There’s just one well being clinic for the northern half of Grimes County, a reasonably large rural county in southeastern Texas, 80 miles northwest of Houston. At this sole clinic, there’s a sole well being care supplier: nurse practitioner Elizabeth Ellis. On any given day she sees greater than a dozen individuals. She manages the clinic with the assistance of only one entrance desk employee.
Again within the spring of 2020, the BIS Neighborhood Clinic, positioned in Bedias, Texas, nearly shut down for good due to an absence of COVID-19 sources. The city has a inhabitants of lower than 500 individuals, however the clinic serves the encompassing neighborhood so extensively that some individuals journey 40 minutes to succeed in it. Lots of the sufferers are older than 65 and have advanced medical circumstances. “They’ve been underserved and have main well being disparities due to their lack of entry to healthcare,” Ellis says. Some don’t have any healthcare till they’re sufficiently old to qualify for Medicare. “They’ve five-plus, generally 10, generally 15 or extra diagnoses.”
Ellis moved to Bedias after her husband wished to retire to the city the place he’d grown up visiting buddies and searching. Ellis continued her one-way, two-and-a-half hour commute to a Houston hospital till three years in the past. Sick of the drive, she determined to intestine a neighborhood constructing and switch it into the BIS Neighborhood Clinic. It’s been a pillar in the neighborhood ever since. When Ellis didn’t have the monetary help or private protecting gear she wanted to serve the neighborhood through the pandemic, her neighbors banded collectively, donating cash and hand sanitizer and cleansing provides so the clinic might keep open.
“It was an incredible outpouring of generosity and workforce effort,” Ellis says. As time went on, she ultimately obtained COVID-19 aid funding by way of the CARES Act and extra funding for assessments from the US Well being Assets and Companies Administration. The Texas Group of Rural & Neighborhood Hospitals additionally helped her procure masks and robes, as did one affected person who ordered provides from abroad. However closure remains to be a every day fear for Ellis.
Throughout the pandemic, Ellis has been seeing sufferers for his or her routine well being wants within the morning. Within the late afternoon, she strikes outdoor to display screen COVID-19 circumstances. Sufferers with virus-like signs drive as much as the clinic’s car parking zone, the place Ellis swabs their noses, then runs a speedy antigen take a look at in-house or sends it to a lab for a PCR take a look at. Earlier than and after the clinic hours, she pays home calls to sufferers who’re too sick to go away or who don’t have transportation. Typically, the solo work is overwhelming. “There are days that you simply marvel how you bought by way of it, and you’ve got your moments of gentle breakdown,” Ellis says. “However we’re right here to serve, and we maintain trudging by way of.”
The nurse practitioner isn’t too involved about getting COVID-19 herself. However as a result of she works predominantly with sufferers who’re over 65 and her husband can be in that age vary, she’s extraordinarily cautious. “I am going to work, and I am going dwelling,” she says. “We haven’t even seen my husband’s youngsters since February.”
Working in well being care isn’t the one purpose she’s been taking COVID-19 severely. Her mom, who lived in a nursing dwelling in Mississippi, died at first of the pandemic from problems associated to the illness. “Being hit with a tragic lack of a member of the family on the very starting of COVID, that basically opened my eyes to how critical this virus is,” she says. She used her private expertise to teach her sufferers in regards to the significance of taking precautions comparable to social distancing and sporting a masks.
If Ellis had been to get COVID-19 herself, the clinic must shut down. There are not any back-up suppliers to take her place. She’s already gotten a style of the difficulty that might convey. The clinic needed to shut for 10 days when the entrance desk employee turned unwell and so they didn’t have an in-house take a look at but. Within the time it took to verify if that they had the virus or not, Ellis tried to maintain up together with her sufferers by way of telehealth. However entry was restricted: Most people in the neighborhood don’t have excessive velocity web or dependable mobile phone service. The clinic itself simply bought a fiber-optic hookup in early December.
The pandemic has uncovered not solely technological points with telehealth, but in addition authorized ones. Sometimes, Ellis isn’t in a position to schedule telehealth appointments together with her sufferers resulting from restrictive privateness provisions from the federal authorities. The foundations for rural well being clinics, and plenty of prefer it, had been created a long time earlier than telehealth turned widespread and haven’t been up to date since. A brief waiver from the Facilities for Medicare & Medicaid Companies permits Ellis to apply over video or the cellphone through the pandemic, however as soon as the exception ends, she gained’t be capable of anymore. “The most important takeaway from managing this virus and dealing on the entrance strains, particularly within the rural well being areas, is that a few of our guidelines and laws are antiquated,” she says. “We have to take away any barrier that’s prohibiting us from working towards to the highest of our license.”
It’s laborious sufficient to maintain a rural well being clinic operating in regular instances, and the pandemic places much more pressure on suppliers. COVID-19 stunted the clinic’s development, and plenty of of her current sufferers are too scared to come back in for an appointment. Though Ellis expects to bounce again this yr and even rent a nurse assistant, she nonetheless worries about having to close down. Seventeen rural hospitals closed in 2020, leaving individuals in these areas much more starved for ample healthcare. “We’re always having to develop new laws and battle to maintain ourselves sustainable,” Ellis says. “There’s nonetheless quite a lot of groundwork to be completed.”