Clinic brings affordable care to Canyon community

The first patients start arriving in the old school hall just after 9 a.m. on Thursday. A large concrete block outside the building in Hungry Horse still reads “Canyon Elementary School.” Inside, though, classrooms have been reshaped into exam rooms, a lab and a counseling room bedecked in soothing colors and art. Instead of young students, the hall fills with several residents from the Hungry Horse, Coram, Columbia Falls and other surrounding areas.

The Flathead Community Health Center’s Hungry Horse clinic has been open for a couple years now, but renovations completed last month have transformed what was once the Canyon Elementary School, closed in June 2011, into a rural health center designed to treat patients with tenuous access to medical care.

“I love the way this is growing and how it’s blossomed,” said Dr. John Tremper, a family medicine and rural health specialist who practices at the clinic, as he walks through the newly separated rooms.

On this Thursday morning, he’s preparing to see somewhere between 18 and 23 patients over the course of the day as part of the Flathead Community Health Center’s foray into rural health care, open Monday and Thursday, 9 a.m. to 5 p.m.

Nationwide, community health centers are often on the front lines of affordable, accessible family health care, and in Montana, community health centers treat one out of 10 individuals, according to data available for this month’s national Community Health Center week. In rural states, federally funded community health clinics such as the one in Hungry Horse can be the only available resource to rural residents.

Practicing rural health care, said Dr. Tremper, means “you do a lot more emergency room and you know a lot more (obstetrics) and pediatrics.”

The Hungry Horse clinic also provides minor surgical services; counseling, behavioral and mental health services; critical women’s health concerns such as family planning, pap smears and breast exams; preventative health care such as immunizations and screenings; and primary care staples such as maintenance of chronic conditions, medications, and prescriptions for non-emergency illnesses.

The clinic accepts patients regardless of their insurance status, offering payment plans on a sliding fee scale based on an individual’s financial situation.

“Community health centers are by definition supposed to bring down the barriers of care in disadvantaged communities,” said Tremper. “We take all comers...but especially for people without insurance, we ratchet their prices down.”

The clinic also fills a niche in the community for people who are unable to travel longer distances to Columbia Falls or Kalispell. Some don’t have a vehicle, while others lack the ability to drive for more than a few miles.

Glenn Kenzie, of Columbia Falls, made his monthly trip to the clinic to monitor several chronic conditions. Multiple sclerosis, COPD, chronic pain and a couple degenerative discs in his back have curtailed Kenzie’s ability to travel over the years. The distance from Columbia Falls to Kalispell may not seem great to many Flathead Valley residents, but for Kenzie, a drive of that length means at least two or three Charlie-horse cramps that will sideline him for several minutes on the side of the road.

Going to the Hungry Horse clinic is “a lot easier than going all the way to Kalispell,” he said. “For people like me, it’s like a godsend.”

He elaborated that, “There’s a lot of people who live up in this area who don’t have a lot of money and have problems with transportation and stuff like that. And it just makes people like me...it makes things a lot easier for us.”

The issue of transportation, or lack thereof, comes up frequently, said Rachelle McPhee, a licensed practical nurse at the clinic. “If you don’t have a vehicle, it doesn’t matter” that Columbia Falls is relatively close. “It’s not convenient — if you don’t have a vehicle, you don’t have a vehicle.”

Dr. Nicole Russell, who practices family medicine at the clinic on Monday afternoons, echoed the outsize role a lack of immediate transportation plays on patients’ medical care. She orders the same labs and images for her patients in Hungry Horse as she does at the community health center in Kalispell. But that can pose complications, as “it’s difficult for patients to access transportation for appointments.” However, through counseling, communication with patients and taxi vouchers, “our clinic has really stepped up to help get them there.”

Part of the mission of the Flathead Community Health Center, and the Hungry Horse clinic in particular, is to treat people pragmatically while not ignoring the factors, stressors or concerns outside the clinic which could limit a patient’s ability to respond to medical care.

Tremper described his job as, primarily, problem-solving. “We don’t just deal with health issues,” he said. “We deal with mental health and depression and addiction and homelessness. It’s never one disease ... everything is interlaced.”

When a patient comes in — in many cases, for their first medical appointment in months, or even years — they bring a host of concerns, some discernible, some hidden. They may have diabetes but have not been able to afford insulin. Or have struggled to keep up with doctor appointments due to underlying depression. Or have contracted HIV, but have not received medical treatment for it.

Tremper, said McPhee “builds a rapport with (patients) and we get them to come back for their high blood pressure, their diabetes, their chronic stuff, and pretty soon we’re treating the whole person.”

Part of that care is mental health or behavioral counseling, provided by Yvonne Olson, who Tremper described as “invaluable.”

Olson, who lived in the Canyon community for a time as a young girl, said she approaches each patient individually, with a “learning perspective.” “Who is this person who’s coming in?” she’ll ask. “What are their needs? There’s going to be a much different approach if their needs are that they’re homeless or have food insecurity, or if they don’t have transportation.

“A strict mental health approach to someone with those needs would be, well, useless, if their basic needs aren’t being met.” In other cases, where basic needs are met but the patient is hindered by other issues — alcoholism, depression, or behavioral struggles such as eating properly for diabetes maintenance, struggles with obesity, or smoking cessation — Olson hears out their difficulties and “whatever it is, we start from there.”

The clinic is usually booked with appointments on its two open days, said Olson, but she still makes room to accept walk-ins who have just discovered the old school location or are in pressing need of someone to talk to. Because she’s the only behaviorist on staff, she said, “if someone comes in and the doctor wants them to see me, even if I have someone scheduled, I’m going to see them.”

“The last thing we want is for money to be a barrier to health care,” she said.

The Flathead Community Health Center’s clinic in Hungry Horse is located in the old Canyon Elementary School at 200 North Street. To schedule an appointment, call 752-8113. For dental appointments, available starting in October, call 751-8221. For more information, visit www.flatheadhealth.org.

Reporter Adrian Horton can be reached at 758-4439 or at ahorton@dailyinterlake.com.