The stories are personal, but familiar. A 47-year-old mother of two, working full time, bleeding for the past three yearsmore days than notwithout an answer or even a place to ask the question. A 34-year-old newlywed, working at a restaurant, her pap test last year was suspicious for cancer, no follow up. A 54-year-old former advertising executive laid off in February has not had her period for five years, now bleeding every day for six months. A 32-year-old part-time student from Uganda lives with fear because of a mass in her pelvis.
While each of these stories is unique, the women have something in common; they have preventable, treatable medical problems, but are uninsured. Some have been uninsured for months, some for years, some for a lifetime, all sharing a similar experience that lack of health insurance has on their ability to seek and receive care that can be life changing and lifesaving. These stories are familiar to those of us who care for our communitys uninsured.
In 2012, after practicing in Madison for 16 years, I was asked a simple question by an OB/GYN intern. Dr. Landry, where do women go in Madison who have gynecologic problems and no insurance? She raised the question after caring for several young women with advanced cervical and endometrial cancers at the University of Wisconsin Hospital and ClinicsMadison on the Gynecological Oncology service. One died less than three months after diagnosis. My answer was, Nowhere, a reality I was embarrassed to admit had been the truth for decades. Despite cancer screening programs and free clinics for the uninsured, limited options remained for uninsured women who needed evaluation for abnormal cervical screening tests or vaginal bleeding.
In January 2014, Share the Health Free Gynecology Clinic, Inc. opened its doors as a free gynecology clinic serving Dane and contiguous counties, offering free outpatient specialty procedures for uninsured women referred for care who are below 300 percent of the federal poverty level. Katherine ORourke (the OB/GYN intern above) and I initially tried to join an existing health clinic already serving low-resource patients to provide gynecological services, but for many reasons, we were unsuccessful. We plunged ahead and cofounded a community nonprofit 501(c)3 organization, and did so in a way that brought together a community of Madison OB/GYNs from varied healthcare organizations. Together we created a solution to address preventable cancers and other gynecological conditions to support patients and refer providers caring for them.
Share the Health is a collaboration of volunteers: receptionists, RNs, medical assistants, lab technicians, ultrasonographers, medical interpreters, pathologists, physical therapists, fundraising professionals, Meriter Hospital anesthesiologists, Meriter electronic health record support, social workers, and lawyers. Madison Womens Health hosts our monthly evening clinics, providing space, staff, and electronic medical chart resources along with all the equipment and supplies to perform colposcopy, LEEP, endometrial biopsies, hysteroscopy, and ultrasounds. We see 8 to 15 patients a night, have diagnosed one early and one advanced uterine cancer, and prevented dozens of other cases of cervical and uterine cancers. For our patients with cancer, care was arranged at the University of Wisconsin Hospital and Clinics, a community partner that also delivers care to these women free of cost.
The most common reasons for referrals to Share the Health include abnormal uterine bleeding, abnormal pap smears, and pelvic pain. The most commonly provided procedures are colposcopy, endometrial biopsy, and pelvic ultrasound. Each would have a price tag of over $1,000 if the patients had to pay for the services. We deliver over $100,000 of free medical care a year to patients in the communities we serve. To patients and their families, the care is priceless. To our community, $100,000 of prevention is worth millions when compared to the monetary and emotional cost of cancer care.
In addition to providing direct patient care by board-certified OB/GYNs, Share the Health includes as many learnersmedical students, OB/GYN residents, and public health studentsof womens health and public health as possible. Whereas our goal for patients is to address difficult and frightening gynecologic health problems, our goal for learners is to encourage and support a sustainable womens health workforce of future healthcare providers with hearts for caring for under or uninsured patients in low-resource areas.
Volunteers also include undergraduate students with Spanish language proficiency to assist with patient check-in and exit interviews to assess areas of need beyond medical care. University of Wisconsin Masters of Public Health students assess patient and referring clinic resource needs, and arrange education talks and update the ShareTheHealthWI.org website with gynecologic screening resources for uninsured patients, including the Wisconsin Family Planning Waiver and the Wisconsin Well Woman Program.
Its a true privilege to support the care that longstanding area clinics have provided to low-resource patients in our community for decades. In the Madison area, the clinics that provide excellent womens healthcare and referrals include Access Community Health Centers, Planned Parenthood, Benevolent Specialists Project, Good Neighbor Clinic, and a handful of others. Share the Health provides outpatient procedural care otherwise not available at these clinics to uninsured women without duplicating services already available. After free consultation or treatment, we reconnect patients with their community providers, who receive guidance and recommendations for providing ongoing care.
Some patients are referred from providers or organizations that have not provided a basic gynecologic exam and assessment of a problem for a variety of appropriate reasons from no trained providers to no private exam rooms. Share the Health does not have the capacity to perform basic gynecologic evaluations on all patients and instead we refer these patients to Planned Parenthood, where they receive excellent care and appropriate referrals for consultations and procedures with a gynecologist.
Often I hear members of our community discussing Planned Parenthood from the narrow perspective of birth control and abortions. This perspective diminishes the profound impact that this organization of outstanding womens health providers has on the health of women in our community. I cannot emphasize enough the insurmountable problems of access for cancer screening, cancer prevention, and follow-up care that the loss of support for Planned Parenthood would have in Dane and neighboring counties. There is simply not a viable safety net of care to replace the gynecologic care that Planned Parenthood provides in our community and, similarly, in many communities throughout the country. But even if fully funded, there remains a gap for uninsured women in Madison between abnormal screening tests and cancer prevention.
From my perspective as cofounder, president, and OB/GYN volunteer provider, Share the Health is an amazing collaboration of medical and nonmedical community members who heard our call for change and jumped into action to support members of our community in need of access to healthcare. Appreciative referring clinics make improved health and health costs in our community possible, while appreciative patients make every minute of the work worth it.
Our impact is reaching those from North Freedom to Beloit. The resources available in each county are vastly different, but what we are doing is offering a small change that fills an unmet need in all communities to improve the lives of mothers, sisters, daughters, and neighbors. We provide very costly procedures at no charge to prevent cancer and manage gynecologic problems while supporting the providers and programs committed to screening for these cancers. A unique collaboration of community members and health organizations, Share the Health is reducing fears, barriers, costs, and cancer.
The health of our community is the aggregate health of all who live in our community. If we care about health in this broad sense, we need to care about the health of all who live here, including those we dont knowthe insured and uninsuredwithout judgement as to why. Healthcare access to cancer prevention care is lifesaving as well as cost saving. Cancer is costly and our clinic procedures are cheap in comparison. If we improve access to preventative care and lower the amount spent on treatment in our community, we all will benefit in ways extending far beyond the gains of the medical treatment.
We are proud to Share hope and health with our patients, families, and communities in southern Wisconsin. Its a privilege to be part of this grassroots community solution in my hometown of Madison and to address an unmet need in my backyard. Please Share with us in 2017 through Madison Essentials and at ShareTheHealthWI.org .
Mary S. Landry, MD , is president and cofounder of Share the Health Free Gynecology Clinic, Inc., and is an associate professor of obstetrics and gynecology at University Health Service Womens Clinic at the University of WisconsinMadison.