MOUNTAIN VIEW, Mo. — It was already 1 p.m., and Sheri Noble’s Monday was just getting started.

There were prescriptions to call into the pharmacy, times to coordinate for people to pick up donated supplies, and a schedule of about 30 patients she had to prepare for. 

In many ways it was business as usual for Noble, the administrator of the Good Samaritan Care Clinic.

As she walked through the clinic’s doors earlier that morning to start what promised to be a 12-hour day — something she has done every Monday for 15 years — she relished the busy schedule ahead.

The gravity of the day wouldn’t really hit her until she got home.

After more than 17 years, over 36,000 patient visits and countless hours of work by a set of 125 volunteers, the Good Samaritan Care Clinic held its final weekly clinic Monday night.

The clinic’s mission was rare, especially in rural Missouri. Its services were completely free. No proof of income was required. Patients simply had to be in need and be uninsured.

It’s located in Mountain View in one of the most impoverished areas in the state. In neighboring Shannon County, an estimated 27.5% of residents live in poverty and nearly 19% lack health insurance — both roughly two times the state average, according to U.S. Census Bureau data.

The clinic drew patients from all across Southern Missouri, from as far as Poplar Bluff, Mansfield, Rolla and the Arkansas border. It’s one of just a handful of free medical and dental clinics across the whole state.

An amalgamation of factors led to its closure.

The pandemic contributed to both a downturn in donations and patients. The clinic closed its doors for three months initially, and patients thought it was closed for good when they didn’t see a long line of dozens of residents wrapped around the corner of the clinic each Monday afternoon.

Volunteer medical staff were working long hours amid the pandemic, sometimes treating coronavirus patients at their own jobs. Asking them to come volunteer on top of that felt like it’d be contributing to their burnout.

Patients, volunteers and staff didn’t want to see it close. They did so reluctantly.

“It’s been depressing,” said Dr. Jon Roberts, a 74-year-old Winona physician who helped found the clinic, “because we’ve done it for so long.”

The clinic was never meant to be permanent. And the one silver lining that leaves some both wary and hopeful is that at least 70% of the clinic’s patients will qualify for health insurance through Medicaid expansion.

In its final months, the clinic has worked to see patients who have visited in the last three years one last time. Medical records had to be transferred. Final prescriptions filled. Volunteers walked two dozen patients through how to apply for Medicaid expansion online.

The clinic’s longtime patients are now left figuring out what they will do next.

Like many in the area, Danny Martin works at a local sawmill where he receives no benefits. He had a heart attack a few years ago, and also comes to the clinic to treat his Type 2 diabetes. A month’s supply of his medication costs hundreds of dollars.

“I may just quit taking all of them,” Martin said with a laugh.

But he wasn’t joking. 

With the clinic closed, going without medications is something he said he is seriously considering.

Humble beginnings

Roberts had just returned from a mission trip in Haiti in the early 2000s and was treating a patient when he was asked a question.

“‘Dr. Jon’, he said. ‘Why do you go all over the world and do missions when there’s people hurting right here?” Roberts said. “I didn’t have an answer for him. But he planted a seed.”

Roberts tried to start a free clinic about eight years before Good Samaritan Care Clinic was founded. It didn’t come together.

“When we tried to do it again in 2003, everything worked,” Roberts said. “We got the funding, we got the building, we got the volunteers, we got the patients.”

It started in a house owned by Mercy St. Francis Hospital in February 2004. It was multi-level, and volunteers were often hurrying up and down the steps of the building all night long.

Connie Porter, Roberts’ longtime nurse who recently returned to volunteer on the clinic’s final nights, remembers often staying until 11 p.m. to see patients, fill prescriptions and even sweep the rooms.

“For this area, (it was) unheard of, to be quite honest, to open a free clinic that would be just for uninsured patients,” Noble said.

But the clinic took off, providing over 510 medical visits in its first year alone. They had to start capping the number of patients they would see each Monday night at 60. By May 2006, the clinic moved into a house donated by the First Baptist Church that has since gone through multiple renovations.

What was once the garage is now a dental clinic. The living room is now the waiting room. A triage area and six exam rooms were added through donations partially underwritten by the Department of Economic Development Neighborhood Assistance Program that allowed the clinic to offer tax credits for donations it received.

It’s where the clinic has been ever since, across the parking lot from the church off of U.S. Highway 60.

Over the years, the clinic’s philosophy has remained the same, too.

“We work in a borrowed building, we exist off of donated supplies, donated medication. We exist obviously off of financial donations. But it’s always been our goal that a patient will walk in here, will feel like that we are treating them as if they were a paying patient,” Noble said. “As if they deserve the same respect, the same esteem, the same quality of care that they could receive if they were paying out of pocket in any other facility.”

Funded by donations, it’s the kind of place where patients may not have much. But they give what they can.

“The people with the least you would see drop a dollar or two in the donation box,” said Deb Lewis, a longtime volunteer nurse.

At a clinic last month, John Marcum, a Pomona resident who had visited the clinic for about three years, handed out silk flowers to show his appreciation. Another resident dropped by with a bag full of unused medicine to donate.

“It’s been a lifesaver for me,” said Elwood May, who drove over an hour to visit the clinic every few months for help with his blood pressure. “There’s no way that I can really explain how I feel about this place.”

When patients recount stories of the clinic, many mention Noble in particular.

“Jon may be the brains and the brawn, but she’s the heart,” Dr. Robert Shaw, a longtime friend of Roberts and clinic volunteer, said of Noble.

Noble transitioned from working for an accountant to learning the ins and outs of running a nonprofit. 

She’s the clinic’s only full-time employee, and despite getting nauseous at the sight of blood, has been a steady presence over the years.

But Noble and her husband have been putting off a move, and it’s part of what has contributed to the list of reasons the clinic will close. She will stay through at least the end of the year.

Once, a patient had a critical lab result that needed to be delivered but he couldn’t be found. It’s not uncommon for the clinic to lose touch with patients as their phone numbers change if phones get disconnected or patients are unable to add more minutes.

After even the sheriff’s office couldn’t locate the patient to provide a wellness check, Noble and her husband went to look for his trailer themselves.

“I did go out to look for it, and did find him as a matter of fact,” Noble said.

When Lori Keeling, a 52-year-old Summersville resident, was going through depression, it was Noble who called.

“She just called just to check on me,” Keeling said, later adding: “When you come here you know that you’re loved. They actually really care about people. And they care that you get the right medical help. It’s meant a lot to me coming here, because I don’t know what I would have done without them.”

Medicaid expansion

Dana Blar hadn’t heard about Medicaid expansion until the clinic told her.

She’s not alone. Numerous patients interviewed by The Independent during the clinic’s final weeks said they only learned through the clinic that receiving health insurance through Medicaid might now be an option for them.

This summer, the courts ruled that Missouri must expand Medicaid like voters approved in August 2020. Adults who make less than $17,774 a year are now eligible. Applicants began to be enrolled in October, and as of Nov. 5, 14,550 have been enrolled, according to Department of Social Services figures.

The clinic printed out paper applications, sent mailers home and even on the clinic’s last day, volunteers held one-on-one sessions with patients to help them apply online. 

It’s how Blar signed up.

Unable to afford health insurance, “it’s the best thing I could get,” Blar said.

In their years volunteering Monday nights at the clinic, Shaw and Dr. Naomi Dyck have seen a little bit of everything. And even with Medicaid expanded, they worry it won’t be enough.

“I still think there’s a large population out there that will not have insurance that will need it,” said Dyck, a family nurse practitioner who has volunteered at the clinic for years.

Ken Horgan, who serves on the advisory council for the clinic’s board, has been especially worried by the numerous hospital closures in rural Missouri — some in nearby counties. He hopes Medicaid expansion will be a step in the right direction.

Evelyn Duffey and her husband are just a few hundred dollars over the eligibility guidelines to qualify for Medicaid expansion, Duffey said. Duffey, who had necrotizing fasciitis, a rare flesh-eating bacterial infection, credits the clinic with saving her life.

The clinic helped refer her to other providers, but the questions run through her mind about how she will figure out her care with them gone. It’s not knowing what comes next that scares her.

Marcum, who was able to receive ear surgery to fix his hearing with the clinic’s help, hasn’t qualified for Medicaid in the past and doesn’t think he’ll try again.

Noble has tried to encourage patients to not give up before they even apply. 

“We really have become more like a family than just a medical provider,” Noble said. “And so they consider this their medical home and it’s like they lost their home and temporarily they don’t know what they’re going to do or where they’re going to go.”

In the next few weeks, the clinic will wrap up its services with final labs for patients. Its supplies will begin to be donated to other free and low-cost clinics across the state where they can live a second life.

It’s then, when the rooms usually bustling with activity are bare, that it will sink in for Roberts. 

“I feel like the one that’s grown and been offered this awesome responsibility to be here and to provide this,” Noble said of the clinic. “I’ve been the blessed one. I really have.”

But at 7 p.m. Monday the clinic still had patients to see. And Noble wanted to make sure they had everything they needed.

“You sure you don’t need some test strips?” Noble offered one of the clinic’s last patients. “We won’t be here forever.”