By Frances Carr
to an audio version of this
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
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
"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
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.
"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
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.
"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
"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
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,
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
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.
"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.
"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
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.
"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.
"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.
Broadcast October 20, 2005
Frances Carr reports for the Cape and Islands NPR Stations.