An Enduring Partnership:
Kaiser Permanente and Su Salud | to pdf >>
By Judy Lane

It is well before sunrise in California's San Joaquin valley, and already the line of people outside the main entrance of the San Joaquin County fairgrounds stretches into the parking lot. By 7:00 am, thousands more have joined the queue. Here and there a child's wail breaks the predawn quiet, but for the most part this crowd is curiously subdued. The business of the day is serious, and many of these farm laborers have sacrificed a day's wages and endured a long drive for the rare, once-a-year chance to get free, professional health care screening at the 11th annual Su Salud health and education fair.

José Araña, 45, together with his wife and two children, is among those waiting for the doors to open. Two years ago, Su Salud doctors referred Araña's 15-year-old son to a community hospital, where doctors confirmed that the boy had heart problems. Open heart surgery at a San Francisco children's hospital corrected the heartvalve problem, and today, on this summer Sunday, the boytogether with his grateful parentsis returning to Su Salud.

There is a grim irony in the fact that in California's Central Valley, 700,000 people, including 200,000 children, lack health insurance. The area boasts some of the richest farm land in the state, and many prosper from its agricultural economy; for the most part, however, prosperity eludes those who work the land, and this largely disenfranchised population inhabits the bottom rungs of the socioeconomic ladder. According to a US Treasury Department report, 150,000 people in San Joaquin County alone lack health insurance. That statistic gives San Joaquin County the dubious distinction of having the second highest rate of medically uninsured residents in the United States. Unemployment and its unwelcome twin, poverty, are disproportionately high in that county when measured against the rest of the stateor, for that matter, any other part of the country.

In the current socioeconomic climate, serious illnesses such as cancer, diabetes, high blood pressure, and heart disease remain untreated because the poor cannot afford proper health carelet alone health insurance. Consequently, migrant workers, other low-wage earners, the unemployed, and the homeless rely on hospital emergency departments for care and treatmentand usually not until the need is most urgent.

©Craig Mole

Dr. Michael Wong is "examined" by a young patient

Su Salud
It was against this backdrop of need that Stockton dentist Guillermo Vicuña and a small group of other health care providers first proposed an all-day health fair to address the most pressing health needs of the poor and underserved who live in the rural counties of the Central Valley. Su Salud (Spanish for "your health") debuted in a church parking lot in 1987, when seven health care providers saw 80 patients.

From these modest beginnings, Su Salud has become the largest and most widely regarded one-day health fair in the nation. In 1996, its tenth year, some 18,000 people flocked to the annual Stockton event for one or more of 21 different health screenings and services including dental checkups, mammography exams, immunizations, Pap smears, hearing tests, and screenings for diabetes, high cholesterol, high blood pressure, glaucoma, and tuberculosis.

Partnership with Kaiser Permanente
Dr. Michael Wong, a Kaiser Permanente (KP) pediatrician and allergist at the Stockton Medical Office, together with José Rivera, a KP business leader, are among those who consistently marshaled KP resourcesnot only from Stockton but from throughout Northern Californiaon behalf of Su Salud. As a result, attendees have from the beginning benefited directly from KP's experience in developing more efficient ways to triage and treat patients.

KP's Stockton facility has been an especially strong and enduring partner with Su Salud, and each has benefited from the alliance. In Su Salud, KP has an ally that embodies KP's social mission to improve the health of members through "direct community benefit investment." By providing free health care to the medically indigent, Su Salud improves the health of children and the uninsureda near-perfect example of a resource or program that directly benefits the local community. For its part, Su Salud has come to count on the generous support it receives from KP. Nearly one in three Su Salud volunteersmore than 800 of the approximately 2,500 who volunteered their time and expertise to Su Salud in 1996is a KP clinician or staff member. Many travel to the fair from locations throughout Northern California. Dr. Wong himself has served on Su Salud's board of directors since 1993 and has been its president since 1995.

A throat examination by one of the pediatricians

Self-effacing and quick to praise others who work to help the poor, Dr. Wong is himself a tireless advocate for the poor and disenfranchised. He and his wife and five children provide health care instruction and encouragement to Girl Scout troops each summer in rural farmworker migrant camps and throughout the year to at-risk minoritiesmostly Southeast Asian and Hispanic girlsin the inner cities. One day each month, Dr. Wong and other KP volunteers also travel to underserved California neighborhoods where, in a specially equipped 40-foot mobile van, they provide examinations and urgent care services to the poor. Dr. Wong credits administrative leaders within KP's Stockton facility for providing the van, a clinic on wheels. Similarly, he praises the various hospitals and county health agencies that also participate in this important outreach program.

In March 1999, Dr. Wong will travel with other members of his Lodi, California church to Tijuana to bring health services to those who live in the most deplorable conditions of poverty. The volunteers will sleep in tents and resign themselves to a single shower each week. Despite these privations, Dr. Wong seems buoyed by the prospect of returning to help those who so desperately need health services. In this context, too, he credits KP administrative leaders, who continue to donate all supplies needed for this project.

Kaiser Permanente sponsors both the children's and women's clinics at Su Salud, and both clinics are now cornerstones of the fair. It was the growing popularity of the children's clinic between 1991 and 1993 that spurred interest in a Su Salud women's clinic, which was formed in the early months of 1994 by a core group of volunteers from KP in Northern California together with KP's Latino Association. From its first year, the women's clinic has been an overwhelming success, exceeding the expectations of even its most optimistic supporters.

Sensitivity on the part of KP to the cultural differences of its constituents almost assuredly played a part in this success. For example, from the start, planners showed sensitivity to the reticence of Hispanic women to discusslet alone to undergoPap smears, breast examinations, and mammography. In simulating a clinical environment at the county fairgroundsindividual examination rooms equipped with examination tables, lights, stools, and equipment trayshealth fair organizers were able to overcome this cultural reticence and attract huge numbers of women. So overwhelming was the response, in fact, that volunteers were unable to provide examinations to all women who sought them on fair day. KP again came to the rescue, setting up special Saturday clinics at its Stockton Medical Offices for the overflow. Pathologists and radiologists at KP's Oakland Medical Center then read and interpreted the Pap smears and mammograms.

The Su Salud health fair

A Model for Others
Su Salud is widely respected and often emulated for its fiscal responsibility as well as for its commitment to a social mission: Accepting no contributions from companies whose products are injurious to health, Su Salud is funded entirely by private donations and by grants from corporations and foundations. Su Salud's organizers are justifiably proud of the fact that its all-volunteer staff thus dispenses millions of dollars in free health care without expending a single tax dollar.

Communities in other California counties (eg, Stanislaus, Contra Costa) have used Su Salud as a model for organizing their own health fairs, as have communities in Phoenix and Tucson, Arizona, as well as in Albuquerque, New Mexico. Within KP itself, the Denver and Washington, DC facilities have sponsored similar fairs in the communities they serve.

Expansion of Health Efforts
With each year that has passed since the first Su Salud health fair, it has become painfully evident to the hundreds of people who volunteer their time and health care expertise that a one-day-a-year health fair falls woefully short in meeting the needs of those who have no access to regular health care. At a recent Su Salud fair, for example, only 8% of participants reported that they regularly see a physician, and only 5% said they make regular trips to the dentist. Childhood immunization rates were equally dismal: only 30% of families reported that their children had received all their shots. According to Dr. Wong, "It became increasingly apparent that the needs of the people we serve could be more effectively met if Su Salud could offer more than just a one-day fair. The uninsured and the working poor desperately need health education. Not only do the poor typically lack access to health care, they lack the knowledge to prevent illness."

Demand is high; the lines are sometimes long.

Accordingly, the plan to open a year-round Su Salud health care and education center was universally praised. Announced in February 1997 by Su Salud's founder, the center would emphasize intensive health education, including preventive health care instruction. Like the annual health fair, the center would provide 21 health screenings as well as immunizations for children and the elderly. Like the fair, the center would rely on grants and on the community's generous provision of donations and volunteers. The year-round clinic opened in October 1997 and is now open from noon until 7:00 or 8:00 pm, Monday through Saturday. Despite the fact that most migrant farmworkers do not arrive in the Central Valley until May of each year, the clinic has consistently seen between 10 and 20 children and adults each day.

Moreover, county agencies have begun to refer clients to the health center, a trend that is heartening to Dr. Wong and others, who state unequivocally that the health center is both the best in the valley and a model for health education.

Dr. Wong and others are encouraged by the enormous impact that Su Salud has had in the community. Not only has the one-day fair evolved to a year-round center, but it has spawned a proliferation of other local health fairs and health-related events for the underserved. This year, for example, KP's Stockton facility will for the first time sponsor its own one-day community health fair. This fair will not require a setup at the county fairgrounds but will instead take place within KP's own well-equipped Stockton Medical Office.

Pleased by the inroads that Su Salud and Kaiser Permanente have made in educating the poor in basic health care practices, Dr. Wong nonetheless cautions against complacency, for only by waging a continuous battle against ignorance will we empower people to learn how to take better care of themselves and to enjoy better health.

For a biography of Judy Lane, click here.

Neighbors in Health, a Kaiser Permanente-sponsored one-day health fair and open house, was held on Sunday, July 26 at the Stockton Medical Office. The health fair emphasized health education programs, displays, and brochures; consultations with Permanente clinicians; and several screening services, including Pap smears, mammograms, and immunization updates.