themselves on the back, Mary Doughty, who is a jack-of-all-trades, went quietly about her work creating an orderly flow of charts, information, materials and supplies. She is one of the unsung heroines of the VIM Clinic. She neither sought, nor has received, all the credit she deserves for her enormous contribution to the success of the VIM Clinic . She is a large part of the glue which held, and Maria Koncul still holds, together the VIM Clinic. With colleagues such as her you can climb mountains . Policies and procedures were no longer ink blots on a page but clear directives which we needed to put into practice. The physicians went about their business with a seriousness of purpose and dedication. There was an air of excitement and anxiousness about the Mary Doughty place. They were intent on not making a mistake. The next week things were much more relaxed. They had all been through their paces at least once and had a feel, once again, for office practice and care of the patient.
At our first Sandwich Seminar after we opened, we had
OPENING THE DOORS
over 100 in attendance. They were all excited that they had succeeded in getting the hurdles behind them and getting the clinic under way. They were proud to be a physician or a nurse or a dentist giving their services to those in need . There was an enormous sense of excitement.
Circle of Caring
THE CONCEPT
Together, the administrative staff, professional staff and the lay volunteers have created a Circle of Caring , which is the spiritual base of our clinic. To the best of my knowledge our Circle of Caring concept is unique. I do not think it exists anywhere else in the practice of medicine in the United States - at least not in the same breadth and depth. The Circle of Caring is the heart and soul of the Volunteers in Medicine Clinic.
We obtained the plans for the clinic from the architect in the latter half of 1993 . Ross Rutherford, John Clarke and I reviewed them carefully, making suggestions for changes as seemed appropriate. After we were satisfied that we had a set of plans which would allow us to get the job done, I developed a mental model of how a patient would move through the clinic. I soon realized we had planned for good medical care but that we had given almost no thought to the culture in which the caring would occur. Were we happy just delivering the care and moving them through the clinic? Would we and the patients be enriched by taking this opportunity to get to know each other? How would I like to be treated if I were a patient?
Late one afternoon, after everyone had left, I was reflecting on these questions when my eye fell on a small statue of mother and child with the mother reaching down and the child reaching up and their arms becoming as one with no designation where the mother's arms stopped and
CIRCLE OF CARING
the child's arms began. I had obtained the small sculpture in East Africa on one of my several trips there as a member of the African Flying Doctors. I realized that the sculpture was a metaphor, a true symbol of what I was trying to achieve. The caring and the healing moved in a circle from both the mother and the child. It could and did flow in either direction. It was truly a Circle of Caring. That is what caring has always been, a continuous flow of concern, compassion, love and healing with no regard for the origin or who gives and who receives. It is love freely given. The irony is that although there is no thought to who gives the most or who receives the most, it often happens that those who give receive more joy than those who receive. It is one of the paradoxes of life. It is a simple but very powerful lesson and one which I seem to need to relearn and reiterate every day.
The next day I began working on the elements of the Circle of Caring. How do we want to perceive and be perceived by those who come to us for care? How do we want the community to perceive us? To properly address these questions I decided to have copies made of the architect's plan and invite physicians, nurses, dentists and lay volunteers to discuss these issues. We decided we would use and be guided by: (1) The Golden Rule - Do unto others as you
CIRCLE OF CARING
would have them do unto you; and, (2) The Second Commandment - Love your neighbor as yourself. After much discussion we agreed we wanted to perceive those who came to us for care as friends and neighbors who did not feel well and were coming to us to see if we could help them. What could possibly be more perfect? For some reason I expected the conclusion to contain rather grand and glorious language. But instead, the terms were magnificent in their plainness and candor. We would perceive our patients as friends, or those who would become our friends if we treated them with dignity, competence, care and compassion. (Please take note of the word we chose first - dignity. Dignity can be given as easily as it can be taken away.) And then, as neighbors - first because we all live or work in this Island town; and, second because someone asked two thousand years ago, "Who is my neighbor?" and was told the story of The Good Samaritan.
THE PROCESS
The process of applying the Circle of Caring is not complicated, but there are precise steps involved in transforming the idea into a reality.
Greeters: When a friend and neighbor arrives at the door a "greeter" is there to receive and welcome them . The greeters are instructed to say something such as, "I am sorry you are not feeling well . Please come in and let us see if we can help you. We want you to know this is not our clinic but your clinic. You are welcome here any time you need help."
If our patients bring children , we ask if the children would like to go to the reading room where someone will
CIRCLE OF CARING
hug and hold them and read to them. When the children are ready to leave, we strongly urge the youngsters to take the book home with them, and if a family has more than one child, we encourage them to take additional books for each of them.
Escorts: Patients are then brought to the reception desk where they are "logged in" and then turned over to their "escort," who guides them through the eligibility review and registration process or else seats them in the reception area, whichever is appropriate. We try to see that no one sits alone more than fifteen minutes without someone sitting down and visiting with them. It does not have to be an in-depth conversation about their illness - just some friendly, kind words.
When it's their time to receive care, they are escorted and introduced to the nurse and the same seamless weave of caring goes with them at every step. At no time do they have to fumble around trying to figure out what they are supposed to do and where they are supposed to go.
Care Givers: Most importantly, we wanted the care givers to know that they were not limited by time or expertise. If they needed to take 45 minutes, take it. If they needed consultation, Dr. Montella was there and willing to help them. The same thing was, and still is, true for the nurses and the dentists.
How I wish I could receive this same sort of care in the office of my own physician. More often than not I walk into an office which is too small and either too hot or too cold. Everyone there is sick and unhappy. There is no one to greet me with a smile or make me feel welcome, just someone tapping wordlessly on a lined pad, indicating that I should sign my name. All pretty cold and sterile. It cer-
CIRCLE OF CARING
tainly does not put anyone in the best frame of mind to be healed.
Not so at the Volunteers in Medicine Clinic. Throughout their visit at the clinic, friends and neighbors will be welcomed and cared for every step of the way. They are "folded into a mantel of caring and compassion" by everyone they meet. It doesn ' t take any more time and it is therapeutic not only for our friends and neighbors, but also for the professional and lay volunteers who provide the care.
Exit Interview: It was our early policy at the clinic that we would invite our friends and neighbors to participate in an exit interview. We wanted to know how we had done. How could we improve? Did they have others at home who needed care or possibly immunizations? Had they received a prescription? Did they understand it? Could they afford it? And then last we asked , "How is life treating you?"
At that point the escort was instructed to "listen with energy" to what the patient had to say. They did not have to get involved with their problems or accept them. Just listen with energy. Listening with energy is different from listening - as different as looking at a window and seeing the dust and flyspecks versus looking through the window seeing the beautiful world beyond. Listening with energy allows you to hear beyond and behind the words and understand them at their deepest level. What are people really trying to say?
What we had at the outset of the interview were two individuals representing two very disparate constituencies on Hilton Head - one affluent and the other very poor. What we had at the conclusion were two individuals
CIRCLE OF CARING
locked in a moment of sharing and caring, each of whom knew that they were just two human beings needing healing and were at that moment in the process of becoming healed. The curing begins in the examination rooms but it is here that the healing begins.
THE RESULTS
So, how could we objectively rate our performance? I think the following illustrates best how well we succeeded in applying our Circle of Caring paradigm in reality. Shortly after we opened the clinic, July 5, 1994 , two fellows in their twenties were walking out of the clinic at the same time as our Director of Development, Jill Briggs. She overheard some of their conversation.
"Well, what did you think of that?"
"That was the best I have ever been treated by anyone, any time, any place on this Island, and I wasn't even a patient. What did you think of it?"
"I was born and raised on the Island and it's the first time anyone ever called me "Mister." And I like it!"
Dignity. It is something we can easily give and easily withhold or take away. At the VIM Clinic, we are committed to building it into every contact we make with our "friends and neighbors."
From an older couple who had brought their grandson to the clinic for care, I learned how our Circle of Caring affected the lives of our patients - and myself.
As I was walking through the reception room , I noticed an older couple and their grandson standing by the large board on which we had listed, in alphabetical order, the names of those who had contributed to the building of the clinic facility. I chatted with them for a few minutes. As a
CI RCLE OF CARING
parting question I asked if there was anything I could do to help them . The older gentleman said:
"Yes, there is. I know our church has given a donation to the clinic, but I don't see it listed on the board."
"What is the name of your church?"
"The Mt. Calvary Missionary Baptist Church ." It was the same church that had held the baptism described earlier.
"I too know they made a donation," I replied, "and that their pastor, Rev. Williams, also made his own donation. Now that I think
Searching for a name on the contributors' wall of it, I remember both checks were over the name of the pastor and I expect we gave him credit for both donations. I'll look into this and have it corrected."
I thanked him for bringing it to my attention and went on my way.
A few minutes later I passed through the reception room again, and there he stood with his finger on the board, motioning me to come over.
"I found the name of my pastor," he said with such pride and joy that it brought a smile to my face as well as to many other faces in the reception room.
Then the most marvelous thing happened. He drew himself up to full height and asked, "May I make a dona-
CIRC
tion?"
"That's really not necessary. But if you want to, we would be honored to receive it."
"I am going to write you a check ," he declared and , pointing to one of our lay volunteers , announced, "and she is going to help me."
"Wanda, you are going to help him?" I asked.
''Yes. He 's one of my literacy students and this may be the first thing he has ever written." I turned to thank him and shake his hand and noticed that he, his wife and I all had tears in our eyes .
This may be one of the best examples why we don't have a "waiting room," but rather a "reception room ."
Things often end up being what we call them. If we call our reception area a "waiting room," our friends and neighbors will have to wait. But if we call it a "reception room ," they will be "received."
Several of the most uplifting comments have come from the care givers themselves. Many .. have expressed to me that their '----- -
'Dr. A rt Friedman time spent at the VIM clinic is not work, but a truly energizing experience in their lives.
One of our physicians, Dr. Art Friedman , has been quoted as saying, "At the end of the day I feel as if I have done my work for my God and my fellow man. " Art is 87 years young and works in the clinic every day it is open . If there is anyone who epitomizes the spirit of the clinic , it is Dr. Friedman.
CIRCLE OF CARING
Another physician said to me, "There is something spiritual about taking care of the poor. There are times at the clinic when I feel as if I have 'touched the hem of His garment'."
I knew exactly what each of them were saying.
This approach, this "Circle of Caring," transformed an ordinary, common, small, nascent health care clinic into an uncommon and extraordinary institution which has been extremely well received by our "friends and neighbors" and the physicians , nurses, dentists and lay volunteers who work there.
Another result of the VIM approach to care giving is transforming the care recipient and the care giver - traditionally an "us-them" relationship - into people working together with a common purpose. This can be seen as a microcosmic result. On a larger scale, we are transforming the diverse elements of a town into a community. No town can become a community as long as it leaves a significant segment of its citizens without adequate food, shelter, potable water, appropriate sewage disposal and access to at least a basic level of health care.
The Circle of Caring is the heart and soul of the VIM Clinic. Without it, we would be a very ordinary institution with limited interaction between care receiver and care giver. It is only when we realize that none of us is healed and made whole until all of us are healed and made whole that we begin to have an understanding of the transforming nature of the Circle of Caring we have created. It requires a lot of effort to communicate and instill the elements of the Circle of Caring into the operation of an entirely volunteer clinic. Even as important as this attitude is to our mission, without continuing effort the Circle
CIRC LE OF CARING
of Caring could dissolve into the hurly-burly of the everyday irritations and we will have lost something valuable and beautiful.
Ifwe at the VIM Clinic feel , as others do around the nation , that the Circle of Caring is unique , it is worth the effort and the vigilance to make certain it remains a v ital and essential element and the core of the operation of the Volunteers in Medicine Clinic.
Transitions
FRIENDS AND NEIGHBORS
In the early days of the operation of the clinic essentially all of the patients approached the clinic with apprehension and skepticism. They were distrustful and unsure of us. It was certainly understandable. They had been misled so often that there was no reason to trust. Some told me of their skepticism. They felt the idea of a free medical clinic was a trick that was being played on them . Free health care appeared too good to be true.
One could see their lack of trust in their faces when they entered the clinic. They entered hesitantly, seldom looking at you, speaking so softly it was difficult to hear what they were saying. Even their posture suggested a lack of trust. They stood side ways to you, as if they were in a position to turn and walk away if need be.
If I could start over again one of the things I would do differently would be to study the impact of the clinic on the patients and the impact the patients make on the clinic personnel. I would interview the patients and videotape their facial expressions as they walked into the clinic. We could then compare that to the way they presently approach the clinic.
They walk in with a confidence and assurance they will not only receive health care but embraced in an atmosphere of caring and concern for them as individuals. Their whole demeanor suggests they know they are welcomed and belong there.
TRANSITIONS
The patients - our "friends and neighbors" - and the clinic volunteers have come a long way in their journey to create a climate in which everyone is respected. Those whom we know best, those who have made frequent visits to the clinic, are greeted as dear friends and neighbors. We greet each other in a rich spirit of joy. We now know them not only as patients who come for care but as decent human beings who are trying to get thorough the day the best way they possibly can. We inquire about their families, rejoice with them on the birth of a child or a grandchild , applaud the successes of their children and sympathize with them over a death in the family. They are truly our "friends and neighbors" and some of the most wonderful and courageous individuals I have ever known .. Events in their lives impact us deeply. I recall one of our first patients, I will call her "Irene", came to us with a long list of complaints. She was a 51 year old diabetic who had been diagnosed 15 years previously but had received no care. She had gone so long without treatment that she had developed essentially every complication a diabetic possibly have. She described her condition by saying her eye sight was poor, her kidneys were about shot , her heart was not working right , she had tingling and pain in her arms and legs and she had developed ulcers on her feet which she couldn't get to heal. She was in despe r ate need of care .
We brought her diabetes under control and stabilized her medical condition . Ultimately we began to feel confident the r e would be no need for amputation of her toes or foot.
As you can imagine , she was a frequent visitor to the clinic . In spite of all of her medical problems she had a
TRANSITIONS
calmness of the spirit which gave courage to all of us.
One morning, as I was entering the clinic, I opened the door for "Irene" and her companion. She was crying so that all I received in exchange to my "Good morning" was a quick nod. I went on to my office wondering what could possibly be the matter. She was registered in and seated in the reception room. An hour or so later I was walking out of the clinic when I heard someone following me chuckling half out loud. I turned to hold the door and, lo and behold, it was "Irene" with a big smile on her face.
I said , "You don't look or sound like the same person I held the door for earlier this morning."
She replied, "I am not. I found heaven" I asked, "Please tell me about it."
She said, ''When I came here this morning I thought my diabetes was causing me to go blind and I couldn't handle that because I have to take care of my sick husband . But I learned I am not going blind but will be able to see. The eye doctor tested me and showed me I could still see and gave me a prescription for new glasses. I have found heaven."
I observed, "And you are not crying any more."
Laughing out loud she said, "No I am not. I have cried away all of my tears. All I have left is laughter."
It is difficult to know who was the most blessed by that encounter - "Irene" or me .
Those who come to us for care are not faceless individuals. They and we become woven into each other's lives in the most incredible and exciting fashion. Of all of the wonderful features they exhibit it is their courage I most admire and respect. They exhibit more courage in one day than most of us exhibit in one year. Often it takes more
TRANSITIONS
courage for them to get through the day than I could possibly muster.
Very early one cold February morning our first patient came in wearing work boots, jeans and a sweat shirt. They looked as if they had not been washed or cared for recently. She was about five feet tall and underweight. It was difficult to tell her age because she had "lived hard" as the saying goes. Her skin suggested she worked outside. When I shook hands with here I could feel the rough skin of someone who did manual labor. I was not sure of her age. Thirty I suspect but I doubt if she was as old as she looked .
In response to my question she said she needed to see a doctor about a bladder problem. But the character of her voice suggested we should also examine her chest. While she waited to be called for her examination I sat and visited with her.
She seemed to want to talk to someone. She had run away from an abusive marriage , was divorced, lived in her van, cooked her meals on a propane gas stove and was looking for a job. She looked so underweight I asked what she had for breakfast . She said she had been unable to get a job and had not eaten for two days because she had no more propane gas, either for cooking or for heat in the van .
I waited until she had been seen by the physician and walked out with her and asked her if she would like to have breakfast. We walked across the street to the Huddle House Restaurant. She ate like a stevedore. She followed me in her van to the propane gas store where we had her tank filled. I asked her to be sure to come back and let us know if there was any other way we could help her. I recently checked her file and learned she had not returned .
TRANSITIONS
I hold her gentle in my prayers, wondering how she is making out. She should not be alone. She needs to come back for follow up on her bladder and chest infections and for her to know that someone truly cares about her. Our Director of Nursing, Maria Kon cul, not only knows the medical condition of essentially all of our patients but also knows them personally. In addition to all of the myriad of details involved in the oversight of the clinic activities she somehow manages to keep in touch with some of our patients who move away from the Island. We had one patient who was manic/depressive . She needed significant psychiatric help. We were able to improve her situation and stabilize her sufficiently for her to obtain a job. A few years later she decided to return to her home town of Buffalo, NY, where her sister lived. Several months later we received a call from her wanting to talk to Maria. She informed Maria she was, at that moment, planning to commit suicide. Maria was very calm and controlled and managed to get one of the clinic volunteers to contact the local police and her sister. Thorough the intervention of the police and the Emergency Medical Services Team they were able to reach her and prevent her from taking her life. It is significant that the one place and the one person she chose to contact for help at the time her life was most at risk was The Volunteers in Medicine Clinic and Maria Koncul, her friend and nurse. This is an example why we consider those who come to us for care as our "friends and neighbors" .
THE VOLUNTEERS
Working in the clinic is therapeutic not only for the patients but also for the professionals who volunteer their
TRANSITIONS
time and expertise. I am fascinated how a few of our physicians "look their age" but most of them "look much younger than their age". I don't know how old Dr. Harry Nelson is but I expect he is one of those who has a set of genes that give him perpetual youthfulness and allow him always to look younger than his age. I think another reason for his youthful appearance is the fact that he has always been committed to using his MD degree to helping others. In his practice, patients came first. He did not wait long after he retired to Hilton Head to find the VIM Clinic. He fits in here so well that one could think the facility had been built especially for him. And in one dimension that is correct. He is the kind of professional we hope will be attracted to the VIM Clinic.
He is a handsome fellow with a ready smile and carries his trim six foot frame as if he just came out of the military. But the feature one cannot escape is the ready smile he has for everyone, staff or patient. I expect he practices in our clinic the same way he practiced surgery in Pennsylvania, with a ready eye and heart for the under privileged.
I recall one patient , a thirty year old African-American female, who walked into the clinic one day almost as if she were trying to slip in unnoticed . It was difficult to determine her looks because she did not look up enough to see her face. She mumbled something in response to the questions that were asked of her. Her neat appearance was in contrast to her presentation. She sat in the reception room with her head down and resisted opportunities to speak or visit with the other patients. One could have thought that her problem were rooted in her psyche . They were but they did not originate there.
TRANSITIONS
Dr. Nelson welcomed her with his warm and genuine smile and started his inquiry and examination. He soon learned that her principal problem was a set of keloids scattered across her back and neck. Keloids are a raised fibrous scar tissue caused by excessive tissue repair due to surgery or trauma. She had them since early age and as they protruded up onto her neck and face she was ashamed of them and did not want to be in the company of others.
Dr. Nelson set about repairing the keloids and did a superb job of removing and repairing the site in such a way that one would hardly know they had existed. When she returned for her final visit one could not have guessed she had ever had her skin covered by the unsightly keloids. She was a different person when she walked into the clinic. She walked up to the reception desk and said she wanted to see "her doctor" , Dr. Nelson.
Dr. Nelson not only removed her keloids but also her shyness and gave her an interest and willingness to begin again exploring life to the fullest .
It was at the clinic that Dr. Nelson may have received his reward for his good deeds. He found in our Director of Volunteers, Kay Clark, the one he wanted to marry. They had both been widowed and it worked well for everyone. While we lost our Director of Volunteers he gained a wonderful and beautiful wife.
All of our volunteers would "go the second mile" for our patients. In one case the doctor went an extra 100 miles for the patient. Dr. Brooks Poley is one of our Ophthalmologist and a darn good one. He and Margo Harrison, who serves as coordinator, manage the Monday morning
TRANSITIONS
eye clinic with great efficiency and compassion . I recall a patient who needed surgery for a cataract which had gone far too long without attention. Unfortunately, Dr. Poley was unable to get him admitted into our local hospital. He was not deterred. He arranged to have him admitted into the Medical University of South Carolina in Charleston and then drove him there himself He waited to see that he was appropriately taken care of before leaving. That is what I call a caring physician. He did what he could in his office; asked for help and, when rebuffed, took him to a place where he could obtain care. Dr. Poley is a modern day version of "The Good Samaritan."
Our dental division had a few ups and downs during its early stage of development. Dr. George De Young did a great job of helping us organize it but we did not carry it forward as well as he had planned. It was not until Dr.
Dr. Art Frazier, Una Jackson and patient.
Sherman
Gans, as Director of the Dental Clinic, and Una Jackson , as Manager, combined to give us a superb dental operation.
I have known that our patients would, on occasion, spend money for health care but almost never for dental care. But I had not seen such poor dental care in my life, not even in Africa where I
TRANSITIONS
served with The African Flying Doctors, as I have seen in the VIM Dental Clinic.
One day a 40 year old fellow, "Henry" , from West Virginia walked into the clinic. He had a job but it did not pay very much. He had a long neatly trimmed mustache which covered his mouth, much of his upper lip and hid his dental pathology. Henry was so ashamed of his poor dental hygiene he did not want to open his mouth even for Una to take x-rays of his mouth. He said, "Mam, I am too ashamed to open my mouth." Una explained the importance of taking x-rays and how she was trying to help him. When he did open his mouth Una saw what she termed "the worst mouth I have seen in my entire career".
He had four front teeth, all in poor condition, from the rest he had removed the crowns with his pliers. The roots were still attached. All one could see were rotten stumps where teeth once were. We gave him anesthetic and did what we could that day and told him to come back to have the rest done next week. He thanked us and said he was going to wait until he got back to West Virginia because he felt ashamed he could not pay us. Una explained that we were a free clinic but that was not enough to keep "Henry" in the chair or get him to return.
It is cases such as "Henry" that leave one feeling empty. We reach out to give but "Henry" reminds us that we are in a partnership with the patients and they must reach back to receive, else neither of us is fulfilled.
The Huddle House Restaurant is just across the street from the clinic. Many of our patients eat there because they are open 24 hours a day. While the food is not the healthiest it is good value. From time to time we will go
TRANSITIONS
there for a meal.
One Sunday after church Una and her husband went there for lunch and as she was walking in a woman who had been a dental patient of ours, "Cecelia" , met her on her way out. She immediately recognized Una and made her way through the crowd toward her.
Una is a short attractive blond who is about five foot one and weighs about 95 pounds. "Cecelia" is a five foot eight African-American and weighs about 300 pounds . When they met Cecelia reached out and enfolded Una in her h uge arms until all you could see was a small blond head peeking up above "Cecelia's " arms . It was a sight which brought laughter to those who saw it . It was a genuine reaction of thanks by "Cecelia" and gave life to her feeling of gratitude to Una and the VIM Clinic for the care she had received. Not many people have the experience of such enthusiastic and uninhibited expression of thanks.
One afternoon when the clinic was finished and almost all had left but Una, in walked "Rosa" seeking care fo r her toothache . She had arrived by taxi and was crestfallen when she learned she could not rece ive care and would have to pay taxi fare back without r elief from her pain. Una's husband had arrived during the discussion and asked "Rosa" where she lived. They offered to take "Rosa" home, even though it was not the direction they were planning to go.
The next day "Rosa" showed up for her appointment and had her decayed tooth extracted. She was placed on antibiotics and when she returned for her check up she brought Una a bottle of perfume. Una was concerned that "Rosa" had spent money on her but accepted it with style
TRANSITIONS
and grace. "Rosa" told her she had not only found a new home here on Hilton Head but a new friend. In truth they had both found a friend and were equally blessed , which is what happens when you give your self in love to help another.
We thought we designed the clinic for the patients but in fact we are so blessed by their thanks and gratitude that we may receive as much or more than they do . We try not to have favorites but it is sometimee impossible not to . One of them is Elizabeth, a delightful Hispanic who lives on the Island . She has a beautiful inner peace which shines through. She is divorced and is raising her 17 year old daughter by herself, in spite of the fact that she has Lupus , a devastating arthritic condition , and is a very brittle diabetic.
She came to the United States several years ago and has honored us by having obtained her citizenship. Let me tell you a bit abut her. In the course of our contacts with her said she wanted to learn to do office work and how to use the typewriter and computer. We had an old typewriter which we were about to give away so we started her on it and before long she became quite proficient. She moved from typewriter to computer and now works in the office of Maria Koncul and helps her with her filing, typing and general office work. When we were disposing of some chairs and a folding table we learned Elizabeth could use them. From our standpoint they were not much to brag about but they were a genuine gift to her. She called her father in California and told him she now had a table and chairs and did not have to sit on the floor to eat any more. It was a small gift by us but of great value to her. As you
TRANSITIONS
can imagine, they have become wonderful friends.
The Luders grace the clinic with their presence. She is a slight white haired 95 year old former teacher with such a gentle spirit that there appears to be a halo around her head. Her husband, whose career was in science, is nearly her age and is the perfect match for her. They are Quakers and live the gentle life of one. She bakes their bread and he grows their vegetables. When they walk in the clinic the whole place seems to develop a brightness and sense of newness about it. Sadly she has cancer of the pancreas and we must enjoy her while we may.
Christmas season is a difficult time for those who are alone. We all know that but few of us bother to look around to see who is in need of attention, personal attention. We often give money to the Salvation Army but few will invite those home who the Salvation Army are trying to help. Not so Maria Koncul.
Last Christmas she noted that Elizabeth and her daughter along with Mr. and Mrs. Luder had no one with whom to spend Christmas day, so, Maria, instead of going home to spend Christmas with her large family who lives about 40 miles away, invited Elizabeth and her daughter along with Mr. and Mrs. Luder to be her guest. She also heard that a member of our staff, Bill Haberman, was unable to travel as planned so she invited him as well.
She cooked a fabulous dinner, they exchanged presents and truly enjoyed the spirit of Christmas. When they had finished they took the leftovers to a family who comes to the clinic who they had just learned had no electrify and as a result no Christmas dinner. The circle of giving has just been enlarged and everyone is eligible to join in.
TRANSITIONS
Our Vision Statement says: "May we have eyes to see those who are rendered invisible and excluded". If ever there was a group who fits that description it is the AIDS patients. They are among the most invisible and excluded in our society. They are scorned by society, churches and often their own families. I remember "Dave" came to the VIM Clinic with easily diagnosable AIDS. We treated him for over a year and he responded so fully that one would not have guessed his diagnosis.
One afternoon I had an opportunity to visit with him. We talked about his family, boyhood, education and work experience . He had a strong family, or at least he did until they learned he had AIDS. He hasn't heard from them for over three years . He was the youngest of four boys , all active and involved in sports. His choice was basketball and track, where he excelled in high school and in a small private exclusive college. He worked as a market analyst until he became ill and was fired and abandoned by essentially everyone he knew.
I asked him how he happened to end up in Hilton Head and he said: "I don 't know. Or least I didn 't know until I found the Volunteers in Medicine Clinic. I am surprised I am still alive. I contemplated suicide before I found the clinic. It was here that I received the kind of treatment I couldn't possibly get anywhere else . You managed my disease, supported me while I adjusted to the loss of family and friends and gave me a sense of hope that maybe I could function as a human being again . I began to realize why I came to Hilton Head when I found this clinic. This is where the angels work"
Another AIDS patient , "Marty" , came to us well after he was deep into the disease. He had the wasted look and
TRANSITIONS
sense of impending doom. He had lost 50 of his 150 pounds and needed all the help he could get . We set up a schedule of therapy and supportive care for him. Our Social Services group found him a place to stay and source of food and care for several months. He responded with surprising speed.
He has gained back much of his weight , has a job and, as he says , a sense of hope and the knowledge that someone cares about him. When we see him walk in the clinic with that great smile for us we know that we have played a part in restoring his health and nourishing his - and our - spirit.
The Circle of Caring is alive and well and living in the hearts of our patients and the professional and volunteer staff at The Volunteers in Medicine Clinic in Hilton Head . Here is where we not only see those who have been rendered invisible and excluded , but also have open arms and hearts to reach out and include them , healing hands to touch thei r lives with love and in the process heal ourselve s.
My 0\Nn Journey
One cannot create a health clinic for the medically underserved without being changed in the process. You will never be the same again . You will see the poor, and those who serve them, in an entirely different light. You will also see yourself and your previous work in adifferent light. I have been asked several times how I compare that which I achieved in my professional life with the creation of The Volunteers in Medicine Clinic. I am quick to say that all of my other achievements combined do not compare to the joy and satisfaction of the creation of The Volunteers in Medicine Clinic. I consider myself one of the luckiest people in the world. To be given the opportunity to create the VIM Clinic is the highlight of my professional career
As I wrote earlier in the book, when Mary Ellen and I retired to Hilton Head we planned to enjoy a "routine" retirement, complete with lots of golf, eat in good restaurants, travel to those places we had delayed seeing, and read those books we had set aside until retirement. I soon realized my fulfillment would not occur on the golf course. If anything, it diminished me more than I would have liked. Travel became less attractive because it took us away from our friends. And eating in restaurants , no matter how good they were , did not compare to eating at home.
I was not restless but neither was I fulfilled. It is possible I was looking for a project which had merit and value to society. If so , I was not conscious of the fact . I cannot
MY OWN JOURNEY
recall ever "looking for a project" to do . It was by the strangest of circumstances I stumbled into the creation of The Volunteers in Medicine Clinic.
I did not hesitate to pick up those walking or hitch hiking along the back roads of the Island or along the main thoroughfare. My father had never had a car. It was his position that, on the salary of a Methodist minister in the hills of Southwestern Virginia and East Tennessee, he could not "support Mr. Ford" see that all seven of his children received a college education. He achieved his ambition for his children. Of the seven who lived to adulthood, there were six Bachelor degrees , three Masters and four Doctorate degrees. One of my sisters married relatively early and chose not to go to college.
Daddy walked everywhere he went or else someone "gave him a lift". It was instilled in me at an early age that I should return the favor to others who needed a ride. In doing so on Hilton Head Island I discovered the need for health care by a large portion of the population. I also learned what very special people they are.
I have had a chance to get to know them as decent human beings who need help. I marvel at the great courage they exhibit, often just to get through the day. I recognize the dignity they have and wonder if I could be half as dignified as they if I were in their situation. I try, to the extent possible, to understand their position and make every attempt to augment their dignity. And I try to put my faith into action by responding with love in all of our interactions.
I hope that developing the clinic has made me more sensitive to the needs of those who come to the clinic for care. I thoroughly enjoy their company. They have incredibly
MY OWN JOURNEY
interesting stories to tell . Some are of the cou r age they exhibit under trying circumstances. Others are truly funny stories about their everyday life. They will share them with you if they think they can trust you and that you truly care about them . They have a very sensitive antenna to hypocrisy. They seem to sense whether or not you are genuine. No doubt they developed the talent in response to those occasions when they have been misled.
I find I am, with increasing frequency, seeking their company. I find their honesty and innocence refreshing. They do not have the time or interest in dealing with ambiguities. They much prefer to deal in candor and expect you to do the same . I welcome the times we meet by chance in the shopping centers or at a filling station. It is not uncommon for us to pull aside and take a few minutes just visiting. For the life of me I cannot remember at this moment anything specific we have discussed but I remember vividly the occasions and the joy I received in the interchange .
I have a new appreciation for their culture . Their love of the land is admirable. They have a healthy respect for the land and how they must maintain it in good condition so it will nourish them , their children and their grandchildren yet to be born. If more of their influence was included in the planning of developments, including Hilton Head, we would have less need to worry about the future of the Island and the resources necessary to maintain it and the increasing population which lives here.
I envy the slow pace of their lives. I keep time by a watch. They keep time by the tides . I tend to hurry from one thing to another. They move with an easy grace through the events of the day. I may fret if I don't finish
MY OWN JOURNEY
all of the tasks I set for myself They recognize that only so much is possible , and even necessary, to try in one day. They exhibit a wisdom which I envy. Wisdom is a difficult thing to define. The American Heritage Dictionary defines it as: understanding of what is true , right, or lasting. Personally I like the observation of Maya Angelou , "In those homely sayings was couched the collective wisdom of generations. " How true. They have collected their life experiences over generations and distilled them down into homely sayings which can be easily passed from one generation to another.
Dorothy McCall suggested, "One cannot have wisdom without having life ". I would have preferred it if she had said. "One cannot have wisdom without having lived." Those whom I have met through the clinic have lived. Their life experiences are rich in struggle, toil, adversity, search for peace and tranquillity, search for a Higher Being in whom they can put their faith , and the opportunity to pass on their wisdom to their children and grandchildren .
The question that troubles me is one which Prof. Ben Ward of Duke University has raised: "Can two cultures live side by side without one feeling the need to consume the other?"
I am eternally grateful for the opportunity I have been given to develop The Volunteers in Medicine Clinic and , in the process, get to know how very special those are who come to us for care. Someone recently asked me, "With no experience in doing this sort of thing , Jack, how did you go about it?" I replied by quoting Red Barber when someone asked him how he wrote such splendid columns and what was the technique he recommended to other writ-
MY OWN JOURNEY
ers? He said, "When I write a column I sit at the typewriter, open my veins and pour my soul onto the page." I would like to think that is what I did . I poured the best of me into the clinic .
When I resigned from the position of Chairman of the Board of the clinic I wrote the Members of the Board the following letter.
RESIGNATION
With this note I submit my resignation as Chairman of the Board of Trustees of The Voluntee r s in Medicine Clinic. I have labored over this decision for several months. Pleased be assured this is not a decision hastily arrived at. And for reasons known and unknown by you, and to some extent to me, I have chosen this time.
I have enjoyed being a part of the creation of The Volunteers in Medicine Clinic more than anything I have done in my professional life. Indeed, more than everything I have done!
I have been most fortunate to have a Board such as you . In one dimension I chose you and I take pride in that . I n another dimension, deeper and probably more real than I know, I did not choose any of you. You were a gift to The Volunteers in Medicine Clinic, the same as all of us who came to this effort.
Your support, suggestions, advice , counsel , and criticisms were an essential and vital part of the creative process. To those who suggest that you have been a "rubber stamp Board", I would say, "Please show me the stamp."
I am grateful you allowed me to make my mistakes, many of them in your presence and with you full knowledge, without too much censure. Your gentle guidance, en-
MY OWN JOURNEY
durance and forbearance have been appreciated more than you will ever know.
The Volunteers in Medicine Clinic will be in good hands under your guidance. It should continue to flourish and provide health care to the medically underserved and , in some mysterious way, healing to both the care recipient and the care givers, lay and professional.
I want you to know that this is not an easy decision . As a friend of mine said on a simila r occasion, to start a project such as this it to realize the day you begin , that the price you must pay is the day you will leave it. Some part of me, possibly the best part of all of us, will forever be a part of The Volunteers in Medicine Clinic . The friendships I have made are some of the strongest and deepest of my life. It is possible to leave only because I know that all I have done will be eclipsed by you .
The Volunteers in Medicine Clinic requires your service, if freely given and with joy, so it can continue as a mountain of strength that can never be shaken by fortune or faction . With your help it will continue to be a beacon to all who have been rendered invisible and excluded as well as those of us who must learn anew that there is no peace or joy or happiness or health for any of us until there is peace and joy and happiness and health for all of us.
Jack B McConnell , M D September 12 , 1995
Are We Unique?
APPLYING THE CONCEPT IN OTHER AREAS
Can our approach to the delivery of care to the medically under-served be replicated in other towns around the nations? The answer is yes - even in the poorest towns in the nation. The necessary resources to provide health care for every person in a town already exist in essentially every community. The key is the decision to do it. It can also be achieved by every physician in his office. It is simply showing the same respect and concern for the patient that he would like to have for himself.
VIM Clinic in Columbus, IN
After we had been open slightly more than a year, I spoke as a member of a panel in Columbia, SC at the invitation of the South Carolina Hospital Association and I highlighted our Circle of Caring. A well-trained primary care physician, Dr. Monniegue Singleton, practicing in one of the poorest towns in the poorest county of South Carolina , said at the end, "That may be possible for Hilton
AR E W E UNIQUE
Head with all of your retirees. We don't have anyone in our county who is retired. " I asked if he provided free care to some of his patents .
"I see charity patients every day, several times a day. "
"How about instead of referring to them as ' charity patients ' you think of them as ' associates'," I suggested. "Invite two of them to join you in your practice to serve as 'greeters ' and ' gofers' each half day your office is open . Purchase a jacket for each of them with their name on it and give them a sense of dignity. Lift them out of the ordinary and make them
''VIM Clinic" in Erie, PA extraordinary. In the process you will not only transform them but your practice to a more efficient process and your view of them from ' charity patients ' to ' associates ' ."
He was not fully convinced it would work for him in his practice but approached me to discuss it further at the close of the panel , which we did .
Can our clinic be duplicated in other towns? Yes , it can , has been , and continues to be. See the Volunteers in Medicine Institute website (www.vimi.org) for a current li s t of open VIM clinics .
I hope society will soon recognize the value of the approximately 160 ,000 r etired physicians and the estimated 400 ,000 retired nurses and approximately 40 ,000 retired dentists and organize them to deliver care to the 40-45
ARE WE UNIQUE
million of our fellow citizens who now have little or no access to health care. Bring them together with the senior medical student or the newly graduated physician and we will have a potent combination on site addressing the issue of no access to health care of 45 million of our fellow citizens.
We could address several issues at the same time: introduce the new physician to the joy of providing care to the medically under-served; match up the new insights with the wisdom and experience of the retiree; introduce the new physician to the ethic of caring for everyone which was a part of the older generation; and encourage more young physicians to go into Family Practice.
If I had one wish for our nation and the medically under-served, it is the fulfillment of our Vision Statement which says:
May we have eyes to see those rendered invisible and excluded, open arms and hearts to reach out and include them, healing hands to touch their lives with love, and in the process, heal ourselves.
ARE WE UNIQUE
Appendix
OPERATING STATISTICS
Survey
The initial survey was invaluable in setting the clinic on the right course. Essentially every important decision we made following the survey was determined or influenced by the survey. That included the size and type of facility, the number of care givers necessary to deliver the care , the amount and type of equipment we would need , the type and amount of supplies and materials, the approximate operating cost of the clinic, and the funds we would have to raise to complete the task and keep it operating.
Our survey suggested there were 8-10,000 individuals in the target population who met our eligibility qualification - no insurance, no way to provide it, household income not in excess of 200 % of poverty, and live or work on Hilton Head Island. They were , for the most part , employees of the hospitality, construction and landscaping industries. The distribution by race suggested 45 % were black, 45 % were white and 10 % were other, mostly Hispanic , 88 % lived on the Island and 12 % commuted to the Island for work.
Volun teer Staff
We opened the clinic with a volunteer staff of 48 physicians , 74 nurses and 3 dentists . After three years we
APPENDIX
have 44 physicians, 64 nurses and 15 dentists.
Volunteers: seated, Hannah Swimmer; standing, Janet Hovis, Mary Doughty and Betty Dougherty
Paid Staff
When we opened we had a paid staff of four full timeMedical Director, Director of Nursing, Clinic Director and Director of Developmentand one part time - Office Manager. Three years later we have a paid staff of five full time - Medical Director, Nursing Director, Office Manager and Director of DevelopErnst Pfrunder and patient ment and Secretary and two part time - Director of Lay Volunteers and Manager of Dental Clinic. In addition we have a CPA who is paid as needed.
PATIENT VISIT STATISTICS
Patient Visits
The first year we had approximately 5 ,400 patient visits , the second year, 10,000, the third
APPENDIX year, 13,000 and Lay Volunteers: Kate Cox and Peg Harty 15,000 the fourth year. The number of visits correlated with the number of patients we treated , approximately 3,500 patients the first year, 7,400 the second , 8,200 the third and 9 ,000 the fourth.
I was delighted to see the increase in patient use of the clinic from the opening until the end of the third year. That suggested we were reaching the target population and they were using the clinic. Of course, growth also suggested that some of our patients were not receiving care in the earlier years . I will feel better when we plateau and we can be fairly certain we are reaching essentially all of those patients who belong in the clinic.
Second Area Clinic
Even though it is in our Charter, we have not done anything about establishing a clinic on Daufuskie Island, a lovely barrier island just a mile across the Calibogue Sound from Hilton Head Island. There is a population of Low-Country Native Islanders whose culture is Gullah. They speak Gullah, a mixture of African and English and some other dialects. They also cook in the Gullah tradition.
APPENDIX
One would almost swim across the Calibogue Sound for some of their spicy Daufuskie crab cakes. Just as we were in the process of starting a clinic we hired Dr. Bret Williams as our Medical Director. He lives on Daufuskie Island and started a clinic for the retired community as well as the native island Gullah community. He is an enormous gift not only to the residents of Daufuskie Island but also to The Volunteers in Medicine Clinic - to which he commutes every day by boat. If there were enough Dr. Williams ' i n our profession, there would be no discussion regarding the millions of our fellow citizens who lack care.
Savings To the Local Hospital
Soon after we opened, the Director of the Emergency Department called to say that the Emergency Room was an inappropriate place for the care of Dr. Oliver Crawford non-paying patients with primary care problems and he wondered if they could refer those patients to us. I agreed that they belonged in our clinic and we would welcome them. I then asked if we could use the Emergency Department as the referral point for our patients who needed secondary or tertiary care. He agreed and the deal was
Dr. Bret Williams
APPENDIX
struck.
We have records for only the first year of operation and it appears we reduced by at least one-third the number of non-paying primary care patients who used the hospital ER. The increase in patient visits our second and third years suggests we reduced the number of non-paying patients on the ER by the same figure , suggesting we then took one-half of the remaining non-paying patients . This resulted in significant savings to the local 64 bed hospital, between $650 ,000 and $750,000 per year.
The staff of the local hospital has been most cooperative and supportive. They understand and appreciate the value we bring to the health care system . They present many of the lectures of our CME (Continuing Medical Education) program, are available for consultations, and, when possible, accept our patients who need secondary or tertiary care.
We have demonstrated that a free health clinic for the medically under-served can effect considerable savings for a hospital, whether for-profit or not-for-profit. It would appear that the hospitals would be the first to want to see such a clinic in the community - and to cooperate in seeing that it not only survives but thrives.
GOING FORWARD
Lessons Learned
I would advise those who are planning clinics for the medically under-served to put resources toward studying the target patient population . Treating diseases is not enough. We should try to understand better the origin of
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the diseases and the conditions which affect them. Disease does not exist in isolation of one's environment. Why do our poorer patients have a higher rate of diabetes, hypertension and cardiovascular disease, and what can we do about it? What role do diet , poverty, ignorance, race, housing, habits of alcohol and tobacco , and social justice play in the health of our patients? Quite likely, more than we can document and probably more than we can address meaningfully. At least we should know the demographics of the diseases which impact our patients. Also, developing a relationship with the pharmaceutical companies is important. Johnson & Johnson, Smith Kline Beecham and Pfizer have been very generous in their support . From the rest, for the most part, we have received very little. I know they can help. I just need to find a way to make it obvious that our type of clinic is as beneficial to them as it is to our community. Finally, we need to do a better job of credentialing those who work in the clinic, especially the members of the staff. Apparently, health clinics such as ours attract a very interesting group of people - those needing and hoping to be healed themselves. They probably need more healing than many of our patients. This situation can eventually cause problems if not detected early. Fortunately, most volunteers and staff come to the clinic for the best of reasons and enrich the lives of all they touch.
P r ojections
The Volunteers in Medicine Clinic will continue to exist and, I hope, thrive. It has become an institution recognized in the community, the state and around the nation for its innovative delivery of health care to the medically
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under-served. The clinic's endeavors bring considerable good to the community and increase the quality of life of all of those who live or work on Hilton Head Island . Our town would be greatly diminished if the clinic ever ceased to exist. I cannot imagine a situation where the citizens of this town would allow the clinic to fail.
The citizens of Hilton Head Island take a lot of pride in the clinic's accomplishments. That does not suggest, by any means, that we can sit by and do nothing to improve ourselves or the position we hold in the community. In many ways it means there is an extra burden on us to make sure that we continue in the pursuit of access to health care for all.
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Index
Abbink, Opal Duke: ack , 52 , 53 , cp4 , 77
African Flying Doctors: 86, 102
Anderson, Ken : ack., 8, 10, 18, 48
Angelou , Maya : 112
Atkinson , Dr. Sam : 77
Audet , Dr. Jean: 77
Baehrans, Dr. David: 13
Barber, Red: 112
Barnwell, Thomas C. , Jr.: ack ., 7, 39 , 40, 41, cpl
