Maria Julia Cruz ruffled her purple-streaked hair while clutching a plastic Food Lion bag that contained the medicine keeping her alive. One bottle for her high blood pressure. Another for low blood sugar. Eye drops for her glaucoma.
On a recent afternoon, health care workers checked her temperature before Cruz entered the clinic that has provided the insulin needed to control her diabetes for over two years — the clinic that never shut down in a pandemic that’s threatened health care for those who needed it most.
“CROSSOVER Healthcare Ministry,” read one sign near the entrance. “Uninsured & Medicaid Patients Welcome.”
For nearly 6,000 people like Cruz, CrossOver — the largest charitable clinic in the Richmond area — stabilizes a vital safety net punctured by a virus that has disproportionately impacted its patient population, which is more than 60% Black or Latino and 100% low-income.
As COVID-19 cases surged, so did the shift to meet the increased need for patients at CrossOver who saw the blue-bricked building off Cowardin Avenue as their only chance to receive medical care.
Since 1983, the community health center has been a crucial link to a fragmented health care system Latino communities nationwide distrust. They serve uninsured pregnant women; treat chronic diseases; families from low-income areas who need vaccines; older individuals grappling with diabetes; people in search of stable housing.
Regardless of immigration status. Regardless of ability to pay.
Like free and charitable clinics nationwide, however, CrossOver is balancing an issue exacerbated by the pandemic: volunteer and funding shortages.
The clinic is operating at a 15% reduction in volunteers, the almost 400-person backbone of the South Side and Henrico County clinic operations who are nurses, interpreters, dentists and OB-GYNs. Some left due to being high risk, above the age of 65 or college students who were sent home. Others chose to retire.
CEO Julie Bilodeau doesn’t blame them. They have families, too, she said, and the emotional exhaustion health care workers are facing in an unending pandemic has taken its toll.
The loss has left the clinic and its staff strained as they pivot to increase an already limited capacity. They don’t want to turn people in need away.
“We all thought it was going to be a month or two. We all thought, ‘Oh, we can do this for a month. We can do this,” Bilodeau said. “Now it’s like, ‘How are we going to regain that capacity post-COVID?’ Man, that’s the toughest thing for us.”
But they’re not giving up.
Nationwide, the continued spillover effects of COVID-19 and its disruption to routine checkups and procedures for communities already ravaged by the virus — in Richmond alone, Black residents are five times more likely to be hospitalized with the virus than white Richmonders, according to health department data — has threatened the medical care of more than 29 million people depending on free health clinics, according to the Health Resources and Services Administration. In May, 1,954 community health center sites temporarily closed. For now, the number sits at about 602.
CrossOver was never one of them, nor do they plan to be, assuring their patients that they’d have somewhere to go in a pandemic that’s forced high unemployment rates, evictions and extraordinary measures to afford medication and food.
The spike in need is coupled with stretching resources. CrossOver’s one-time $535,000 Payment Protection Loan and grants helped offset part of the clinic’s financial shortfalls.
In a typical fiscal year, the clinic’s operating costs are $3.8 million, according to Megan Mann, CrossOver’s director of resource development and communications.
Eleanor Sanchez, a Richmond clinic manager who’s been with CrossOver for more than 16 years, said longtime donors have done what they can in the uncertainty, but patient donations have dried up due to financial struggles — a loss projected to cost the nonprofit clinic anywhere from $100,000 to $250,000 in the upcoming year.
And even with more than 12 community health centers within Richmond city lines, including Health Brigade and Daily Planet, to cater to a patient base that is predominantly people of color in essential jobs, there’s tremendous demand.
In fiscal year 2020, CrossOver alone had 15,719 primary medical care visits that the clinic is leveraging technology to keep.
The clinic shifted resources to the new reality of telehealth: mental health services, home health care kits to monitor blood pressure, delivering medications, Medicaid applications, financial screenings, ramping up education through 1,500 outreach calls and texting people in their native languages.
The call center continues fielding 5,000 calls per month, or about 166 calls per day. A majority of the calls have dealt with fending off virus misinformation for the past several months. Some patients report having symptoms but delay going to the hospital, fearing being hospitalized means they’re going to die, said CrossOver clinical coordinator Elizabeth McNutt.
As Latinos nationwide face being 4.2 times more likely to be hospitalized with COVID-19, McNutt continues seeing more patients refusing to seek care even with symptoms.
Then there’s the mental health toll, not knowing if they should get tested or leave the house and fearing that if they isolate, they will lose their low-wage jobs.
It’s hard to hear the stories, McNutt said.
But as the days roll by, and the pandemic continues, she keeps showing up as waiting rooms fill and then empty out again.
On a recent evening, the hallway foot traffic dulled to the slight squeaks of nurse shoes on tiled floors as the daytime staff readied themselves to go home around 5 p.m.
One by one, lights flickered off. Doors locked.
Sanchez, the last to leave, eyed the wall of rosaries and crosses given to the clinic by patients and volunteers from countries like El Salvador, Honduras and Venezuela — symbols of protection, prosperity, hope; of patients Sanchez has come to know as family.
The phones ringing with people hoping to access an appointment quieted. Tomorrow, they’ll start again. Sanchez will answer.