UC Davis, volunteers give tiny Knights Landing its first health clinic since 2008

02/21/2012 12:00 AM

02/21/2012 7:53 AM

Medical students and undergraduates in white coats and blue scrubs swarmed around patients at the new Knights Landing health clinic Sunday, sometimes as many as three to one.

The attention was a welcome flood after the medical drought that the tiny farming community has suffered since its only clinic closed more than three years ago.

"It's good that you're here," Alexa Calfee, a medical resident and the clinic's co-director, told patient Armando Garcia.

Tests showed that the 44-year-old, who works in a mattress factory, has high cholesterol and high blood pressure. Garcia said he hadn't seen a doctor in three years.

Sunday was the official opening of the free clinic, the product of several years' planning by students and faculty at UC Davis School of Medicine and residents of Knights Landing. Housed in the office of the nonprofit Yolo Family Resource Center and staffed entirely by volunteers, the clinic gives free medical care.

It will be open one Sunday a month – which isn't much, but residents say it's better than nothing.

And if it works well, it could be one piece in a patchwork of solutions needed to fill the giant voids in medical care for rural communities across California and the nation.

Statewide, one in five Californians live in a rural area, reports Rural-PRIME, the UC Davis medical school program that prepares students to do rural primary care. Yet fewer than one in 10 doctors practice there.

As recently as the 1980s, "You still had the kind of country doctors who were willing to drive around in an old pickup," said Gail Nickerson, director of clinic services at Adventist Health and board president of the California State Rural Health Association. But the modern costs of practicing medicine have made it difficult for independent doctors to survive in isolated towns with small caseloads, Nickerson explained, and managed-care models like Kaiser Permanente have scooped up doctors with the appeal of just seeing patients and not "having to be the businessman, too."

The gaps have a real impact on people's health.

In communities without a local source of care, "Women tend to get diagnosed with pregnancies later. They end up seeking prenatal care later. Immunization rates get worse," said Thomas Nesbitt, the medical school's associate vice chancellor and a founder of Rural-PRIME.

Chronic disease rates and cancer death rates are higher in medically deprived areas such as Knights Landing, Nesbitt said.

The community consists of little more than a school, two gas stations, two small markets, one Mexican restaurant, and rows of modest houses, all clustered along the Sacramento River at the northern border of Yolo County. About 1,000 residents live there.

A local women's group organized by the Yolo Family Resource Center launched the effort for a new clinic after the nonprofit CommuniCare Health Centers site in town, which had been open 12 hours a week, closed because of budget cuts in 2008.

The new site is a satellite of Sacramento's Clinica Tepati, one of seven free health clinics where UC Davis medical students train under supervising physicians. It is the first site run entirely by students in Rural-PRIME.

The clinic aims to serve people who aren't insured or don't have regular transportation to medical centers in Woodland, 12 miles away – common obstacles in Knights Landing, where many residents are Latino immigrants who earn meager salaries working in the fields.

The community on Sunday showed its appreciation the simple way: through food. Members of the women's group carried in pastries, roast chickens, and homemade rice and beans. They have organized a rotation to bring lunch every Sunday that the clinic is open.

All told, about 20 medical students, undergraduates, nurses and doctors served a dozen or so patients. They performed Pap smears, diagnosed a case of diabetes, and prescribed cholesterol and blood-pressure medication for Garcia, who already exercises regularly and eats a low-meat diet.

For managing chronic diseases, a once-a-month clinic like this "makes a major long-term health impact," said David Naliboff, a retired Kaiser physician who volunteered Sunday. For acute problems, though, "it doesn't help when the kid's screaming at 3 in the morning."

The clinic received $7,000 in startup funds from an anonymous donor. The PRIME program contributes $1,000 a year for supplies, and lab tests are free through the UC Davis medical school lab.

But the student-doctors need more equipment, such as eye scopes and blood-pressure cuffs. The site also is not equipped for more elaborate diagnostics, such as mammograms and heart stress tests.

And though the care is free, patients still have to leave town and pay full price to pick up prescription drugs or see medical specialists.

"We're a long ways from filling the gap," Nesbitt said.

Nesbitt and Nickerson hope that, beyond helping Knights Landing, this effort will encourage more medical students to become rural doctors.

"There's hundreds of communities like Knights Landing that need a doctor to practice there, and the way we're going to address that is by exposing more students to how rewarding this kind of practice can be," said Nesbitt.

University training clinics could eventually be part of a hybrid service model for rural areas, where mobile clinics, telemedicine and retail clinics like those at Walmart stores all play a role, Nickerson said.

"Either we'll learn that this is something that doesn't work and we won't try it anymore," she said, "or we'll learn that this is a best practice, and we'll try to get more people to do it."

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