Jennifer Fuller was among 31 women who recently went to a Rome clinic for a free Pap screening.
Fourteen of the women had not had a Pap test in the past three years. Two had gone more than 10 years without the screening. (Two years is the generally recommended interval.)
It had been four years for Fuller, 30, of Rome. She has no health insurance and, as a nursing student with three children, has a low family income.
She came to the two-day Rome clinic, she says, ‘‘because they’re doing it free.’’ It costs $200 simply to be seen at a local physician practice, Fuller says.
The free testing at the Women of W.O.R.T.H. clinic provided a complete exam, including the Pap smear to find cell changes that can lead to cervical cancer. Five of the 31 women were found to have breast lumps and were referred for mammograms.
Two women, part of the area’s growing Hispanic community, were referred immediately to a local emergency room — one with anemia and an abdominal mass, and the other with apparent congestive heart failure.
Another woman, apparently the victim of a sexual assault, received a test for sexually transmitted diseases.
The clinic, run by certified nurse midwife Marilyn Ringstaff, is fairly unconventional for the Rome area.
It’s a city with modern hospital facilities and thriving physician practices, yet the clinic, in a modest rented house, fills a void for low-income uninsured women. Rome, like the rest of Georgia, is mainly a conservative area, while Ringstaff is firmly on the other side of the political spectrum.
The steady flow of patients into the waiting room illustrates a crucial gap in the health care system: Despite the array of free and low-cost clinics across the state, many financially strapped patients can’t get certain services they need.
Ringstaff is a fierce advocate for preventive care for women. And she’s a critic of a system that often fails to address the needs of poor, uninsured women.
The Georgia public health system has suffered from years of budget cuts. Ringstaff says Pap screening at public health clinics now is often unaffordable to many women, when they can get such screenings at all.
“We see patients who can’t afford public health,’’ Ringstaff says. ‘’I saw one woman who hadn’t had a Pap screen in 37 years. She had a lump on her breast.‘’ The woman is having surgery this week, says Ringstaff.
Most free clinics in the state do not perform Pap tests.
The Rome clinic is open on Fridays and Saturdays, plus some additional odd hours. There’s nothing fancy about the layout. The former kitchen serves as a lab area, and the vaccine-only refrigerator contains Gardasil, the vaccine for HPV, which causes cervical cancer.
The furniture is donated. Medical supplies are donated as well, or are bought at reduced prices. Volunteers run the office and help with patients.
The women’s clinic gets little funding. The grants that Ringstaff has received help pay for the free Pap screenings.
Besides Pap smears, Ringstaff offers a range of gynecological services on regular office days. She does complete physical exams, STD testing, birth control counseling and prescriptions, and other services, with fees ranging from $20 for an office visit to $45. Many patients who have no money ‘’don’t pay a dime,’’ says Ringstaff, who also works part time in the health law section of the Atlanta Legal Aid Society.
“We do everything a GYN office can do,’’ Ringstaff says. W.O.R.T.H. stands for Women’s Organization for Reproductive and Total Healthcare.
Cancer is a particular focus. Though cervical cancer is highly preventable, about 120 women in Georgia die from it each year — one of the highest rates in the nation.
Among Ringstaff’s hundreds of patients is Christina England of Summerville, whose visit to the clinic led to the discovery of a high-grade lesion on her cervix. Georgia Medicaid has a program that covers low-income women with breast or cervical cancer, and England is trying to get qualified.
England, who until recently was homeless, says she faced problems getting seen at a local health department before she came to Ringstaff’s clinic. “I just wish they paid more attention to women who have these problems,’’ she says of the health department.
For Janie Morris, 60, who lives in a homeless shelter in Summerville, it had been roughly 12 years since her last Pap smear before she arrived at the clinic.
Morris says that during that time, she had no insurance and no money. “I had a job, but it was paycheck to paycheck.’’
A biopsy at the clinic found cancer of the vulva. The Medicaid program did not cover it, but Morris was accepted into a cancer aid plan, and will have laser surgery soon.
Ringstaff also helped Donna Maxwell, 50, of Rome get Medicaid after a Pap test found abnormal cells. “I‘m just so thankful to Marilyn for giving me an inkling of what I had to do,’’ Maxwell says.
“I feel like she saved my life.’’