WATERLOO - As Peoples Community Health Clinic has grown, so has the Cedar Valley's health safety net.

The clinic, founded in 1976, has made that its business.

"It was started by a bunch of volunteers providing basically free care," said Jennifer Lightbody, the clinic's executive director. "In the next couple of years is when the Community Health Care program began to take off. That the root of the whole thing, and we've been in town ever since."

And, it is bigger. Today, the clinic operates on a yearly budget of $8 million, about a fourth of which comes from the federal government, to provide care for uninsured and "underserved" patients, Lightbody said.

The Iowa Collaborative Safety Net Provider Network, which the state General Assembly created in 2005, also provides funding, as it does for community health centers, free clinics and rural health clinics across the state. Last year, the network provided an opportunity for safety net providers to access direct funding. A total of $200,000 was available for these awards, including $90,000 for free clinics, $90,000 for rural health clinics and $20,000 for community health centers.

The budget has grown $3 million to $4 million over the last 10 years or so, according to Lightbody, but she said that growth is a little misleading.

"In that are new services," she said. "Pharmacy services have come in with that. Our federal dollars haven't grown by that much."

Support from the business community has been occasional.

"We have not had a very strong donation or giving campaign," Lightbody said. "We did have terrific support around getting this building set up here. There was a nice campaign and a lot of donors then that made this happen. But, as far as ongoing operations, that's kind of hard now, especially with the economy the way it is. The trust funds don't have money to give out."

Growth over the years

The organization's growing role has brought changes of venues over the years. The clinic moved into a new building, 905 Franklin St. in downtown Waterloo, in 1999 after having operated in a number of facilities.

The clinic's first home was at Antioch Baptist Church in the 1970s.

With all the changes, the organization's fundamental mission has not changed, Lightbody said.

"Our whole purpose is to provide health access," she said.

And not just minimal service, she added.

"We have some who could go anywhere in town but choose to come to us, because they really like the care," Lightbody said.

A few statistics:

The clinic has the equivalent of about 100 full-time employees.

About 40 percent of its clients have no insurance.

About 30 percent are covered by Medicaid.

About 8 percent are covered by Medicare.

"We do have some people with insurance that often has high deductibles and doesn't cover basic primary or doctor's care," Lightbody said.

Some clients initially came into the clinic because they had no insurance, but came back because they liked the experience, said Dr. Kimberly Neumann, who specializes in pediatrics at the clinic and shares the medical director's role with Dr. Sharon Duclos.

"They came back after they had insurance because they liked the quality of care," she said.

The staff has eight doctors, in addition to nurse practitioners, physician assistants, three dentists and one dental hygienist.

"We don't rely on volunteer provider help," Lightbody said. "We'd love to have volunteers help, but it's usually around our pediatric reading program, where we try to encourage kids to pick up a book and get parents to read to them."

Last year, the clinic served nearly 14,000 patients, with a total of 61,797 patient visits or face-to-face "encounters," in the clinic's parlance.

"A lot of walk-in traffic," Lightbody said.

More than medical

The clinic provides more than medical services.

"We also have social workers and outreach workers on staff to make sure people can get in for services and reach other resources," Lightbody said.

The clinic has one staffer who actively looks for people who have slipped through society's other safety nets and might need help, Lightbody noted.

"We have an outreach worker who checks under bridges, making sure they have shelter or assistance getting their life back in order," she said. "Do you have heat? We can get you to OT (Operation Threshold) for that. There's a lot of work in the community we do."

Last year, the clinic provided service to 804 homeless people, and 6,740 clients were classified at or below the poverty line. Among all clients, 5,211 had no insurance.

"What we want to aim to be is to be the patient's medical home, for their physician, their dental care," Lightbody said. "We want to be able to provide access to people if they speak a different language. We want to be open and accepting and to be able to care for them."

And, in ways more than simply medical treatment, she added.

"We also realize there are needs beyond just having a doctor treating a patient, so we have other services here that they may not be able to afford," Lightbody said. "On site, we have dietitians, diabetic education, x-ray and pharmacy and lab services."

Podiatry and gynecological care also are part of the medical menu, she said.

Neumann said without the clinic many patients would have to turn to local emergency rooms and would have little access to care for chronic conditions.

"Our primary reason for being here is to care for patients who can't afford to get care anywhere else," Neumann said. "If we weren't here, particularly for uninsured or poorly insured patients, they'd have to go the emergency room, and that would not solve their problems in terms of care for ongoing illnesses, like diabetes, asthma and other problems."

Steady clientele

There is a steady stream of clients, but some times are busier than others, Lightbody said.

"It' ebbs and flows," she said. "Any time of year, but certainly with infections, colds and those kinds of things, it tends to be busy," she said. "We see at least a couple of hundred people coming through the doors every day."

The clinic - and others like it - has to fight misconceptions on a regular basis, Lightbody said.

"One thing that is sometimes a misconception in the community is that we have unlimited federal funding," she said. "Our budget is set and we get a certain amount every year, and that usually depends on what's going on each year in Washington and how much funding is going to these programs. From the federal government standpoint, they want to increase seeing patients and outreach and so forth, but they don't necessarily want to increase our funding. That's the struggle."

It is a lot like running a major medical facility, Lightbody said.

"When it comes to a doctor's office, we work with managed care, we bill insurance companies, we have the challenges of technology, with electronic medical records and all the things everybody in the community is trying to get the right solution for," she said.

Medical students who regularly come in to work at the clinic find it a fertile training ground, too, Neumann said.

"Students get a really good experience," she said. "They find they can do more hands-on than they might in a traditional private practice. They get a wide exposure to medicine."

Contact Jim Offner at (319) 291-1598 or jim.offner@wcfcourier.com