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Colorado Grant Program Helps Primary-Care Providers Pay Off Loans

Author: Physicians practice in the state’s most underserved areas

The first pelvic exam she performed at Salud Family Health Centers as a doctor fresh out of medical school happened to be with a pregnant Somalian woman who — like more than 90 percent of those refugees in Fort Morgan, Colorado — underwent traditional genital cutting as a girl.

“I did a lot of reading after that,” Dr. Aline Hansen-Guzman, 35, said of the women, who visit the clinic in burkas.

The University of Colorado School of Medicine graduate might never have learned more about the childbirth-complicating condition had she accepted an offer at a private practice in Superior.

But a grant through the Colorado Health Service Corps — one funded through state, federal and private partners — paid Hansen-Guzman her medical school loan debt of $119,500 when she started at Salud in 2009 in exchange for a three-year service contract in the eastern Weld County city of about 10,000 residents.

The Colorado Health Foundation late last year awarded $6.4 million to the program, its largest gift by far since the 2006 launch.

Since then, grants up to $150,000 per applicant have relieved 49 doctors and 18 other health-care professionals of loan debt to encourage them to practice in the state’s most underserved areas, according to CHF.

“(These funds represent) a continued recognition by the Colorado Health Foundation that recruiting and retaining a strong primary care work force in Colorado remains,” CHF program officer Colleen Church said.

Community clinics have trouble finding quality doctors like Hansen-Guzman because they typically pay less and those doctors often face school loan-repayment plans over the next 25 years.

Hansen-Guzman estimated that she took a 20 percent pay cut to work for the nonprofit Salud Family Health Centers instead of in private practice.

The recently bolstered CHSC loan-relief program, administered by the Primary Care Office of the Colorado Department of Health and Environment, may turn that tide.

That change benefits the needy community and providers such as Hansen-Guzman, who said she prefers the diversity that community clinics offer. Half of the Salud caseload in Fort Morgan is Hispanic, and its East African population continues to grow.

Last week, a Hispanic cafeteria worker from the meat-packing plant down the street from Salud arrived complaining of headaches intense enough to cause vomiting.

Hansen-Guzman suspected Leticia Rivas, 54, suffered from untreated high blood pressure — something that had worsened two months earlier. Rivas told her she had depleted the prescription medication she had received in Mexico.

Rivas finally made an appointment with Hansen-Guzman because of the doctor’s good reputation for treating other plant workers and her fluency in Spanish — something she perfected before enrolling in medical school during a Peace Corps stint in El Salvador.

Apart from renewing Rivas’ blood pressure medication, Hansen-Guzman ordered urine and blood tests to check for diabetes.

This type of visit — in which the medical picture gets more complicated due to delayed care — is par for the course, she said.

“You absolutely see a different disease burden here. Some people haven’t seen a doctor in years. They just let things go until they just can’t handle it anymore,” Hansen-Guzman said.

Undiagnosed and untreated diabetes leads to nerve and eye damage; untreated strep throat infection progresses into a pharyngeal abscess that requires surgery; rectal bleeding warns too late of colon cancer.

Still, this environment challenges Hansen-Guzman, who grew up with a single mom, a social worker, in Denver.

With every patient, she flips open her laptop computer with its screen background of her baby boy in his tiger costume last Halloween. She takes down the information in the electronic format rolled out at Salud three months ago and does her best to live up to her new role.

“It surprised me how much more patients rely on you here,” Hansen-Guzman said. “Being in a smaller community, I carry around the ‘doctor’ title more. You can’t hide from it. I’m always a doctor wherever I go.”

For more information on the grant program, click <a href="http://www.cdphe.state.co.us/pp/primarycare/chsc/">here</a>.

By Pam Mellskog, Longmont (CO) Times-Call
 

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