“It’s like the United Nations,” Rashid Chotani, MD, MPH, executive director of the Muslim Community Clinic in Silver Spring, Maryland jokes of the sunny, high-ceilinged waiting room. On any given day, it seats patients from places like Kenya, New Guinea, Colombia or Egypt. It’s here, in Montgomery County—a wealthy suburb of Washington, DC—that Chotani sees the types of chronic health problems on par with those among people living in developing nations.
Staffed by a diverse group of providers, the safety-net clinic treats about 16,000 patients a year who have fallen through the gaps of the US health care system. Most are immigrants who live in Montgomery and nearby counties, but some trek in from parts of Virginia or Western Maryland—over an hour away. The clinic counts over 100 languages among its patients, only about 40% of whom are Muslim. The majority are uninsured, or what Chotani terms “underinsured.”
“Most often, new patients [at the clinic] have not seen a physician for a very long time,” he says. Many are 40-50 years old with advanced health complications such as diabetes and cardiovascular disease.
“These people have not been taken care of,” he says, “and they were afraid to go to a physician because they could not afford it. Preventive medicine was not part of the equation. That’s what we provide here.”
Pakistani-born Chotani spent most of his public health career responding to crises around the world. After tsunamis and earthquakes, he set up critical care clinics and helped establish care for disenfranchised populations in developing countries. Last year, he became executive director of the clinic and shifted to addressing the neglected people much closer to his suburban Virginia backyard.
“I never dreamed I would be doing this [work] in our nation,” he says.
The nonprofit clinic is one of America’s largest. Open since the early 1990s, when it provided once-a-week basic care service for about 50 patients a year, it now offers care 7-days-a-week. With an annual budget of nearly $2 million, it offers an ever-expanding list of services, including eye care, dentistry, gynecology, physical therapy and mental health counseling. Founding director Asif Qadri, MD, envisioned a medical clinic for the uninsured. Today, it serves all who walk through the door, regardless of religious affiliation, nationality or ability to pay.
The clinic prioritizes reducing barriers to health care. A pick-up/drop-off service is available to Montgomery County residents; a free shuttle bus helps transport others. The staff speak about a dozen languages (including Urdu, Hindi, Bengali, Arabic, Aramaic and French), and county-sponsored translation services and patient advocates help cover the rest. For the uninsured, a county-sponsored Affordable Care Act enrollment specialist is onsite 4 days a week—patients can sign up for insurance right in the waiting room.
“Even with this intervention,” Chotani points out, “we did not see an overwhelming number of families enroll in the plan.” He emphasizes that many are educated and employed. “They are productive members of society! [But they] are making $50-60,000 a year with a family of 5.” They just cannot afford to pay $2,000-3,000 dollars a month for health care, he says.
He’s also quick to say that while Obamacare isn’t perfect, “22 million gained coverage through health care exchanges in 2016, which is a success.” A full repeal, he fears, would be a massive step back. "With the looming repeal of ACA, I stay up at nights worrying about how will we provide the services that our patients and the community is so used to.
Regardless, patients don’t have to be insured. Diverse funding streams include county and state grants, and tithes known as zakat and sadaqa from the nearby mosque make up the discretionary funds allocated to patients who can’t afford even subsidized services. An echocardiogram—which could cost upwards of $1,500—is available for $50. Pap smears are free. Dentistry, which can be incredibly costly, is one of the more essential interventions the clinic offers, as one of the clinic’s patients, 67-year-old Minh Tran, learned. She moved to the US almost 30 years ago from the former Sông Bé province of southern Vietnam, and now lives in Silver Spring with her wheelchair-bound, disabled daughter. In August of 2016, their apartment burned down after an explosion that killed several people. They escaped, but lost everything. Vietnamese American Services—an area nonprofit that serves low-income and disadvantaged Vietnamese populations, according to Executive Director Tho Tran (no relation to Minh), helped Minh Tran and her daughter with housing and other services. Tran wasn’t hurt in the fire, but she suffered from pain and had trouble eating, as her dentures were left behind and destroyed in the chaotic rush to safety after the explosion.
“I couldn’t eat well,” Tran says through a translator. “I told Miss Tho and she took me to the clinic, and they offered to help to replace the dentures.”
Dentures can cost thousands of dollars, but the clinic offers them well below market cost, Chotani explains. For Tran, this was a vital intervention.
Chotani also hopes to launch a refugee dental program. 4-5% of the clinic’s patients are refugees, most of whom have never been to a dentist. “I’ve seen young patients, 25 or 30 years old, and they don’t have any teeth [due to] a lack of nutrition, a lack of hygiene. They’re in excruciating pain.”
Physical expansion of the clinic itself is inevitable. Outside Chotani’s tiny office window sits a trailer with white lattice skirting where he’d like to build a 2-story urgent care clinic. MCC already promised him the land; he just needs the capital. Someday, he hopes to grow the clinic into a fully operational hospital, where the patients can come, irrespective of their status, insurance, or wealth. After years of seeing critical health problems among neglected populations in other countries, he’s a passionate advocate for accessibility to care.
“Somehow, we have to build that model,” he says. “Somehow, we as communities need to rise, not dependent upon local, state, or federal government, not dependent upon academic institutions; we need to rise and build these institutions that can provide health care to our neighbors, to our communities.”