Opinion: Community health centers come through in a crisis

As COVID-19 began its march across Connecticut earlier this year, community health centers in our state and across the country were faced with the most daunting question we have faced in my 35 years as a pediatrician: how do we continue to provide the best possible care to the most vulnerable people while observing physical distancing and other safety recommendations?

At Fair Haven Community Health Care, a community health center in New Haven that serves 18,000 patients across the age spectrum, we chose to travel three parallel paths. The first, and perhaps most urgent, path was the development of a testing system. At our main site, we tested all comers, regardless of symptoms and regardless of their ability to pay for this critical service. We then started testing patients at our satellite clinic in a congregate housing complex for the elderly and disabled. Local authorities took notice, and soon we were testing at nursing homes and other sites across the city, bringing testing to people who would not otherwise have access. This is a practice that will likely continue for months to come.

The second path was our rapid adoption of the telemedicine platform to facilitate delivery of care that could be performed without the traditional laying on of hands. Almost overnight, our clinical teams developed protocols for “seeing” our patients in their homes, providing wellness checks, caring for people with chronic illnesses, and providing behavioral health visits and initial evaluations of acute illnesses. Our Women, Infants and Children program, Diabetes Prevention Program and Developmental and Behavioral Pediatrics program also began to function virtually. We learned to make the best of the technology that the health center and our patients had at hand.

Undoubtedly, telemedicine is here to stay. As suspicious as most of us were of the utility of telemedicine in a low-income, low-resource, multicultural and multilingual population, we have come to learn that there are many advantages to being able to virtually enter our patients’ homes. One dad took great pride in giving a virtual tour of his family’s newly purchased home; kids enjoyed showing off the books and toys in their bedrooms; we observed the contents of peoples’ pantries and had a close-up look at the physical condition of some of the apartments in our neighborhood.

The third, and arguably most difficult to negotiate path, was the provision of care for well children and pregnant women. First at our site by the Quinnipiac River, and later at our newest site in Branford, we created a safe place to see young children and pregnant women, continuing without interruption critically important well child and prenatal care. With a modicum of cajoling (and, in some cases, a little bit of pleading), we were able to convince families to come out of their homes for long enough to bring their children in for their regular preventive visits and immunizations. While childhood immunization rates across the country have plummeted, ours has remained strong. We believe that our culture of family-centered continuity of care over several generations in the Fair Haven community and beyond instilled the sense of trust that was necessary to allow patients and families to overcome their fears and come in for the types of care that could not be offered virtually.

At all of our patient visits, whether face-to-face or virtual, we used available resources to the best of our collective abilities. It has been said that “when you’ve seen one community health center, you’ve seen one community health center.” Creative and effective delivery of health care services to those who need them most in the face of the unprecedented challenge of a pandemic, demonstrates the power of community health centers. During Community Health Center Week 2020, we celebrate the dedication of staff members at Fair Haven Community Health Care and at community health centers across the country to the health and safety of the patients and families we serve.

Dr. Laurel B. Shader is the Pediatric Department chair and director of the Reach Out and Read program at Fair Haven Community Health Care. She is an assistant clinical professor at the Netter School of Medicine (Quinnipiac University) and the Yale School of Medicine.