No Texan Left Behind: Martha’s Health Clinic

More than three million people live in the 191 Texas counties (out of 254 total) that are deemed rural. Compared with their urban counterparts, rural Texans are older, poorer and sicker. Although many factors contribute to poor health in rural communities, a leading culprit is limited access to health care. Rural Texas has seen more hospital closures than any other state, with 21 hospitals shuttered since 2010. In a state of Texas’ size, many rural residents—hindered primarily by poverty and lack of transportation—cannot afford to go to urban areas to receive basic care. Thus, people in these isolated, low-income areas often forgo regular health care altogether.

At Texas A&M, several research projects and public outreach programs are tackling these rural health disparities. In this “No Texan Left Behind” series, we are highlighting a few of these programs and how they’re helping more people get the care they need: the Southwest Rural Research Center, the Telebehavioral Care Program, and—here—Martha’s Health Clinic.

Martha’s Health Clinic

Martha’s Health Clinic, a student-run health clinic in Temple, Texas, has been offering basic health care and health education to the homeless and uninsured since 1994. Alongside these goals, the clinic also strives to limit the burden on local hospitals by providing care to a portion of the population. If a condition is too serious or specialized for the clinic to handle, however, the clinic refers patients to a local hospital to receive more specialized treatment—such as an emergency or OB-GYN care.

Open every Thursday evening, the clinic welcomes 25 to 40 patients on a first-come, first-served basis for a full examination, which is conducted by a medical student. The volunteering physician from Baylor Scott & White Medical Center then checks the student’s findings and ensures appropriate treatment. If necessary, the clinic’s staff can perform minor procedures such as removing non-cancerous cysts or calluses.

This clinic doesn’t only benefit patients. In addition to credit hours, the medical students who staff the clinic receive both exposure to an underserved population and the opportunity to further develop hands-on skills in a clinical setting.

Nitin Agrawal, who recently graduated from the Texas A&M University College of Medicine, started volunteering at Martha’s Health Clinic during his second year. At Texas A&M, medical students can choose among several locations in which to complete the clinical part of the curriculum. After his volunteer experience sparked his interest in Martha’s Health Clinic, Agrawal chose the location in Temple, Texas. Serving in one of the 14 leadership positions that medical students hold at the clinic, Agrawal observed firsthand the health disparities in rural communities. “There’s a wide variety of medical problems and social problems just within our Temple community,” Agrawal said.

But one specific patient has left a lasting impression on Agrawal.

An uninsured middle-aged woman visited Martha’s Health Clinic for a routine checkup only to learn she had type 2 diabetes. When Agrawal diagnosed her with this chronic condition, she cried. This patient didn’t have the financial means, let alone the time, to handle diabetes. “She’s juggling jobs and her children, and now she has this major medical diagnosis on top of all that,” Agrawal said.

The woman worried that without health insurance, she could not afford insulin, which is commonly prescribed to manage diabetes. Agrawal realized, however, that because the woman’s diabetes was type 2, she might be able to manage it through diet and exercise. Although most patients receive only short time with a student physician, Agrawal spent nearly an hour helping the patient understand how to modify her lifestyle. After following Agrawal’s recommended behavior changes for the next several months, the woman lost 30 pounds and was able to bring her diabetes to a manageable level.

“This is pretty representative of a lot of our patients at Martha’s Clinic,” Agrawal said. “They come here for chronic medical problems and don’t have any form of health care other than this clinic.”

Students working at the clinic also consider how financial constraints affect other aspects of health care. For instance, all medications must be affordable and available over the counter at a drugstore or grocery store to ensure accessibility. “We have to prescribe based on the $4 rule,” Agrawal said, meaning the list of generic forms of the prescriptions that many pharmacies sell for $4. “A lot of our patients don’t really have the resources to get more expensive medications.”

Agrawal’s experience at Martha’s Health Clinic over the last three years inspired him to consider practicing in a rural community someday. He feels privileged to work closely with this population and recognizes the demand for full-time physicians in non-urban areas. “There really is such a great need for doctors here,” Agrawal said. “Not just in Temple, but in other areas of Texas and throughout the country.”

Story written by Sarah Allen