Speaking before a group has never been Meg Erickson’s favorite activity. As a skilled and dedicated nurse, she would much rather spend her time in the practice of her profession. But there she is on a Sunday morning, speaking from the pulpit of Christ Lutheran Church to the 400 or so parishioners packing the sanctuary. Erickson will do almost anything if it’s in the service of Shepherd’s Hand Clinic, the free medical ministry she administers in the church building with her physician husband, Jay Erickson, and a host of other volunteers. The Ericksons are members of the congregation in the small town of Whitefish, Montana, where the clinic has been operating successfully since late 1995, filling a significant need. Every so often Meg Erickson brings the congregation up to date on the clinic’s latest developments.
Whitefish is located in the state’s remote northwestern corner, not far from Glacier National Park. The town’s economy depends largely on tourism. Here in the mountains, the tourist season is confined primarily to the warm months. Even with an increase in winter sports, jobs in the tourism industry still tend to be seasonal and temporary. Most carry no benefits. That means, above all, no health insurance.
Businesses directly or indirectly serving tourism include motels, restaurants, nightspots, recreational facilities, clothing or sporting goods stores, and gift shops. In fact, almost everyone in town depends at least partially on tourism for economic support. The area’s employers are not a bunch of hard-hearted, penny-pinching grinches. Many of them would like to be able to provide employee health insurance but work under the same economic and seasonal restrictions as their workers do, and are simply not able to afford it.
The tourism workers are often young adults drawn to the area for its natural beauty and the idea of living “close to nature.” They frequently come to Whitefish without a job, optimistic and full of expectation. Other tourism employees are longtime residents whose education or other circumstances have limited their job opportunities to waitressing, cleaning cabins, kitchen work, or grounds upkeep.
Meeting Basic Needs
The Ericksons came to Whitefish in the early 1990s from the Midwest. The longer they practiced medicine in the new location, the more they noticed increases in the number of people unable to afford even basic medical care. Having chosen their vocations in the first place as a way of living out their faith, the Ericksons found the situation distressing. They discussed the problem with other parishioners, and at a church council retreat in early 1995, says Meg Erickson, “The idea for a free clinic, as a mission outreach, was born.” After careful research and preparation, the clinic opened in October of that year.
Since that time, the clinic has served between 800 and 1,200 patients per year and, at one time, had to turn away some seeking care. It simply could not accommodate all the people from the wider geographical area who showed up needing care. Fortunately, the demonstration of need and Shepherd’s Hand’s success inspired a second clinic in nearby Kalispell, run by the Salvation Army.
Shepherd’s Hand is completely lay organized and lay led, but the pastors are “very supportive,” according to Meg Erickson, and the ministry operates in the context of the congregation’s overall theology and mission. According to the Reverend John Bent, senior pastor at Christ Lutheran, it reflects a conscious process the congregation undertook to “move from a control-based [concept of] ministry to a mission-based position. We needed to take our eyes off of ourselves,” he explains. The first step in this process, says Bent, was “a worship-renewal stage. That had to come before anything else, including social ministry.”
According to Bent, part of rethinking worship led to this conclusion: “The reason we exist as a church is for the sake of those who aren’t here”—that is, those who are outside the church. The clinic is “an expression of our faith,” says Bent. It has “opened the congregation’s eyes” and helped people change their attitude about how they can perform ministry. It has even changed their views about the church building itself. They used to worry that “if other people come in, they might mess it up.” Now, Bent comments, their attitude is: “In how many ways can we use our building for our community?”
A Quick Transformation
Shepherd’s Hand Clinic meets once a week in the evening. The work starts with volunteers delving into church closets to take out the stored medical equipment and supplies. They quickly transform church rooms into various kinds of medical facilities. The social room becomes an intake and waiting area where the workers set up tables and chairs. Magazines are available for patients to pass the time, as are toys for children. Sometimes the church’s youth group or other volunteers supply cookies.
The two pastors’ offices become medical examining rooms, their regular furniture temporarily moved aside to accommodate wheeled examining tables. Another area becomes a makeshift pharmacy, where volunteer Bob Grady, a retired pharmacist, holds careful discussions with patients and either dispenses prescribed medications donated by local pharmacies or gives the patient a voucher that a pharmacy will fill. Another source of medicine is physician-donated samples. Grady was the clinic’s first volunteer, and has not missed a night since its opening.
The entire clinic staff are volunteers, with Meg Erickson functioning as clinic administrator. All work on a rotating basis, serving as often as they can. In addition to church members, there are volunteers from other churches, civic organizations, and the entire community. There is currently a waiting list of volunteers. The Ericksons have recruited doctors, nurses, and other medical professionals from local practices and hospitals. Usually there are two physicians and a nurse on duty whenever the clinic is open. Hospitals and specialists take referrals for clinic patients who have serious problems such as a major illness or a need for surgery. In such cases, there are ways to help a patient finance very large expenditures.
Carefully trained volunteers fill out detailed questionnaires with each patient about his or her health and financial circumstances. An evening’s problems will range from flu symptoms, to follow-up on chronic heart conditions or diabetes, to job injuries. The latter are common among the area’s self-employed construction workers who might be helping to build a new motel or a house for a wealthy summer vacationer. One night, a Ukranian immigrant who couldn’t speak English arrived in a van driven by his son. He was experiencing back pain so severe that he couldn’t walk, so the doctor went out to see him in the parking lot.
The staff always tries to see children first. The volunteers, including the physicians, dress in jeans or other casual wear to put patients at ease. Communication is informal—and strictly confidential. In a small town, patients are sensitive about receiving medical “charity” and don’t want it voiced about. Volunteers are careful to oblige. For example, Rich Dolven, a local school principal and member of Christ Church, works as a behind-the-scenes office helper processing paper instead of doing something more visible like intake. He doesn’t want to embarrass parents or children whom he may see the next day at school. Dolven notes that the clinic has had an interesting effect on the congregation and on his own spiritual life. It has “given a direction” to generalized wishes to help and has concretized the church’s mission.
“It’s the Economy”
Many of the clinic patients are working people and are reluctant to seek charity. According to Meg Erickson, “68 percent of our patients make less than $11,000 per year even though 50 percent of them are employed.” For those who are unemployed for health reasons, one of the clinic’s goals is to help them become well enough to hold a job. Even then, though, the insurance problem may remain.
Just as all work is performed by volunteers, all finances and supplies are donated—by individuals and groups from the church and the larger community. Some of the financial contributors include small businesses that would like to provide health insurance for their employees but can’t afford it. For example, two members of Christ Church own a local pub and music spot. Their employees do not receive benefits. The pub owners make financial contributions to the clinic as well as volunteering when it is in session. Other community donations have included low-cost bank loans for patients with major medical expenses.
Patients are asked to pay a token fee of $5.00 if they can afford it. In this way, says Meg Erickson, if people “become a partner in their own care,” even in a minor way, they are more apt to take responsibility and follow up with physicians’ advice. The patients also make contributions in kind. One volunteered to mow the church’s grass and shovel snow. When patients have died, family members have donated their unopened medications back to the clinic to help others.
Step by Step
Clinic development was deliberate and methodical. The first step was to establish a steering committee whose initial responsibility was to identify and probe need. That group conducted local research, contacting the county health department, local hospitals, and physicians. Two goals were to avoid duplication of services and to build a sense of community interest and support. For example, the county has an immunization program so the clinic did not include that in its plans. A key to success at every stage, says Erickson, was “a lot of communication.”
Steering committee members also researched how other free clinics around the country (not necessarily church-related) have managed and what lessons they have learned. They came at the issue from another side, too: How had other churches dealt with health-care needs in their own location?
Step two, networking within the community, included purchasing the mailing list from the local Chamber of Commerce and contacting all of its members for their advice and support. They also met one-on-one with local bankers and with community leaders to introduce the idea of the clinic and request feedback. The goal was to build community awareness, interest, and potential for cooperation. The organizers wanted to emphasize that this new ministry was intended for the entire public and that they needed help in establishing it. When it was near time for the clinic to open, organizers placed notices in newspapers and everywhere else people might see them. They gave talks around the community to inform people of the new service.
Further steps are documented in clinic records. As the Shepherd’s Hand ministry has evolved, its organizers have maintained a simple history from the program’s pre-beginnings up through the present. The record of each step includes dates, which provide an overall picture of the time needed for various stages. Administrators can look back and compare results with initial goals, chart progress, see where they took a wrong turn, and learn from experience. A running history can be helpful for any kind of public ministry, especially in the capacity-developing stages. A log of a previously established ministry can also be used to start a new one since many of the steps are the same regardless of the ministry’s content.
Learning from Mistakes
Shepherd’s Hand is a good example of a ministry that is flexible and can change according to needs and resources. For example, in 2001 the clinic added two new components to its offerings: a dental clinic and a prayer ministry.
According to Meg Erickson, clinic organizers had always hoped to include dental services. However, they moved gradually and took one step at a time. When they felt ready to expand into dentistry, they set up a trial program. That attempt ultimately proved unsuccessful due to unforeseen organizational problems. Of necessity, the dental clinic operated away from the church, in the offices of the volunteer dentists. After a time, says Erickson, it became obvious that there was too little communication back and forth between those offices and the clinic administrators.
Also, the dentists were not always clear on expectations of their services and ended up feeling overwhelmed by the program. Shepherd’s Hand suspended dental care while it regrouped and reorganized. Erickson stresses that it’s important to learn from mistakes—not to regard them as failures but as valuable lessons and learning experiences. On the second try, the dental clinic has operated much more smoothly. Changes have included training clinic volunteers to act as liaisons. They accompany a patient to the dentist’s office and take care of all paperwork. The same volunteer accompanies the same patient each time, promoting consistency and familiarity.
Public and Private
The other new Shepherd’s Hand addition is a prayer ministry directed by layperson Kris Teeples, who is trained in that skill. There was, she says, a desire among clinic volunteers to offer “more of a wholistic ministry” to patients, addressing needs beyond their specific physical problems. “We wanted to help meet their spiritual needs—but not in any way to impose on them,” says Teeples. The challenge was, “How could we be available?” without being too much of a presence and making patients feel uncomfortable.
Teeples and Meg Erickson spent two years carefully thinking through and planning this new and sensitive ministry. Once again, they were flexible and open to learning from experience. For example, on a form they first prepared for patients, this question appeared: “Would you like to pray with someone?” They determined that this wording was too direct and may have seemed like an intrusion on patients’ privacy. They later changed the wording to “Would you like to speak with a patient advocate or a ‘caring listener’?” They also retooled their volunteer training, stressing the importance of a volunteer’s overall sensitivity toward a patient and his or her special needs.
The prayer ministry has its own mission statement that includes its scriptural foundation and the “three goals of a Shepherd’s Hand Prayer Team Member.” Teeples has been testing the ministry’s methods, attending every clinic session. She has decided that it’s best simply to sit at tables with the patients as they wait to be seen, and to strike up general conversation in a natural and relaxed way rather than pointedly bringing up the matter of prayer. That may work itself into the conversation, she says. If it does, she invites the person to go into the sanctuary with her.
Sometimes the volunteer and the patient may simply sit together in silence for awhile. Teeples emphasizes that the most important aspect of her training has been in “how to build relationship.” She notes that, interestingly, the patients’ most frequent prayer topic “is not their physical needs”; in fact, it’s not for themselves at all. Rather, she says, “They may want to pray for problems a family member is having. One evening a mom wanted to pray for her children, who were getting into drugs.”
The greatest challenge in the prayer ministry, according to Teeples, is “getting people to step over the comfort zone,” that is, to learn to trust the listener and feel at ease in conversation. This is true for all aspects of ministry with strangers. Building trust is essential, but perhaps even more so with prayer since it is such a personal matter.
Part of the Shepherd’s Hand Prayer Ministry includes volunteers’ commitments to pray regularly at home for clinic patients. This is an intriguing type of public ministry. It does not occur “in” the public or even “with” the public, but, rather, behind the scenes in the privacy of the volunteer’s own quiet prayer space. According to Kris Teeples, the experience of taking the ministry home and making it part of one’s private life has the additional benefit of significantly enriching the volunteer’s own spirituality. It integrates public and private in ways that nothing else can and thereby enhances both. It turns out that the “wholistic ministry approach” the parishioners desired has affected them as much as it has their public.
This is but one discovery in what Pastor John Bent calls the congregation’s “attitude and openness to possibilities and freedom regarding mission.” It is important once a ministry is established that its organizers remain flexible and responsive to any new possibilities the ministry itself might suggest. Such openness might lead to further creative interpretation of the congregation’s mission. This process could result in changes to a current ministry. It could also result in new ways of thinking about that ministry or about ministry in general.
This article was excerpted from Public Offerings: Stories from the Frontlines of Community Ministry, to be published by the Alban Institute in August 2002 (AL258).