A Pensacola emergency room doctor recently picked up the phone and called Health and Hope Clinic about a man who kept coming back to the hospital, struggling to breathe.
The patient needed an inhaler. He also needed money to pay for it.
He did not have that.
So instead, according to clinic executive director Sally Bergosh, the patient would end up back in the ER when his breathing got so labored that he could no longer manage it on his own.
At Health and Hope Clinic, staff members say stories like that have become harder to ignore over the past year.
People are arriving sicker. Problems that could have been handled months earlier are turning into emergencies. Dental infections. Uncontrolled diabetes. Blood pressure that has gone untreated for too long. Patients rationing medication because they are trying to stretch grocery money or keep the lights on.
"Uninsured adults are far more likely to delay or skip care for chronic conditions because of cost, leading to worsening disease by the time they seek help," Bergosh said.
The Pensacola clinic provides free medical, dental, mental health, pharmacy, and specialty care for uninsured adults across Escambia County and Northwest Florida. Much of the work is handled through grants, donations and a network of volunteer doctors, nurses, dentists and counselors.
More than 400 volunteer clinicians help staff the clinic, according to Bergosh.
Inside the clinic, the economic strain showing up in patients' lives is often impossible to separate from their health.
"We are seeing the need for primary care services for patients with hypertension and diabetes that can't afford their medication," said Carla Davis, the clinic's director of education and outreach in minority medicine. "We are also seeing a need for dental services."
Bergosh said the oral health problems create some of the most painful cases the clinic sees.
"Dental issues often become emergencies because preventative care is unaffordable," she said. "By the time we are often getting these patients, we are having to act quickly because they are encountering so much pain."
The clinic is also seeing more patients with anxiety, depression and emotional distress connected to unstable finances, chronic illness, and uncertainty about housing or insurance coverage.
Some are adults in their 50s and early 60s who lost employer insurance or Medicaid coverage but are still years away from Medicare eligibility.
Others are hourly workers trying to decide whether they can afford to miss a shift for a doctor's appointment.
Even getting to the clinic can become complicated. Some patients do not have reliable transportation. Some cannot afford gas.
Then there are the patients trying to navigate the healthcare system in a language they do not fully understand.
"We also have a lot of language barriers that can make intake, scheduling and follow-up confusing and difficult," Bergosh said.
The clinic recently started Spanish-language classes focused on helping patients understand how to schedule appointments, fill out medical paperwork, and communicate with healthcare providers. A Spanish translator funded through an opioid abatement grant also helps connect patients with counseling and mental health services.
Medication remains one of the clinic's biggest expenses and needs.
Last year, Health and Hope Clinic provided about $4.5 million worth of medication assistance, according to Bergosh. Through partnerships and donation programs, the clinic filled more than 9,000 prescriptions, including insulin, inhalers, antibiotics and blood pressure medication.
Davis said community outreach events often become the first contact for people who did not realize help was available.
"This is an entry point for referral to care," Davis said.
The clinic also partners with food banks and local organizations to provide nutrition education, cooking classes and fresh produce for patients dealing with chronic illnesses.
"It's not enough to address the patients' immediate concern," Bergosh said. "We need to get our patients the long-term care and education for better overall health. Healthier patients create healthy communities."
Residents seeking care can learn more on the Health and Hope Clinic website.
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