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During this pandemic, Amador Health Center (AHC) is considered an essential service and all staff from the janitor to the CEO are considered health care providers. So, when the COVID-19 cases started to crop up in New Mexico on March 11 and the governor declared a public health emergency, AHC’s staff of 30 people dug in their heels for what is certainly an inconceivable journey.
“Staff seemed to be sharing the same level of anxiety coming into work every day and potentially exposing themselves and loved ones to potential viral infection,” said Richard Wright, a recovery support specialist at Amador Recovery Project, one of AHC’s programs. “At first there was terror and a feeling of not being prepared to handle a pandemic crisis on top of caring for people who are already living with chronic illness, homelessness and mental health and substance use disorders,” Wright said.
While staff began ordering disinfectant supplies and personal protective equipment (PPE) in early February, availability was already strained through its various vendors. Like the rest of the nation, policies and procedures addressing who would wear what type of PPE and in what circumstances were dictated by the availability of supplies, not by actual safety. The weekend of March 13-15, the national news became ever more dire as thousands of people were being infected and dying across the nation, including the medical providers and maintenance workers caring for them.
“We implemented changes even before the governor placed New Mexico on a ‘stay-at-home’ order and that I think has made a big difference to our clinic’s safety,” said AHC Medical Director Fatima McElveen. On March 16, AHC staff took action before the first case was reported in Doña Ana County March 20. All staff and patients were screened for fever and symptoms of COVID-19 before they entered the building. The front doors were locked and a stone pathway leading around the building to an outdoor lobby and screening area was set up.
“Our CEO and administrators supported local businesses by purchasing cloth face masks for personnel and their families which was very thoughtful and beneficial,” McElveen said.
These initial steps were just the beginning of multiple levels of safety changes that took place in the initial weeks of the disease’s assault on Doña Ana County.
“We altered staff schedules, took inventory of our supplies and created a plan to use supplies when necessary to decrease the potential exposure of COVID-19 to staff and patients,” said McElveen. That included limiting face-to-face contact with patients and converting medical and behavioral health visits to telephone calls or web-based programs. Two staff started working from home and they and their patients are adapting well to counseling through telehealth.
Many others are opting to stay in the workplace, although the work environment has been altered through increased disinfecting and social distancing to minimize exposure.
“Every day I struggle between wanting to stay safe at home and not wanting to abandon clients and co-workers at work,” Wright said. “Clients still need medical care, substance abuse treatment (daily) and counseling. Just because a virus has our attention at the moment, the difficulties that people had before COVID-19 don’t end. Mental illness doesn’t take a break, substance use doesn’t stop, people still experience suicidal ideation,” he said. But still, Wright said he is feeling safer at work than the initial days of the virus’s creep toward Doña Ana County.
Amador Recovery Project Director Ray Stewart said that while some services like Smart Recovery meetings were paused in the short-term, they’ve redesigned some workflow processes to reduce risk. His program has a walk-up window where people can request harm reduction supplies (syringe exchange, naloxone) and staff deliver it outside the building. “There is a tremendous opportunity to do good in so many angles with our clients,” Stewart said. “Just delivering a food box or prescriptions, helping someone avoid eviction from a landlord, or assisting in applying for Medicaid or SSI/SSDI may improve an individual’s health status.”
With a clinic that integrates behavioral health with medical care, AHC is able to provide in-depth primary care to anyone in the community, even if for now it is at a distance of six feet or by telephone or video. A prescribing psychologist and a medical provider can serve a patient for their depression as well as their chronic disease condition. While patient visits are down by about 30 percent and the clinic has seen a decline in revenue from insurance billing as well, there have been several federal funding infusions for the clinic through its federal Health Resources Services Administration grant.
The first funding from the federal Coronavirus Aid, Relief and Economic Security (CARES) Act is intended to address preparation, prevention and response and included enough funding to purchase a vehicle, more PPE and workstations to separate staff. The second infusion is for “Safety, Response, and Capacity” and will help AHC meet the current needs, as well as remain secure in the future.
The state public health plan for New Mexico includes increasing COVID-19 testing and tracing positive exposure connections to help reduce the spread of the virus. AHC has helped coordinate two testing events through the New Mexico Department of Health for essential volunteers and staff, and clients on the Mesilla Valley Community of Hope (MVCH) campus. Of the 100 tests performed April 22, two percent of those tested were positive and put into self-isolation, which is less than the state average of five percent. The results of the May 11 testing event are not yet available.
With the federal funding, AHC is able to maintain its full staff and will provide testing at local housing programs as well as host its own testing events. These events are important to preserve PPE, which still remains an access problem, since the medical staff performing the tests can continue to wear most of their protective gear in between patients, rather than dispose of it after performing a single test when a patient comes to the clinic. Due to the lack of COVID-19 test kits available, AHC has only been performing tests for people who are showing symptoms. The commercial lab that services AHC will be providing more tests as they become available and more PPE orders are delivered.
The federal funding will also help AHC make upgrades to computer systems and telehealth equipment and hire crucial staff to help create a stronger foundation for the future, including a clinic operations manager and resource developer. The irony of AHC receiving federal funds that will enhance the clinic while thousands in our community and nation have lost their livelihoods and much more is not lost on the 30 staff who have not had their hours or pay reduced. Funding that helps AHC keep its doors open to those in need of services has also allowed staff to feed their families and pay their bills.
“I feel very honored to be part of a healthcare organization and campus of nonprofit agencies serving people coping with extreme poverty or experiencing homelessness or housing instability,” said Stewart.
If people in the community take personal responsibility by practicing social distancing, washing their hands often and vigorously and wearing masks of any type in public, it may help slow the course of the disease in our community and encourage Gov. Michelle Lujan Grisham to further roll back some of the restrictions on businesses that are deemed non-essential. The governor is utilizing health professionals and data to make reasoned decisions week by week. She has a tremendous burden on her shoulders.
On the national level, we really do not know where this pandemic is going. With the relaxing of restrictions, and in fact, other state and business procedures which don’t provide the protections AHC has implemented, the future is frankly, pretty scary. AHC will remain vigilant and try to exceed the decisions that are being made by our state and federal officials.
“I feel that it is our duty to keep ourselves healthy, for staff to practice good hand hygiene, maintain proper social distancing and cover our coughs and sneezes,” said McElveen. “We all must be good stewards to our fellow human beings and ourselves.”
AHC is located on the MVCH campus alongside a soup kitchen, day care center, food bank and housing service center. Its hours of operation are 8 a.m.-4 p.m. Monday-Friday. Appointments for medical, behavioral health or substance use services are open to the entire community and can be made by calling 575-527-5482. Visit www.amadorhealth.org and Faceboook.com/amadorhealthcenter. AHC is on Instagram @amadorhealth.
AHC celebrated its 30th anniversary on May 4, 2020.