On a normal evening, a member of the KeyArena’s Encore Club might park their car, smelling of conditioner rubbed into its leather interior, in reserved parking spots before making their way up through a private entrance to an exclusive bar. They might gaze down at a sports event, their view unencumbered by the heads of less-privileged spectators. Far from the hoi polloi, this is where corporate clients are wined and dined, according to the website that promises that Encore Club membership is akin to owning season tickets — but better.
For four days this year, however, the Encore Club, along with the rest of KeyArena, belonged to the masses.
This is the annual Seattle/King County Clinic, a yearly event that transforms a hub of recreation into a haven of care.
In the space where beer is usually swilled are seven medical cots covered in plain white sheets. Nurses and podiatrists care for low-income, underinsured and homeless individuals with open wounds, complications from diabetes or fungal conditions born of too much time spent with feet in wet socks or no shoes at all.
People don’t think of their feet, said Frankie Manning, a retired nurse.
“Feet aren’t like tires,” Manning explained. “You only get one set in a lifetime.”
Manning is one of roughly 4,000 volunteers who worked in shifts between Sept. 20 and Sept. 23 to put on the fifth Seattle/King County Clinic, a massive undertaking that provides free medical, dental and vision care to thousands of patients in nearly 50 languages.
For those four days, private rooms for the wealthy elite were transformed into mental health counseling offices for the poor. The spot where Sue Bird sank the winning shot in the WNBA semi-final became a pop-up dental clinic with a sanitization station at the far end. A bar on the lower level, with its shiny brass-colored taps and low lights, became an opioid education clinic and calming station where people with high blood pressure could get away from the hustle and bustle all around them.
It is a logistical feat to keep the operation running smoothly, shepherding more than 4,000 patients toward doctors, dentists, optometrists, nurse practitioners and more. The event is critical; the patients at the clinic are there to receive help that they would otherwise go without. It is also an outpouring of generosity from the public and private sectors, sustaining itself on volunteer medical professionals and laypeople as well as monetary and in-kind donations.
At the same time, the clinic is a symptom of a deeply broken health care system that allows poor people to suffer preventable, treatable conditions that ultimately worsen and shorten their lives.
The clinic is a symptom of a deeply broken health care system that allows poor people to suffer preventable, treatable conditions that ultimately worsen and shorten their lives.
“It is sad that we live in America and we can’t take care of people,” Manning said.
Prospective patients gathered under a large white tent outfitted with hundreds of chairs and space heaters. Some, like Ms. Johnson, a 62-year-old woman experiencing homelessness, had been there since the night before.
The chairs weren’t meant for sleeping, but Johnson needed new prescription glasses. The inexpensive reading glasses from the Dollar Store just wouldn’t do anymore, and she would have been sleeping rough anyway.
The organizers advised that people start showing up at 5 a.m., but many arrived much earlier to ensure their spot in line. Johnson is one of them; she arrived at 10:30 p.m. on Wednesday to assure herself an early spot in the queue. Exhausted, her speech punctuated with yawns, Johnson had returned to the tent to rest a while after her eye exam, glancing over books donated by Friends of the Library.
Patients received a color-coded ticket that corresponded to the generic type of services they would receive that day. They’re restricted to certain combinations, said David Efroymson, an executive director at Kaiser Permanente who focuses on supply chains for the medical giant.
“The rules of the day are you can come to the clinic and do dental and medical, if you’d like, or vision and medical in a day,” Efroymson said. Because of the demand, people are restricted from receiving dental and vision in the same day, although they are free to come back on another clinic day to line up for additional services.
Patients were called in batches of 50, their colors and numbers blasted through large speakers that penetrate the length of the tent. Guides with signs affixed to long wooden poles brought them to the entrance of the stadium. From there, they were triaged and their vitals checked. Patient received a green folder with their medical information and treatment plan du jour.
From there, volunteers brought patients to their next station, providing a steady hand to guide them through the warren of services and rooms that make up KeyArena.
An area of the bottom floor was set up for immunizations. Another section conducted rapid HIV tests — public health officials recently noted a spike in HIV among heterosexual people, according to news reports. Further along, in what is normally a beer garden, eye charts hung on walls between brick pillars, illuminated by temporary lights affixed to the roof of each alcove.
In previous years, people waited in Fisher Pavilion where Seattleites ice skate during the winter months. This year, the clinic was held almost a month early to accommodate the planned $700 million renovations of KeyArena recently approved by the Seattle City Council.
Those same renovations mean that, unless an alternative venue is found, there will be no clinic in 2019, said Meredith Li-Vollmer, director of communications for the clinic and a risk communications specialist at Seattle King County Public Health. This could leave thousands in dire need.
“They’re looking for other options,” Li-Vollmer said, noting that the next clinic would likely take place in spring of 2020.
The success of the event is a testament to the functionality of the KeyArena as well as the ingenuity of Seattle Center staff, who arrange all of the tiny details that can turn a sports arena into a high-quality medical facility, Li-Vollmer said.
“It turns out the Seattle Center knows everything about throwing a giant event,” Li-Vollmer said.
They’re aided by the Key’s unique ability to host this exact kind of pop-up clinic.
Concession stands that would normally vend obscenely expensive sodas and nachos instead offer water and free snacks calibrated to avoid spiking patients’ blood sugar. A legion of furry friends in their green vests denoting them as therapy dogs roamed the halls with their handlers, bringing the comfort of unconditional love to people in distress.
Organizers attempt to predict and meet the needs of the folks who come to utilize services. Needs like being able to tell the doctor what the problem is.
People in bright red vests provided in-person translation services, but many patients could be seen with headsets next to a screen. These devices were donated by InDemand Interpreting, a Seattle-based business that specializes in medical interpretation services.
It’s not enough to just go to a doctor, explained InDemand CEO Cecil Kost.
“If you can’t communicate, it leads to patients not understanding their treatment protocol, their medications or whatever they’re supposed to do post discharge,” Kost said. Such lapses can lead to bad outcomes for patients.
InDemand has partnered with the clinic since it began in 2014. Last year, the company provided 8,100 minutes of translation in 46 different languages over four days, Kost said.
It doesn’t need to be this way
The triumph of the annual Seattle/King County Clinic is also a tragedy.
Only 7 percent of Washingtonians lack health insurance, according to the Kaiser Family Foundation. While that number is encouraging compared to the state of play prior to the expansion of Medicaid — the government insurance plan for low-income households — it doesn’t mean that 93 percent of Washingtonians can always access necessary care.
Many people are considered “underinsured,” a term that generally means that a person has insurance that isn’t sufficient to cover expenses incurred as a result of health care. Some may have basic medical care but no dental or vision or a deductible — the amount a person has to pay out of pocket before insurance even kicks in — that is just too high.
Another persistent barrier to improved health outcomes is the lack of access to dental care.
Another persistent barrier to improved health outcomes is the lack of access to dental care. Low-income adults who receive health insurance through Apple Health, the Washington state Medicaid program, also have dental benefits. But less than a quarter of adults saw a dentist last year, said Diane Oakes, president and CEO of Arcora, the foundation established by nonprofit dental insurance provider Delta Dental.
That’s a problem, Oakes said.
“Dental health is an essential part of overall health and well-being,” Oakes said. “Anybody who has been in pain from a toothache knows how significant it is. Oral health is about more than just the mouth.”
Folks who can’t get to a dentist regularly can suffer from more than a toothache. Visible tooth decay may make it harder for a person applying for work and hurt their self esteem. Oral health is related to other chronic conditions such as diabetes and cardiovascular disease — people with diabetes and gum disease have a harder time controlling their blood sugar levels, Oakes said. Still, only 23 percent of adults with Medicaid coverage had any sort of dental visit in the past year, she said.
This is particularly galling, Oakes said, because oral disease is nearly 100 percent preventable as long as a person gets preventative care. Unfortunately, that’s the exact care that many low-income individuals and families do not receive. Large parts of the state are designated as “health professional shortage areas,” meaning even if a person has dental coverage, there aren’t always enough dentists to meet the need, particularly in rural communities.
“We are in one of the most prosperous parts of the world and one of the most prosperous parts of the country,” Oakes said. “People in Seattle are doing very well, but there are people standing in line overnight to get free dental care.”
Even people with decent insurance can have trouble accessing care, said Rick Arnold, a clinical professor of medicine at the University of Washington. Along with a team of UW students is using the clinic as a living laboratory to figure out why.
“We want to better understand the barriers to health care in our community and try to get the word out about that,” Arnold said.
Next stop: 2020
Next year, people may be wishing for the line. The city council recently approved a nearly $700 million, privately funded renovation package for KeyArena that will up the seating capacity and increase the square footage of the facility so that it can play home to a professional hockey or basketball team. Seattle sports fans were so thirsty for a new team to disappoint them that thousands have already purchased season tickets for a hockey team that does not yet exist.
The changes mean that KeyArena will be under construction in 2019. No new facility has yet been identified for the clinic.
The construction was one reason that Johnson was checking out books in a large tent instead of the Fisher Pavilion. The clinic had to be bumped up a month earlier than in years past to accommodate the renovation schedule and the pavilion had already been booked for that weekend.
Without the clinic, thousands of people may go more than a year without seeing a doctor or dentist, Arnold said.
“That is a tragedy,” he said. “There are a lot of people who count on the services at this clinic.”
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Follow Ashley on Twitter @AshleyA_RC
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