The healthcare disparity in America is an ever-growing issue that affects hundreds of cities around the country. One of these cities is Baltimore, where many residents are unable to access treatment for their curable ailments. Due to this issue, too many residents of Baltimore succumb to treatable illnesses.

The Charm City Clinic, a non-profit organization, works to alleviate this health disparity by creating and maintaining a support system for patients that allows them to navigate health and social service resources, as well as overcome barriers to medical care. In order to better understand the mission of the Charm City Clinic, I interviewed co-founder Ramy El-Diwany, Program Director Tulha Siddiqi, and Executive Director Wynn Engle-Pratt.

Co-founder Ramy El-Diwany is a MD/PhD student at the Johns Hopkins University School of Medicine. While doing his PhD work in the genetic basis of treatment response for Hepatitis C patients, El-Diwany found that the drug available at the time, Interferon, worked for some people, but not for others. Furthermore, when he was a first-year medical student, El-Diwany noticed that the Johns Hopkins Hospital shared the same zip code with some of the most devastating health outcomes in the United States. Residents of East Baltimore were succumbing to cardiovascular disease and diabetes, among other ailments which could have been treated with the proper medication. These individuals who were in dire need of medical treatment were not able to obtain it, as they could not receive health insurance. In order to get health insurance, individuals were required to read at a 10th-grade reading level, but most of the residents of East Baltimore read at a 4th or 5th grade level. El-Diwany made it his mission to put an end to these devastating health outcomes, and founded the Charm City Clinic.

The clinic started out by enrolling individuals in Primary Adult Care (PAC) and filled out their applications for the DMV. The clinic also provides an Access Partnership to community residents in need. With this partnership, individuals with special needs can be evaluated, free of charge, at the clinic. Patients get a physical exam when they come into the clinic, and are then guided to specialty care. These physical exams provide an appropriate access point to medical treatment for these individuals. For instance, the clinic provides quick cardiovascular disease screening tests, and has found that many individuals meet the need for treatment for hyper intensive health concerns.

The Charm City Clinic has grown exponentially in the Affordable Care Act era, as funding has increased, and the number of the clinic’s full-time employees has grown due to the act’s passage . El-Diwany realizes that individuals in underserved communities are tired of people told what they want and need, and must be understood for that reason. Therefore, the clinic’s employees are dedicated to listening to what people want, and working with them to get what they want, which is to be healthy.

El-Diwany believes that the biggest challenge currently facing domestic health in the United States is misunderstanding the role of healthcare in people’s lives. He believes that if we do not fund programs for individuals who cannot afford healthcare, we will be paying for their medical treatment in other ways. However, El-Diwany also recognizes that the U.S. has made improvements in domestic health. In his opinion, the most significant advancement that has been made in domestic health was expanding the catch net for Medicare and Medicaid with the Affordable Care Act. Now, Medicare and Medicaid are asking the Charm City Clinic for lists of patients, whereas, prior to the passage of the Affordable Care Act, the clinic had to ask Medicare and Medicaid for patients. The accompaniment model that the Charm City Clinic follows is found elsewhere in the U.S. and developing world. El-Diwany believes that this model

will perform very well, as it can evolve easily to changing climates, is a durable approach, and provides more efficient care.

In order to better understand the day-to-day operations of the clinic, I also interviewed Program Director Tulha Siddiqi. Siddiqi graduated from the University of Maryland in 2013 with a Bachelor’s Degree in Psychology. During his Post-Baccalaureate Fellowship, Siddiqi looked at health outcomes in Baltimore’s neighborhoods. He found issues with healthcare access and getting people connected to care. Seeing these devastating health outcomes led him to the Charm City Clinic.

On a day to day basis, Siddiqi fields emails, checks the quality of chart notes, and ensures that the clinic’s clients receive the care they deserve. Furthermore, Siddiqi manages the volunteers who devote their time to carrying out the clinic’s mission. Siddiqi also visits patients’ homes to follow up after their clinic visits, as he believes in developing relationships with his clients in order to provide more effective care. He maintains a caseload of ten clients per month. Siddiqi is humbled by seeing more and more individuals being connected to medical care in East Baltimore through the Charm City Clinic. He believes that the most significant impact that the clinic has had on the Baltimore community is developing a relationship between itself and the community, by helping them obtain health insurance, advocating for them, and aiding them in deciding treatment options, among other services. The most challenging aspect of Siddiqi’s position as Program Director of the clinic is is making sure that stakeholders’ needs are met, and ensuring that stakeholders are maintaining a grassroots community approach.

According to Siddiqi, the biggest challenge facing domestic healthcare in the U.S. today is the repeal and replacement of Obamacare, a program through which 20 million people have received health insurance. Before Obamacare was created, many individuals could not receive substance abuse treatment. Once Obamacare was created, individuals who were suffering from substance abuse were able to get primary and preventative care at places other than the emergency room. With the repeal of Obamacare, Siddiqi worries that these individuals will no longer have a place to get treatment, and will be forced to visit the emergency room for primary care treatment. However, like El-Diwany, Siddiqi recognizes the advancements that have been made in domestic health over the past few years. In Siddiqi’s opinion, the most significant advancement in domestic health over the past few years has been focusing more on preventative care. In the past, organizations focused on treating patients as they came in. Now, there are many initiatives that go into communities and teach the residents about heart disease, diabetes, and other preventable ailments. This emphasis on prevention has reduced the number of individuals who become ill.

In the future, Siddiqi sees the Charm City Clinic expanding its services to the Baltimore community. With three employees, the clinic can easily move around Baltimore and offer clinical and case management services. For instance, the clinic can have pop-up clinics in community centers. Furthermore, the clinic is working on a pilot program that involves medical students calling clients and conducting motivational interviews to help patients live the best lives they can. I also asked the Charm City Clinic’s Executive Director, Wynn Engle-Pratt, about the clinic’s plans for the future. Engle-Pratt explained how the clinic plans to increase its accessibility to the residents of Baltimore, and will be partnering with other community-based organizations in order to help more individuals gain access to the healthcare they need. The Charm City Clinic has made significant progress in providing healthcare to underserved residents of Baltimore, and will continue to improve the health outcomes of even more individuals in the future.

Posted by Kopal Bansal

Kopal is a freshman at the Johns Hopkins University, pursuing a major in molecular and cellular biology, as well as a minor in entrepreneurship and management. As a member of HMR’s Domestic Health Team, she writes articles that focus on healthcare in the United States. When she is not busy studying, Kopal enjoys to play piano, practice tennis, and run. She is particularly interested in understanding health inequities and working to combat them through organizations such as MEDLIFE. In addition, she is the founder of Smiles for a Child, a non-profit organization that creates magazines for pediatric patients. She aspires to become a physician, and provide more effective treatments to a wider range of individuals.

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