How nonprofits are filling in southern Arizona’s health care gaps

Lisa Kiser (right) is a volunteer nurse practitioner while Ivana Burruel is a volunteer nurse at Clinica Amistad in Tucson. Sarah Lapidus/The Republic

How nonprofits are filling in southern Arizona’s health care gaps

Uninsured patients slowly trickled into the waiting room of Clinica Amistad, a free health clinic in south Tucson, filling up every seat in the room shortly after it opened its doors at 5 p.m. on a weekday in the fall.

Volunteer promotoras, or community health workers, had decorated the room for Día de los Muertos, Day of the Dead, with colorful papel picado and pictures of skeletons, giving the clinical setting a welcoming feel.

Clinica Amistad is one of Tucson’s only free primary care clinics, in addition to a clinic run by University of Arizona College of Medicine medical students.

Run by a host of volunteer health care providers and others, the clinic aims to fill the gap of providing health care to people without access to health insurance, including many people without documentation.

In 2020, the clinic had 2,400 patient visits and provided 1,772 volunteer hours by doctors and nurses, according to the organization’s most recent annual report. In addition, about 88% of patients that year identified as “Hispanic or Latinx” with 58% of patients currently uninsured with previous insurance, while 30% have never had health insurance and 12% declined to answer.

Low-income residents in southern Arizona rely primarily on federally qualified health centers that provide health care at decreased costs, county public health departments for a wide range of preventative care services, and free primary health care clinics like Clinica Amistad.

However, there is still a large gap in treatment services for uninsured people who have serious issues. It ends up costing patients thousands or tens of thousands of dollars to treat, said Lisa Kiser, a nurse practitioner and an assistant professor at the University of Arizona.

Kiser is one of the many volunteer health care providers who work at the clinic.

Although Kiser has seen innumerable patients throughout her career, she has an impeccable memory of her patients, their stories and the inequalities they face trying to access care.

She recalled one woman who came to see her whose intrauterine device, or IUD, had perforated her uterus and migrated into her bladder. The woman had frightening symptoms such as painful urination, blood with urination and severe abdominal pain.

However, after going to three different emergency departments in Tucson, no one would take it out.

“No one would call an IUD in her bladder an emergency,” Kiser said. “If you walked in and had an IUD stuck in your bladder and you have your insurance, they would immediately take you back and operate on you.”

Kiser said she had to work with a gynecology specialist to have the IUD removed, five months after it had gotten stuck in the woman’s bladder.

While emergency care is offered to those who are uninsured – thanks to the Emergency Medical Treatment and Labor Act of 1986 — not every issue is considered an emergency and treated.

According to an article in the The Western Journal of Emergency Medicine, board-certified emergency physicians are trained in emergency and not primary care. Thus, they do not typically specialize in disease prevention or chronic diseases such as high blood pressure, diabetes, asthma, heart disease or cancer, among others.

Kiser recalled another uninsured patient with uterine cancer who had an impossible decision to make: to stay with her family in the U.S. and die from her disease or return to Mexico for care and risk never seeing her family again.

“She couldn’t get treatment here, so she would have to go back to Mexico, but she would not have a legal or easy way to cross back in the United States,” Kiser said.

Not wanting to be away from her family, the woman chose to stay with her family and died shortly after.

“It’s just appalling in 2022 that I have five people on my schedule that most of them have bleeding issues,” Kiser said. “It is really hard night after night to look at somebody and say, ‘Can you go back to your country of origin (to access care).’”

She noted how many of her patients cannot return to Mexico. Some were brought to the U.S. as children, while others crossed the border in ways where they cannot return, or they do not know anyone in their home country anymore.

Kiser also highlighted one particularly vulnerable population that Clinica Amistad serves: people applying for permanent residency. Many immigrants on temporary visas waiting to become permanent residents are scared to apply for federal programs because they do not want it to affect their admission into the country.

According to the National Immigration Law Center, officials can deny immigrants permanent residence into the country if applicants are likely to become a public charge, or dependent on public assistance, which includes Medicaid.

While the Biden administration stopped enforcing much of that policy, unlike the Trump administration, those fears persist, Kiser said. For people in those situations, paying for health care out of pocket or applying to public programs are not viable options.

“That is why Clinica Amistad exists,” Kiser said.

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