Friday, June 5 Update
This week I was seeing a patient I’ve been working with for a couple of years now. We talked about his medication, his health, where he is living now, and his future plans. After his blood work, I bought in his bag of medications. He stopped before leaving and told me, “I just want to thank you all here for helping us homeless guys. I don’t know what I would do without you.” While I felt grateful that he took the time to share this encouragement, I mostly felt anger. He shouldn’t have to be thanking me for primary health care. What kind of world is it where people experiencing homelessness expect to go without care?
His words seemed especially poignant because when he started his care with Good Sam, he had severe respiratory disease. I remember many visits where he literally couldn’t breathe. Breathing should be the expectation, not a privilege.
In the midst of a pandemic already wrought with racial disparities, recent events demonstrate the pervasiveness of racism in our country. My work at Good Sam is largely mitigating the physical impact inequity. At the clinic this week, I also saw a patient who left the clinic on a stretcher just a month ago. “I honestly wasn’t sure I would see you again,” I told him. He smiles, “Guys from my neighborhood don’t live to be my age so I guess God has more for me to do.” He’s right. As a black man from a poor neighborhood, he has exceeded the life expectancy for the census tract he was born in.
For Good Sam, this week has been a time to consider how we work toward health equity and what more we can be doing. We have had some recent positive steps forward in our COVID-19 response and increasing access to care. We hosted our Virtual Institute on responding to COVID-19, where 48 people from 7 states attended to talk about how charitable clinics respond to COVID-19. We launched a walk-up COVID-19 testing clinic in our outdoor pavilion, thanks to a partnership with CVS. Primary care visits are increasing, and our dental department is back to 5 days a week. But, there is so much work to be done. Work to do individually and work to do collectively. And while we are working to address the COVID-19 pandemic, I am reminded of a much more pervasive, devastating pandemic: racism. No matter how much we improve our COVID-19 response, saving lives depends on our collective ability to confront racism and inequity in this country.
Friday, May 22 Video UPDATE
BLOG AND VLOG ARCHIVE
Adapting to the New Normal
If we’re honest, what we want is a date, a line in the sand, after which everything goes back to normal. A day when we simply go back to our normal lives and plans and leave the COVID-19 pandemic behind us. Quarantine is hard, and the challenge is compounded by the unknown. This would all be easier if we knew when it would end. The truth is that we aren’t going back to normal. We will slowly redefine work, community, travel, and healthcare. COVID-19 isn’t in our control, but our response to it is. We can face the inevitable change with anger and resentment, or we can give grace and shape change intentionally.
I miss going to places and seeing friends. I haven’t been able to see my mom. She lives alone just 20 minutes from me, but all I can do is leave groceries on her doorstep. I miss celebrating birthdays and inviting friends over for a meal. I miss attending church and singing with the worship band. As I think about the summer, I think of the plans that have been canceled. For many, quarantine has brought loneliness and financial hardship.
The virus itself fuels my longing for it just to disappear. I am used to fixing things at the clinic. We can provide vaccines and education to prevent disease, medications to manage and cure. With COVID-19, there is nothing I can do. No treatment to give or reassurance to offer. I recite the same guidelines repeatedly each day, “go to the ER if you start having difficulty breathing.” I am reminded daily that the best thing I can do for my patients is to commit to social distancing and decrease the spread of COVID-19.
This week I called to check in on a patient with COVID-19. She had classic symptoms but had been doing OK. Her son answered the phone and told me she was in the hospital. He is a young adult with severe developmental delays, and she is his only caregiver. I will continue staying home except for my weekly trips to ALDI to make sure her son isn’t on his own.
Another patient called me panicking this week because a close co-worker has COVID. He has a wife and three kids and was worried that he could be exposing them. His test came back negative, but he’ll return to the same job where more and more people are testing positive. I’m going to continue joining church via a virtual live stream to help keep his family safe.
For all of us who are weary, lonely, fearful, and longing for an end, remember we are each other’s keepers. We may not have much in our control right now, but we can adapt. We can choose a new normal in pursuit of saving the lives of people we have never met.
The Power of Volunteers
I'll confess, the past week has been discouraging. We had a couple busy days in which I felt like I was sending everyone I talked to in for COVID-19 testing. There is a picture of a nail salon worker in a basic facemask and what looks like a clear poncho giving a manicure that I can't get out of my head. A colleague who has been faithfully continuing street outreach with the best precautions possible, just posted that his COVID-19 test returned positive. The week ended with a new record daily COVID-19 death tool in the U.S. As the weeks drag on, and it feels like the hopefulness and comradely that marked the early days of the response have given way to anger and fear.
In these moments, I remind myself of those who are responding in love and compassion. Such examples are not hard to find at Good Sam. Our team shows up each day with smiles and energy as they don masks and prepare to serve patients. A patient told me this week, "I can tell you are smiling even with the mask on." A group of boy scouts brought tubs of handmade facemask for patients, and a woman I have never met just emailed to see if she can send the staff lunch. Most of all, a group of twenty dedicated volunteers run our daily helpline so that patients and community members with questions or concerns about COVID-19 can immediately reach someone. This team answers questions routes people to us so we can refer them for testing, and helps people get care throughout our telehealth partner, Giving Health. They have taken calls from all over Atlanta and even one from Texas. As HelplineSOS moves into 25 other clinics across the U.S., many of the volunteers are now assisting the team that will make this happen. They remind me daily that our country is filled with people like them who are in it for the long run.
For anyone, like me, who could use a little encouragement, I invite you to read this interview with Mike and Priyasha, two of our volunteer coordinators who make HelplineSOS possible.
What was it like getting started?
Mike: In the first week, we created a detailed script, onboarding material for volunteers, a clear workflow for how the helpline would know this is a triage system, and connect them to the appropriate providers and information. Then it was all about making sure we could support volunteers. We had almost 20 volunteers in the first few days -- they were so enthusiastic they were asking us for more calls!
Priyasha: We had to develop new processes for everything since COVID-19 began, and with the helpline, at first, there were many new questions -- how do we connect a person from the phone to a provider? The main piece of this has been categorizing our callers -- complex, simple, symptomatic, information seeker, test seeker, and then as Department of Public Health guidelines have been changing every other day, keeping these categories updated. We pulled off setup in a week. We've been doing this for two weeks, just with Good Samaritan staff.
How does volunteering work?
Mike: When the call comes in, the volunteer does the majority of the work -- gets to know the patient's situation as well as they can, then helps provide the support that person needs, both for callers that are Good Samaritan patients and other patients. Regardless of their status, all callers get connected to a provider if they need one. For those who are not Good Samaritan patients and are uninsured, they get registered with Giving Health, a nonprofit telemedicine provider, and they're able to get an appointment at no cost, for COVID-19 related issues or other critical health issues.
What are success stories like?
Priyasha: One example: a volunteer took a call from someone who wasn't a patient at Good Samaritan, who then called back later with other family members who needed this service to access testing. This caller was routed to Giving Health for an appointment. It's great when we can reach as many people as possible. The caller was so impressed with the service that they are referring other people to call-in.
What's amazed me is how many people have called us back: we've had people call in, and they're having mild symptoms, not ready to talk, but then, because of the connection they have with that volunteer, they will call back later. I am confident in the system we've set up because it provides callers with support and connection. They know that if they need it, in an hour they're connected to a provider, and it's why they call back. It's powerful to talk to someone and hear the relief in someone's voice when we address their concerns. It could be as simple as educating the caller about COVID-19 and informing them of the common symptoms, but even that small piece of information can ease anxiety.
Mike: Here are a few sample caller questions that we were able to help:
- "My mom tested positive for COVID-19. My siblings and I have close contact with her but do not have any symptoms. Should we be tested?
- "I have a history of high blood pressure and have been exposed to COVID-19 at an assisted living facility where I work. Now I have a dry cough, occasional fevers and muscle aches."
- "My sister and nephew were diagnosed 1-2 days ago with COVID-19. My mother is around them everyday and now she feels sick as if with a stomach virus. She has a history of diabetes but does not have health insurance."
- "I've been taking care of my daughter who was hospitalized and tested positive for COVID-19. I feel like I'm getting short of breath when I climb stairs."
How does HelplineSOS help health care in the community?
Priyasha: That system of taking care of the uninsured, our community of providers, just giving this already set up community the support they need.
We're lessening the burdens on E.R.s, hospitals -- because they can work with people who are calling, some of which can be helped without going to the hospital or might need assistance but are reluctant to go into a facility due to fear of COVID-19.
Mike: In my perspective, I'm amazed by how much everyone wants to help out, support. We didn't have too many people, willing to help in whatever way I can, that attitude has been a big part of all of our work.
Priyasha: It feels good to help people right now and make sure we are getting them the testing and support that they need, including the emotional and mental health support.
What are you most proud of from the volunteer experience?
Priyasha: I was excited to be a part of this because I love working with patients, and it felt like a great way to help the community in a strange time. The speed through which so many people in the community are rising to the challenge, setting things up asap, guidelines, clinics, all of it. Our team is able to adapt and build and grow from every call, even as the situation worsens in Georgia.
Mike: The connection between a caller and a volunteer and a coordinator and a telehealth provider -- when it works together, it's extraordinary. It all starts with a call on the helpline.
Words of wisdom from the volunteers
Priyasha: This situation is dynamic, evolving -- for Good Samaritan, we are getting new rules from Georgia's Public Health Department, and adjusting every day. Volunteers need to understand the script deeply so they have the confidence they need to know what to say, to really provide the support and care that callers need in this triage model. With the script, they'll know immediately what this person needs to know.
For our volunteers, we work to be thoughtful about the power we have -- letting the empathy show in our voice, creating the level of comfort someone needs to be able to call back.
Mike: Don't underestimate the power of information.
Building for the Long Run
For the last month, I have been, like most of you, in crisis mode. It has felt like I can’t solve problems as fast as they are appearing. We finish implementing a new policy to find the guidelines have changed again. This week, I find myself entering a new stage. I already know Good Sam can mobilize, change, and adapt. Our staff proved this weeks ago. But now I am asking a new question: what does it look like to sustain our work in a new reality? This question is an important one because I know two things for sure: COVID-19 is not going to disappear, and neither is Good Sam.
Early on in the process, as we were launching the HelplineSOS, I was concerned about every detail being in place when we began. My colleague assured me there would be time to adjust and get it right. “I know you provider types,” he said. “You want to fix things, but this is just the start of a marathon. You have to pace yourself.” He was right. Weeks later, our crisis response is well-practiced, and vulnerabilities have been addressed, but there are so many miles to go.
I have found my prayers shifting from “don’t let me get sick” to “let me recover quickly.” “Let me have enough symptoms to know to stay home and not spread it to every patient I see for a week.” “Let me make enough antibodies to be a donor.” Our supply of PPE should carry us through May, but will the supply chain be re-established by the time our supplies get low? Right now, patients forgo telehealth and postpone appointments because they “can wait until summer.” But what if the risks aren’t substantially different this summer, and how will we accommodate three months of delayed medical needs in a single month? I can choose to be consumed by the need for answers I don’t have, or I can pace myself. Pacing myself means focusing on the big picture and allowing that to guide my every day decisions. I have been asking myself these questions:
1. What needs to happen for us to come out of this whole? Whether at Good Sam or at home, plans will be delayed, programs stalled, and outcomes won’t be those we planned in January. That is OK. I want to come out of this with the same motivated, passionate team who started this journey together. I want to come out as the same holistic, patient-centered clinic earning community trust through action that we have always been. There will be ups and downs and wins and losses in the months to come, but I want us to look back and know that we never compromised our mission or the people who make it possible to live out that mission.
2. What makes a meaningful difference in the lives of those I can impact? As much as I wish I could, I can’t fix everything. I need to focus my energy on the way I am best equipped and positioned to mitigate the damage COVID brings. I am trusting that others are doing this in their own spheres and that doing my best in my space support them in theirs.
3. How am I demonstrating the response I want to see everywhere? The news is a daily reminder of our brokenness, of persistent health disparities, of how fear and selfishness drive decision-making. I can choose to speak the truth and pay attention. I can seek the wisdom and perspectives of others to make informed and proactive decisions. I can choose to view the responses of others and my own shortcomings through a lens of grace. I can extend gratitude and compassion because we all need that right now.
Calls from the Department of Public Health with positive results are commonplace now, and the number of patients I know who have been diagnosed with COVID is growing. We won’t get to wake up on May 1st and go back to normal, but we don’t have to be defeated either.
The week has been filled with beautiful spring days: clear blue skies and budding trees. It’s quiet with less traffic and the drive to work is even faster than usual. The streets are empty. No one speaks during my once a week trip to the grocery store. Everything is oddly quiet while the pandemic rages on.
Good Sam has felt a little this way as well. We have moved nearly half of our patients to telehealth. Instead of the sounds of patients walking and greeting staff in the hall, providers meet patients over a computer screen. Sick patients are masked outside and taken to our triage area which has a separate entrance. Our voices are muffled behind our respective masks. Our Friday clinic designated for individuals experiencing homelessness has changed from a family-like atmosphere of devotion, breakfast, and multiple appointments, to an outdoor waiting room with chairs 6 feet apart, sack lunches, efficient visits, and psychiatry consults by phone. Today, one of my patients for the past 5 years told me, “You might as well give me 2 months of medication. If I can’t get my hugs here anymore I might as well wait a little longer before coming back.” We are working hard, but it is different. It is quiet in an unsettling kind of way.
While so much is different, our mission is not. We are staying open and serving our community in a way that demonstrates God’s love for everyone. We are refilling medications, providing phone and telehealth consults, accepting walk-ins, bringing medications out to people's cars, and fielding phone calls all day long. Our message is clear: it’s going to be different for a while but we are still here. You can still depend on us.
This week hundreds of flyers went out to our community with our clinic number. We assembled a volunteer call center ready to answer questions and connect people to care. The HelplineSOS system we have piloted is set to be used by hundreds of clinics across the U.S. We joined the Westside Future Fund for their broadcast again this week, delivered cell phones to a local shelter to facilitate telehealth for residents, and helped a dozen people get testing for COVID-19 through the Department of Public Health. We are doing what we do best, providing the care our community needs at this time.
I would rather be hugging my patients. We are all grieving the loss of life as we knew it. But like all of you, we are doing what is best at this moment. Stay strong, friends.
So many of you have reached out to ask how we are doing and what we need. Thank you! I am going to respond to each of you but wanted to provide a general update, as it will take me a little while to get caught up on emails.
So much has changed in a short time. We have reconfigured clinic flow to operationalize outdoor triage and transformed our previous staff entrance into an isolated assessment space for anyone presenting with fever or respiratory symptoms. We spent an afternoon in all-staff training around new policies and procedures related to COVID-19. The majority of our administrative staff have moved to work remotely. Nutrition consultation and counseling are conducted remotely, and all health education programming and classes are temporarily suspended. Dental is providing emergency services only. We are now using a telehealth platform for virtual visits and are moving as many office visits to telehealth as possible. We continue to operate our clinic dedicated to people experiencing homelessness with new procedures and the use of our outdoor space as a waiting area. We have a designated provider covering sick visits each day. We’re wearing scrubs and have detailed routines of showers and separate hampers at home, so we limit the risk to our families.
In partnership with the Coronavirus Support Network, we have created a helpline for our patients and our community. This system allows us to rank incoming calls by risk factors and utilizes volunteers to provide information and route appropriate requests to our health care providers. We are the first pilot clinic for this program, which will be used by hundreds of clinics across the nation over the next two weeks. We hosted the Westside Future Fund’s community broadcast on Friday to offer facts and resources to our community. So we have been busy, and I have never been more proud of our team.
While we have mobilized quickly, the last week has also been a reminder to me of how the inequities in our country further complicate this crisis. Many of our patients do not have access to medications, if not for our dispensary. While telehealth is a solution for some of our patients, others do not have smartphones or reliable access to any phone. Testing for COVID-19 in Georgia remains limited. We are not testing at Good Sam so if we want to test a patient we have to fill out a request on the Department of Public Health’s website. We select one of the driveby locations and then inform the patient that we will know after 24 hours if they were approved for testing. We had a patient Friday who is living in a shelter but has no phone to be notified if he is approved for testing and no transportation to get to a testing center. I am reminded that our response in this crisis is critical, but our work, mission, and advocacy must continue both during and after COVID-19.
Many of you have asked how you can help. Here are a few specific ways:
1. We need volunteers to sign up for shifts for the hotline. The volunteers for the call center work remotely from scripts and help us give information and route calls to the appropriate people. Volunteers do not provide medical advice, so you do not need to be a provider. Our longtime volunteer and PA, Mike Tremmel, is heading up our volunteer team. You can sign up here or email me, and I will connect you with Mike.
2. At this time, our staff medical providers are addressing all calls from symptomatic people needing medical advice. At some point, it is likely we may not be able to keep up. If you are a provider who would be interested in helping advise people by phone to prevent unnecessary clinic and ER visits related to COVID-19, let me know, and I will start working on how best to accomplish this as needed.
3. Donate or encourage others to donate. As most of our patients are uninsured, a move toward triage and telehealth will result in a dramatic decline in patient revenue. We are committed to retaining as many employees for as long as possible, but this will require new revenue sources.
4. Pray. We would love prayers for wisdom in what feels like a million decisions a minute and protection for our staff and their families.
5. Encourage your sphere of influence to stay home. As we post updates on our website and Facebook, please share. I keep telling my friends and family that what I am doing is damage control. Their decisions are the only hope of changing the direction of the pandemic in the US.
To keep all of our volunteers and partners informed and connected to us during this time, I am working with John Allison to provide weekly updates here the form of a short blog or video. We look forward to having you all back at the clinic, but for now, be safe.