Dian Cooper remembers her first working day as director at the Cowlitz Family Health Center in Longview. Back then — 30 years ago — it was called Family Planning and WIC, for "Women, Infants and Children."
"My first day on the job, the person on the front desk had quit," Cooper said. "So I ended up working the desk. That day, and whenever I have worked it since, it's a very humbling experience.
"To realize again — to see the faces ..." Cooper said, searching for words. "I sit here writing grants. I'm two steps removed." Greeting clients, she said, "you realize how many barriers they're dealing with, barriers they overcome every day. It's just great to be able to do that whenever we can."
Before taking over the health center, Cooper had worked in services for troubled youth, so compassion was already in her toolbox. Still, it's a temptation to see that first-day surprise as setting a tone for the next three decades.
In a time of slashed budgets and soaring costs, the medical facility hewn from a strip mall on 12th Avenue is woven into the local safety net, treating a sizeable portion of local people and taking some of the heat off of the emergency department at St. John Medical Center.
In concert with PeaceHealth, Kaiser Permanente, St. John, the Cowlitz Free Medical Clinic on Wednesdays and the Lower Columbia Mental Health Center, the Family Health Center meets needs of "folks who have challenges, who don't have the economic means," Cooper said. Of the health center's clients, "a third are uninsured; two-thirds do have insurance and half of those are on Medicaid."
Whatever their means, some patients said, they are treated well.
"They have a really good staff," said Randy Devlin of Longview. "They seem happy to see me. Probably they're just kidding around," he added, chuckling.
Devlin, 61, retired and moved here from Nevada two years ago. "Money got tight," he said, so he found a part-time job in late September driving a logging truck. Some months he only gets called in five days, he said. "I don't have any kind of insurance."
He goes to the health center to manage his emphysema. "I needed everything checked out because of my age," he said. "I see a nurse practitioner for all my needs. I get my medications, my prescriptions. And Billie (Rantala) in billing really goes to bat for me."
He pays $15 at the counter, Devlin said, and then he gets a bill. He has made payments of $45 and $96, he said. "It depends on your financial status. If you're broker than I am, everything is covered. ...
"These people, every one of ‘em down there, the counter gals, the billing, they bent over backwards to help me. They assist me any way they can. I don't have to go to the emergency room."
Another piece of the puzzle is the free clinic on Wednesday nights, where doctors volunteer to deal with urgent care needs. "They have expanded to do some care management," Cooper said, as well as "send some folks over here. Everyone sends folks over here."
Medical professionals at the Family Health Center are paid a "competitive wage," she said, and the doctors have privileges at PeaceHealth. "For pediatrics, Child and Adolescent Clinic covers hospital care of our patients. ... the local medical community is great to work with."
Although the center handles primary care for cancer patients, diabetics and people with chronic issues like Devlin's emphysema, "the center does no specialty care — brain surgery, chemotherapy, orthopedic or physical therapy," Cooper said.
Some behavioral treatment is available at the center, and although the programs have been cut, the center's First Step program continues to help clients with family planning and the nutritional needs of babies and tots.
Adults with no dental or vision coverage pay on a sliding fee scale at the center. "I would like to think that we work together with the private sector," said Dr. Roxane Oshiro, a dentist there. "Those that the private sector aren't able to see, we welcome them. Even though we are limited in what we can provide, we try our best to help anyone that seeks care at Cowlitz Family Health Center."
Robert Duncan of Longview said he goes to the center to get his teeth fixed "and to get my self esteem back."
Duncan, at 55, has lost 165 of his 450 pounds during care at the center. He wasn't crazy about being interviewed at first, but, he said, "they accommodated somebody who was morbidly obese. Now, we're getting my teeth fixed."
Duncan, who sees Oshiro, said "she's a wonder."
"I'm a big chicken — I couldn't even handle the thought of a dentist. But she has a calming effect. I don't even need Novocain."
Oshiro "cares about what she does," Duncan said. "She has a passion about seeing someone benefit, whether it's being able to eat corn on the cob or have self esteem. ..."
People fear dental work because of "traumatic experiences, pain, financial barriers, embarrassment and not realizing that there is an office that will accept them regardless of their economic or social status, or knowing that something could be done for them dentally," Oshiro said. "I personally like to use humor as well."
It's important, she added, because good teeth give a patient a sense of relief, better chances at a job, and "a glimpse of what it feels like to be pain-free."
Duncan, now fitted with top dentures, said "I have a whole new appearance. I can hold my head up, I don't have to smile looking down at the ground, I'm able to speak a lot clearer, and I look presentable - I no longer look like I belong on the side of a milk carton."
People at the Family Health Center "feel like family, and I'm not trying to butter them up," he said. "I would have ceased to exist without people who really care, and obviously, the Lord, but also people who care for other people. If somebody cares about you, you try to improve."
Most of the center's funding comes from fees and payments from patients, Cooper said.
Some fees are discounted, based on federal guidelines that figure in gross income and size of family. Medicare, Medicaid and other federal grants help support the cost of discounted care. And Cooper said the center still receives a federal grant for $1 million annually, "knock on wood."
Knocking on wood is a habit in these pinched times.
"Everything is in jeopardy," Cooper said. "We've had no increases (in grant money) and decreases to community health centers nationwide totaled $600 million last year. Locally, we had to cancel a planned site in Kelso and services for the homeless."
Stimulus money in 2009 allowed the center to go live with electronic records and build new office space at the 12th Avenue location that expanded staff and allowed more patients to be seen.
"We forecasted out enough to sustain the record-keeping part. Fortunately we were able to lay off very few staff" members, Cooper said.
Since then, special sessions in Washington state have cut the First Step program by 50 percent and re-jiggered disability and mental health services. It's the first time in her tenure, Cooper said, that the center has been forced into a "tough conversation" about what they'll do if they have to "turn away that next patient."
If anyone can steer them through such a conversation, said Billie Rantala, it would be Cooper. "She is a huge instrument for getting things done in this community," Rantala said. "Things for the good."