At the end of February 2020, our clinical director left Oasis for new opportunities. Two weeks after her departure, the global pandemic arrived, and everything changed. The first few days of the pandemic were filled with confusion and uncertainty. Without a clinician on staff and no personal protective equipment in the clinic, we asked ourselves, “How can we safely provide primary care to our patients, many of whom are working on the frontlines of customer service without endangering staff?” On March 16, 2020, we made the difficult decision to stop seeing patients in the clinic.

Oasis Free Clinics 45Despite that decision, our patients still needed us. Their diabetes, anxiety, and asthma didn’t take a break because a pandemic had arrived. Our small staff came to the clinic every day to make sure that there was someone to answer their calls. Our volunteer physicians, Dr. David Inger and Dr. Jeff Maher, and our nurses, Laura Labbe and Patricia Burrell, increased their time to make sure our patients had the continuity of care they needed. We renewed hundreds of prescriptions, hand delivering medications to anxious patients in our parking lot. We called all of our patients to let them know that we were here for them and learned that many people were very scared – of leaving their homes, of getting COVID, and of losing their job. It felt like we were all in survival mode.

In April 2020, we hired Michelle Barber, a nurse practitioner who quickly became the heart of our medical clinic. I can’t imagine starting a new job in a pandemic, but Michelle walked into the clinic with ease and warmth. As the COVID rate lowered through the spring, we re-opened the clinic for in person visits on June 1st, and it felt better having patients back in the clinic.

When the pandemic arrived, we knew that providing dental care safely was out of the question. We made the decision to temporarily close the dental clinic until there were guidelines on how to control or mitigate aerosolized particles. Our dental director, Dr. Rick Elsaesser spent the next six months researching options for the safe removal of aerosolized particles from dental suites. We worked with an industrial hygienist who volunteered his time and expertise to help us identify the best solution to provide the safest environment for our staff and volunteers. The new systems were purchased, and our dental suites were renovated over the summer.

The need for our dental services did not stop because of the pandemic. One of our patients was on antibiotics to treat his dental infection for six months until we could see him in the dental clinic. Because all dental offices were forced to close except for emergencies, there weren’t many options available, but because our patients were unable to pay, their options were fewer.

We realized that many of our volunteer dentists would be hesitant to return to the clinic, either because they were in the high-risk group or because they were so busy trying to recoup the losses from their practices being closed. The dental workforce has taken a particularly hard hit because of the pandemic, and while many of our longtime volunteers would like to return, because of staffing shortages in their offices, it has been challenge. We have been fortunate that some of our volunteers have returned, and new dentists have volunteered. Our community is incredibly fortunate to have such giving and compassionate dental professionals.

So what has changed two years later?

Besides the masks, goggles, scrubs, and gowns (none of which we had before COVID), there is a lot of air filtration and circulation happening. We have invested significantly in ventilation systems to assure our patients, volunteers, and staff that we are providing care in an environment that is safe. In the dental clinic, we understood that the changes with our dental volunteers would be impactful, so we have budgeted for a part-time, paid dentist on our team. We hope by adding a staff dentist, we will begin to address the huge need for free dental care in our community.

Many of our patients struggle with anxiety and depression, and we have hired a mental health coordinator to provide case management services and to connect patients with community mental health providers. Another change has been to increase appointment times. We saw that our patients had more complex issues to discuss into the exam room, and we expanded our standard appointment time to 45 minutes. We offer telehealth technology as a way to reduce transportation costs and travel time. Our waiting room is quieter in the absence of multiple people gathering before appointments.

The stress of the pandemic has taken an extra toll on those living in poverty. Some patients experience unsafe living situations, and the pandemic has forced them to stay. The same is true related to employment. Many of our patients have expressed their powerlessness around supervisors who refused to wear masks or enforce masking policies, or their fear of getting COVID because they work directly with the public. The pandemic has highlighted the inequalities and inequities among us: who can afford to stock up on food and toilet paper, who can work from home, which jobs have paid sick leave so wages aren’t lost if you have to quarantine for 10 days.

The past two years have been incredibly hard on all of us. None of us have gone through the pandemic unscathed. Many of us have lost loved ones or gotten sick ourselves. The end of the pandemic seems distant, even as the case count recedes. There is a lot about our world that is changed as result of COVID.

One thing that hasn’t changed is how special this community is. People came together to help each other in countless ways. During some of the darkest and hardest times in recent memory, our community found opportunities to spread hope, kindness, and compassion. While so much of in our world has been turned upside down, this is still a place where neighbors help each other. Two years later, at Oasis and beyond, we are still here, caring for our community.

Anita Ruff is the executive director of Oasis Free Clinics, a non-profit, no-cost primary care medical practice and dental clinic, providing patient-centered care to uninsured adults in Midcoast, Maine.

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