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Sara Nichols, Open Arms

How Wisconsin’s Open Arms Clinic Provides Free Health Care to Those In Need. The story behind Walworth County’s community clinic.

Sara Nichols started as a volunteer at the Open Arms Clinic in 2012. Three years later she became the community health clinic’s first employee. Now, as executive director she oversees everything at the Open Arms Clinic, which delivers free, non-emergent care to those in need. Here, she writes about how Open Arms grew from a strip mall to a fully-integrated health care clinic and anchor of the community.

Walworth County, Wisconsin is a very beautiful, very conservative area. There are a couple alternative universes here. You can be very wealthy, only knowing the lake as your second home. Or you could be part of the 40,000 people who live here year round, working two or three jobs to make ends meet.

Father Dan Sanders saw the latter. He always had a dream to start a free community health clinic and shared that vision during a ceremony where he was celebrated as Citizen of the Year for the West End Chamber of Commerce in 2011. That summer, he would drive down to Walworth County and sit at a friend's kitchen table, mapping out what the free clinic would look like. At the time, there were 13,000 people without health insurance in Walworth County. There had never been a free or charitable health care entity other than the major hospital systems, and those often left the patient with crushing medical debt. That's basically how the poor were receiving health care.

We fit that in between. Our patients aren’t poor enough to qualify for Medicaid, but they can’t afford their own health insurance on the exchanges or private marketplace either. It’s especially costly for people who have chronic diseases, because the medication costs are so expensive.

How it started

When we were starting out, we found a location, a storefront piece of property in a strip mall. We thought it would be perfect: 1,800 square feet, small exam rooms, a little waiting room. And it was in the center of the county. The Kikkoman Foundation donated $15,000 to cover the rent for one year, and private donors matched that $15,000. A local hospital system was closing a medical office building, and they said we could take whatever we wanted. Our volunteer nurses and medical professionals went through the building, tagging what they thought we needed, and another group of labor volunteers showed up with the U-Hauls and moved everything.

We opened for intake on November 7, 2012. It was a Wednesday. We didn't want to do a huge promotion of the opening because we didn’t know if anyone was going to show up. Through word of mouth, we had 10 people.

The intake screeners were bawling. The nurses were bawling. No one knew how bad the health care situation was and how badly the clinic was needed. A 55-year-old diabetic woman came in who had gone without insulin for three years. She had already resolved herself that she was going to die because she couldn't get insulin. I can still see her face. It was really rewarding to be able to help her. We provided her the care she had gone without for years.

What came next

The need was there. We grew quickly, all thanks to grants, donations, and volunteers. In 2014, we realized we needed more space. We found a medical clinic that had been vacant for a year. Through a bit of serendipity, a major community donor bought the building for us. There was a local food pantry that was also looking for more space so we remodeled the building into two separate condos. It's a great marriage synergistically because we serve similar populations.

We started dental services in April of 2015 and, thanks to a grant, behavioral health services that July. In September of that year, the Lions Club Foundation provided funding to start eye exams. By the end of 2016, after only taking patients only two days a week, the entire clinic was operating four days a week. In early 2017, we were able to hire dental staff. At the end of 2018, the dentist that was in his private practice right next to our clinic told us he was building a new clinic and leaving his vacant. We held a gala in 2019 and raised 100% of the cash to buy it in full. We upgraded from two dental chairs to six, which was huge.

We also have volunteers who are specialists: cardiologists, podiatrists, dermatologists, neurologists. We get all of these specialists coming in for one day a week or one day a month, consulting with our patients. Just this year, a psychiatrist came on board.

A full picture of health

We’ve finally reached our goal of offering integrative care. Everything our patients need in one place: medical, dental, behavioral health, medication, lab management, care coordination. It is the full picture of what a person who is really struggling to get access to care needs.

We walk alongside them on their journey. Because we're so integrated, everybody who comes into the dental clinic gets a blood pressure check. At our medical clinic, everybody gets a depression scale and anxiety scale. In the behavioral health clinic, people talk about how their medications are working.

We're talking about the whole person and their care; no matter which doctor is talking to them.

That holistic approach has huge benefits. For example, in October, a woman with special needs came in for a dentist appointment. The dentist did a blood pressure check and it was high—too high to do the dental treatment that was scheduled for that day. The dentist referred the patient to the medical clinic, and she came in the next day where our medical director Dr. Fasano checked her blood pressure again. It was high, so Dr. Fasano ordered some blood work—but something was still off. A counselor was available, so Dr. Fasano asked him to do a wellness exam. The counselor found out that she was being physically abused in her home, and that her dad was bringing in the abuser.

She was stuck and disconnected from all of her care for the last three years. It was because of her teeth that her dad got her to the appointment. She was in the clinic the entire day. The counselor then stayed with her. We had advocates come into the clinic. We called the police detective to come in. And they sat in our conference room, sorting all of this out. We got her safely housed that night. All of this happened because the dentist did her blood pressure. Now she's safe and she's thriving.

How we handled COVID

We can respond to real-world events, too. When COVID-19 hit, nobody in our county was doing public testing. I was getting really angry because in some cases our patients couldn't go back to work because they couldn't get a test. Not having public testing had a huge negative economic impact on the working poor.

When I had the opportunity to apply as a free clinic provider that could offer community and public testing, I jumped at it. We organized a crew of volunteers and did drive-thru testing. We administered 500 tests, outside, in a two-week period, which showed the need; and then showed the county and state leadership that maybe they need to add some reinforcements. The National Guard has been doing testing ever since.

When COVID vaccinations got started, again: conservative government, conservative county. They said they were going to use their electronic health records to communicate to people. I said ‘that doesn't work for people living in poverty, people who are our neighbors, who are in the grocery store with us, who go to church with us. They are our people, our friends and family.’ So I put in an application to be a vaccination site. I said we have a vulnerable population—and the current system is not working. They approved us. We've done over 800 shots in arms in four weeks.

Word-of-mouth breeds trust

That's what we do: help take care of our community. From that first day of 10 patients who walked in our door to enroll, we've taken care of over 4,000 patients to date. It's been the word of mouth, one family member or one friend saying, "no, they really are what they say they are. You really don't have to pay. You really can get all of these services to keep you healthy and well."

We're moving the needle for people living in poverty because we can respond quickly with volunteers, with donated supplies, with grants, and with a whole lot of positive willpower.

How the Hostetler / Wrigley Foundation Helped

A grant from the foundation helped Open Arms hire our former intern, Luserito Renteria, full time. Renteria first worked at Open Arms as an intern in 2019 while she was getting her master’s degree in social work. She now works four days a week as a bilingual counselor, which has helped many people, especially with addressing the psychological needs of young women in crisis. This summer, a 17-year-old Hispanic girl came in who was unhoused and in distress. Lucy met with her and has the consistency and flexibility to work around the client’s unique needs. Having her skillset and her bilingual background helps us help those in need.