The bump on his forehead would not go away, and his circulation problems were getting worse, but Alexandria resident Gregorio Segura could not afford to see a doctor.
That was, until the uninsured 50-year-old musician heard about the expanded medical services being offered at the Arlandria Health Center.
"This has been my salvation," Segura said as he waited to see the doctor at the clinic recently. It was his fourth visit since January.
"If they did not exist, I could not take care of these problems," he said.
Thanks to a new federal grant, the clinic staff is hoping to reach more people like Segura. The health center, established in 1993, traditionally served only low-income women and children in Alexandria. The three-year, $1.85 million grant, awarded last year, means the clinic can now provide medical services to anyone who walks through the door, regardless of income, sex or where they live.
"We're breaking new ground in a number of ways," said Jennell Charles, executive director of Alexandria Neighborhood Health Services Inc., the nonprofit organization that oversees the center. "This center is one of the few of its kind in the country and the first in Northern Virginia."
With surging health care costs and more people without insurance, the need for accessible and quality health care is not just an issue for the poor, Charles said.
"This is not poor care for poor people," she said. "It's good care for people who need health care no matter what their income, residency, race or status is."
Nationally, about 15 million people use these types of centers, and about 6 million of them are uninsured, according to the National Association of Community Health Centers. But Dan Hawkins, the association's policy director, said there are millions more who don't have access to the kinds of services these clinics provide -- even those who have insurance.
"We just released a study that shows 36 million Americans do not have a regular family doctor or a regular source of primary care," Hawkins said, adding that half of those cited have health insurance. "There is just no place for them to get the care they need."
The Arlandria Health Center is one of 20 centers that oversee 73 sites in Virginia referred to as "federally qualified" health centers, officials said.
These centers receive federal grant support to provide care for the uninsured and are recognized by Medicare and Medicaid, Hawkins said.
In Virginia, about 172,000 people visit these centers for services ranging from physicals to fillings. Of those patients, more than 35 percent are uninsured, said Rick Shinn, director of public affairs for the Virginia Primary Care Association. Medical, dental, preventive, behavioral and pharmaceutical services all fall under primary care, and the services offered at individual centers vary based on community need, Shinn said.
The 17-member staff at the Arlandria Health Center includes a medical director, two family nurse practitioners, two registered nurses, three nursing assistants and a part-time pediatrician. Clients pay for services on a sliding scale based on income, Charles said.
The clinic expanded its services about nine months ago, and word has been spreading throughout the Washington area. Maryland resident Chereka Elam, 23, learned about the Alexandria clinic from a friend after she found out she could no longer afford her Kaiser Permanente health plan.
"She told me about this facility that takes anybody," said Elam, a hairstylist.
Elam drove five miles to the Arlandria clinic to get a checkup. The cost: $10.
"This is better for me," she said. "I pay as I come, and I can afford it."
At the clinic, people from all races, incomes and geographic areas trickle in, but the majority of the clinic's clients continue to be Latino immigrants, Charles said.
The clinic is at the Presidential Gardens Apartments, where a majority of residents are black and Latino, she said.
More than 80 percent of Latino immigrants in the Arlandria community are uninsured, and among them there is a higher rate of illness, including asthma, diabetes, hypertension and respiratory problems.
As part of the federal grant requirements, 51 percent of the clinic's 17-member board must also use the clinic, so Charles has been recruiting volunteers such as Justiniano Perla and Marlene Bonilla, both of whom have sought medical care at the clinic, to serve on the board and help with community outreach.
And outreach is more than handing out brochures in the neighborhood.
"There are many immigrants who can't speak English and they can't read Spanish," Charles said, "so we can have all the brochures and booklets, but it's kind of pointless."
In particular, the clinic wants to reach out to men, who, as a group, tend to not seek medical treatment as often as women.
"We want to encourage men to come in and get medical checkups," said Roger C. Chinery, the center's medical director. In some immigrant cultures, for example, men do not seek care until there is a serious problem, he said. Since the center expanded its services to include men and adjusted its hours to accommodate people after work, Chinery said, he has seen some male patients who have never been to a doctor.
Chinery said many are suffering from illnesses that can result from neglect, such as diabetes and hypertension.
In addition to medical services, the center offers counseling and therapy. The small administrative office has brochures that address myriad mental health issues, from dealing with domestic abuse to building self-esteem.
Clients say that not only are the services valuable, but the clinic's proximity to their homes is also invaluable.
Perla works in construction, and he said he developed terrible allergies to the chemicals he is exposed to in his work. Before the Arlandria center opened its doors to men, he used to go to a clinic near Tysons Corner to get the medicated skin cream he needs.
Perla, who lives in Presidential Gardens, said it would sometimes take all day to make the trip to the Tysons Corner clinic. Now, he can just cross the parking lot to see a doctor.
"It's quick and it's fast," he said.
The proximity from her home to the center is also invaluable to Alexandria resident Francisca Ventura. She said that if she had to travel far, she wouldn't seek medical care for herself. A private doctor would be out of the question because of the expense.
"We could never afford it," she said. "This is so much cheaper." When informed that the clinic now takes male patients, Ventura said that was a nice surprise.
"I'm going to go home and tell my husband he needs to come here," she said.
Hawkins, of the health centers association, said that is the goal in establishing these types of clinics: affordable, accessible, quality health care.
"It's not winning the war, but it's a critically important first step," he said.
"Hopefully, it won't be the last step."