public health determinants and trends

1. Public HealthDeterminants and Trends
1. Social Determinants in Health
I completed my internship at the Anderson Free Clinic this semester,
performing patient triage and working on the Care Navigation program. As said in
their mission statement, the clinic works “to serve the health needs of the
underserved citizens of Anderson County through community engagement and
partnerships with those who care.” The populations that the clinic serves are those
living beneath the poverty line. Our patients earn little to no income and have no
health insurance. Under the direction of Barbara Baptista, the clinic attempts to
reach those with little access to primary care.
The free clinic patients lack healthy places. Whether that be where they
reside, the conditions in which they reside, transportation, or food, our patients live
in some of the poorest conditions in the area. In my time there, I have seen several
homeless patients, but more commonly I see patients’ addresses change as they
move from one place to another. Many of them live with family members or
significant others, but that never seems to be secure. With that instability, comes the
lack of healthy conditions to live in. Hygiene is not a top priority for the patients.
Most come in with raggedy clothing and a bad case of body odor. This leads to
infections and the spread of other diseases. A couple of times during my internship,
the clinic received a donation of travel-sized soaps, shampoos, deodorants, etc. that
were given out to the patients for no charge. The clinic attempts to improve the
conditions in which its patients are living as much as they can by providing hygiene
products and providing education about the importance of healthy living conditions.
The availability and safety of transportation is also a major issue for the clinic
patients. On days or times when the buses do not run, many of our patients have to
cancel their appointments because they have no other mode of transportation.
Additionally, we had a patient whose car caught on fire in the clinic parking lot
because of the poor condition it was in. At times the clinic is able to provide bus

2. tickets to the patients, but resources are scarce overall. The patients need to have
reliable transportation in order to even receive the clinic’s services.
Lastly, the food that our patients consume is a major issue for their health. A
large portion of the patients are overweight and/or diabetic. For a diabetic patient,
the food they consume can have a major impact on their condition. Because of the
low-income status, most patients are on food stamps and cannot afford healthier
foods. If healthier foods were available at a lower cost, the health of the patients
would improve greatly, given they had the education to choose to buy these foods.
The clinic can only go as far as providing worksheets with suggestions of healthy
portions and meals and talking to our patients about choosing healthier options.
These four social determinants are key reasons why patients required the
services from the Anderson Free Clinic. The clinic is able to offer not only medical
services for the consequences of unhealthy places, but also resources, such as free
food and shelter, that can prevent the illnesses from occurring.
2. Organizational Behavior and Governance
Because the Anderson Free Clinic operates solely on donations, cost-
effectiveness is key to the survival of the clinic. The clinic is operated by eleven paid
staff members and relies heavily on volunteers. There is one paid provider and the
rest are volunteer providers from the area who give their time about once a month.
Because of the amount of different people cycling through, the clinic can become a
place of chaos and inconsistency very fast if not managed well. The clinic can’t afford
to spend money on extra staff members, new technologies, or additional supplies.
The staff does the best they can with what they have to work with. One of the most
important goals of the clinic is to keep its medical and dental services free for its
patients. If the director does not seriously focus on cost-effectiveness, the clinic
would not endure and would no longer be available to serve the needs of Anderson
County.
To be cost-effective, the director, Barbara Baptista must choose wisely where
the clinic’s money is spent. Providers cannot be compensated for their work and

3. time; it must be given for free. Most of the equipment used, such as blood pressure
machines and thermometers, are donated to the clinic. There is a paid staff member
whose job is to reach out to the community to obtain donations. Besides providers,
other volunteers help with office work: filing charts, pulling charts for
appointments, pre-audits, and more. Volunteers keep the system functioning. As the
intern this semester, I have been able to fill in the gaps where they need it, which
has been mostly with patient triage. In the pharmacy, patients can receive all of their
medications for $2. This is an incredible deal for the patients, and thus, the
pharmacy has be very careful with how they spend their money in order to be able
to continue this. Their formulary has to be made up of the cheapest, effective
medications and providers must comply with this. Additionally, the clinic partners
with AnMed Health to provide some additional resources, such as IT services. On a
day-to-day basis, the staff must be cautious of the materials and supplies they use.
Wastefulness is not an option. Only the most basic necessities can be afforded in
order to keep the clinic alive.
It can be difficult at times for the clinic to operate with the bare minimum.
From experience, I saw one of the front office staff members have to go home
because the clinic cannot afford to pay overtime. This created a shortage in staff,
resulting in longer wait times for patients and more work for the other front office
staff member. One thing I would change about the clinic is the amount of printing
services that are used. The patient charts are all paper, which means every record,
visit, and lab result has to be printed out and filed. By going completely electronic,
the clinic could save a large amount of money on printers, paper, and ink, as well as
the time of their staff filing papers in charts and searching for charts all over the
clinic. While the clinic has looked into doing this, the complete transition is a long
process that is farther in the future. In a perfect world, the clinic would receive
enough donations to be able to operate at the capacity of normal clinics and
practices, but that’s not the case. The important part though is that the clinic does
continue to run and provide the best care it can to its patients.

4. 3. Pre-professional Concentration
During my internship at the Anderson Free Clinic, I was able to observe many
different professionals in the health care field. Most of my time and training was
spent with Elizabeth Young, the nursing coordinator. For three months, I observed
her communicate and interact with patients in a way that was respectful and
effective, even when the patient did not show her the same regard. The free clinic
deals with a different population of patients than most other health care facilities.
Our patients have no health insurance and live below the poverty level. Most are
uneducated and unemployed. For the most part the patients at the clinic are very
grateful for our services, but just like any health care facility we do get patients who
can be impatient and volatile. One day in particular, Liz had a man who had been
waiting for a few hours because the volunteer provider was running late. He kept
coming up to the front counter to ask how much longer, slightly less patient each
time. At last, he caused a scene yelling at Liz, saying that he would never come back
to the clinic, along with other expletives. Instead of just kicking the man out, Liz
remained calm and took the time to explain to the man why the wait time was long
and that it was essentially out of her control. This is a moment that stands out in my
mind because of my unbelief at the maturity and respect she showed towards that
patient.
Liz also showed professionalism in the way she interacted with the
providers. Those of us who work the triage part of the clinic are there to serve the
providers in many ways: set rooms, clean rooms, bring them supplies, etc. Liz had a
way of being very respectful and gracious, but firm at the same time. She did not let
the providers walk all over her. If a provider demanded something from us that
could be done by the provider himself or herself, she politely let them know this. She
had expectations for those who worked around her and she made the clinic a better
place because of it.
Liz taught me many things while working at the clinic. She trained me from
day 1. I was taught to always have a professional appearance and a confident
demeanor. My scrubs were not to be wrinkled and my hair was to be pulled back. I
went into a room with a patient paying attention to detail and not second-guessing

5. myself. I was taught to be reliable. Liz was always on time, stayed late, and worked
to the best of her ability. I was taught to be respectful of everyone around me.
Another thing that stood out about her was that she didn’t speak badly of her co-
workers, which often happens in such a small work environment. She spoke
respectfully to patients, providers, co-workers, and volunteers alike. Liz embodied
many of the traits I hope to one day bring into my career as a physician assistant.
Professionalism is very important in the health care industry because it keeps the
patient at the focal point of every decision and action. We are the producers and the
patients are the consumers; we don’t survive without them.