PART ONE: “Healthcare Oasis” Arbor Family Health helps expand health care in Pointe Coupée

Minimal healthcare options have plagued rural areas for several decades, but a non-profit clinic is working to keep Pointe Coupée Parish and surrounding areas ahead of the curve.

Arbor Family Health, which opened its first clinic as Innis Community Health Center in 2001, has helped provide access to health care for the uninsured or underinsured in the area.

Health-care age ranges from pediatric to elderly.

Lower income residents in rural and urban areas across the nation have struggled to find affordable health care, while access to any health care in general has been tough for rural residents.

According to a 2020 study from the Kaiser Family Foundation, 7.7 percent of Louisiana residents lack health insurance.

Meanwhile, the poverty rate in Louisiana is 21.6 percent in rural areas compared to 17.1 percent in urban areas of the state.

The clinic is a Federally Qualified Health Center (FQHC).

The clinic bases fees on “sliding scales” to help the indigent, uninsured and underinsured with medications.

Dr. Michael Ramagos, who has served since 2017 as medical director for Arbor Family Health, said he has seen the demand increase.

It’s not only indigent residents who seek care through Arbor, he said.

“I also see what I call ‘the working poor’ – they have a job, they don’t quite qualify for Medicaid or food stamps and those sorts of things,” said Ramagos, an Addis resident.

“They don’t qualify for Medicaid, but they can’t afford insurance.”

Approximately 40 employees were on staff when Ramagos started in 2017.

That number has doubled, he said.

Along with Ramagos, the staff has grown to include seven nurse practitioners, one physician’s assistant and one part-time physician.

At the same time, Arbor has added locations and expanded its scope of services.

Arbor also offers dental care, vision and hearing, mental health treatment – including a clinical psychologist – and treatment for diabetes and hypertension.

Arbor also has a podiatrist and two dentists.

“We have Pointe Coupee General Hospital – a huge asset, right in our own backyard – and we have a very good relationship with them,” he said.

“Pointe Coupee is an oasis in that regard. Many parishes – particularly in the northern part of the state – don’t have clinics within 50 miles.”

Education also plays an important role in the health services Arbor offers.

Of all the things we implemented over the last year, they meet with all patients willing to meet with them to go over social determents of health.

Those determents include where the patients live, employment status, access to transportation and the challenges they face to be healthy.

“Arbor helps with transportation, signing up for insurance, and – if they can’t read – they help with certain things,” Ramagos said.

“They help them find free programs for medications, and I think that helps even more than what I do.”

Affordability and access to services should not be an issue, Ramagos said.

“Since we’re spread across the parish, it’s accessible to the entire parish,” he said.

The pharmacy also offers discount prices on medications.

“With the services available in our community and with us being an FQHC, we do the traditional medicine and primary care of every other clinic you think about, and we have the ability to see anyone regardless of their ability to pay,” he said.

It does not stop with prescriptions.

Arbor also offers mail-out and at-home delivery.

“The purpose is to help people who have difficulty maintaining medicine, driving to the pharmacy or having medicine shipped out to them,” Ramagos said.

Other programs include a health coach who helps diabetics and those with hypertension.

Part of the program involves instruction on the medications required in treatment.

“They call them to see if they have any questions, check on refills and make sure they understand the prescriptions for the medicine,” he said.

The treatment of diabetes plays a major role in treatment of patients at Arbor, as with most other family medical clinics statewide.

More than 505,000 Louisianians – or 14.2 percent of the adult population – have been diagnosed with diabetes, according to a 2021 study from the federal Centers for Disease Control and Prevention.

An additional 113,000 people in Louisiana have diabetes but don’t know it, while 1,243,000 people in Louisiana – 34.4 percent of the population – have pre-diabetes.

The large number of diabetics in Louisiana coincides with the culture, Ramagos said.

“In Louisiana, there’s a culture of starchy comfort foods,” he said. “That culture comes from our heritage of their own good food.

“Diabetes and obesity cross all socioeconomic classes,” Ramagos said. “I think it’s a cultural thing instilled in us that we must eat a lot and eat the ‘good stuff’ such has fried okra, and rice and gravy – and it’s also cheaper.”

Treatment focuses on a change in culture to curb the number of diabetes cases in the region. 

The staff of diabetic educators and health coaches at Arbor have taken creative approaches to guide patients to a healthier lifestyle, Ramagos said.

“They put menus together that help people to enjoy things, but on a healthier level,” he said.

Arbor Family Clinic also offers mental health treatment, including a clinical psychologist

“Mental health is a huge component of every other medical problem, every other chronic issue,” Ramagos said. “If your mental health is not well, you can’t control diabetes, hypertension, heart disease – all the regular things we get with old age.”

Arbor’s inclusion of mental health services plays an important role in expanding the availability of health care in Louisiana, which ranks 35th in the nation in access to mental health care, according to Mental Health America, a Virginia nonprofit group that promotes mental health as a critical part of overall wellness.

“Sadly, mental health issues often stay in the shadows until there’s a problem,” Ramagos said.

He worked in residency at a state mental health facility when five of the eight mental hospitals closed – including those in Jackson, Greenwell Springs and New Orleans.

“I remember being on my psychiatric rotation and being told the place was closing,” he said. “At the time, looking back, I don’t know what happened to those people … I was young in my career.”

Mental health is a huge component of every other medical problem and every other chronic issue, Ramagos said.

“If your mental health is not well, you can’t control diabetes, hypertension, heart disease – all the regular things we get with old age,” he said.

“That goes into compliance with medications and ability to understand medications, so when we expanded the mental health department, we can see the rewards as people go through that.”

NEXT UP: The growth of Arbor Family Health and what it hopes to accomplish during the next five years.