Good morning! Now that I am over my initial writers block, I want to chat about some of the direct care places we have been to over the past two weeks as that is what my social enterprise business plan will focus on. The first one is Unjani Clinic, which means “How are you?” in Zulu, and is one of seven such primary care clinics in South Africa. Made out of old shipping containers, these 40 foot long “clinics-in-a-box” contain a waiting room area and a private examination room/office with running water and electricity.
This particular Unjani Clinic, that we visited on July 29 serves the township of Delft and is run by Dr. Patricia Philemon, a passionate and charmingly bubbly woman. She used to be a well-paid physician in one of Cape Town’s hospitals, but he couldn’t get rid of the nagging feeling that she should be doing more to give back to her community. So she quit her job and broke ground on her clinic in February of this year.
My first reaction is that the clinic is deceptively large inside. Our entire group of 23 adults fit inside, along with Pat and her assistant Samantha… and we were only in the waiting room. Pat provides a check-up visit along with any medications for a fee of around 100 Rand (about $10). They meticulously track how many patients have visited each month as well as notes from the patients’ visits. Most people come in for general ailments and women can come for birth control. In a couple of extreme cases she had one man suffering from a stroke and second man suffering from a heart attack in her clinic… at the same time! Another time, a woman almost gave birth in Pat’s car as she was driving the woman to the nearby hospital. Pat is also focusing on getting her patients to practice risk reduction rather than pester them to quit all together at first, which I feel is a very realistic approach. So instead of forcing them to stop smoking, she first focuses on having them reduce from a pack a day to half a pack, then a pack a week, etc. She also uses this stair step method to encourage her patients to gradually increase healthy habits like exercise and eating more nutritious foods.
However, she has noticed that in the 6 months since she has opened she has really become a sympathetic listener for the residents of Delft. One of the patients who was there when we visited talked about how doctors don’t listen when she visited the hospital and she sat there for hours while providers walked by her. Pat on the other hand will take as long as she needs with each patient. She has one patient that has visited 11 times already (and got his 11th visit free with his frequent visitor card) and another stops by almost daily to bring them snacks (she brought muffins while we there that were still warm from the oven) and to chat for a bit. That really struck me that the residents simply need a mental health release. Many many problems plague their township – substance abuse, unemployment, food shortages, HIV/AIDS – and the list goes on and on. No wonder they seek out Pat’s professional and comforting ear.
My biggest worries for Unjani’s future though are their sustainability of funding and how Pat is the one integral piece that keeps the clinic functioning. While there is a fee for service payment model, a lot of care is either subsidized partially or completely by Pat herself from her own savings. I also got the feeling that Pat doesn’t pay herself a salary. Her personal pot of money can’t last for ever though. She already knows that she wants to expand her services to create family planning and nutrition programs. Also, while Samantha runs the clinic with intuitive precision, she has no medical training, so Pat is the sole health provider. If Pat were to leave (which judging by her endless energy will not be any time soon) so too would Unjani.
These things that Unjani does really well and ones they need to work on will hopefully make my own primary care business plan is more efficient and well rounded. Washington, DC’s Ward 8 (the Anacostia region in South East DC for you non-locals) is a health professional shortage area with little to no primary care, dental, or mental health providers for over 79,000 residents. My business plan will focus on establishing more health care providers in Ward 8, potentially using this “clinic-in-a-box” approach. I will need to ensure that my clinic can bring in enough patients each month to break even and or have a second steady income from another lucrative business. I also will need to make sure to have a broader base of health providers so that the clinic is not relying on the passion of one person who may burn out after a year or so. Finally, I want mental health to be a larger focus than a traditional primary care clinic as I have realized throughout my public health studies that everyone has personal problems they wish to vent to a professional.
I am in awe of Dr. Philemon’s commitment to solving the health issues in South Africa and her desire to assist every single person that she meets regardless of their ability to pay. I wish her and Delft’s Unjani luck as they enter their second 6 months in operation!