DALLAS — Robert Garcia sat on an examination table, his hands in his lap with his fingers laced together. He looked at ease even though he was at the doctor’s office.
The 61-year-old considers his doctor a friend — in addition to someone who cares about his health and whom he trusts to treat him well.
“They helped with my medicines and some sicknesses,” Garcia said as he waited to be seen at the south Dallas clinic. “They’ve been real good to me, real nice.”
The two doctors who work at The Baylor Scott and White CitySquare Clinic make it a point to build relationships with their patients. Instead of the typical 15-minute visit, they see their patients for at least 30 minutes at a time, and live in the same neighborhood as most of them.
They’ve visited barbershops to spread the word about their clinic and have partnered with faith leaders in an attempt to build a bridge of trust that health experts say is often missing between doctors and communities of color.
The Dallas clinic is in the 75215 ZIP code, where residents have one of the lowest life expectancy rates in the state at 67.6 years, according to a UT Southwestern study.
The neighborhood is similar to those in Fort Worth’s 76104 ZIP code, including Historic Southside, Hillside and Morningside.
The 76104 ZIP code has the lowest life expectancy in Texas at 66.7 years. The Fort Worth Star-Telegram analyzed the records of 396 deaths in the ZIP code that were investigated by the Tarrant County Medical Examiner’s office between 2005 and 2014 — the time frame of the UT Southwestern study. The No. 1 cause of death was heart disease, which can be linked to factors such as poverty, lack of access to health care and insurance, poor availability of healthy foods, lack of exercise and pollution.
But there is a difference in Dallas’ 75215 ZIP code: Residents have a clinic in their neighborhood, where doctors know their names and the struggles they face. The clinic was opened the year before the study concluded, so it’s difficult to measure the effect the clinic has had on life expectancy, but the doctors who work there see the value in what they do.
And, they’re “more than just doctors,” Garcia said.
The CitySquare Clinic, on Al Lipscomb Way near Fair Park, is within walking distance of a post office, a Family Dollar, a salad restaurant and a produce store — businesses and services that are lacking in Historic Southside, Hillside and Morningside.
To break another transportation barrier, the clinic has a small pharmacy inside.
Just over 1,800 people of the ZIP code’s 15,000 residents are without insurance, according to the U.S. Census. Of those with insurance, more than 50% use public insurance.
“We wanted to see what the need was in Dallas, and we did a lot of research to understand where the city is divided,” Dr. Benjamin McKinney said. “We saw that where there was concentrated poverty, there was also a lack of medical resources.”
The hospitals in Fort Worth’s Medical District, which are in the 76104 ZIP code told the Star-Telegram they don’t have clinics in Historic Southside, Hillside or Morningside because the hospitals are close to the neighborhoods. But residents on the east side of I-35W see the interstate as a divide between them and the healthcare services on the other side.
For the more than 1,118 households in the ZIP code without cars, getting to the Medical District is difficult, particularly for those who live on the east side of the interstate.
Barriers extend beyond transportation. They can include income, access to health insurance and even a patient’s trust in the medical system.
That trust is why doctors Benjamin McKinney and Garrett Schwab live in the neighborhood they serve.
“Being white males in a neighborhood predominantly filled with people of color, I think it helps to step in and build a bridge to the barrier that’s there,” McKinney said. “I think there’s a lot of walls up for one reason or another when it comes to caring for patients, and so much of the medical field is built on trust. Patients have to trust their doctor if they’re going to take their medicine when we’re giving them something they might have to put into their body for the rest of their lives.”
The trust became important when COVID-19 began to spread throughout Dallas-Fort Worth.
As of Sept. 9, there were 671 known COVID-19 cases in the 75215 ZIP code, according to data released by Dallas County Health and Human Services. The data shows that the ZIP code is in one of the lowest affected areas in Dallas. Its neighboring ZIP code, 75217, is one of the highest.
Since the start of the pandemic, the doctors have shifted their focus to working in the hospitals and less in the clinic. McKinney said he has seen that Black and Hispanic residents have been affected by the virus more harshly.
“I think there’s still some questions of why, but we’re really looking at those social determinants and the lack of resources that were already in place in some areas,” he said.
Many residents in the Fort Worth neighborhoods are unaware of the services offered to low-income or uninsured people by the nearby hospitals, the Star-Telegram found.
In Dallas, McKinney and Schwab make their presence known in the neighborhood.
Even without official marketing, the clinic sees about 80 new patients a month.
Recently, an increasing number of those patients have been from the Hispanic community, which isn’t the closest to the clinic, but word of mouth has built trust.
“I think, with the current climate of politics right now, and that fear of taking help from the government, for fear of deportation, I think when patients can come and say, ‘You know, these people love me and they care for me, and I’m safe, and they look out for me, and they not only give me what I need, but they speak my language and they want to be a part of my life,’” McKinney said. “I think that’s why people come here.”
Because of coronavirus, the clinic began operating more strictly, which reduced the number of patients being seen on a given day. Patients are allowed inside one at a time, and their temperature must be taken before they enter. Those picking up a prescription must wait outside for someone to bring it to them.
After learning about the Star-Telegram’s findings about the lack of health care in some neighborhoods in Fort Worth’s 76104 ZIP code, McKinney said he thinks the affected neighborhoods could benefit from a similar clinic.
There are no such plans by any of Fort Worth’s hospitals. The county-owned John Peter Smith Hospital plans to build clinics as part of an $800 million bond package approved in 2018. But it’s not yet known what areas will get them — the hospital serves all of Tarrant County, not just Fort Worth.
County spokesman Bill Hanna said a decision hasn’t been made on the locations of four regional medical centers.
The medical centers will be similar to the Medical Home Northeast Tarrant facility in Euless. It services include behavioral health, enrollment eligibility, lab services, primary care, radiology, pediatric care, a pharmacy and other services that go beyond a traditional clinic.
These clinics are more extensive than the one in Dallas, but McKinney said any kind of additional health services for those neighborhoods would be helpful to residents.
Health is a small piece of the puzzle, he said, explaining that the clinic asks patients to fill out a social-needs questionnaire. Clinic employees can help connect people with services that help pay bills, get healthy foods and transportation.
“This allows us to take better care of our patients,” McKinney said.
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