Thread: Morris' poor patients getting a much-needed lift

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08/7/06 - Posted from the Daily Record newsroom

Morris' poor patients getting a much-needed lift
St. Clare's mobile clinic opensdoors to health care for needy

BY TIEN-SHUN LEE
DAILY RECORD

For years, Francisco Vasco always felt thirsty, no matter how much soda he drank.

The undocumented immigrant from Colombia finally turned to St. Clare's free health care van in Dover for help in June after losing 15 pounds.

A blood test ordered by nurse Theresa Zito-Maixner showed that Vasco had a blood sugar level of 769 -- a frighteningly high level compared to the normal range of 80-120.

"The gentleman's lucky he didn't go into a coma," said Zito-Maixner, who attends to all patients on the van.

Zito-Maixner's first priority was to get Vasco to the emergency room to be treated with diabetes medication. But that was only the beginning of treatment for a long-term illness. Even as the thin patient with glasses traveled by bus to St. Clare's Hospital, Zito-Maixner knew that a long-term relationship had begun between herself and Vasco.

Hundreds of poor patients turn to the St. Clare's mobile health van every year for free medical care. While some have only minor health problems, many have more serious ailments that require long-term care.

Getting patients medication and follow-up care for the long run is one of the biggest challenges in dealing with the low-income population, Zito-Maixner said -- especially when the patients do not have the documents necessary to apply for charity care and prescription assistance.

Vasco, 61, has neither health insurance nor a Social Security number, which is needed for most assistance forms. He and his wife, Mariella, 57, came to Wharton from Medellin in May to be with Mariella's sister. At first, Vasco helped his sister-in-law clean houses. But he stopped working after he became ill.

Having dealt with scores of poor, undocumented patients during her three years as advanced practice nurse on St. Clare's van, Zito-Maixner knew that a significant amount of paperwork would have to be done to get Vasco the medical care and medication he needed for the future.

The first step was to get Vasco to apply for charity care, a form of aid that partially is funded by the state. Charity care covers patients' hospital bills up to 100 percent, depending on their income.

"It wasn't difficult to apply," said Mariella Vasco, a petite woman who also is being treated by Zito-Maixner for high blood pressure.

"At first, one woman asked us for a ton of papers that we didn't have. But then another woman reassured us that we didn't need so many papers. We just needed to show if he works, if he has insurance, how much he makes per week and some other papers."

Less success

Many patients are not as successful as the Vascos in dealing with paperwork. Though the application form for New Jersey charity care is only two pages long, it requires a number of supporting documents that patients may not have.

"We've had tons of cases where people, for whatever reasons -- maybe there's a language barrier at the hospital, or they don't understand how charity care works, or there's just general fear -- the people have these bills, and they don't know how to pay them, so they just keep not paying them," said Mabel Ramirez, a community outreach supervisor for the Morris County Organization for Hispanic Affairs.

Sometimes a year will lapse from the time a patient is treated until the time he or she comes into the Hispanic Affairs office with a hospital bill, Ramirez said. At that point, the person is no longer eligible for charity care, because the medical procedure took place over one year ago.

"It's really hard," Ramirez said. "Sometimes I just have to tell people, 'I'm sorry, but I don't know what to do for you.'" Undocumented immigrants do not qualify for Medicaid, Medicare or New Jersey Family Care.

The Vascos left St. Clare's Hospital with a one-month prescription for diabetes medication, and Vasco was told to come back to the St. Clare's Diabetes Center to learn more about his illness and how to treat it.

Vasco's sister-in-law helped pay the $94 for the first month of oral diabetes medication. About two weeks ago, Vasco also started taking daily shots of insulin after attending a few classes at the diabetes center.

"They taught him how to check his blood sugar level by pricking his middle finger," Mariella Vasco said in Spanish.

"Every day he takes shots of insulin and pills for diabetes. He's doing very well. He's no longer thirsty all the time, and he's gained back two pounds. His blood sugar level is under 200."

Low-cost drugs

While Vasco's charity care application was being processed, Zito-Maixner began thinking about where to apply to get free or low-cost insulin for Vasco. The first thing she did was apply to the Diabetes Foundation for a free three-month supply of insulin. For immediate treatment, she brought bottles of insulin to the van that had been donated as free samples by pharmaceutical companies.

"It's really, really difficult. If I'm going to prescribe a cholesterol medication, or medication for hypertension, diabetes, or high cholesterol, the biggest problem is in getting the medication to that (low-income) population," Zito-Maixner said.

"I know what to prescribe to make my life easier, because some companies are easy, while others won't approve the application without a Social Security number. Sometimes I switch medications so that the process will be easier."

The process of getting affordable medication seems so complicated to Mariella Vasco that she prefers to get her pills for high blood pressure from Colombia. She brought a supply of them with her when she came to New Jersey, and recently, a friend brought her more medication from Colombia.

"Here, I don't know where or how to get the medicine," she said. "In Colombia, I know where to buy the medicine, and it's cheaper there."

More costs

Even if Vasco successfully receives prescription assistance for insulin, there still could be out-of-pocket costs that he must pay to treat his illness. Blood glucose test strips, which are used in conjunction with a glucometer for checking blood sugar levels, cost about $80 per month, Zito-Maixner noted.

At Zito-Maixner's advice, the Vascos now go to Costco to fill prescriptions for oral diabetes medication. There, the pills cost about $20 per month, Mariella Vasco said.

Vasco still comes to the van every week to see Zito-Maixner for checkups.

"The doctor is a super darling with all the patients. She has treated us very, very well," Mariella Vasco said this week.

The St. Clare's van is funded by grants. Since it was founded in 2000, it has become not only a place that poor people turn to for medical care, but a place that people come to for comfort.

"When my mother died, I came to talk to (Zito-Maixner). I didn't know where to turn," said Hector Orama, a 38-year-old patient who came into the van recently to get treatment for shoulder pain.

Aiding recovery

Orama met Robert Grimes, a 40-year-old man who suffers from post-traumatic stress disorder, on the van. He took it upon himself to help Grimes recover from a severe problem of shaky hands by urging him to practice holding a cup every day.

"I've never had a friend like Hector who spent time talking to me when nobody else would because of my mental illness," Grimes said last week while giving his friend a pat on the shoulder.

Miguel Pagan, 37, has been volunteering as a Spanish interpreter for Zito-Maixner ever since he came in to the van four years ago with a cold, and the nurse asked if he could translate for her.

Pagan negotiated this week with van coordinator Lee Collins to exchange a $10 ShopRite card for $10 in cash. After receiving his cash, Pagan, who does not own a phone, borrowed the van phone to call his landlord to tell him that his rent would be late.

"My philosophy is that when you help somebody, God helps you," said Pagan, who suffers from diabetes, high cholesterol, high blood pressure and anxiety.

Dover H.S. grad

Another volunteer translator, Jhonn Cueto, 20, recently graduated from Dover High School, but has had trouble finding a paying job because he is an undocumented immigrant.

Zito-Maixner said the best part of being on the van is feeling very helpful to people.

"They're very grateful for any help you can give them," she said.

Orama gratefully accepted a tube of Neosporin from Collins on Wednesday. The antibiotic ointment is one of a number of basic supplies that are given out on the van, along with toothbrushes, toothpaste and Listerine.

Zito-Maixner accepts about 10 to 15 patients every day that she is stationed on the van in Dover. Some of the most common problems she sees include diabetes, hypertension, stomach problems, arthritis, cardiac issues and pain management issues. When she is not in the van, Zito-Maixner works at the St. Clare's Sister Catherine Adult Medical Clinic.

Most patients follow up their care on the van, though a few patients per week are referred to other health facilities such as the Sister Catherine clinic, Planned Parenthood, the St. Clare's Regional Diabetes Center or the St. Clare's Behavioral Health Center.

"This St. Clare's program is not just a program," Orama said.

"We really put in love. We try to deal with people who are doing really bad, to make them not afraid, and to let them know that it doesn't matter where they come from. Without this program, we'd be losing a lot."



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Tien-Shun Lee can be reached at (973) 989-0652 or at tslee@gannett.com.

"Here, I don't know where or how to get the medicine," she said. "In Colombia, I know where to buy the medicine, and it's cheaper there."

Well if its cheaper in Colombia, and you know where to get it, MOVE BACK!