Monday June 29, 2020
By JOEY PETERS
Lost COVID-19 revenue and the Lake Street fires are turning immigrant neighborhoods in south Minneapolis into health care deserts. The outcome for patients? “Their chronic conditions are getting, frankly, worse.”
Ahmed Muhumud stands in front of the now-closed Midtown Eye Clinic, which he helped found seven years ago. Credit: Jaida Grey Eagle
For Abdirizak Abdi and five of his seven children, a visit to the eye doctor used to be a simple walk away from their home in south Minneapolis.
But in the unrest that followed the police killing of George Floyd last month, the complex where Midtown Eye Care was located, on Chicago Avenue near the Lake Street intersection, was completely destroyed. Now, just as Abdi makes a longer drive for groceries, he and his kids will have to eventually find a new eye clinic.
Abdi has a car, so he will be able to drive to a new eye clinic whenever that day comes. But he worries about Midtown Eye Care’s other patients who don’t have access to good transportation. The clinic, which has been around for seven years, was created to serve patients who don’t feel comfortable at bigger, more mainstream clinics.
“A lot of the elderly in the Somali community would go there,” Abdi said. “And they didn’t need interpreters, they would just be able to go in and get their needs taken care of.”
Midtown Eye Care illustrates much broader problems that are turning immigrant-heavy neighborhoods in the area into de facto health care deserts. It’s not only this one clinic, and it’s not only about the looting and arson that followed Floyd’s death. It’s also the result of economic issues resulting from the COVID-19 pandemic. Even neighborhood clinics that have remained open have run into issues serving patients since the pandemic hit.
Just a few blocks east on Lake Street, M Health Fairview near Bloomington Avenue will close permanently at the end of June. In a letter to that clinic’s patients at the beginning of June, both Clinic Administrator Deb Barger and Medical Director John Bjorklund wrote that the Lake Street clinic “is one of our smaller locations, and consolidating its services with other clinics will allow us to provide patients with access to more services and providers than we can offer at Lake Street.”
Farther east, Hennepin Healthcare temporarily closed its Lake Street clinic near Minnehaha Avenue after protesters damaged the property. In the meantime, the healthcare provider has directed its Lake Street patients to a nearby clinic in the Whittier neighborhood, as well as online visits. In the nearby Cedar-Riverside neighborhood just north of the area, HealthPartners’ clinic has been temporarily closed since April, another casualty of COVID-19-related economic troubles. Patients there have been encouraged to do virtual visits as well as being sent to other Healthpartners clinics across the metro.
Most patients at Midtown Eye Care used Medical Assistance, Minnesota’s version of Medicaid, to pay for their visits, said Ahmed Muhumud, who co-founded Midtown Eye Clinic in 2013. Bigger clinics often won’t accept government insurance because of its low reimbursement rate, he said, but Midtown was focused on an underserved population.
“This was something that was in the community, on the street level, on a bus line,” Ahmed said.
After the unrest “we lost everything,” Ahmed said, and he is now picking up the pieces to try to relocate and reopen as soon as possible. Insurance will cover only a fraction of the damage, and a GoFundMe page that, while full of supportive comments from patients, is far short from its $100,000 fundraising goal.
Two federally qualified health centers in the area, which receive special federal support to provide healthcare in underserved areas, have not seen patient visits increase since nearby health clinics have shut down.
At People’s Center Clinic and Services, in the Cedar-Riverside neighborhood, patient visits dropped significantly during the first few weeks of the pandemic. At that time, the clinic shut down many of its procedures as a precaution against spreading the virus and saw only about 30 percent of its regular patients.
People’s Center also shifted slowly to online video and telephone visits at first, said Paula Guinn, who works on fundraising and building partnerships with other organizations for the clinic. In the ensuing weeks, as more of the clinic’s services started opening up and staffers and patients got a better hold on televisits, visits crept up to roughly 80 percent of what they were during pre-pandemic times.
At the nearby Community-University Health Care Center (CUHCC), another federally qualified health center in the area, CEO Colleen McDonald Diouf could only speculate why the clinic isn’t seeing new patients from shuttered clinics.
“Maybe people are just not doing as much,” she said. “That’s the big challenge, that people are delaying care.”
At the beginning of the pandemic, CUHCC’s patients were simply scared to show up to the clinic over a fear of contracting the coronavirus, she said. In the weeks after the pandemic began, Diouf said many patients also just assumed the clinic was closed.
In the face of this, Diouf said CUHCC staff has been doing outreach to try to get patients, especially older ones with serious health issues who shouldn’t miss visits, to make appointments.
“People are so afraid, and their chronic conditions are getting, frankly, worse,” Diouf said.
CUHCC is now seeing about the same number of patients as before the pandemic began, but with the vast majority of these through virtual or audio-only telephone visits.
But that’s not the full story. CUHCC patients are still having a tough time adapting to online video visits. Many run into problems because of poor internet connectivity or lack of connectivity at all. Others need help accessing and navigating the proper online applications to do so.
CUHCC doesn’t have enough staff to properly guide patients through this process, Diouf said, and staff probably would have to do so in person to help in the most effective way. Social distancing guidelines are, of course, preventing this.
In lieu of video visits, doctors at CUHCC have been conducting several patient appointments over the phone in audio only, which the federal government approved for full Medicare and Medicaid reimbursement only temporarily during the pandemic.
It’s not clear how long Medicare and Medicaid will fully reimburse audio-only phone visits. The Trump administration made this temporary change in March, and Diouf said it’s not sustainable for CUHCC to rely on this practice staying in place for the long term.
Both practices also risk missing big issues that an in-person examination would be more likely to catch, and Diouf said this is apparent when in-person visits do happen..
“We have started to see when people do come in, they’re coming in for longer appointments,” Diouf added, “because there’s so many different health issues that they’re trying to cover.”
Patients at Healing Path Wellness Services, an independent mental health clinic located on East Lake Street just under a mile west of Midtown Eye Clinic, also didn’t adapt to video appointments well during the pandemic. Healing Path served as a resource hub for the community in its physical location, providing a space for the community to access resources and connect with providers in person. Online visits were not a good fit for the clinic’s mission, said Sulekha Ibrahim, Healing Path’s founder.
If patients needed an interpreter online or over the phone, that added another layer to the difficulty. Older patients also ran into technology access issues, she said.
“It’s not the same as when it’s all happening in person,” Sulekha said. “We really couldn’t do it.”
A public health nurse, Sulekha started Healing Path in 2018 to serve immigrants and people of color to seek treatment that she said is often stigmatized in their communities. The clinic offers culturally specific treatment that doesn’t always rely on traditional mental health techniques, she said. It also focuses on building trust with patients through help outside of the clinic by providing them with resources like transportation.
This made losing the clinic, which serves a large East African population, during the week of unrest in late May all the more crushing. The clinic lost everything, Sulekha said, including contact with many of its patients. Still, she said she’s heard from several patients who told her that the protests and unrest was nevertheless liberating, especially in how so many young Black and Somali people were involved.
“It triggered a lot of [post-traumatic stress disorder] and a lot of worry and stress,” Sulekha said. ‘But for a lot of people in the community, it empowered us.”
Now, Healing Path is looking for a new location, preferably still in south Minneapolis, where 80 percent its previous patients live. Its GoFundMe page has currently fundraised nearly $90,000, which is still less than half of the clinic’s target goal.
Midtown Eye Care is also scouting for a new location near its old one. Ahmed said it’s important to stay in the community.
In the meantime, eye clinic patients are still calling Midtown Eye Clinic for things like prescriptions. In some cases, Ahmed said the clinic is still able to contact labs and get them to deliver glasses and contacts directly to patients.
“We try to connect them with other providers,” Ahmed said. “It’s hard without having a place or a system.”
Becky Dernbach contributed reporting to this story.