Clinic had bumpy start

SUNSHINE -- Sunshine Clinic was formed in 1987 when a group of area residents received a small Alaska Community Health Facilities grant to start a clinic in the Upper Susitna Valley. They rustled up a board of directors, bought a trailer, and hired a part-time nurse practitioner.

Jessica Stevens, a physician assistant and medical director of the clinic, came on board as a practitioner in 1993. From the early years of financial difficulties to the recent dedication of a new state-of-the art medical facility, Stevens has worked diligently to see that the clinic obtained the services, staff and space to serve the Upper Susitna Valley area well.

What brought Stevens north to Sunshine? "I was looking for something different," she said. "I had just become pregnant, and we knew we wanted a change." A friend told Stevens about this little clinic that was looking for a practitioner. "She told me she could just picture me there, happy, kicking back, enjoying the quiet," Stevens laughed.

Stevens said it has always been a personal goal to be a part of a community. She moved around a lot growing up.

"This community just seemed to fit us. So then we said, 'OK, if this is going to be our community, let's help make it a healthier place.'"

In the winter of 1995, the board and staff of the clinic held a strategic planning meeting. "The clinic had no money, overdue bills, all sorts of problems," Stevens said. "Our facilitator, a man of great experience, reminded us to dream big, to focus on where we wanted to be, not where we were at the moment."

At that meeting, according to Stevens, the group made some tough decisions, but those difficult choices started the clinic down the road to where it is today.

Identifying ways to improve the clinic over the years has been simple. "It's always been easy to find our focus," Stevens said, "because our needs as a community have always driven our goals. The funding was the big hurdle to our success."

Stevens' husband, Robert Ambrose, agreed. Ambrose has been involved in the clinic in one aspect or another since Stevens came on board. He became the grant writing expert by default, shaping Stevens' and others ideas into well-written funding requests.

Of their first grant effort, in 1995, Stevens said, "We had very clear ideas of what was needed, but weren't sure how to shape and mold this into the nuts and bolts of programs and services. One day in the shower, it all came together for me," Stevens said. "I came running out of the shower and said, 'Robert, I've got it! I've got it!'"

Their proposal for Rural Health Outreach funding was successful. The award resulted in the hiring of seven new staff members, including a second clinician, a family advocate and a family support worker.

"Somewhere I have this photograph of the eight of us that first day," Stevens said. "We are all smiling." But Stevens said she can remember thinking at the time, "Oh no, what have we done?"

In 1998, funding was dwindling once again. Stevens and Ambrose knew that if they didn't get new funding sources the clinic would not survive. Stevens remembers drawing up three contingency plans. "… and the worst one was really frightening," she said.

Ambrose suggested the clinic apply to become a federally funded Community Health Center. The clinic received that designation, and the funding that goes along with it.

"Finally," Stevens said, "we had the operational funding to be what we had been all along -- a community health center.

"When a clinic becomes designated as Community Health Center they agree to provide 100 percent access," explained Ambrose. "This means caring for anyone, regardless of his or her ability to pay."

With 43 percent of the clinic's current clientele uninsured, being able to qualify for special service costing makes the difference in many of their clients seeking help at all.

Sunshine Clinic also received funding in 1999 to develop a network called Susitna Rural Health Services. Partnering with hospitals and other organizations supporting rural primary care, they were able to hire an executive director and more clinicians, and add care coordination and home health care programs.

Most residents appreciate the clinic and the new variety of services now available, but there are those who groan at the federal dollars being spent on its programs. A Sunshine Community Health Center satellite clinic is operating in Willow now, and some community members question the need.

"Willow is growing, and those who need our services will only increase as the area grows," Stevens said. "If people know we are there, if they know we provide good care and service, when they need us they will come. It's really about making more services available to more people in the area. As a 100 percent access provider, we are there to help everyone."

The clinic's growth has been beneficial to the community. Ambrose pointed out that the clinic now employs 35 local residents in good jobs with benefits and excellent training -- jobs that are hard to come by in the area. And with an annual influx of more than $2 million in spending, the clinic offers other economic benefits as well.

In 2000, the number one priority for the clinic became the building of a new facility.

"We like to say that our goal is to make this the healthiest rural community in Alaska," Stevens said. "So for us, the question is always 'how do we accomplish this?' We identified needs, and we tried to service those needs through the contractual, negotiated services route, but it didn't work for us." Stevens said they found it would work best to bring these services under one roof. "With a new clinic, we would have the ability to do this."

Again, more money was needed.

"We had the money for the design," Ambrose said, "but nothing else."

Construction and equipment costs for the 12,000-square-foot facility would run nearly $5 million. With lots of work and participation from a variety of sources, funds came rolling in. After less than a year in construction, the facility -- located just down the hill from the aging duplex where the old clinic was housed for years -- opened Feb. 21.

Stevens compiled a modest document that tells the history of the Sunshine clinic for new employees to read when they come on board. It is titled "The Little Clinic That Could," but it could have just as easily have been titled, "The Little Clinician That Could," in Stevens' honor. Or better yet, encompassing Stevens and Ambrose and all they've done to improve health care in the Upper Susitna area though Sunshine clinic, perhaps the best title would be "The Little Couple That Could … and Did."

So what's next for Stevens? Ten years after taking her job at Sunshine Clinic, will she finally get that chance to sit back and relax, put her feet up and savor the view from her new surroundings? Don't count on it.

"We need to grow into this new facility," Stevens said, "and so does the community."

Long-range plans for the new center include offering dental services, utilizing the alternative treatment room, and eventually adding an emergency room and a couple of inpatient beds. But for now, it's time to settle in. For Stevens, there's plenty of other work to be done.

"We'd like to diversify our funding," Stevens said, "and become less dependent on federal dollars." Stevens also sees a need to build up a volunteer corps of people who can help the clinic and its patients in a variety of ways. And she wants to make sure the old facility is put to good use. Her list goes on and on and on.