It’s hard to believe that even in a U.S. metropolis of four million people, there are still swaths, entire neighborhoods, where people and children are going without basic preventative care, let alone urgent medical care. And yet, this is the reality in Los Angeles. This Women’s History Month, we honor Michele Rigsby Pauley, a star nurse practitioner and a champion for these communities. Clearly, her career has been more than a profession, it’s a calling.
It’s been 25 years since Rigsby Pauley, RN, MSN, CPNP, and Cedars Sinai Hospital partnered with Children’s Health Fund to develop and launch a model of care that breaks down barriers to care in a place like Los Angeles by meeting kids where they are. Today, COACH for Kids, sees over 3,000 families and their children each year through mobile medical outreach. It also reaches thousands of community members through health education, outreach, and vaccine drives.
We spoke to Rigsby Pauley about her passion to care for children experiencing profound need, how her work on the mobile clinic allows her to care for families and communities holistically, and her deep belief that healthcare is a fundamental human right.
Can you tell us about your journey and how you came to your work on the clinic?
My journey started early on, with my very first job at 15 or 16 as a day camp volunteer in a neighborhood park. I was working with very little kids and at one point I just thought ‘I have to work with these creatures—they’re just fabulous.’
Eventually, I decided you know what? I want to be a nurse. I did well in math and science. I grew up in the ’70s and it was a time of female empowerment; I went to an all girls’ high school; I was a Girl Scout from five to eighteen. I just always felt I could accomplish whatever I wanted to.
My first job as a pediatric nurse was in tertiary care with very sick kids, with very rare illnesses or severe injuries. But as time went on, I went to a lot of funerals for children and when I ran out of fingers and toes to count them on it was time to get on the other end of the healthcare spectrum: keeping kids well and healthy.
I had seen babies who fell off of heights because mothers didn’t know they rolled over at a certain age, or things that were caught too late because parents didn’t recognize the difference between an unwell and well child. My focus became prevention and early detection. That became my mission in life: teaching parents how to keep their kids well and how to recognize when they’re not well.
I returned to school and became a pediatric nurse practitioner, and then moved to LA and worked at Cedars Sinai teaching residents about well-child care. I was the very first nurse practitioner they ever hired at Cedars. This was 30 years ago. I was brought on to revamp the training unit by two physicians who knew the value of what a nurse practitioner can do. The residents were learning all about illnesses but they weren’t really learning about wellness, like nutrition, safety, breastfeeding. I also had my own patient load at the clinic, which was a Medicaid clinic.
Then there were discussions about a mobile clinic at Cedars Sinai and they asked me to get the clinic up and running.
What was it like in the early years?
I thought I knew from my work at the Cedars clinic what poverty looked like, but now I am suddenly in communities like Skid Row and this is a whole different level of poverty. We’re just 10 miles from Cedars Sinai but it’s a completely different world. In ‘94 I didn’t know anything about mobile health care but I was handed the keys and I figured, well, we will just do the same things we do at Cedars but on wheels and in a much smaller space. Figuring out the scope of care for a primary care mobile clinic was the easy part. The hard part was discovering just how much need there was; I had no idea of the depth of the need.
I had to pause and learn so I could meet people where they are. They just didn’t know or they didn’t have the resources to keep their kids well. For example, oral health: you can preach about oral health, but they don’t have a toothbrush. It’s great to talk about nutrition and vegetables and all that, but they don’t have access to it.
One of my very first patients had a simple respiratory infection. At that time we didn’t yet have medications on board, and Mom doesn’t have the two or three dollars to buy the over-the-counter cold medicine. So I give her an easy home remedy: I tell her to run a hot shower and steam up the bathroom to help with the congestion. But she doesn’t have a bathroom to do that. I was able to link her to the LA Mission and they brought her the medication free of charge, but I realized we needed medication on board the mobile unit.
I also realized we needed a social worker because once I took care of the infection, the mother felt comfortable enough to tell me they were living in a car. I just thought how could this be? I could treat that upper respiratory infection; that was the easy part but now I’m sending you home to live in your car? We need to do something about that. The providers for the Children’s Health Fund, given the populations we’re dealing with, look at the whole picture whereas doctors in other situations don’t typically think to do that.
So that’s why we always go out with a social worker: to deal with social determinants of health. A lot of our work is making connections to resources in the community to address the conditions, be they social or economic, that affect people’s well-being. Food access, for example, is a social determinant. Even today, 25 years later, there are families who don’t have refrigerators. They are using ice chests. I didn’t realize these apartments came without them. I’ve never known anyone who didn’t have a refrigerator. So this means they’re eating a lot of fast food. It’s very basic things.
How has the program changed over the last 25 years; has there been a change in the patient population?
The demographics of need have shifted over time. One hundred percent of our patients live at or below the poverty line. So it’s more of the same just different geography. The beautiful thing about a mobile clinic is that when the need has changed, you move onto another area of need. When FQHC’s [Federally Qualified Health Centers] open in areas where we are working we make sure to connect our patients to them as a resource, and then we can move on to other areas. The only site that is the same today is in Watts.
Some areas we go to now, it’s like going back in time. The first day at a new school site, 20 pre-school children lined up and 15 out of 20 of them had rotted-out teeth. These kids hadn’t had any access to dental care or other healthcare; they were way behind in their immunizations.
What are some of the barriers to healthcare that your specific program needs to address?
An issue that you might not expect is the whole gang turf issue. The housing development we were servicing was on a different gang turf than the health clinic. So they weren’t utilizing the clinic. There’s no sign that says you’re now entering Crips or Bloods territory. But they know that if you’re on one side you can go; if you’re not, you can’t.
One of the things we have done is have a representative from the local community health center come with us and station themselves outside our mobile clinic. People can meet a person from the center and have any questions or concerns answered, and hopefully have their fears allayed. Our goal is to have their health center be their medical home, but if they can’t get to these clinics then we become their medical home.
I’ve seen kids that are now grown up who are bringing their kids on the mobile clinic. They trust us, we have a great rapport, and there are no healthcare access barriers and we are happy to be there for them. But we’re not there every day; LA is too spread out. Transportation is a huge barrier to access. So that’s why we try to get the clinic closest to our service sites to come out with us, and they can help with whatever resources they have. We have bus passes to help get people places when it’s an urgent issue.
There are so many issues that are bigger than us. We try to put systems in place to get them the healthcare they need and have a right to. And that continues to be a work in progress—unfortunately.
What are your views on healthcare and where we are today?
Healthcare is a civil right, a basic right. Some people might argue that some kids shouldn’t get anything because they’re not here legally, but from a human, caring standpoint, why not? I just came from an Immunize LA Families Coalition meeting, and we’re talking about the measles outbreak here in California, so from a public health standpoint, you want those around you to be immunized.
Most kids are well; the goal is keeping them well. If you treat an issue early, you save healthcare costs: they don’t show up in the ER with something that was minor and now has progressed to the point where they’re hospitalized. I look at it from the viewpoint of a human being: wellness is a right. It’s the right thing to do. I always think of what Martin Luther King said: “Of all the forms of inequality, injustice in health is the most shocking and inhumane.”