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Health Talk 

The city's ailing health-care infrastructure — especially for the poor — continues to need a cure. The 2005 levee failures saw the closing of the Charity Hospital system, which was considered the "safety net" for poor, uninsured people in New Orleans. Now these same people are left to seek care, often last-minute, in emergency rooms or in private hospitals where health professionals often are not reimbursed for services rendered. But Dr. Karen DeSalvo, vice dean for Community Affairs and Health Policy at Tulane University, says community health centers might have the remedy for the current state of indigent health care. Before Hurricane Katrina, she helped start the Tulane Community Health Center at Covenant House New Orleans to provide not just emergency care, but also preventative care for the poor. Now she and her Tulane team, in partnership with the Mary Queen of Vietnam Church, have started a similar clinic in eastern New Orleans that will provide primary care to adults 18 and older, regardless of their ability to pay. DeSalvo talks about the new clinic and why she thinks we should try to keep people out of hospitals.

Q: What is considered to be a community health center?

A: There is actually a federal definition of a community health center that means it meets pretty intense specifications from the government. But it's also kind of like whatever people call it. The Covenant House (clinic) is a community health center not in a federal way, but in what we offer. Most people would say in this town ... that term is used as a way to indicate a place that has a community-oriented primary-care approach rather than just putting a doctor in an office. It's a team of providers that supports patients, while thinking of the population that will be serviced. Sometimes people think of a clinic as an old-fashioned term for health care, but it's about health and prevention and being proactive about health in concert with our medical team. Covenant House also had cooking classes, outreach programs ... and would even go as far as to offer things like free Internet access to patients.

Q: Why the eastern New Orleans area for a health clinic?

A: We started in February doing a vetting process across New Orleans to establish criteria for ourselves. Tulane received a grant from the Qatar Katrina Relief Fund ... two years ago and we have been able to get other funding for our main site, and I was able to squirrel away some money to start a clinic in another community. We considered the neighborhood, first of all, if there was a particular high need, if there were no other health services available, if there were people in there who didn't have other options, if there was strong community leadership and an organization that would be able to work with us ... to design a service that would meet immediate needs and also be sustainable in the long run.

Q: You opened the Covenant House clinic after the storm, and now you're opening a similar clinic in eastern New Orleans. What draws you and Tulane to this kind of health care?

A: Tulane University has a clear understanding that as the community goes, we go. We're the largest employer in Orleans Parish, and we need to be a part of this recovery. Dean (Dr. Benjamin) Sachs ... actually changed the mission of the medical school to "We heal communities." That's pretty amazing. As for me, personally, I grew up in a single-family home below the poverty line and had the really good fortune of good mentorship and a mother who gave me encouragement. I guess I'm really driven because of the fact that although she was poor, she volunteered. She always gave back.

(I believe that) health care for everyone ought to be dignified. ... It shouldn't feel so scary and power-driven. Patients want to understand, want to be involved, but the system is complicated. [Community health centers] make it more packageable and [it's] in their neighborhoods and with people there that are like them. [They're] not an afterthought, or a place that makes you feel uncomfortable. ... It's a place you can be embraced.

Since Katrina we've had a remarkable opportunity to do that. ... We got to start from scratch. After Katrina, we did initial stuff and the university said "This is good, you should replicate this model." (Doing this work) is too personal, to be frank. (But) this is important for our city's recovery.

Q: What role does the community health clinic play in a post-Katrina, post-Charity Hospital New Orleans?

A: I want to be really clear about this: Neighborhood health clinics don't replace hospitals. It doesn't mean we don't need hospitals. ... My goal is to keep people out of [hospitals]. It's like the same analogy with the criminal justice system: We have to have prisons, but you have to keep people out of them with other things along the way. Also, Dean Sachs taught me that in Boston (where he was a professor at Harvard Medical School), community health centers were economic revitalization opportunities. They bring jobs and an infrastructure. ... It creates a new economic engine.

Q: Many poor, uninsured people in New Orleans are accustomed to seeking care only on an emergency basis. How will you promote the benefits of preventative care in this community?

A: In a community-oriented approach, you go out into the community. We'll go to health fairs, do screenings and identify people who need care. You've got to get out of your walls. You've got to get out there and work with the community and make yourself really accessible and friendly. Covenant House (health center) was open every evening to 7 o'clock and on every Saturday, so that is a place you can go even if you work a 9-to-5 job. But people in New Orleans do care about their health. A lot of people don't know where to go and do tend to use emergency rooms, but patterns of using clinics like ours have changed. Clinics are making a difference, and data is starting to show it.

Q: To what extent will you still be involved with the Covenant House New Orleans?

A: That's our flagship, so we'll always be there. We're trying to relocate it only because we don't have parking. ... It'll always be our flagship.

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