Models of Domestic Healthcare Missions

Ten days ago, Alabama reported that they had zero confirmed cases of COVID-19. When pressed, it turns out that Alabama had done almost no testing. This inspired Dr. Robert Record, CEO for Christ Health Center (CHC) in Birmingham, to take the initiative to find testing for their patients. Last week Christ Health Center, in partnership with Church of the Highlands and a local testing lab, opened a drive-through testing center. In five days they performed 2267 tests. They have received just over 2200 results back, and had 73 people test positive for COVID-19. Robert had a contact with the founder of a private testing lab who had been trying to implement testing, but was overwhelmed. He visited his friend one Saturday, and listened to him talk about the challenges that the lab was not prepared to meet. Robert proposed that Christ Health set up and do the tests, while allowing the lab to process the respiratory panels, which is what they were good at doing. Robert and his team met with the leaders of Church of the Highlands, a mega church where Dr. Record and a number of the staff attend, and a church that has been a close partner throughout the development of CHC. In only a few days they designed a drive-through testing model that is a national model of efficiency, trained staff and a small army of volunteers, published a video, and implemented the largest testing center in the state, and one of the largest in the country. If all of this sounds like something slapped together, watch this nine-minute video: https://www.covid19-testing.churchofthehighlands.com. It is impressive. Almost immediately, Dr. Record and his team began thinking about how those who would test positive would receive care. As he was praying early one morning, he got a picture in his head of what they should do. They trained UAB (University of Alabama at Birmingham), which is the largest hospital system and employer in the state, how to do the testing. Christ Health has now turned their drive-through testing over to them. Simultaneously, they constructed four “bubble rooms” in the building next to their clinic to care for sick patients. These plywood and plexiglass exam rooms allow the doctor to interact with the patient, but from the safety of being on the other side of the glass. They instituted a text-to-access system for positive patients. They started seeing COVID+ patients today (3/25) to work out any bugs in their system. Christ Health’s medical director, Dr. Cleon Rogers, is overseeing “COVID-Care” for the 73 positive cases that they tested who are not hospitalized, plus is taking non-UAB patients who test positive through UAB’s efforts. They provide safe, best-practice care for all of their COVID positive patients primarily through telehealth calls and visits. They do frequent telehealth check-ins—daily for high severity patients, and every other day for low severity patients. They created an internal “off label” use protocol in conjunction with academic infectious disease and cardiology to offer hydroxychloroquine/azithromycin treatment with informed consent for their high risk COVID positive patients. They provide wholistic care for their COVID positive patients, including, where needed, food and prescription delivery, and spiritual care. They do this in collaboration with their church partners. While they are only six days into this COVID-Care program, so far none of their patients have required hospitalization. “Being able to keep 73 people at home is huge! And we are not just providing for those 73. Each one of them live with family members, and we are providing this care to everyone in the house during their quarantine”, said Dr. Rogers. If this model proves fruitful, Dr. Rogers will be sharing this resource with the medical community soon via a paper and video. We post those links on the CCHF website when they become available. How has this impacted their other primary care efforts? Christ Health does a fairly large volume of behavioral health work, and those visits seem unphased so far. In terms of medical visits, they continue to see their mental health and higher risk patients, but in-office volume is down by about 50%. The rest of their work is going forward through telehealth. You might wonder how all of their efforts are funded. Christ Health is an FQHC, and some of the visits and testing are billable. But uninsured patients are tested for free, and they opted to not collect any copays for their insured patients. They raised no money for any of this. “We were ‘action first’, and then trust God for resources. We don’t want to be fiscally irresponsible, but God has met both us and our patients.” said Dr. Record. “We saw what was and wasn’t happening, and we entered into the pain of our patients and my friend at the lab. We knew we had to do something, and show that it could be done quickly.” Private funders, having heard about their work, have sent unrequested donations after the fact. That has helped. The state health department has provided little or no help. The government mechanism was simply moving too slow. To date, 80% of COVID-19 testing statewide is being done by the private lab that partners with Christ Health; and 25% of all COVID positive patients in Alabama are now receiving care through Christ Health. Dr. Record, Dr. Rogers, and their team are well ahead of most of us in the CCHF community, and wide open to share processes and procedures with other CCHF clinics. Dr. Record: “If you are going to share one thing with the other clinics, tell them that we need to turn our attentions, energy, and resources from testing to treatment. That is where we need to be leading at this point in the curve.” Dr. Rogers: “We should not underestimate the impact of spiritual care for these patients. God has opened doors for me to provide meaningful spiritual ministry to my patients every day.” Download full ebook "A Healthcare Worker's Response to COVID-19" here​

There is a story in the Old Testament about the tribes of Israel coming to David before he was made king. Each tribe was described by their skill set. The skill set of the smallest tribe stands out most to me: the sons of Issachar, who “understood the times and knew what Israel should do.” This pandemic of both virus and fear needs us to be sons of Issachar—understanding the times—knowing what to do. It is not enough to rely on our training, because none of us were trained for this. Crises like this tend to expose our weaknesses. My instinct is to try to cover up my weaknesses, to bluff my way through. (Ask me how well that has worked over the years!) The truth is that understanding comes from humility and seeking. Confident leadership comes from a place of faith and peace. We cannot lead through chaos unless we come from a place of peace. Humility embraces our weaknesses and acknowledges that we have something to learn—that we need help from God and from those he has placed in our lives. That must be our starting point. I got a call this morning from someone who was conflicted about how to handle a situation in their clinic related to the pandemic. We talked a bit, but then we prayed. We acknowledged that too much of our thought was influenced by frustration, emotion, and partial information. We asked God for wisdom to help us discern between wisdom and fear. And we asked for the courage to do what is right. When we finished, I think we both found peace and had a better understanding and knowledge to do what needed to be done. This pandemic is affecting CCHF clinics (Christian Community Health Fellowship). Some are committed to maintaining their role as primary care providers. Others see their roles shifting toward patient education during this season. Some are leading testing stations, while others are reallocating resources to support local hospitals. Most are finding that the ability to provide spiritual ministry through prayer is a great asset during this crisis. According to the New York Times, New York state has roughly 5% of coronavirus cases worldwide, and New York City has over 25% of all COVID-19 patients in the US. It is hard to imagine the city that never sleeps with near empty streets in the middle of the day; but the city has closed all non-essential businesses and gatherings, and most folks now seem to be taking it seriously. But there has been conflicting messaging from local, state, and federal sources about the virus, and it has created an atmosphere of fear and confusion. Beacon Christian Community Health Center, located on Staten Island, is living up to its name. Beacon is a Christ-centered, long-time member of the CCHF community. Its founders, Drs. David and Janet Kim, were tailor-made for a situation like this. David is a med/peds doc with training in emergency preparedness, and Janet, also a med/peds doc, is trained in epidemiology. After Hurricane Sandy hit New York in 2012, the Kims played a significant role in setting up emergency medical care for Staten Island. They consulted other CCHF clinics after hurricanes Harvey and Irma, and have offered workshops on emergency preparedness. It is almost like they were born for this. “God has called us to be a beacon during this crisis. There is so much fear and misinformation out there. A big part of our role is to help people respect this virus, but not fear it,” David said. “Our numbers are down. Everyone’s numbers are down. But our phones are ringing off the wall with people who are terrified and panicking. It’s like everything they built their lives around is crumbling. I can’t tell you how powerful it is to share with them that God is still in control, and that He cares about them.” David shared that during this crisis, there were really three main roles they felt they were to fulfill. First, they were to be a beacon to the people of New York—to be a visible pillar of truth and peace, helping them understand the facts in a way that empowers them and dispels fear. Second, they were to keep showing up, taking care of all of the things that people can’t go to the hospital for now. They are still providing full scope primary care, and making sure their patients have continuity of care. And third, they are deeply involved at the state and local level with the health departments and hospitals, facilitating reliable exchange of information and coordinated care. I asked David about some specific ways they are walking out their role, and about how the pandemic has impacted their work: Their patient volume is down by approximately 25% due to increased no-shows, but they are still providing full service primary care. About half of their patient encounters are in-office, and half are telemedicine. That seems to be working pretty well. Telehealth visits with video for Medicaid patients are billable, and they hope that when Congress passes the relief bill this week that telehealth visits with Medicare patients will also be billable. Their staff is doing well, in part because of the clear protocols and systems they have put into place, and in greater part because they are people whose faith in God and dedication to the mission is strong. They have set up a dedicated space inside the clinic for patients who present with symptoms, have had exposure to someone with COVID-19, or have visited countries where there has been an outbreak of the virus. They are following CDC guidelines to the letter. They find social media to be particularly important right now. Their social media presence and messaging has generated a lot of phone calls for information, and a lot of ministry opportunities as they address anxiety and fear among their neighbors. The team at Beacon has always strived to love people well, and to respectfully and boldly share the hope we have in Christ. As we talked today, I was reminded that we help our patients and neighbors find inexplicable and unshakable peace when we direct them to take their anxieties to God in prayer (Philippians 4:6-7). That goes for us, too. Download full ebook "A Healthcare Worker's Response to COVID-19" here