The Olympia Free Clinic Removes Barriers, Improves Patient Care
Before COVID-19, hot shower and coffee helped connect people to medical care.
The solid blue building on the corner of State and Franklin has sturdy awnings and a generous overhang above the entrance where people used to find a little shelter from the rain. The wide sidewalk wrapped around that corner was often alive with people from all over—people with different circumstances and stories. Intercity Transit's Olympia Transit Center, a major hub of arriving and departing buses, sits on the other side of State Street. With so much stopping and waiting and coming and going, it was a busy corner.
If you walked through the blue building's front door, you'd find yourself in the Community Care Center's big open day room. Here, the noise of engines and hissing bus doors would give way to the sound of ringing phones, voices, and squeaky wet shoes on linoleum; the traffic fumes and salty air replaced by coffee, laundry soap, and the body smells of 200 people coming through every day.
The Community Care Center day room—a collaborative effort of Providence Health & Services SW WA and other health and social services agencies—was a vital single access point where people could connect with much-needed resources like health care, food, and housing support. What truly drew most people inside, though, was simpler. They came in to warm up, have some coffee, take a hot shower, or use the bathroom. For The Olympia Free Clinic, those comforts were a way to engage with people in a convenient moment and connect them with medical care they wouldn't otherwise seek out.
"When someone is constantly worried about where they're going to sleep that night or where their next meal is coming from," explains Katie Madinger, Olympia Free Clinic Executive Director,"they aren't necessarily thinking, 'I'm going to make an appointment with the doctor to get this wound looked at.'"
That “meeting people where they are” model was successful, but it fell apart under the strain of COVID-19. Prior to the pandemic, about 48% of free clinic patients, who were mostly housed and worked during the day, would come in for evening clinics. The other 52% were mostly unhoused. The evening clinic times conflicted with other services like meals or shelter bed lotteries, so the best time to reach them was during the day. COVID-19 posed a serious risk for these patients, but there was no way to practice distancing in the busy day room or in the clinic waiting room, which could sometimes be packed with 30+ people.
In March of 2020, the Community Care Center day room was closed and fencing went up around the building, now vacant much of the week. The sidewalk grew emptier and the bus traffic slowed to a trickle. The Olympia Free Clinic remained open, shifting from a walk-in model to an appointment-based one. This allowed for COVID-19 phone screenings and staggered arrivals—vital layers of safety with a dangerous virus on the loose—but, for most unhoused patients whose life circumstances made keeping appointments difficult, if not impossible, those changes created enormous barriers.
Responding to the challenges, The Olympia Free Clinic imagined a new level of place-based care
The team began brainstorming how they could safely regain the ground they'd lost and reconnect with those patients. They needed a place where people could walk up with no appointment and get health care and advice in a safe environment. They decided on a mobile satellite clinic, an outside medical tent they could set up anywhere. That would provide a measure of privacy and basic care, and people wouldn't have to make an appointment or come into the clinic at all. They took inspiration from EGYHOP, an all-volunteer grassroots group of street outreach workers, who had been successful at setting up around town to reach people with harm reduction services and emergency aid throughout the pandemic. They also sought advice from Seattle Public Health, which had years of experience running a mobile health clinic of their own.
It was an energizing time for the team, including the group of volunteers who convened to develop the scope of care. "They were really excited to be involved at the ground level to shape this program and help us see what's possible," says Katie. "They see this as a way to really dismantle as many barriers as possible, which is always our goal. We're also excited to focus on the concept of place-based care, which is the idea that the ability to access as many things as possible in one place at one time greatly improves the rate of people getting care. That's important. And this goes one step further to overcome transportation and mobility barriers by bringing that care to where people are at."
A Focus Grant from the Community Foundation provided funding to try something new
In the summer of 2020, the Community Foundation opened a new Focus Grant opportunity to explore how more concentrated funding could positively impact the community. The Olympia Free Clinic took a chance and presented their experimental new idea. Their request for support to build a new satellite clinic was funded. "We saw potential in their vision right away," says Mindie Reule, Community Foundation President & CEO. "What's remarkable is how The Olympia Free Clinic's creativity and determination was able to turn a staggering challenge into an improvement—something that will help them care for their patients even better in the future. We were honored to help fund that work."
Funding in place, the team was able to outfit a new medical tent and set it up outside the permanent building in March of 2021. For the first time since the pandemic began, they were able to accommodate the walk-up patients they'd been unable to reach with the appointment-based model. The mobile clinic also gave them new flexibility to go beyond downtown, and the timing could not have been better.
COVID-19 vaccines were ramping up. Thurston County Public Health and Social Services had been vaccinating in shelters, but they needed a way to get vaccines out to places that were harder to reach. The Olympia Free Clinic was now ready to take on that partnership. They began spearheading efforts to bring vaccines directly to the encampments. They started with clinics at the Ensign Road and Jungle encampments, then Deschutes, with plans to add clinics at the Decatur, Percival, Wheeler, and Nickerson encampments in the near future. Re-establishing a connection with patients who felt abandoned during the pandemic has not been easy. Many have had negative past experiences with mainstream medical care or are distrustful of systems in general.
Mindful of those perceptions, the team has been setting up the tent and then walking into the encampments, dwelling-by-dwelling, on foot with backpacks, supplies, vaccines, and wound care. Along Ensign Road they connect with several families. Here, people keep potted plants outside their RVs and neighbors check in on each other. Shadowed by the forest canopy, clinic days at the Jungle encampment are quieter, the dwellings more varied. Deschutes, on the other hand, is near a busy road. You can hear the hum of traffic outside the medical tent, and if you look up you see the WA Capitol building on the other side of Capitol Lake. By meeting people in all these diverse places where they're comfortable and providing a positive experience, The Olympia Free Clinic is slowly gaining people's trust, which can ultimately serve as a gateway to connect them with more health resources.
The mobile satellite clinic expands what The Olympia Free Clinic will be able to do in the future
This approach has created some unexpected benefits. Providing vaccines has led to opportunities to treat wounds, schedule follow-up visits for more intensive care, and conduct health education. It's also created a way to connect people to other services like dental care, food security programs, or housing support. Other patients start out vaccine wary, only building up a willingness to get vaccinated against COVID-19 through the trust and rapport they build being helped with other issues.
"It became this incredible opportunity in ways we didn't even realize it could be," says Katie. "We went out there thinking we were going to be providing vaccines and we brought a few wound care supplies because usually that's a need, but it was also this chance to meet people and establish a connection as we provide medical care. There was someone we provided care for right there in their van, where they were living. That's when we've had success when we've been able to make it personal."
The benefits of those personal connections will continue long into the future. Even now, with buses back on a regular schedule and more services slowly opening up, people in the encampments are increasingly disinterested in coming downtown. "They no longer have as much incentive to come in and engage with us at the Community Care Center just for medical care—unless we've already established a relationship with them in the encampments," says Katie. "Being able to go out and build those relationships expands what we'll be able to do going forward."
With community support and collaborative partnerships, the important work will go on
That work is rapidly growing, building on the momentum and learning developed by these early efforts. They're working on bringing along more volunteers and increasing collaboration. "We've always liked to work collaboratively with other groups, but this project has opened new doors," says Katie. "We've gone from cordial relationships to really working together. We feel privileged by the support we're getting and the way that local outreach workers have been willing to help us make new connections."
Helping them make those new connections are other groups who've established trust with people in the encampments. The Free Clinic has had support from a group of local outreach workers called GROWL, as well as PiPE, Capital Recovery Center, Family Support Center, and others. The effort has also become a rallying point for other health organizations, including Providence, which is currently considering a larger, more robust mobile clinic of their own—a nearly semi-truck sized vehicle staffed with providers from several agencies. The larger mobile clinic has incredible potential for synergy with the Free Clinic's smaller more nimble one. They're hoping the trust they're building today will help patients get more comfortable with the idea of visiting the larger clinic for additional services like mental health care, on-site phlebotomy, and eventually even dental services.
In the meantime, they'll continue to bring in more partners, recruit volunteers, and apply their creativity and determination to improve and adapt. "The ability to share a completely new idea because we believed it would have an impact and to try that out and see that it's been beyond successful is exciting," says Katie. That excitement will continue to propel them forward along with the learning, trust, and relationships they've established this year. So will community support. You can learn more about the Olympia Free Clinic on their website, keep up with their work and current needs by following them on social media, or donate to support their efforts HERE.
Community support matters. The Olympia Free Clinic has made a lot of progress and the team is excited for the future, but the work remains challenging. Holding clinics at every encampment each week would still not meet the need. Even rotating through the encampments one-by-one, which is all they have capacity for right now, that enormity of need regularly overwhelms their small team. Being stretched thin creates concerns about consistency, which is important for the patients they serve. They worry that the months between visits will break trust and it's hard knowing the need continues to exceed their ability to show up.
They plan to keep showing up anyway.