Small-scale clinics bridge the gap in health care east of the Anacostia

This article was first published by Street Sense.

Painted in bold shades of blue, red, green and pink, Whitman-Walker Health’s Max Robinson Center has stood prominently in the historic Anacostia neighborhood, just a few blocks from the Big Chair, since the early 1990s. It was opened to fill a gap in HIV services in Southeast DC, after having already provided such treatments in Northwest, according to Medical Director Colleen Lane.

“Whitman-Walker honestly sort of jumped at the chance to serve that part of the community,” Lane said.

But nearly three decades later, Whitman-Walker Health and other small-scale health-care operations share a much larger role: providing most of the primary care in wards 7 and 8.

Only one hospital is currently located east of the Anacostia River, while six of DC’s seven acute care hospitals are located in Northwest — even though wards 2 and 3 have close to the same number of residents as wards 7 and 8. As a result, primary-care clinics are filling the gap.

The Max Robinson Center is one of more than 10 such clinics located east of the Anacostia River, with others operated under the purview of Unity Health Care and Children’s National Health System. Today, in its expanded role, the Max Robinson clinic offers a wide variety of medical services, including gynecology, chronic disease management, transgender care and services, substance abuse treatment, dental health services, legal services, and insurance navigation services. A pharmacy run by Whitman-Walker Health is just around the corner.

Lane came to work at the Max Robinson Center about four years ago. Now, she says, “the vibe of the neighborhood is starting to turn toward gentrification.” She mentioned the addition of a high-rise apartment complex across the street from the clinic and a Busboys and Poets restaurant a few blocks away. One thing that hasn’t improved amid that upheaval, Lane said, is access to specialty health care. She said there is no longer a place for a pregnant women to give birth in Southeast DC. The obstetrics ward at United Medical Center, the lone hospital east of the Anacostia River, was closed in 2017, after a series of dangerous mistakes were made with multiple pregnant patients.

UMC is scheduled to fully close in 2023, and a new city-owned medical center at the St. Elizabeth’s East campus is set to open that same year. The new hospital, located in Ward 8, will be operated by George Washington University Hospital. In July, Ward 7 got its first urgent-care center, operated by MBI Health Services on the Providence Hospital campus, in place of its shuttered emergency department.

Lane said that because of the current lack of specialty services east of the Anacostia River, some patients have to take significant time off work to travel to different parts of the city to keep their appointments; others may miss appointments because of transportation costs. Seeing a specialist can be an even bigger “burden,” so such referrals are often pushed off for “as long as we can,” Lane said.

Clinics have adapted in other ways. Lane explained that Whitman-Walker and some other federally qualified health centers recently partnered with public insurers to provide transportation — through services such as Uber or Lyft — for patients traveling to their appointments. For patients in treatment for substance abuse, Whitman-Walker is able to provide SmarTrip cards to defray some of the cost of commuting to appointments.

Whitman-Walker is also able to “prescribe” fresh fruits and vegetables, where patients can receive a voucher to purchase produce at the Giant grocery store on Alabama Avenue. Additionally, city officials recently announced that free three-mile taxi rides are available for residents east of the Anacostia River to travel to grocery stores.

“There are some kind of creative-thinking interim interventions that are happening, I think, that’ll help in the short term,” Lane said. “I think that ultimately the final goal is to have our health systems in the city invest and commit to having a quality in Southeast that we’re used to seeing in the rest of the city.”

Health-care professionals and community leaders have argued that there should be more than one hospital east of the river. Recently, community discussions have focused on crafting arguments for a “full-service” hospital that would offer a wide array of specialty services.

In the meantime, health-care workers said there should be a greater focus on medical assets that are already in place.

“We have those clinics. The question is how do we get people to them?” said Vincent Keane, the president and chief executive officer of Unity Health Care. “Most importantly, how do we motivate people to get care early?”

Unity Health Care, which launched in 1985, oversees six of the clinics east of the Anacostia River, including East of the River Health Center and Anacostia Health Center. Keane said Unity Health Care’s presence in southeast DC has grown in recent years.

Keane said that while hospitals are critical to any community, hospital-driven health care is not the “way to go” because it isn’t cost effective and does not necessarily focus on preventative health care. Consistent primary care, he noted, prevents expensive hospital visits.

Keane said DC residents often rely on emergency rooms as a source of primary care. For example, Keane said a parent may take their child to the emergency room if their child has a cough and they are concerned that their child’s temperature will rise. Rather than jump to seek urgent care — which Keane said should be reserved for critically ill patients as much as possible — residents should first seek care from local clinics.

“It’s less stressful on parents, it’s less stressful on the health care system, and it avoids crowding emergency rooms,” he said.

Keane said that while there are many primary-care clinics in wards 7 and 8, social determinants of health — such as income, housing, and transportation — prevent individuals from accessing the health care they need. He said that almost all of Unity Health Care’s clinics offer walk-in hours that make it easier for residents who work or have children to access clinic resources.

“We need to get people within the community using the clinics that are already there,” he said, “so people are not moving out of their wards to get health care elsewhere when they could get it next door.”

That proximity can help for a few reasons, according to Sahira Long, the medical director for Anacostia-based Children’s Health Center, operated by Children’s National Health System.

“Primary care is always going to be better in the place where the team knows your child the best,” Long said, and in non-emergency situations, children “are better served in a place where their medical history is available and accessible.”

The overutilization of emergency rooms in the District is one of the reasons Children’s National decided to extend its hours of care. Long said Children’s National clinics have seen a steady increase in patients in recent years; the Anacostia clinic alone recorded about 28,000 visits and more than 10,000 patients in 2018. Last year, Long said, 79% of the patients seen at the Anacostia location were residents in wards 7 and 8, and 90% were DC residents.

Long said that as Children’s National’s presence east of the river has become more prominent, the health organization has grown in both its patient base and its resources. In addition to pediatricians and nurse practitioners, Children’s National also offers services including on-site social workers, peer counseling, legal counseling, lactation support and food insecurity screenings, with some starting at birth.

Long, echoing Lane, said that while residents east of the Anacostia have struggled with access to food and medical resources, the community is making the best of what is available.

“I’ve seen a resilience in the community,” she said. “It’s been through a lot of changes, either for the worse or the better, and the community has gotten stronger.”