CENTRAL FALLS – What happens when community needs triumph over corporate desires when it comes to investing in health care delivery in Rhode Island?

The answer to the question can be found on Monday morning, Jan. 24, when there will be an official ribbon-cutting ceremony to open the new testing and vaccinations clinic at 597 Broad St., under the leadership of Dr. Beata Nelken, and her pediatric practice, Jenks Park Pediatrics. The vaccine clinic will operate under the umbrella of a nonprofit, the Central Falls Children’s Foundation.

Since her private practice first opened its doors two years ago on Feb. 3, 2020, Nelken, with strong support from Central Falls Mayor Maria Rivera, has reshaped health care delivery in the square-mile city, responding to the urgent community needs caused by the continuing contagion of the COVID pandemic.

Nelken has built her pediatric practice around the creation of a welcoming environment for community residents – and the willingness to treat all children regardless of whether or not they have health insurance. In recent weeks, the news media captured long lines of children and families stretched along Broad Street, awaiting tests provided by Jenks Park Pediatrics and by a site run by the state. [Mayor Rivera invited Gov. Dan McKee to witness first-hand the long lines, which resulted in the state securing an indoor site nearby for testing.]

Nelken’s views were recently shared in an op-ed published in The Boston Globe, “A pediatrician calls on Rhode Island to cover all kids,” in which she wrote: “The COVID-19 pandemic has revealed many of the inequalities in our state, one of these being access to health care.”

Nelken wrote she had opened her private practice for children in Central Falls, a community with one of the highest child poverty rates in the state, “specifically to provide a medical home and free medical care to the children of Central Falls, one of the communities hardest hit by the pandemic.”

One of her strategies has been to create what she described as “an incubator site” for young professionals seeking jobs in the health care industry, hiring employees from Central Falls. Her child-friendly logo – a ladybug wearing a stethoscope – has become a familiar sight throughout the city.

“Families feel welcome here and they trust our care, which is the greatest honor for me,” she told ConvergenceRI in an interview conducted last week late in the evening, after another long day spent treating an overflow of patients.

“I think it is really a delicate matter to ask uninsured adults to come in for a vaccine that they may or may not trust, into the office of a stranger, when they may or may not have literacy skills, and they definitely don’t speak English,” Nelken said. “It can be very intimidating.”

Based on the demographics of the population that her practice has seen, Nelken continued, “50 percent of all our vaccinated patients and testing patients every day are uninsured, which to me is a huge vote of confidence from the community that we are meeting their needs.”

The new facility will serve the needs of the overwhelming demand for testing and vaccinations by adults and families, with the original home of her practice at 577 Broad St. reserved for pediatric patients.

Here is the latest ConvergenceRI interview with pediatrician Dr. Beata Nelken, whose career ConvergenceRI has reported on extensively since 2019, detailing her plans for the new facility that she hopes can be expanded to offer an array of services – including behavioral health services and perhaps even a gym – all driven by community needs.

ConvergenceRI: How did you make this happen, launching a new facility?
NELKEN: Honestly, it was mostly [Central Falls Mayor] Maria Rivera, who was the driving force behind all of this. I had secured the building, and I was going to keep it residential, because we didn’t have the bandwidth to expand out financially.

Mayor Rivera helped us to secure private and public investors – one is a private foundation that wishes to remain anonymous, and the other is still in development.

Two years ago, I asked Maria Rivera to be the president of the board of the Central Falls Children’s Foundation. She declined because she was announcing her run for mayor the next day. She ended up being that most important person for the foundation anyway, just in a different role than I had imagined.

ConvergenceRI: What does the expansion of your practice say about how to reinvent health care delivery based upon community needs?
NELKEN: We designed our practice with an ability to stay flexible, based on where the currents take us. We have to stay connected to the community, so that we can respond when the need changes.

While it is lovely and nice to set up a little private pediatric office and see your small roster of patients in it thrive, if we are paying attention to what is going on in the streets and in the community, we know that there are other urgent needs.

As long as we can extend ourselves in a healthy manner and maintain sanity, meeting some of those urgent needs, everyone is better served.

ConvergenceRI: What has been the response to everything that you have been doing?
NELKEN: I can only gauge by the line outside my door, which is encouraging – and the growing number of pediatric transfers that I receive on a daily basis. To me, it says that we are doing something right. And, we hire from the community. We are “of the community, by the community, for the community,” as I like to say.

ConvergenceRI: You are responding in real time, to the needs of the community, as an improvisation, a call and response. Is that accurate?
NELKEN: Absolutely

ConvergenceRI: Those are the kinds of skills that they do not necessarily teach you in medical schools, I would think. Philosophically, looking ahead, what are the lessons that medicine and the delivery of health care can learn from what you are doing?
NELKEN: We have to learn how to blend our social programs with medicine. And, the better we can do that, the better we will meet the needs of the public.

My next project will be securing a transportation van for my patients, to help them get here for their vaccine and pediatric visits with their toddlers, instead of having to walk across the one-mile city. However short that [route] is, it is still a lot for little feet.

My top priorities are getting transportation for my patients, getting more responsiveness with our call center, getting mental health support, getting tutoring, and eventually, getting physical exercise equipment, and maybe even creating a dream gym one day for the community. We have a layering of infectious, mental health, and obesity pandemics to tackle ahead – there is plenty of work to be done.

There is so much potential in this community; I want people to thrive fully. And, unless they have all the tools to do so, they are not going to be able to meet that potential.

In the pediatric arena, those are priorities, at least as I see them.

ConvergenceRI: I know you have recently advocated to “cover all kids” in a recent op-ed in The Boston Globe. Apparently the Governor is listening in part, proposing to cover all kids in Medicaid.

Yet when he claimed that 98 percent of all children in Rhode Island have access to health insurance, I wonder, from your direct experience, is that statistic accurate? I suspect that there may be a large number of children and adults who are uninsured. When you talk about covering all kids, what is your definition of what that means?
NELKEN: Ninety-eight percent of the kids who are counted are insured. But there are many families who mqy not be here in a legal manner, and who may not be included in any official count. The Central Falls Census jumped by more than 3,000 from 2010 to 2020, due to enormous efforts by the city and community in Census outreach. Those are 3,000 people that may have been here all along, but were just not counted in any official manner. There are many more still uncounted behind them. The 98 percent is only as accurate as your denominator is reliable.

It has been estimated that 20 percent to 30 percent of the kids in Central Falls are not covered by any insurance. It could be that the rest of Rhode Island makes up for that, but my sense is Pawtucket is around 20 percent for uninsured kids, and Providence maybe 10 percent. And, granted, there are plenty of suburban cities and towns to make up for those numbers, but I go by what I see in the clinic, what I experience on the ground, and it is nowhere near 98 percent, not by a long shot.

ConvergenceRI: When you are building your team for your practice, you said that you put an emphasis on hiring people from Central Falls. From my experience, working as an editor and reporter with the alternative news weeklies in the 1970s, back in their heyday, people wanted to work for them, because it was invigorating to be actually turned loose and be able to write and report what you wanted to write about, what you observed. Have you experienced a similar kind of response? That people want to come work for you?
NELKEN: Absolutely. It is not hard to find people. My strategy has been to focus on people from Central Falls first, especially focusing on medical professionals of all skill levels – whether they are medical assistants who can’t get their first job anywhere else, whether they are students, or medical assistants who are going to college part-time and need part-time work to support their career in their field while parenting.

I have several pre-med high school students who are employed here, part-time. I have hired several part-time college students who are pre-med, some of whom have gone on at different points to research positions at Dana Farber and gotten scholarships.

We also have international doctors that are from the community and speak the languages of the community, who are in the process of applying for residency here in the United States and will eventually get their licensure.

It is an incubator approach for the community of Central Falls in the medical professions.

ConvergenceRI: Is your approach to community-based health care delivery something that could be scaled in other communities, by other entrepreneurial, community-minded practitioners? If it works in Central Falls, I assume it could work in other communities around the state that are really in need of this kind of approach to health care delivery.
NELKEN: Absolutely. It is all about the community. You want to hire someone from the community who lives the experience, and who knows where the needs are, and who can guide the clinic in how it delivers its care, based on the feedback in real time. It is scalable and needed in other communities.

ConvergenceRI: Your partnership with Mayor Rivera has really helped this come project to fruition. How important is it for elected officials to engage in this kind of partnership that prioritizes community needs, in a collaborative approach?
NELKEN: I can tell you, from a personal standpoint, I am too focused on the clinical care and the day-to-day management to know what resources are around me. To have someone with that wider community lens, to pull resources together building a stronger nework of services, that is something that can be done at a leadership level. So, whether it is the mayor or other community leaders that have a broader perspective and are able to leverage assistance, it is a critical link.

I am beyond grateful for the assistance that has been provided.

ConvergenceRI: So, is it true that good people will find each other?
NELKEN: For sure.

ConvergenceRI: What exactly will be happening at the ribbon-cutting ceremony on Monday? I assume that there will be officials there and that there will be speeches. And, also, that you will try to avoid being in the spotlight.
NELKEN: There is some formality to it, only because I feel like this was not built by me. This is Mayor Rivera’s community center, basically. I want to give a public space to honor that.

Tufts Health Plan and Neighborhood Health Plan of Rhode Island are both going to be there and say a few words.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to talk about?
NELKEN: The private foundation really stepped up and provided the investment for the formation of the nonprofit to happen. So now we have the platform to provide extended specialty care for kids without insurance, if they need to go to a specialist, or get an x-ray or a lab, or go to a dentist, all things that they would have had to pay for. Now we can help them reduce the costs, if not get the services to them for free.

And, we have this fully staffed, operational vaccine clinic in a new, beautiful space, open to all comers in the city, because of them.