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Management in Practice

Leading through COVID: Delivering Holistic Healthcare in an Underserved Community

In this series, we talk with Yale SOM alumni about their professional and personal lives during the global pandemic. Dr. Suzanne Lagarde ’14, CEO of Fair Haven Community Health Care, describes how her federally qualified nonprofit health center is both adapting and expanding to meet the additional needs of an underserved community.

Adapted from a phone interview on September 2, 2020.

Q: How has COVID impacted Fair Haven’s patients?

It’s a difficult time for lots of people. Many factors impact health—food insecurity, poverty, systemic racism, gun violence, domestic violence. These issues that we call social determinants are always on our radar; our patients are living with them every day. The pandemic’s health and economic impacts have come on top of that.

Anxiety is high. Mental health visits are at an all-time high. Lots of our patients are dealing with economic issues. Food insecurity is huge.

Before COVID, we were hosting a food bank on the third Saturday of every month in conjunction with the Connecticut Food Bank. In February, which was the last one that we held in that fashion, we had over 300 people show up for food. Because of the pandemic, starting in March, we were able to get some funding to partner with M7, the cab company. A line of cabs comes into our parking lot. We load them up with boxes of food. The company does the routing to a list of people who know it’s coming. The drivers love it because they ring the bell, leave the boxes, and there are people at the window thanking them. We’re trying to accommodate the need, but the magnitude of the demand at this point has really expanded.

The other big thing is the state, quite appropriately, is pushing us to test, test, test. If you drive through Fair Haven you will see large billboards that we put up encouraging people in the community to come get tested. In addition, we’re testing in nursing homes. In Connecticut most of the fatalities from COVID were in nursing homes. Very early on, we worked on testing and the response to positive cases at the Mary Wade Home, which is in our community and where many of our patients are staff. Mary Wade is now in an excellent place. As a result of that initial work, we were invited by the state to work with eight nursing homes.

Q: Fair Haven was a busy healthcare provider before COVID. Is it possible to deliver non-COVID healthcare?

We have 18,000 people we care for. For months, people with diabetes, hypertension, and other chronic illnesses that we know are significant in our population were not getting the attention they deserve.

We had been introducing dental services into our practice. That stopped completely when COVID hit. In January, we opened a new site in Branford in partnership with another nonprofit called BHcare. It is a great resource, providing fully integrated behavioral health and medical care. Since it was opened just five weeks before the COVID lockdown, we haven’t been able to really market it.

For a while, 96% of our visits were telemedicine. As part of getting us back to face-to-face healthcare, I now know more about HVAC, air flow, and filtration units than I ever expected to know in my lifetime. We have more demand than we can meet for in-person care because we can see only so many people while keeping everybody six feet apart. That’s just another challenge we’re confronting.

Q: Has the pandemic delayed other projects?

We’ve had to pivot in some things, but we’ve also continued with plans that we had before.

We were one of a small number of centers in the state to get grant funding from the Federal Communications Commission for a pilot program on remote patient monitoring. Patients with complex chronic illnesses will be using Bluetooth-enabled home devices that are going to give us real-time data every day for blood pressure, glucose, weight, and temperature. It’s a new exciting undertaking for us. But I can tell you in the state of Connecticut, they don’t reimburse for it, so we’re doing it because it’s the right thing to do.

“It’s incredibly demanding. I’m working literally 14- or 15-hour days seven days a week. It’s also something I wouldn’t trade for anything.”

In October, we will take over the care of 12,000 children who currently are cared for at Yale New Haven Hospital’s Primary Care Center. This has been in the works for five years. We just didn’t plan on doing the implementation during a pandemic. We’re going ahead. It’s an opportunity to bring our brand and our care to more people. But it’s an additional layer as staff who are already working very hard are also doing the work of opening a large new site.

Q: What has it felt like to deliver healthcare during a pandemic?

In terms of COVID, Connecticut is in a better place, today, because of social distancing and wearing masks all the time. But, early on, we had patients and staff getting sick. Fear was a huge factor for everyone, myself included. We knew providers in health centers in the state and certainly in the country were dying. We really had to rally the forces.

Our staff has done incredibly well. We’ve had some turnover, but most people rose to the occasion despite their fears. About 10% of our staff have gotten the infection; no one has died. Fortunately, we were spared that tragedy. We still get an occasional staff member who tests positive, but in all instances I’m confident those were community-acquired, not work-acquired, infections.

For me and for many on the staff, the biggest anxiety has been bringing the infection back to my family. It’s been a very stressful time. It’s a very isolating time. But as the need has expanded in numbers and in urgency, it’s what we are here for.

I’m in the eighth year of doing this. It’s incredibly demanding. I’m working literally 14- or 15-hour days seven days a week. It’s also something I wouldn’t trade for anything.

During the pandemic, someone approached me with a job that 10 years ago I would have jumped at in a heartbeat. But now, I could not leave Fair Haven.

I’m making a difference. Some days it’s hard to know that for sure, but I hope I am.