Duffy Health Center

By Frances Carr

(Listen to an audio version of this story).

A conservative estimate of the homeless population on Cape Cod ranges from twenty-five hundred to five thousand individuals at any given time. An estimated eighteen percent of Cape residents do not have any health insurance. What do you do when you can't afford to make insurance payments?

Five years ago Billy B, who asked that we not use his last name, was a working commercial fisherman. He owned his own boat and a home in West Yarmouth. When a work related back injury forced him to stop working, he no longer had an income. He sold his boat and when he couldn't make his mortgage payments, he had to sell his house.

Billy B: "After my last back operation, the doctor told me, you might as well sell your boat. And I thought he was nuts. I told him, when you sell your house I'll sell my boat 'cause I worked my whole life for that boat. But he was right and I was wrong and I ended up selling the boat. I was incapable of going back to work. And at sixty years old, where are you going to find another job? So consequently I'm totally disabled without employment and I'm on social security, disability, which doesn't pay for . . .well it certainly doesn't cover rent on Cape Cod."

In his mid-fifties, Billy was suffering from alcoholism and plagued by chronic back pain. He could no longer afford his health insurance. He found himself homeless and with no family on Cape Cod, he felt he had no choice but to take to the streets. One winter night, Billy set up camp with some others in the woods near Hyannis. Billy remembers a group of people appearing, seemingly out of nowhere. He later found out they were volunteers from the Duffy Center.

Billy B: "I was homeless in the woods. And they used to come out with their stethoscopes and their blood pressure machines and their thermometers and their little black bags and they made sure there wasn't anybody with pneumonia or somebody dying from hypothermia . . .And they'd bring us out warm clothes, beg us to come in and take a shower, get cleaned up, and have a hot meal. That's what I remember. That was my first encounter with the girls from the O'Neil Clinic and the Duffy Center."

This outreach, which initially brought Billy in off the streets, is one of the many services provided by the Duffy Health Center in Hyannis. Duffy serves adults who are without insurance, homeless, or "at risk" for homelessness. The O'Neil clinic, Duffy's second site in Hyannis, is a smaller facility and is attached to the NOAH Homeless shelter. The third site is the Pilot House, where Billy calls home. Patients stay at the Pilot House while they work on their sobriety. Billy has been there for fourteen months, the same amount of time he's been sober.

Dr Arthur Bickford is one of the founding members of the Duffy Center. It was with his help that the one-night-a-week clinic that was initially housed in a broom closet, became the three-sight comprehensive facility that it is today. At seventy-nine he is a tireless advocate for the Cape homeless and culturally underserved populations.

Dr. Bickford: "Many of the people we have here that are homeless are homeless because of a medical illness, that's been well recorded. If you break a leg and lose your job then you lose your house then you lose your health insurance, the next thing you know you're homeless."

Dr. Bickford says a lot of patients don't do well when referred somewhere else to get service.

Dr. Bickford: "You get patients that come in here and you tell them to go over to the hospital and get their chest x-rayed and they say 'what?s a hospital? What's an x-ray? How do you get in the door? What door do you go in? What do I need to take with me? You know, my lunch?' Whatever. I mean they've never done this and they need a lot of case management. It's hard for a lot of us to realize that vast numbers of people have had no real meaningful encounter with a healthcare system so they need a lot of case management and a lot of direction."

Duffy provides comprehensive health care services and case management. Dr. Lisa Zandonella-Huhta, or Dr. Lisa, as she as known at the clinic, serves as the assitant Medical Director, under Dr. Bickford. She is the only salaried physician on staff. The other doctors work on a volunteer basis. Dr. Lisa says these "wrap-around services" are an essential component of clinics like Duffy.

Dr Lisa Zandonella-Huhta: "We usually end up seeing folks who have been turned away at other practices or are too unreliable to follow through with medical care . . .That's why wrap-around services, if they can be provided, are essential . . . Wrap-around services means your clinic is able to provide medical and behavioral health and some parts of subspecialty needs, like we had a chiropractor, we had a dermatologist . . . we had a dentist, those are wrap-around services. That model works best in a community health setting and for the homeless population. You have to, when they come, try to engage them in as many things as you possibly can at that moment. You have to take them in the moment because they're so transient, at times."

In addition to primary health care services, the clinic helps its clients apply for free health care benefits. They also provide referrals, counseling, substance abuse support, even acupuncture.

Bob Lindsay is the director of substance abuse for Duffy. He's a recovering alcoholic and addict himself. He says this helps him understand his patients, on a personal level and he says that while people share commonalities, there is no typical patient.

Bob Lindsay: "It gets frustrating, because you see the same thing, the same repetitive behavior, the same stuff over and over again and it just makes you want to smash your head against the wall. But what keeps me in check is that I know that that is a sick and suffering person, someone who needs somebody like me to help them out regardless of their belief system or what have you. And one day they may get it. One day they just might get it."

Lindsay acknowledges that for most of his clients, it's often not just a question of behavior but of being overlooked by society.

Bob Lindsay: "When I came on board here I was like wow. I mean we're working with the hardest of the hard, the lowest of the low, we're talking about multi-complex, mentally ill and substance abusing people, who most of our society and community shun, push away from, don't want to deal with them, don't have time to look at the situation. So when you see them and they feel like they're cast offs, throw away people, I'm like, wait a minute, no you're not. You're still part of our community. You're family here."

The Clinic gets about a quarter of its two million dollar annual budget from direct state and federal funding. The rest comes from Mass Health, Medi-care, the Mass free-care pool, and private donors, like the Duffy Family, for whom the clinic is named. Still, Dr. Bickford says, they barely manage to make ends meet.

Dr. Bickford: "The hard times have been mostly in the sense that you need something, like there's two exam rooms in here that have no sinks. And as most people know, it costs a lot of money to get them. We don't own the building and the landlord isn't inclined to give us two new sinks, so we've never gotten them. But that kind of hard times is always with us. It seems there is always something that would make life better for us but we can't afford. And who wants to go out and do a fundraiser for two sinks."

Though the Duffy Center may be lacking some material things, for people like Billy B, the clinic is fine just the way it is.

Billy B: "I do have one goal in life that I know is feasible and I am going to have fun doing it. I'm going to keep myself happy.Somebody asks me, hey Billy, you got any goals? Yeah, just one. Be happy . . .Plain and simple."

Last year, some twenty thousand people visited the Duffy Health Center. That might seem like a lot but statistics show that nearly fifty thousand Cape residents, homeless or not, have no health insurance. In spite of all their hard work and commitment, the people at Duffy all agreed that there is more to be done, more outreach, more subspecialty services, and eventually more clinics. In the meantime though, they can find some comfort in their successes.

Duffy Health Center
105 Park St.
Hyannis, MA

Broadcast October 20, 2005

Frances Carr reports for the Cape and Islands NPR Stations.