When Ahmad Nooristani, MD, became a physician, part of his motivation was to help his native country. “I wanted to become a physician so that I could give back,” says Dr. Nooristani, who emigrated to the U.S. from Afghanistan in 1981. He graduated medical school in 2008.
One way to address preventive care for the uninsured, he reasoned, was to open a free clinic. In 2009, in addition to his seven-on/seven-off duties as a hospitalist, Dr. Nooristani began work on establishing a clinic for uninsured patients in his new hometown. Almost three years and countless fundraising events later, the Noor Foundation Clinic opened its doors in October 2011, offering not just primary care but ophthalmologic examinations, nutrition counseling, physical therapy, and point-of-service testing, too. For now, the clinic is open Friday and Saturday afternoons; all care is free.
Dr. Nooristani has worked 20 hours a week on the project. He’s recruited 400 volunteers, ranging from high-level administrators from the county’s hospitals to community fundraisers to off-duty nurses and physician colleagues.
“He’s a hard-working guy and is always looking for ways to improve things,” says hospitalist colleague Christian Voge, MD, medical director and president of San Luis Hospitalists. “I think he saw a need and is trying to give back.”
A Gap to Fill
Located on the central coast of California, San Luis Obispo County has a population of 269,637, according to 2010 U.S. Census figures. County public health officer Penny A. Borenstein, MD, MPH, says that figures from such surveys as the California Health Interview Survey and the Census Bureau indicate that approximately 35,000 of the county’s residents had no health insurance at some point in the last 12 months. The number of those who are underinsured (i.e. who carry minimal catastrophic insurance with high deductibles) is harder to quantify.
——Christian Voge, MD, medical director and president, San Luis Hospitalists AMC
Although other clinic options exist in the county, through Medi-Cal and the County Medical Services Program, Dr. Borenstein believes that the Noor Foundation Clinic will help address gaps.
“Even a sliding scale fee [such as those charged by community health centers] can sometimes be a deterrent to people,” she notes. “I give [Dr. Nooristani] many kudos for taking the bull by the horn and saying, ‘Let’s at least try to put something together to help fill the gaps in a very imperfect healthcare system.’”
New Skills Acquired
During an interview just days after the clinic opened its doors, Dr. Nooristani voiced some amazement about the long permitting process. “The hoops you have to jump through—it’s unbelievable,” he said.
Subject to federal, state, and county regulations, the clinic had to be retrofitted with a $25,000 air filtration and ducting system, among other upgrades. As a result, the foundation was paying rent for two years before the clinic opened its doors. “I could have seen a few thousand patients,” Dr. Nooristani says. “I mean, think about the complications I could have prevented.”
Still, he’s philosophical about the process. “On the flipside, I’m glad I did it this way. As tedious and time-consuming as it was, it served the purpose of bringing the whole community together,” he says.
Fundraising events for the foundation, as well as private donations, raised a total of $80,000 in a two-year period. Just before the clinic opened, the San Luis Obispo County Board of Supervisors approved a $75,000 grant to the Noor Foundation to cover the annual costs of point-of-service testing. And a broad swath of the county’s office holders, healthcare administrators, and community leaders attended the clinic’s grand opening.
Geared to the Patient
Keeping in mind his patient population, Dr. Nooristani plans to incorporate patient education on managing chronic illnesses. An ophthalmologist has volunteered one day a month. A separate optometric examination room is outfitted with all the requisite equipment, and eyeglasses have been donated.
Furnished tastefully throughout, the clinic does not have the stark quality sometimes associated with free clinics. Dr. Nooristani also is respectful of patients’ time: “I don’t want anybody sitting in the waiting room for more than 30 minutes,” he says.
That’s why the appointment calendar is structured to accommodate future appointments, and he currently staffs each clinic day with two physicians and additional providers. He’s also savvy about his use of volunteers, limiting their hours to avoid burnout. (Listen to Dr. Nooristani talk about access to preventive care and starting free clinics.)
Dr. Nooristani already has his sights set on more clinics, hopefully in his home country. In the meantime, though, he says, “people need care here.”
Like the meaning of the clinic name (“noor” means hope, and his name translates to “land of hope”), he hopes to inspire others to follow his lead. “Any community, big or small, can do this,” he says, enthusiasm in his voice. “You just have to keep your eyes on the prize.”
Gretchen Henkel is a freelance writer based in California.