21st-Century Mission

By Pamela Constable
Washington Post Staff Writer
Tuesday, July 29, 2008

The waiting room at La Clinica del Pueblo is a busy but intimate scene where doctors greet patients with a hug, new mothers drop by to show off their infants, and Spanish-speaking seniors come for help translating their mail. No one minds if you miss an appointment or try a home remedy for your ailments.

The ethos of the nonprofit clinic in Columbia Heights, founded in 1983 to help the poorest, most marginalized refugees from Central America, is summed up in a plaque just inside the entrance: "Our mission is to provide free and culturally appropriate health care to the Latino community."

But today, La Clinica is trying to leap into the 21st century by modernizing its operations and stabilizing its finances through an annual federal grant. In return, it must meet government requirements to double its patient load, increase revenue and make services more efficient.

The changes, though recognized as necessary by most people connected with the clinic, have also led to a severe cash crunch, a bitter internal debate about whether its all-embracing mission has been betrayed, and a worry that its traditional clientele will no longer feel comfortable or welcome.

"I understand that we need to create structures and systems as we grow, but it is sensitivity to clients that makes this place so special," said Omar Reyes, an HIV/AIDS counselor. "We were created to help a population that fled from the trauma of civil wars and crossing borders. The idea was not to cause more trauma or put up more barriers. We have to modernize, but without losing the essence of what we are. This is my great fear."

La Clinica was founded by an exiled Salvadoran doctor, Juan Romagoza, who believed that health care for poor immigrants should be free. For years, it charged nothing for most services, surviving on volunteers and charity. Last year, as part of becoming a federally qualified health center, it switched to sliding-scale fees based on income, bringing strong objections from some staffers.

Romagoza, a political refugee and torture victim with fierce egalitarian ideals, quit as the clinic's director early this year, in part because he disagreed with the way it was changing, and returned to El Salvador.

To continue receiving federal grants, the clinic must go even further, charging a minimum fee of $20 and seeking more patients with Medicaid or other insurance. Now, every new patient is greeted by a staff member carrying a laptop computer to record personal information that once would not have been requested.

The changes have been especially trying for employees, who must fill out myriad new forms, keep better track of expenses and either cut back or formalize the services that are not strictly medical, such as family chat sessions and cooking classes.

A related concern is the amount of time staff members spend with patients. Many local Latinos have come to view La Clinica as a place they can drop by to share their troubles or joys, and the staff has always accommodated patients who cannot plan appointments because of irregular work demands.

One recent morning, a couple came in and asked for Sammy Caro, a case manager with a heavy workload. They had no appointment but were there to show him the newborn boy they had named after him. Caro dropped everything and devoted his full attention to the baby, who was asleep in his mother's arms.

"Sammy is really like my family," said the beaming father, Jesus Salinas, 41, a hotel cleaner from El Salvador. "He has helped me with so many things over the years. Whenever I come in, he sees me right away. I really appreciate that. We went through a lot of names for the baby, but then we decided it should be Sammy."

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