Published on Monday, September 28, 2009
When asked what he ate for dinner the night before, Jackson resident Jerome Thompson confessed that he violated his dietary guidelines and scarfed down some chicken nuggets. That earned him a lecture from his nurse practitioner on how to properly manage his diabetes.
Dr. Audwin Fletcher examines 3-year-old Edward Smith of Jackson.
"It's not quantity, it's quality," explained Dr. Audwin Fletcher, advising Thompson to avoid fried foods and to stick with vegetables and meats that have been baked or broiled.
"It's a lifestyle change," he told him. "It's going to take some time. We need to work on you losing 26 pounds. When was the last time you've been to the dentist?" Thompson, who lives nearby in the midtown area, visited the UNACARE health center on a recent Friday morning for a check-up and to get his prescriptions renewed. But Fletcher wouldn't let the patient leave before convincing him to get both a flu shot and a pneumonia shot.
Friendly and effusive, the 52-year-old Thompson has visited the clinic several times since being referred by a clinic physician at the Jackson Medical Mall Thad Cochran Center. "So far, so good," he said, smiling.
The School of Nursing operates UNACARE, and Fletcher is one of four nurse practitioner faculty members who practice at the clinic, keeping it open five days a week.
Doddato is the associate dean for administrative affairs and practice in the School of Nursing.
"We provide primary and episodic health care," said Dr. Terry Doddato, associate dean for administrative affairs and practice in the School of Nursing.
She said the services they provide range from prenatal care and newborn care to managing diabetes and hypertension.
"Of the people we serve, only about 30 percent actually live in the midtown area," she said. The clinic also sees patients from surrounding counties and as far away as Vicksburg and Kosciusko.
"We get referrals from local emergency rooms when patients do not have primary providers," Doddato said. "Most like to come to us because it embraces an old-time doctor's office."
The clinic's origins date back to 1997, when the North Midtown Community Development Center invited nursing faculty to perform pre-employment physicals for participants of a work program.
Doddato said they found that most of the patients they treated had no primary-care physicians. Both the nursing school and the development center saw an opportunity to maintain a presence in the area and partnered to open the UNACARE clinic in the summer of 1998. At the time, the School of Nursing was developing its faculty practice, so the timing was perfect.
And it was Doddato who gave UNACARE its name: it stands for University Nursing Associates - Community Access to Health Resources and Education (she admitted the "H" doesn't quite fit the acronym).
Because it's located in a disadvantaged part of Jackson, the facility treats a lot of low-income patients, but it's not a free clinic.
"Our ultimate goal was to be self-supporting," Doddato said. "We're not in the business of making money, but we are in the business of supporting ourselves."
Over the past 10 years, UNACARE has rendered more than $450,000 in uncompensated care.
She said the clinic accepts any insurance a patient might have, and if a patient has no insurance, the clinic charges Medicaid rates. UNACARE also refers uninsured patients to the Jackson Medical Mall Thad Cochran Center for financial counseling.
Along with Fletcher, Pamela Helms, Dr. Barbara Boss and Dr. Joyce Brewer - a midwife who specializes in women's health and prenatal care - round out the clinic's faculty. All except Fletcher were on faculty when the clinic opened, but Helms was not yet a nurse practitioner.
"This clinic is probably what led me into the family nurse practitioner field," Helms said. "And I've been here ever since."
Not only does UNACARE provide community health care, but it also offers unique teaching resources for the School of Nursing. Undergraduate and graduate nursing students undergo clinical and didactic training at the site. Clinical training is incorporated into the nursing curriculum, and the clinic gives them a chance to observe and interact with patients where they live.
"There's a student there 90 percent of the time," Doddato said.
Housed in an unassuming single-story brick building on North West Street, UNACARE is a pilot site for the electronic health records system - Allscripts - that went live in the clinic last October. The clinic also collaborates on projects with the community development center and Catholic Charities.
Dr. Barbara Boss, left, professor of nursing, and senior nursing student Kathryn Dambrino, center, examine midtown resident Jessie Lee Butler.
On Friday morning, several patients were waiting in the clinic as early as 8:30 a.m. UNACARE's waiting room is devoid of magazines - an effort on Doddato's part to curb flu transmission - but a flat-screen television airs Everwell programming. A media service that provides entertaining health content through its TV network and Web site, Everwell was added to the waiting room thanks to Helms, nurse practitioner and director of clinical services.
With his co-nurse practitioner wrapped up in meetings, Fletcher was handling the patient load alone.
Shortly after his session with Thompson, Fletcher visited 41-year-old Latricia Blackmon, who was waiting in an exam room with her arms pulled inside her T-shirt in an effort to keep warm. Fletcher came in and apologized, saying with all his running around, he likes to keep the air conditioning going full blast.
Blackmon said she was feeling some flu-like symptoms despite having recently gotten her flu shot. She could be experiencing side effects of the flu vaccine, Fletcher said, but he gave her a flu test to make sure.
He produced a test kit, snapped on a pair of gloves and, after preparing her for what to expect, he swabbed one of her nostrils. Fletcher mixed the swab with an extract solution, then added a test strip to the solution.
"If two lines appear, you have the flu," Fletcher told her. Results take about 10 minutes. While Blackmon waited, Fletcher visited another patient.
Doddato says a third component of UNACARE's mission is educating the patient.
"We really believe in preventive health care and teaching and education," she said, adding that the nurse practitioners usually spend 15-30 minutes with each patient.
Accordingly, Fletcher instructed Jerome Thompson in what foods are healthy for a diabetic to eat. When Blackmon's flu test came back negative, he explained why the flu vaccine can have side-effects that mimic the flu.
Doddato says their motto has always been, "we bring the care to the community, rather than bringing the community to the care."
"We're there for the patients," she said. "We became nurses to help people and to learn about how to care for people."
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