Nurse practitioners are often on the front lines of providing basic care, especially in smaller communities. As part of our Profiles in Health Care series, New Hampshire Public Radio's David Darman spent a day at the Health First Clinic in Franklin. He found that area residents expect a lot from their small clinic.
The Health First Family Care Center is a neat red and white, one-story building on the main street in Franklin.
Its next to Pizza Hut and across the street from McDonalds.
Inside, a middle aged woman sits at her desk and checks her Imac computer for the medical records of the patients she expects to see today.
03 I;m Ginny Wright,…. I’m a family nurse practitioner. Have been for the past 3 and a half years. 03 12
About 3,000 people from Franklin, Tilton, Bristol and Sanbornton rely on the clinic.
About a third have no insurance.
Wright says the Center fills a critical need for these people.
24 29 I think because we’re the only one in the area that do sliding fee scale I think we serve the people, the working poor, who can’t afford health insurance, or have jobs that don’t offer health insurance.
At Health First, people can see a doctor or nurse practitioner, meet with a social worker, or work with a nutritionist.
The clinic even does a surprising amount of mental health work.
10 35 if I’m treating somebody with depression mental health services in this area are pretty limited. There’s very little option for low cost counseling. We do a lot of in office treatment of depression.
Treating mental illness often requires patients to take expensive drugs.
Wright says this points to one of the biggest problems faced by the uninsured.
They often can’t afford their prescriptions – whether they need drugs to fight depression, reduce cholesterol, or anything.
09 206 …I can write up any prescription, but if the prescription costs one hundred and fifty dollars and you can’t afford it, it doesn’t do any good.
The clinic has tackled the drug affordability problem head on.
Health First employs a part time staffer who does nothing but ask big drug companies for free samples.
It’s a critical part of the clinic’s operations.
Even if they can’t offer the exact drug the person needs.
... We have a fairly good supply of sample medications, and some patients we’ll treat out of the sample closet, using the same category, you know, a different medicine but the same category. 09 236
Wright sees 2 to 3 patients an hour throughout the day.
At one point in the afternoon, a teenage girl came in literally crying from a broken tooth.
Clinic staff would agree Health First is probably not the best place to handle her problem.
But because she couldn’t see a dentist until December, the clinic was the only place that could stop the girl’s pain.
Wright says she doesn’t like this part of the job.
29 44 real frustrating to treat something like this with naracotics as a band aid until the tooth can be pulled. I’m not a dentist but it looks like its beyond repair. She’s only seventeen, so…its sad.
People use Health First for just about every health problem.
But the clinic doesn’t only deal with a variety of ailments; it also deals with a variety of languages.
Many Bosnians and Croatians settled in the Franklin area, after emigrating from the war in the former Yugoslavia.
They came here because it’s affordable.
Near the end of the day, a young Bosnian mother and her children came to the clinic.
She had back pain.
34 50,you have pain? here in my back. Bonus, bonus Both sides. Yeah, I’m here here. For two months. Always. Does it hurt all the time? Yes everyday. In the morning? Yes. Does it go away. When you pee, does it hurt? No. when you move your bowels? Do you know what I’m saying.
Wright wants to ask another question, but is not sure how.
Technically, regulations say that a translator must be on hand.
Wright says Lutheran Social Services usually provides one.
34 624 ….They generally will send an interpreter with them to the visits. But not always. And we’ve asked them if they don’t have an interpreter to come with them, let us know, because we are required to provide an interpreter. But if we don’t know that one’s not coming we just do the best we can.. 706
Health First Family Care Center relies on some unusual assets to deal with its patients.
Wright herself is one of those assets, not just for her skills as a nurse practitioner.
Just as important, are the 20 years she spent as a nurse at Franklin Hospital.
Through that, Wright knows many of the medical specialists in the area.
And she’s used that knowledge to create an informal kind of charity network.
18 147 I was able to get a young woman with skin cancer, a malignant melanoma, significant skin cancer, in with a very, very good plastic surgeon. Because I send them my patients on a regular basis and I called and talked to him personally, and said, she can’t afford you can you do anything, and he saw her for a very minimal co pay. 213
There are nine other clinics around New Hampshire that are similar to Health First. Together, they serve over 40 thousand people.
For people with insurance and especially for those without, these clinics have become a key part of the state’s health care network.
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