Dr. Jeffrey Maher, volunteer medical director, works in a nearly empty Oasis Free Clinic earlier this week. Hannah LaClaire / The Times Record
BRUNSWICK — As cases of coronavirus in Maine started picking up steam, so did Blake Cromwell’s anxiety, and with that came near-daily panic attacks.
The 27-year-old Dunkin’ Donuts employee has asthma and is considered at high-risk, but as an essential employee who depends on every paycheck, taking an indefinite period of time off to quarantine is not an option.
“I feel lucky that I still have a job to go to, but at the same time it’s scary,” Cromwell said. “I don’t know who has been exposed and I’m working with customers.”
Cromwell is one of over 100,000 Mainers working without insurance, according to the Maine Center for Economic Policy, and one of even more with worries about the potential cost of getting sick.
Anita Ruff, director, stands in the Oasis Free Clinics dental cleaning room. The clinic is currently closed to in-patient visits during the coronavirus pandemic. Hannah LaClaire / The Times Record
Oasis Free Clinics in Brunswick provides primary care, dental and mental health care, free prescription assistance, among other services for people without insurance. It serves about 500 people in the Midcoast area, including Cromwell.
Right now, the clinic is closed to visitors but is still taking calls, doing telehealth when possible and is providing medication to patients in a “curbside to go” type model.
For patients who need to be seen or who are experiencing symptoms of COVID-19, the respiratory illness caused by coronavirus, Director Anita Ruff said they are being directed to the walk-in clinic or calling the provider line at Mid Coast Hospital. They do not have the capacity to do testing at the clinic.
“We don’t have any kits, we don’t even have any N95 masks,” Ruff said, referring to the type of face mask believed to be very effective in preventing the spread of the virus. “I’ve come to understand that the free clinics in Maine are such a small piece of the pie that we often get forgotten about.”
For those 500 patients though, the nonprofit clinic is crucial.
As coronavirus cases and the potential economic impacts of the pandemic continue to increase, Oasis officials worry that not only will their existing patients suffer disproportionately from the impacts of the virus, but also that they are unprepared to meet the surge of patients they expect will need their services.
“We have people who work in the service industry who have already lost their jobs,” Ruff said, and many patients found themselves unemployed almost immediately.
These so-called “stay at home” and “shelter in place” orders have a certain degree of privilege attached to them, Ruff added. Many hourly jobs, like retail and food service, are not ones that can be done from home.
For those who are still working, the battle is remaining healthy and calm.
Cromwell is working as close to full time as possible, but hours have been cut back. Cromwell wears gloves and washes hands as much as possible; to the point that they are sore and cracked.
“We’re all just going in and doing our jobs, we all have the same worries,” Cromwell said.
Cromwell is meeting remotely with an Oasis therapist during the pandemic, and said that while it is an adjustment to not meet in person, it is still helping.
The clinic is fielding multiple calls per day from worried patients working in restaurants, grocery stores and childcare centers asking if it is still safe to go into work.
Some are over 60, others with lung diseases, hypertension, diabetes, asthma and other conditions, many of which can be exacerbated by the current state of anxiety.
Ruff further worries that patients who are sick will not seek help right away, despite what she described as a great working relationship with Mid Coast Hospital/
Jeffrey Maher, a doctor and the clinic’s volunteer medical director shares her concerns.
People who have experienced poverty tend to be skeptical of systems in general, he said, whether by employers, the medical field or the criminal justice system, they have often been left out or let down.
To compound matters, some of the effects of poverty, like homelessness or housing insecurity, lack of transportation and odd working hours can make it hard to keep appointments and get necessary medications, making it harder to manage other health conditions and therefore making a person higher risk than they might be otherwise.
“In healthcare all around, poverty is a detriment to health,” Maher said.
If already skeptical of the healthcare system, uneasy about the potential cost of being seen and then treated, let alone the added costs of gasoline and potentially missing work, they may “suffer longer and seek care later,” Maher added.
“That’s why I keep showing up here,” Ruff said, “because I want somebody to be there to answer the phone.”
In the 2008 recession, it was bankers and financial advisors who were hit first, Maher said, but right now, people in the service industry, people who often have less money set aside, are losing their jobs first.
“Somebody in that industry will probably have less banked than someone who works for Lieman Brothers,” he said, so the impacts will be “quicker and worse and on the population that can least afford it.”
Oasis’s long term goal is to not be needed and go out of business, but now it looks like that may take more time than they hoped.
“We are at what appears to be the tip of the iceberg with unemployment,” he continued. “In this country, insurance is tied to employment, so when the jobs disappear … . There is going to be a huge number of people that lose insurance in the weeks and months ahead and we are not prepared for that.”
Times are already tight for the clinic. There are not enough volunteer doctors and a paid, on staff provider is expected to start soon. The dental need in the community is so huge that dental care is only available to patients who are already receiving medical assistance from their providers.
Meanwhile, the Center for Economic Policy reports that by June, more than 87,000 Mainers may be unemployed.
“I have a feeling we’re going to see a surge in the number of people who are going to need us,” Ruff agreed. “I think the economic damage is going to be huge (and) we don’t have the resources to deal with a surge.”
There are some glimmers of hope, though.
People are resilient and now more than ever, people are stepping up to help, from companies like L.L. Bean boxing food for local food pantries to neighbors checking in on neighbors.
“There are slow-moving, unseen epidemics that are poverty-related all the time,” Maher said. “Maybe this kind of epidemic that sweeps through and impacts everyone might draw some attention to some folks who are not well-seen. I don’t despair.”
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