Womankind: Wonderful Healthcare for Women in Need

Behind the rollicking façade of female impersonators, Ernest Hemingway look-alikes and margaritas in the morning, Key West hides a community where everyday people work 2 or 3 jobs just to put food on the table. Although the unemployment rate is an enviable 4.4%, the economy is anchored in low-paying work that does not provide benefits.   Consequently, a staggering 40% of employed adults under age 65 (compared to the national average of 15%) have no health insurance.   Confounding the problem, Key West lies a slow, slogging four hour drive from the Florida mainland, where healthcare is more plentiful. In short, the population is largely poor, isolated, and sorely in need of healthcare.  Enter Womankind.

Founded in 2000, Womankind offers free or low-cost gynecological and primary care to about 2,000 women a year.  A 501 (c) (3) not-for-profit organization funded by grants and individual donations, this unique, wonderful center was founded by two compassionate nurse midwives who saw the and envisioned a place where women took care of women.  The very opposite of a stereotypical  clinic for poor women, Womankind offers prompt attention and compassionate, high quality care to rich and poor alike.  Every woman who calls for an appointment is seen within days and rarely sits in the waiting room for more than 15 minutes. She spends 20 minutes or more with a provider who listens attentively and relates to her holistically, stressing education and prevention and addressing all the physical, emotional and social factors that affect her health.

Nurse Practitioner Carolyn Daly (R) & Angelica Valdez, Hispanic Teen Outreach Coordinator/Front Desk

“I love that I can walk into the waiting room . . . and see one of our wealthiest donors waiting for her appointment while a hotel cleaning woman sits across the room waiting for the same,” said Betsy Langan, Womankind’s grant writer.

The formula is brilliant. Indigent women receive care for free.  Low-income women receive care based on a sliding scale. Women of means, who are drawn by the high quality care and warm atmosphere, pay full (though comparatively low) fare, which helps to subsidize the care of those less affluent. Care is also subsidized by government and community grants, individual donations, and special events.   As the proportion of low-income patients increased with the recent recession, Womankind introduced revenue raising services – spa treatments, weight loss seminars (scholarships available), and bioidentical hormone replacement -- to offset the growing imbalance of haves and have-nots. To further lower cost, care is provided by nurse practitioners under the supervision of a physician.     At the same time, Womankind offers free workshops on smoking cessation, stress reduction, cancer and heart disease prevention, and financial health to the entire community. And they reach out into the community providing sex education in the middle and high schools and free screenings in some of the poorest sections of town.  The net result is a center warmly embraced and strongly supported by the Key West community. 

As a result of broad based support, Womankind moved into a bright and spacious new home last year.  The space boasts a very Key West waiting room, where party lights ring the ceiling and a large bowl of free condoms sits atop a cobalt blue administrator’s desk;  a cozy, comfortable, extra-sound-proofed  room for mental health counseling; a spa room; and exam rooms each warmed by natural light.  While this attractive center is valuable to the entire community, it is most precious to those of limited means.

Fifty-five-year-old Danita Valdez is a case in point.  Between Danita, who works part time as a house cleaner, and her husband, who is disabled, the couple brings in about $500 a month, $142 of which covers the rent on their subsidized apartment.  Her annual tests at Womankind -- blood tests, pap smear and occult blood check – usually cost $75-80.  This year, however, that care was free.

“Evidently they had a little more money to balance with this time,” speculated Danita, who donates $20 or $25 to Womankind whenever she can spare the funds.

Like other patients, Danita especially likes the way her care is managed.  When she developed recurring respiratory infections, Womankind ordered numerous tests, some of which needed to be done at the hospital.  Womankind kept track,  followed up and called Danita with results.

Kristine Dion, age 34, also sings praises.   With a household of six and an annual income of $40,000 she could not afford medical care.

“They were amazing,” said Kristine, who was pleasantly surprised when she was treated with kindness and patience even though she qualified for reduced fees.   She is especially grateful for receiving a mammogram when a lump was discovered in her breast.

“They just took care of me very, very well,” she said.   

With federal Title X family planning funds, Womankind provides basic gynecological  care -- breast and pelvic exams, Pap smears and other cancer screenings, HIV testing, pregnancy testing and counseling, and affordable contraceptives -- for free to all girls under age 18 and to women living at or below poverty level  and on a sliding scale for women of low or moderate income.
 

TEST	OUR PRICE	Typical Price Elsewhere
Pap Smear	$79	$75
Complete Blood Count (CBC)	$14	$38-60
Complete Metabolic Panel (CMP)	$19	$46-120
Thyroid Panel (T3,T4, &TSH)	$50	$240-280
Urine Culture	$24	$64-98
CA 125 (Ovarian cancer screen)	$30	$60-250
Lipid (cholesterol) panel	$24	$97
Pregnancy test (urine)	$12	$76

MEDICATION	OUR PRICE*	Typical Price Elsewhere
Ortho TriCyclen Or Lo	$18	$45
Depo Provera	$53	$56
Valtrex (30 tabs)	$101	$366
Next Choice	$22	$31

With funding from the women’s advocacy organization Zonta, Womankind subsidizes mammograms. Womankind also offers primary and mental health care at flat but reduced rates.  The nurse practitioners treat minor illnesses like colds and urinary tract infections and manage easily controlled chronic diseases.  When disease diagnosis or the management of diabetes, thyroid problems and the like exceeds the nurse practitioners’ abilities, Womankind has funding to subsidize referrals to more sophisticated primary care or specialists.  Thanks to partnerships that Womankind has established, additional help comes from the local hospital and some specialists, who provide care to Womankind patients at significantly reduced rates.  What’s more, between medications offered in Womankind’s own pharmacy, medications provided by Publix supermarkets for free (to anyone, no questions asked), and prescription assistance programs to which Womankind helps patients apply, patients  can affordably obtain many of the medications they need.

Still, the staff recognizes an unmet need that they are seeking to fill: although Title X subsidizes gynecological care for indigent and low-income women, there is no comparable funding for primary care.  And while Womankind offers primary care at below market rates, there are many women in the community who cannot afford even these.  So the staff is investigating how they can parlay some of their grant money into subsidies for primary care.

Protecting the reproductive health of young girls is one of Womankind’s principal concerns.  Early on, the founding midwives discovered that the girls didn’t know how to protect themselves. 

“STD rates were going through the roof,” said Kim Romano, executive director. “The girls didn’t know how they got pregnant.  They didn’t know about their bodies.  They weren’t even having pleasure having sex.”

Today, Womankind reserves Thursday afternoons for teens, when the nurse practitioners can give them extra time and the girls can come in without having to worry about running into their moms’ best friends.    When rumors spread in the community that only bad girls came to Womankind, Kim built a teen advisory board to find out what the kids were thinking and what would make them feel comfortable.  That teen advisory board morphed into a survey posted on Facebook; a drawing for an iPad served as an incentive to fill it out.  Based on the results of the survey, Womankind will hold several “Pizza Presentations” during the school year to discuss birth control, body image, relationships and other concerns the survey highlighted.

 One 17-year-old spoke for many in a testimonial of appreciation she gave to Womankind. The daughter of two lesbian mothers who sought care for her when she became sexually active, she received contraception, contraceptive counseling, medical care and mental health counseling at Womankind.  After graduating from high school, she spoke about how Womankind helped her deal with the social pressures she felt as an attractive heterosexual girl.  Thanks to Womankind, she went off to college a strong, self-confident young woman.

As a result of its attention to adolescent reproductive health, 100% of Womankind’s teens tested negative for HIV in 2011, compared to Monroe County as a whole, where 50% of new female HIV diagnoses were in women under age 29.  Moreover, Womankind reduced the number of teens testing positive for reportable sexually transmitted infections by 64% between 2010 and 2011. And Womankind’s teen pregnancy rate is consistently lower than that of the state and the nation overall.

Separately, Womankind has improved the health of the community by giving care to women who would otherwise not get it. Typically, people without access to regular healthcare care rely on the emergency room for treatment of everyday illnesses. This practice raises the cost of routine treatments and strains the emergency room’s ability to care for people with real medical crises.  In addition, people without access to regular healthcare  are  typically sicker and incur costlier care when they do obtain treatment.  Womankind interrupts this pattern by keeping routine problems out of the emergency room, preventing serious illness, and diagnosing disease at an incipient stage, when cost is lower and prognosis better. Womankind diagnosed five cases of early breast cancer in 2011, giving a chance at life and health to five women who might not otherwise have it.



Tracy Bradach, Medical Assistant

Womankind boasts a staff of 12, including two nurse practitioners, a physician’s assistant, a mental health counselor, medical director, and auxiliary and administrative personnel. Annual budget is just under $900,000.

Womankind
1151 Truman Avenue
Key West, FL 33040
305-294-4004
www.womankindkeywest.org