Opinion: The privilege of providing care to those who need it most

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I came to Mendocino Coast Clinics many years into my medical career, having spent the previous 14 years practicing HIV care in San Francisco. Originally, I applied for a job in Ukiah. I had a very nice phone interview with them, and we were all very interested in each other. Then I asked, “What’s the temperature there today?” They replied, “115 degrees.” I asked my next question: “And am I correct that you have rattlesnakes there?” And they said, “Yep.” That sealed the deal: living in Ukiah was not for me. Fortunately, they connected me with Paula Cohen, then executive director at Mendocino Coast Clinic (MCC), and she hired me. I started at MCC in 2004, 20 years ago this year.

I have always had a firm belief that everybody should have healthcare, regardless of their finances or background. There was a private group operating in Fort Bragg when I started at MCC, but that was not as attractive to me compared to what the clinic represented: accessible healthcare for everyone.

Filling the gaps in care

Living in a rural area presents challenges, one of which is accessing specialist care. Because of our remote location, we have a limited referral pool, which means patients often face long waits for specialist referrals. We do the best we can, addressing as many needs as possible in primary care visits to bridge those gaps.

When telemedicine came on the scene in a significant way in 2020, it not only allowed us to access healthcare locally without being in the same room, it made it possible to connect with specialists without having to travel long distances. Patients can book appointments directly with specialists outside of the clinic because of advances like these. Telemedicine has been a game-changer for everyone.

Life-changing programs

I practice internal medicine, where I often work with my patients to manage chronic conditions like high blood pressure, diabetes, and asthma. It is rare for me as an internist to witness a dramatic turnaround in a patient’s health. On the other hand, in MCC’s medically assisted treatment (MAT) program (which combines medication like suboxone with other treatments to help people with substance abuse disorders recover), the changes are astonishingly fast. Suboxone treatment makes a difference very quickly. You can actually see people get their lives back together. People who have been abusing substances can go back to work, get the chance to see their families again, reconnect with other people, and rejoin society. Patients will say, “Oh my god, I feel like a normal human being again.” This is moving for me as a provider because those patients have usually not been feeling that way for a very, very long time.

I experienced something similar in my work caring for people infected with HIV. In the mid-1990s: we finally found an effective treatment, and it was transformational. Providers like me went from caring for hundreds of HIV-positive people who knew they were going to die to suddenly being able to put a lid on the virus. People’s immune systems came back and their energy came back. Many people came back from the brink of death to lead essentially normal lives. 

My work with the MAT program and HIV care has been especially rewarding. Both have allowed me to develop wonderful relationships with people who are so appreciative. That is the great gift of my career, and it’s a reminder of the profound impact we can have on people’s lives.

Flu and COVID vaccines remain vital to community health

Having lived here for 20 years, I have now been through 20 flu seasons. I want to reiterate an important message as we embark on another one: Everyone ages six months and older should receive a flu shot each fall. This simple act lowers the risk of passing the flu to vulnerable people in the community.

COVID vaccination is also important, especially as we enter the time of year when COVID often surges alongside the flu and viruses like respiratory syncytial virus (RSV). We are seeing the normalization of COVID. It has shifted from being a pandemic to being endemic: a part of our everyday lives. COVID cases might not drastically impact us as much as they once did, but it is important to take it seriously. Even people who have very, very mild versions of COVID can get long COVID, which we still don’t fully understand. 

When you plan vaccine appointments, you can receive the COVID and flu vaccines at the same time, or stagger them if you prefer. If you are hesitant to be vaccinated, talk with your medical provider. I encourage people to remember that they are living in the same community with older people, immunocompromised people, and very young children. Our choices impact others.

We’re lucky to have MCC

Having worked in many settings—including clinics, hospitals, and private practice—I consider MCC the best place I’ve ever worked. My colleagues are dedicated to their patients and to our community. We are all committed to the mission that drives us. I am enormously proud of any contribution I have made to our community’s health.