Los bebés y el río

I am SO sick of the story about the babies floating down the river.  You know... the one where a village discovers dead babies floating down the river and keep pulling them out, one by one, until finally someone thinks to go up river and find out exactly why there are babies dying and floating downstream.

Lately I feel like I'm constantly pulling babies out of the river while my heart just wants to run up the river and work on the underlying issues.  (I guess it's a good thing I'm applying to public health school instead of medical school...)  Obviously the big underlying issues I'm dealing with are health care and immigration, but I think it would help to be a little bit more focused in my case.  Currently, there are two big on-going issues at the Good Samaritan Clinic:
1. Tons of our patients are from more than an hour away in rural Georgia.  This makes their care quite difficult, since they can't exactly run down the street to get their fasting lab drawn or to have an X-ray or whatever.  In fact, most of them can't make it to do a new patient assessment with a nurse before their actual appointment with a doctor, which creates less productive appointments in the long-run. I get super frustrated by this and wish I could just go start another clinic with Good Sam's model in Claxton or Hinesville or Glennville...but instead, I spend hours on the phone each day trying to coordinate peoples' appointments based on travel and my patients waste valuable work hours in the car going to and from Savannah.
2. Another clinic in Savannah is absolutely horrible according to many of its patients.  The clinic is a federally qualified health center (aka it receives lots of federal stimulus money) and currently gets all of the Chatham County health care funds (the latter point is supposed to change soon, but that's a relative amount of time in the south...).  They charge their patients based on a sliding scale, but are very militant with making sure to collect the money.  Most people are charged $12 per visit and $7 per prescription, which isn't a lot of money and obviously doesn't help much with the operations costs.  However, many of the people who come to my clinic are barely making it financially, so an extra $20 or so will actually break the bank.  Theoretically, the other clinic isn't allowed to turn people away if they can't pay, yet person after person has come to my door and said that they were made to feel unwelcome because of their inability to pay (especially at the end of the month).  Good Samaritan doesn't receive federal, state, or county money, and never has.  We want to serve everyone we can, but it seems ridiculous that we would be expected to pick up the slack of another clinic in town that keeps getting more and more funding.  I want to find out why the other clinic is being so ridiculous (after all, maybe it's just one or two tough employees) and what we can do to work collaboratively.  However, I feel so overwhelmed with keeping up with all the other daily operations work at Good Sam that I would have no way to figure out what's going on at the other clinic.

In a way, I know it would be worth the time investment to think creatively about how to be more efficient with the care at Good Sam.  I can think that all I want as I sit here calmly, on my couch on a Tuesday evening.  However, when the phone is ringing off the hook and people are ringing the doorbell and Good Sam is experiencing lots of internal changes as it is, it seems nearly impossible to do more with my working hours.

No wonder people are scared of big reforms in this country.  I think it's kind of a comfort to focus on what's in front of our faces and not dig deeper.  After all, asking questions can lead to very messy answers.