Whittney Smiley sees a doctor at least once a month for anemia and asthma, but the 28-year-old has few choices for treatment in her hometown of Century.
Not only is she uninsured, but also she lacks transportation to get to the one place in town that takes patients without medical insurance coverage — the Health & Hope Clinic.
“Most of the time when something comes up or I’m sick, I go to Health & Hope,” Smiley explains, “but it’s only open on Wednesdays. The rest of the time I have to go to Jay. Sometimes it’s hard to get those places.”
Health and Hope Clinic is a volunteer, donor-driven clinic established by the Pensacola Bay Baptist Association to help meet the needs of the uninsured and medically underserved in Escambia County. The clinic that opened in Century three years ago, now sees 210 patients for primary care, but sometimes they need specialized care in Pensacola or Jay, where the closest hospitals are located.
“It’s a matter of transportation,” said Smiley. “Not everybody has the transportation to get to their appointment. Most of the time my auntie takes me or you have to pay people.”
Escambia County Area Transit, or ECAT, makes two runs from Pensacola to Century a day, but the bus doesn’t makes any other stops around town. Since more than 40 percent of Century’s estimated 1,500 residents live in poverty, transportation is a big challenge.
“It’s a problem for many of the patients we see,” said Jessica Simpson, executive director of Health & Hope Clinic. “Not all of our patients need to see a specialist in Pensacola, but it’s to the point that when some do, our volunteers are taking them on their own time.”
Simpson said the Century clinic has a 25 percent no-show rate, meaning a quarter of their patients or more miss their appointments merely because of the transportation issue.
“We had a similar problem at the Pensacola clinic before we instituted a healthy no-show policy,” said Simpson, “but we haven’t dropped the hammer here because it’s not irresponsibility, it’s lack of transportation.”
Simpson is looking for solutions to a problem, Maxine Ivey has been struggling with for more than two decades. Ivey is Executive Director of the Northwest Florida Rural Health Network, a nonprofit organization recognized by the State of Florida to coordinate and integrate health care services. She has been working with underserved patients in northern Escambia and Santa Rosa counties most of her career.
“The north end of the county is forgotten,” said Ivey. “People have chronic health problems because they haven’t been getting consistent medical care.”
Ivey makes arrangements for patients from Century, Brewton, Jay, Munson, and other rural communities to get the prescriptions and medical care they need. Some pharmacies and businesses offer free supplies, but Ivey and Simpson end up providing the drugs because patients simply can’t get to the places where they’re offered.
“We could quit spending resources on items like that, if we can address transportation,” Simpson said.
Theresa Chmiel, executive director of Escambia Healthy Start Coalition, is in the process of opening a new clinic next door to Healthy & Hope in Century. Healthy Start is a non-profit that provides dedicated to improving the health of pregnant women and their babies.
Chmiel plans to open their doors in June, but she also worries about transportation being an obstacle to pre-natal care. Although Northern Escambia County, has a much lower birth count than the South end, it a much higher infant mortality rate.
There were three infant deaths out of 288 births in Northern Escambia in 2013, a rate of 10.42 compared to 6.82 in Southern Escambia.
“The highest risk population of women and children are in the northern part of the county,” said Chmiel. “Accessing quality, consistent care is a huge burden and so often they don’t do it. They end up with high infant mortality because they’re not taking care of themselves.”
Ivey and Simpson are willing to coordinate scheduling and manpower for a transportation service in the north end of Escambia and Santa Rosa Counties, but the problem is funding.
“At this point, it’s not so much buying the van, it’s paying for the insurance,” said Simpson. “Volunteers are great, but consistency comes with a paid position for a driver.”
In the meantime, many patients are walking, paying for rides, or neglecting their appointments altogether, which often makes existing medical worse and more expensive.
“If they don’t have a way to get to the doctor,” said Smiley, “they’re going to cancel it, until they do.”