Breaking Cultural Barriers Is Key to Success at Smith Health Center
By Andrea Decof
In 1968, when Joseph M. Smith, a community activist, saw that Allston/Brighton residents lacked comprehensive health care, even though three major hospitals were based nearby, he set out to create a nonprofit health center to serve everyone from infants to the elderly at an affordable price.
In 1974 the Brighton Allston Health Corporation opened its doors, later renamed the Joseph M. Smith Community Health Center after Smiths death, and today serves more than 50,000 patients a year, the majority of whom are bilingual and lack health insurance.
The Smith Health Center, which serves patients from as far away as western Massachusetts and Cape Cod, illustrates how a nonprofit health care center can deliver complex services to a highly diverse population.
Run by a community-based board of directors, the Center offers medical and dental care, mental health services, vision, and other specialized services to patients spanning all ages. Patients pay on a sliding fee basis, based on their income.
To keep up with the growing demand for its services, a second Smith Health Center opened in Waltham in 2004.
Staff Speaks 24 Languages
Over the years the Smith Health Center has maintained an active dialogue with its constituency, growing and developing in response to the changing needs of the community.
The staff of seven dentists, five doctors, five nurse practitioners, and 100 support staff speak a total of 24 languages. The patient population is 65% bilingual, with communities of Spanish, Portuguese, Vietnamese, Russian, Polish, Bulgarian, German, Italian, Thai, Hindi, Mandarin, and Cantonese all getting the care they need in their own language. Most everyone on staff speaks at least two languages, with some speaking as many as eight. The newest staff are Brazilian and Thai, reflecting recent growth in these patient populations.
As Sonia Mee, Director of Outreach and Community Services, describes it, part of our mission is to provide community education and outreach. We try to understand the different cultural issues affecting our patients, and to develop cultural competence.
Breaking down cultural barriers opens the way to successful health care, Mee says. She and her staff attend community events, visit churches, schools, shelters, and elder care facilities in search of patients in need. She estimates they see 250 to 300 new patients per month at the Center.
Preventive medicine is a big part of the picture, and Mee and her staff do health screenings in the community to address emerging concerns, such as the current surge in diabetes cases. To address the issue head-on, the Smith Health Center has partnered with Beth Israel Deaconess Medical Center and the Joslin Diabetes Clinic, bringing in a specialist once a month to examine patients at risk. In between those visits, the diabetes case management staff assists patients in complying with medication requirements, providing nutrition counseling and support for self-care management.
In its prenatal program, the Smith Health Center partners with Mt. Auburn Hospital, providing comprehensive care to women throughout their pregnancy. They also offer a substantial Womens Health Networking Program, sponsored by the state Department of Public Health, which provides cervical and breast cancer screening and cardiovascular risk reduction education to 925 uninsured women.
All Smith Health Center doctors are board certified in family practice, which means they can treat patients of all ages. When specialists are needed, patients are referred to area facilities, like Childrens Hospital Boston and Beth Israel Deaconess Medical Center.
In regular staff meetings not only cultural barriers, but treatment barriers are discussed and addressed. If transportation is an issue, the Center provides free transport to area hospitals.
The multicultural staff get along very well, according to Executive Director Kathy Phenix. There are no racial tensions because everyone is mission-oriented. She notes that comfort in working with diverse populations is a prime criterion for hiring.
To better serve the working population, the Smith Health Center offers evening and weekend hours. Transient patients are harder to keep track of, but outreach workers go to their homes to monitor medication or check on their medical status.
Funding Remains a Challenge
Aside from patient revenue, the Center depends on federal and state funding, as well as private foundations, to meet its annual budget. Although 74% of its grant applications are approved, the Center needs still more funding to hire additional staff, says Phenix.
Given a patient population that is 65% uninsured, and 40% below poverty level, the Center continuously struggles to maintain service quality and meet patient demand. Last year the Center registered a record 51,500 patient visits, a 26% increase over 2004. This years pace has increased another 10 percent so far.
Phenix notes, Patients come here for the range of services, the relationships with providers, the support services, and the sliding scale fees. Were nearing capacity now. Were hiring two new doctors, who will ensure timely patient access to services.
New Health Care Law Spawning Confusion
But, she adds, the biggest challenge right now is the new health care reforms the state is mandating. As new legislation changes patient access to health care, requiring everyone to have health insurance, its creating problems and confusion for both patients and staff.
Space limitation is another challenge. With over 100 staff and 50,000 visits a year, the Smith Health Center has outgrown its Allston space. The board of directors is tackling the issue of raising funds to increase their facility size.
In spite of these issues, the Smith Health Center feels it is on the right track. Phenix says, We know how to be a safety net provider. We meet the medical needs of the community, and we work hard at providing good quality health care and the support that families need.
To learn more about the Smith Health Center, click on www.jmschc.org .