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Search The Fig Tree's stories of people who make a difference:

Persistence brought health care to low-income people

by Kaye Hult

Dirne Community Health Center helps meet the health needs of 18,000 people in Kootenai County, particularly for individuals and families who struggle to make ends meet. [As of 9.9.2013, Dirne Health Center became Legacy Health Center, a re-branding in the wake of the morphing landscape of the healthcare system.]

Sandy Mamola

Sandy Mamola tells the story of the Dirne Health Center.

No such facility existed in the early 1980s.  The clinic was born through the vision and dedication of Lidwina Dirne, Sandy Mamola, and Peggy Irving.

In 1983, Lidwina, who was facilitating a divorce support group at St Pius X Roman Catholic Church, shared with her friend Sandy that one participant had a chronic health condition, but couldn’t afford to see a doctor.

Sandy and Lidwina discussed the difficulty working-class people had taking care of their health because of their low wages.  What they earned needed to go first to pay rent and feed their families.

Those unemployed or homeless had access to more assistance.

The women invited others to help them explore creating a free clinic.   Peggy, a registered nurse who worked in several hospitals and settings, including with student health services at Central Washington University and the Red Cross, became involved. 

In 1983, they founded Lake City Health Care, which later became the Dirne Community Health Care Center, and now Legacy Health.

It took them years of monthly meetings before the clinic opened.  Each month, Lidwina called everyone to remind them the group was meeting. 

“I was running the soup kitchen at St. Pius on Fridays, which I’ve done for 26 years, and working as a lumber broker, Sandy said in a recent interview.  “At times, it felt like the clinic was going nowhere. Lidwina’s drive was key to bringing the clinic into being.”

The first donation the group received, $600, from the Presbyterian Synod of Women, helped them set up their nonprofit status.

Next they needed malpractice insurance.  No doctor would work at the clinic without it.

The board’s second donation came from the religious community in Holland, to which Lidwina belonged.  In 1971, she had come to Coeur d’Alene from Holland, supported by that community, and worked at St. Pius as their director of religious education.  The clinic board used that donation to open a bank account.

The board contacted every doctor in Coeur d’Alene, asking who was interested in helping with the clinic.  The only positive response was from Dr. William Woods.

The clinic opened in 1985 with one doctor in space donated by Panhandle Health, through the help of Carol Couch, the director of nursing, and Larry Belmont, the executive director.

“At first, they let us use their facility Saturday mornings.  We had maybe six patients the first time.  It grew from there,” Sandy said.

Panhandle Health let them store medical records in one room. 

They could only serve patients who had no insurance.  Eventually, Lake City Health Care had people standing in a line that stretched around the corner, sometimes for three or four hours before it opened.  The clinic grew to two nights a week, then to three.  

Gradually, more doctors volunteered.  Most helped every two to three months, but some came monthly.

“Everyone was a volunteer,” said Sandy, “doctors, nurses, clerical people and financial screeners.” 

They sometimes served 30 or more patients, never turning anyone away.

Organizing and running the clinic took much time.  Sandy, Lidwina and Peggy attended every clinic to maintain continuity.

The board hired medical directors, but no one stayed long, because the pay was low.  Because there was so little money, Sandy quit her job to work as the clinic’s director.  She had previously worked in medical offices and had knowledge from having worked with doctors for many years.

They also paid Ginger Seaman as a patient assistant.  Kathy Ream, who volunteered as a pharmacist, was at every clinic.

Joe Morris, chief executive officer at Kootenai Medical Center (KMC), gave the clinic $5,000 credit for x-ray services. 

“We used these infrequently.  Once the $5,000 ran out, KMC continued to foot all the labs and x-ray costs,” Sandy said.  “Without KMC’s support, we would not have survived.”

The hospital was unable to sell drugs to Lake City Health Care, but donated antibiotics and hypertensives.  KMC provided meds for most of the clinic’s patients, keeping them out of the hospital.

Eventually, the clinic grew too large for Panhandle Health’s building.  Steve Meyers and Charlie Nipp, from Parkwood Business Properties, found space to lease at the 1111 Ironwood Building.  KMC helped pay the lease.

 Sandy and other volunteers helped write grants.  “3 Cs (Cancer and Community Charities) was generous to us, too.” she said, “allowing us to expand.”

Offering mental health care was also important.  A student, Skip Frasier, sought a place to do a supervised practicum for his psychology degree.  Once he graduated, he became a mental health provider.  As the mental health component grew, he brought other students to fulfill their practicum requirements there, too.

Glenn Vaughn, a licensed social worker, came as a volunteer.  He is the longest-serving social worker.

“We went out of our way to treat our patients with respect,” said Sandy. 

When patients arrived, they would go through financial screening, which Sandy did, because it allowed her to know the patients better.  The financial screening included social work screening and counseling. 

The clinic had a fee scale from  $5 to $20, although Sandy doesn’t believe any patient ever paid the full amount.  Everyone was expected to pay something, either at the time of service or later.

Sandy thought back to some of the people she met.

A young man brought his wife to the clinic.  A graduate of the University of Idaho, he was insured through his work at a local bank, but his wife and child were not.  He earned $10 an hour, or $1,200 per month, on which to support a wife and child.  His wife became sick.  The clinic was able to treat her, and their child, who was on Medicaid.  The presence of Lake City Health Care made a difference for them.

In 1999, Sandy suggested that the board change the clinic’s name to Dirne Community Health Center in honor of all Lidwina did to bring the clinic to life. 

Lidwina maintained interest in the health center until her death in June.  Peggy died a few months earlier in March.

“People always think it can’t be done,” said Sandy, who left the clinic in 2001.  “It seemed overwhelming, but it was simple.  Anybody can start a clinic or a soup kitchen.”

Alan Brockway, director of development at Legacy Health, explained the transition since 2004.  Dirne grew from a volunteer organization, which saw only uninsured, to being a Federally Qualified Health Center (FQHC), which can treat anyone without regard to insurance.  As a FQHC, it is directed by patients and receives patients with and without insurance. 

“Dirne transitioned from community members taking care of those in need to the board having a majority of its members from the population served,” Alan said.

With paid staff, higher standards of cae are delivered, together with an increased longevity of care, he said.  Several hundred people still volunteer their services, including some retired doctors.  It has grown to the point that the center has moved to a new building at 1090 Park Place in Coeur d’Alene. 

It also serves people throughout Kootenai and Shoshone Counties with five satellite clinics.

It offers primary care for all ages, including pediatric care; preventative, restorative and emergency dental care, and medication assistance through free- or reduced-price medication.  It teaches and provides counseling on diabetes. 

Dirne/Legacy Health offers several counseling options, evening as well as daytime sessions for adults and children as individuals, couples or families. 

It provides outreach and supportive services for the homeless, including a walk-in clinic for acute care.

Sandy is pleased it carries on the legacy of its founders, maintaining much of its original mission of serving people who cannot otherwise afford health care. 

For information, call 208-292-0292 or see Legacy Health.

Copyright © September 2013 - The Fig Tree