Clinics a symbol of help, hope

Some days, when Dr. Philip Reilly looks at the crowd in the waiting room, all he sees are frowning faces and arms crossed in frustration.

There's so much demand now, it's hard for Sea Mar Community Health Center to keep up. Walk-in patients will wait as long as three hours for care.

"It's like an airport when all the flights are canceled," said Reilly, director of the clinic in Seattle's South Park neighborhood.

For the past three decades, as the Latino population has quadrupled in the state, Sea Mar has strained to meet its needs, with everything from medical treatment to mental-health counseling to migrant housing.

More than 83,000 people across the state, many of them Latino, got support from Sea Mar last year.

This spring, the nonprofit is adding two clinics in South King County to meet the rising demand for low-cost health care. About 36 percent of Latinos were uninsured in 2004, the highest percentage for any ethnic group, according to Public Health — Seattle & King County. Sea Mar also expects to open a dental clinic in Oak Harbor this year, and start construction on a low-income housing project in Seattle.

Sometimes it puts a strain on the organization to move so far, so fast, said Rogelio Riojas, executive director of Sea Mar.

"But poor people have been waiting long enough," said Riojas, the son of migrant farmers. "For them, we're not moving fast enough."

It takes a village

These days, there's a medical clinic, a dental clinic and a pharmacy, all lined up on the same South Park street.

Around the corner and up the road, stands a community center that connects Latino nursing-home residents with children in day care. Half a mile away is a drug- and alcohol-treatment facility for boys, and a youth boxing club.

It took decades to set up this village. In 1976, a group of Latino graduate students and advocates decided to provide health care and other support for a community going without. They named the organization Sea Mar, hoping to serve residents in Seattle and migrant farmers around Marysville.

Two years later, the first medical clinic opened in Seattle with $300,000 in federal funds. "In the beginning, we were living paycheck to paycheck, like everybody else," Riojas said.

As it expanded, Sea Mar became eligible for more grants. It now relies on more than 200 grants and contracts, each for a different part of its mission — a business model that's allowed the organization to thrive in lean budget times.

Last year, when the Legislature cut its grant to community clinics, Sea Mar lost $800,000. The organization laid off about 30 people on its medical staff.

But with help from federal funds, Sea Mar opened a clinic in Burien last month and will open another in White Center later this spring. The clinics, which operate on a sliding-fee scale, are expected to serve about 14,000 people.

It's all a marvel to Roger Rosenblatt, who was in social services when the graduate students got that first grant. As vice chair of the department of family medicine at the University of Washington, Rosenblatt now sends students to intern at Sea Mar clinics.

"I thought they had no chance at all of accomplishing their aims," he said. "They've grown now to be one of the most powerful, far-flung, effective, innovative, community health centers in the United States."

"No time to breathe"

On a recent morning in the medical clinic's waiting room, children played on rugs colored with words in English and Spanish.

Some of their parents traveled hours by bus to get here. They felt judged elsewhere, some said, for their ethnicity, immigration status, or inability to pay.

Some of Sea Mar's clients are illegal immigrants. Others are legal, but without insurance. Then there are privately insured patients such as Xenia Rivas, 20, who stood outside the clinic one morning, waiting for its doors to open.

Sea Mar has cared for Rivas' family for years. "They always treat you with courtesy," Rivas said. "I feel comfortable."

Behind the reception desk that day sat seven native speakers of Spanish. Working in the records room was a woman still trying to learn English. Around the corner, Ruth Escobedo was taking notes. A former patient, Escobedo is now a medical-assistant supervisor.

"I love the feeling of helping, as we were helped," she said.

It's part of Sea Mar's philosophy to look for patients with potential, and encourage them to do more. The organization offers training to patients interested in jobs at Sea Mar.

Business might run more smoothly with more experienced candidates, Riojas said. And sometimes, once they're trained, the new employees move on to higher-paying jobs. But Sea Mar sees that as a sign of success: It has put more Spanish speakers into the medical field.

Sea Mar has long positioned itself as community advocate, lobbying for whatever its clients might need.

Years ago, it successfully fought against a tent city for migrant farmers. More recently, it worked with The Children's Alliance to secure 7,450 spots in a state health program for immigrant children.

"They're very active in looking forward, and trying to put in place policies that provide justice and fairness for their clients," said Jon Gould, deputy director of The Children's Alliance, a statewide child advocacy group.

Sea Mar's patients are among the neediest in the state. About 50 percent rely on state and federal programs for the poor. About 40 percent are uninsured.

Apart from emergency rooms, Sea Mar and other community clinics are the primary source of care for the uninsured. At Sea Mar's Seattle clinic, the wait for new appointments has stretched from a month to up to two months, staff said. Follow-ups are scheduled a week out, rather than three days. The front desk is overwhelmed with callers, some of whom are turned away.

"It feels like you're never going to finish," said Gabriela Vasquez, who left her front-desk job recently after eight years. "No time to breathe."

Knowing the needs

In a cramped back office, Sea Mar's medical director, Ricardo Jimenez, sits at his computer, a Peruvian tapestry hanging on the his wall.

It's his job to figure out how to cut the wait times. Most people can't afford to spend three hours. They may just leave without care.

Jimenez recently assigned another doctor to see walk-in patients. But the challenge is significant, he said, even with the new clinics.

When he took this job, Jimenez assumed he'd move eventually into private practice. But at some point, Jimenez said, he realized he could make Sea Mar more efficient, providing more people with better care.

"Lo and behold, it's 16 years later and I'm still here," he said.

Jimenez, who grew up poor in Peru, now runs an exchange program for family physicians in developing countries. He also is responsible for the clinic's residency program, which has moved doctors into several Sea Mar clinics.

And twice a week he sees patients, to stay current with the needs of the community.

That's how he met Jose Alvarado, a day laborer with undiagnosed diabetes. Afraid of the cost, Alvarado waited four months to see a doctor. By then, he was convinced he was dying.

"My heart was pounding like it wanted to get out of my chest," he said.

Jimenez treated him every day, until the man's blood sugar was normal. He gave Alvarardo insulin, enrolled him in a support group, then asked him to speak at a conference about the importance of getting care early.

"Basically, they are taking care of me," said Alvarado, who now pays what he can. "Thank God they were there."

Cara Solomon: 206-464-2024 or csolomon@seattletimes.com