With New Grant Funds, the Open Door Clinic Looks to the Future

MIDDLEBURY - Inside a beige trailer behind Porter Medical Center, the Open Door Clinic (ODC) in Middlebury, one of nine providers of healthcare for the uninsured and underinsured in Vermont, holds free clinics every Tuesday evening and one Friday morning per month. Photos of staff members and dozens of smiling volunteers are tacked to a bulletin board on one side of the entryway, across from rows of fliers and brochures lining the opposite wall, offering everything from bus schedules to counseling services. 

When the ODC established its volunteer database in 2004, it had just 15 volunteers. In 2018, with the help of 148 volunteer interpreters, EMTs and administrative assistants, including 34 Middlebury College students, three college employees, four current professors and two retired professors, the ODC provided care to 889 patients. The Middlebury and Vergennes clinics are run almost entirely by volunteers.

“If you spend more than 10 percent of your annual gross income on your health insurance premium, then we consider you to be underinsured, and you may qualify to be seen by us,” said Heidi Sulis, executive director of the ODC.

A grant the ODC received in 2013 required that it open its doors to any community member, free of charge, and it continues to honor that commitment. The ODC prioritizes case management, ensuring patient access to specialists, and helps those who don’t qualify for its services find insurance coverage — Sulis described the ODC as a temporary stop on the path to a permanent medical care home.

The ODC has received three $20,000 “Vermont Economic Justice” grants from the Ben & Jerry’s Foundation, in 2015, 2016 and 2018. The money allowed staff to pursue projects beyond the normal scope of the clinics, from improving community outreach to biannual training for volunteers interested in interpreting for mental health appointments. A $15,000 grant from the Walter Cerf Community Fund will facilitate expansion of the dental program developed by the ODC over the last few years. It also funds a new staff position associated with the dental program, now held by Paola Meza, a senior at Middlebury College.

[pullquote speaker="Heidi Sullis " photo="" align="center" background="on" border="all" shadow="on"]... our volunteers understand the challenges of our current health-care system, and understand that health insurance is exceedingly expensive and is a real barrier to care for people.[/pullquote]

“I started during my first semester on campus,” Meza said. “I started interpreting, and I’ve been doing that ever since.” Initially, she volunteered for a few hours each month, but she is now a part-time member of the ODC staff and works there nearly every day. Meza, who worked 84 hours at the ODC in 2018, plans to stay on in a similar role after graduating.

Thirty-five percent of the ODC’s patients are migrant farmworkers without access to insurance. “Migrant workers who work in the dairy industry do not have a legal means by which to get into our country,” Sulis said. Migrant dairy workers often pay into social security and other government programs, but can’t receive benefits. With support from a federal HRSA grant, intended to improve healthcare access for vulnerable communities, the ODC gives migrant workers access to family doctors, physical therapists, dieticians, dentists and dental hygienists. Health-care providers visited 32 farms, vaccinating about 300 workers, in 2018.

“I can’t imagine what it’s like to navigate a state like Vermont without knowing the language at all, or being afraid of things like deportation,” Meza said.

Until 2014, the ODC provided rides to the clinic for migrant workers, but helped the migrant workers find alternative means of transportation when the practice became unmanageable. 

“When we stopped doing it, we were able to look for other fields where we would like to invest,” said Christiane Kokubo, the ODC communication specialist. “It allowed us to think in other directions.” 

At the time, many local residents didn’t know about the clinics, so the ODC staff focused on raising awareness and strengthening their brand. Migrant workers attend clinics most frequently, but the other 65 percent of the ODC’s patients live in Addison County and other parts of Vermont and New York. Regular volunteers come from as far as Burlington.

“I think our volunteers understand the challenges of our current health-care system, and understand that health insurance is exceedingly expensive and is a real barrier to care for people,” Sulis said. Volunteers “don’t have judgment about people not having insurance and having difficult lives, and are happy to help them.”

“As a native Spanish speaker and as someone who is also from Mexico, which is where most of the migrant patients are from,” Meza said, “I feel like I can connect to them, and I feel like I’m comfortable with the patient and the patient is comfortable with me. The fact that I can do this is a way for me to show support for this population.”

Asked what the most difficult aspect of working at the ODC was, Meza said, “It’s frustrating to see that it’s 2019 and there are still so many people who don’t have adequate health care.”

In the future, along with expanding the dental program, ODC staff hope to streamline their volunteer manual and trainings, taking the print materials used by volunteers and patients to another level. With the funds from the Ben & Jerry’s grant, they are also looking into a new video interpretation service. 

“Not everyone here at the office speaks Spanish,” Kokubo said. “If someone calls and there’s not a Spanish speaker here, we have a system now that is not great, so we would try to get another company to do a conference call thing, interpreting through the phone.”

Middlebury College students, particularly Spanish speakers, who are interested in volunteering with the Open Door Clinic can reach Christiane Kokubo at odc@opendoormidd.org.