The Little Clinic That Could
As written by Jessica Stevens & Susan Mason-Bouterse
As of writing this in 2005, Sunshine Clinic has over thirty employees and manages multiple programs spanning the gamut from primary health care to behavioral health, care coordination and oral health, including a satellite clinic located in Willow. But it wasn’t always like that…
Act 1: Our tale begins in 1987, back in the last millennium, in the Upper Susitna Valley, in South Central Alaska. For the folks who lived in the Upper Susitna Valley, there was no local health care for an area the size of Delaware and Maryland. People had to drive between 70 and 80 miles to the nearest hospital if there weren’t too many moose, or too much snow or ice on the roads, and if they could get out of their remote cabins by dog sled, snow machine or plane. A group of committed folk from the communities of Talkeetna and Trapper Creek decided that enough was enough! Spearheaded by local EMT Gail Saxowsky (who wrote her thesis on how to start a small rural clinic), the State of Alaska was approached and a small Alaska Community Health Facilities (ACHF) grant was obtained to start a “mid-level” clinic. They formed an impromptu board, bought a trailer, and hired a part-time nurse practitioner. The clinic went through a series of part-time clinicians, in varied shapes and sizes. It was open sporadically and struggled continually to make ends meet. The idea was a grand one, but the vision was hard to realize.
Act 2 (written by Jessica Stevens): Act II begins in 1993. The thought of a quiet, little clinic with only a few patients per day sounded mighty attractive to me. As I sat in a second interview with approximately 16 community members, I felt the power of commitment and will from the people in the room. As I accepted the position, I had little idea of what the bank account held or the uphill struggle that stretched ahead of us. The board ran the clinic and oversaw my position. We hired a front office person and opened the clinic full time. Supplies were limited and outdated, the clinic having been de-funded by the state for the prior six months.
My first clinic patient had a huge gash from a chainsaw. Donned in a black garbage bag with plastic sacks on my feet, I used expired anesthetic and a miscellaneous assortment of cleaning solutions and sutures to clean and repair his wound. That was only the beginning…. We needed to rebuild the clinic, and give people confidence in its ability to meet their varied needs. The clinic began taking calls 24 hours a day. As the only clinician, calls sometimes involved three or four visits to the clinic on a weekend day, with driving totaling sometimes as much as 120 miles a day. People knocked at my door at all hours, and I maintained a small inventory of medicines at my home to meet the needs of people who would drop by. We held specialty wellness clinics, for women, children, and men, using the goodwill and voluntary efforts of many Wasilla, Palmer, and Anchorage physicians. We begged everyone we met for equipment, donations, supplies and help. A gentleman driving up the Parks highway stopped by to ask what we needed. He turned out to be a retired physician from Nebraska who mailed us an antique Electrocardiogram machine and a spirometry machine. We sought mentors and advisors wherever we could. The two of us did cleaning, billing, saw patients, developed budgets, fought with insurance companies, and provided veterinary care all in a day’s work.
I gave birth to my son at 1 am in late September of 1993, having been at the clinic for a little over five months. The day of his birth saw an influenza clinic for approximately 40 local elders, a patient who went into anaphylactic shock, a full day of patients and an extended board meeting to discuss our financial crisis, which ended at 9.20 pm. He was born at home four hours later. (It was at that meeting that we planned the spaghetti feed with the staunch help of Elaine Tobias and Ray Macdonald, at which the $10,000 was raised, which allowed the clinic to keep its doors open.) During those first three years, we were designated as a Rural Health Clinic, which allowed us to receive Medicaid and Medicare reimbursement. We moved out of a large costly building into a tiny family duplex. I saw so many different problems, which I felt ill-equipped to deal with. Wasilla providers got tired of hearing about our needs, and continuously reminded us that there were no resources available to help those “North of Wasilla”. In 1996 after a brainwave in the shower, our proposal for federal Rural Health Outreach funding was successful. Collaborative agreements were developed that allowed us to provide badly needed adjunctive services.
And so begins Act 3: In 1996 seven additional people were hired, and partnerships were entered into with several “lower valley” organizations. Behavioral health services and outpatient drug and alcohol treatment were offered for the first time. A second primary care clinician was added (to save my life), a family advocate (to work with families experiencing violence in their lives), and a family support worker to offer support to new parents and their babies. We worked hard to consolidate this consortium, components of which are still in existence today.
In 1999 Sunshine Clinic received two large Federal grants, which at last, after 12 years, allowed us to attain the original dream of that first visionary board. We became a Section 330 Community Health Center. Finally, we had operational funding to be what we had always been, a Community Health Center, but without any money! We also were funded to develop another network with hospitals and other organizations supporting rural primary care, called Susitna Rural Health Services. Through that progressive partnership we were finally able to add an Executive Director, more clinicians, and a Care Coordination and Home Health Care program
Act 4: In the fall of 2000, at the annual strategic planning meeting, the board and management staff concurred that the most critical challenge for the organization at that time was the need for a new facility. By that time, the “duplex” clinic had 4 exam rooms, including one converted closet, and X-Rays were being developed and viewed in the staff restroom. Staff were crammed 3 and 4 into an office, the lab was co-located in the kitchen, and the garage had been converted into offices and a conference room. So we undertook a major capital campaign to raise funds for a new building.
Early in our capital campaign, we were awarded a community outreach grant from Providence Health Systems of Alaska to help support the design of a new facility. Shortly after that, we were awarded a planning grant from Denali Commission. With those two grants, we engaged a project management firm and a design firm. In September 2001, we were awarded a $2.5 million Rural Development grant from the United State Department of Agriculture. With that award, we were well underway toward our goal of raising $3.5 million dollars. We awarded the construction contract to Wolverine Supply, Inc. in March 2003 and construction for the new clinic began in earnest. Construction was completed, within budget and on schedule, in December 2003 and we moved into the new 12,000 square foot facility in January 2004. The dedication ceremony was held in February 2004 with a tremendous response from community members and across the state.
Going back in time a bit to 2001, our board and management staff were approached by Karen Pearson, Director of State Division of Public Health, with a request that the clinic consider applying for a federal CHC expansion grant to expand our services to other communities. This expansion opportunity was a part of the President’s Initiative to expand community health centers across the nation and Senator Stevens’ “Alaska Initiative” to expand health centers in Alaska. The board agreed to apply for expansion funding, and the clinic was awarded an expansion grant in 2001 to expand our services via a mobile clinic to Willow and Trapper Creek. And as part of that expansion grant, we were able, for the first time, to recruit a family practice physician. For 2 years, we offered mobile clinic services in both communities. We concluded that a mobile clinic in Alaska is not a practical way to provide primary care services. In 2003, we discontinued our mobile clinic services and opened a fixed site satellite clinic in Willow. During the “Alaska Initiative” years, we also applied for and received expansion funding to add behavioral health and oral health services.
At the time of writing, and reflecting on the past of the “little clinic that could”, the journey has been a long one, with the help of countless numbers of incredibly committed individuals. We struggle to be a model rural clinic, offering an approach to health care that recognizes and integrates physical, emotional and spiritual health, with the ultimate goal of a healthier community. We think we have made a good many steps in that direction. This history is included as a component of our orientation because we believe that, in order to visualize where we are going, we need to understand from whence we have come.
Jessica Stevens PA-C , Medical Director (1993 – 2006)
Susan Mason-Bouterse, Executive Director ( 2000 – 2005)