This post was originally published on St. Louis American

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In July, Gov. Mike Parson signed off on Missouri’s 2023 state budget which included nearly $150 million in funding for primary care and behavioral health services. Joe Pierle, CEO of the Missouri Primary Care Association, applauded the effort because it underscored the importance of community health centers and workers who “were so vital in the pandemic response.”

Dr. Abbe Sudvarg, a Family Medicine Specialist in St. Louis, is among the community health center practitioners who heroically rose to the challenge of serving lower income individuals and marginalized communities during the COVID-19 pandemic, one of the worst epidemics in 100 years.

Sudvarg, a 1985 graduate from University of Missouri-ColumbiaSchool of Medicine,  has been a practicing family physician since 1988 and has been with Family Care Health Center in St. Louis’ Carondelet neighborhood since 1994.

Unlike other medical professionals who avoid politics and protests out of fears of damaging their careers, Sudvarg embraces the risks.

She’s board chairman of the Peace Economy Project, an organization that publicly challenges unchecked military spending and advocates for the conversion from a military to a more stable peace-based economy.

She’s a member of “White Coats for Black Lives” (WhiteCoats4BlackLives or WC4BL), a social justice organization dedicated to fighting racism in medicine and health care.She was among WC4BL members who protested the police killing of George Floyd in 2020.

Does she worry that her political passions may clash with her professional obligations?

“No, I feel that what I do as a physician is very consistent with my political values,” Sudvarg replied.

“I am relatively careful not to bring my politics into the exam room. Because I work for an agency that takes care of people who have been historically low income, most of the people I work with share at least a fair degree of my perspective about the political world.”

Politics aside, Sudvarg is one the community health center practitioners who’ve played crucial roles in the past three years. Pierle spoke to this in a recent commentary.

“Over the past few years, through each successive wave of the pandemic, state leaders have depended on community health centers to respond to emerging needs,”Pierle wrote, adding: “They’ve answered calls for help with testing across the state — showing up to assist schools, nursing homes, private businesses, law enforcement and homeless populations.”

With the population I care for, people are anxious, they don’t know how they’re going to pay their rent or get their kids educated, all this creates anxiety and depression.

Dr. Abbe Sudvarg, Family Medicine Specialist

According to the Kaiser Family Foundation (KFF), among the roughly 28 million patients served by health centers, 91% are low-income and 63% are racial or ethnic minorities. The COVID-19 crisis has disparately harmed low-income households. Those concerned know these people suffered economic and health-related deficiencies disproportionately. What many may not know, as Pierle noted in his commentary, is how “extremely adaptable” community health centers were to the changing needs of marginalized communities throughout the pandemic. Sudvarg said this is what community health centers have done even before the pandemic.

“For the entire time I’ve been in this work, I’ve taken care of people who do not have the resources that folk with private insurance have,” Sudvarg explained.

“So, we are experts at finding resources and offering options to patients based on what resources we have. Because we are not always able to give our patients exactly what we prefer to provide, we’ve learned through the years how to provide what they can receive and the way we are structured allows us to evolve to address those needs.”

One of those needs addressed during the pandemic, Sudvarg said, “was free COVID testing sites open to any member of the community.”

Additional family care clinics offered virtual care for people who were not ill enough to be hospitalized but needed medical support. Being adaptable allowed community health clinics to provide services for essential workers like nursing home staffers, bus drivers and meatpackers-people who had no choice but to report to work.  

“So many who had higher-incomes or jobs with health insurance were able to stay home during those early days of the pandemic,” Sudvarg recalled.

“Well, people with lower incomes or were caregivers…they weren’t able to stay home. We even serve people who refuse to get vaccinated. We did a lot of virtual care and that made a difference in their lives.

The KFF report defined community health centers as “a national network of safety net primary care providers that fill an important role in national, state, and local responses to the coronavirus pandemic.”

The centers, KFF noted, contributed to response efforts by providing tests, triaging patients, and reducing the burden on hospitals.”

Sudvarg gave an example of how Family Care Health Centers served in this capacity. 

“We provided Pulse oximeters [a testing tool that measures oxygen levels] to people in their homes so they could check their own oxygen levels and have a better idea when to call 911 and get to the hospital.”

If, or when, the pandemic ends, the work ofcommunity health centers will continue.  According to Human Rights Watch, since the start of the pandemic, 74.7 million people lost work; with the majority of jobs lost in industries that pay below average wages. The latest Census report states that 12.1% of Missourians live in poverty.

Based on her experience serving members of disenfranchised communities, Sudvarg is seriously concerned about the lack of resources and care for people with mental health challenges.   

“Low-income people often struggle with mental health issues anyway whether it’s being poor-not having enough money or not having enough resources for the rest of their lives…this creates anxiety and depression,” Sudvarg said.

“This pandemic has hugely increased that. People have been socially isolated and that’s terribly affected children who are struggling anyway in households where resources are limited. With the population I care for, people are anxious, they don’t know how they’re going to pay their rent or get their kids educated, all this creates anxiety and depression.”  

Sudvarg has spent 37 years in medicine; delivering outpatient and inpatient care, including adult medicine; she’s done obstetrics which includes labor and delivery, and she teaches at St. Louis University’s residency program. Thankfully, she boasted, there are aspects of her work as a community health center physician that still brings her joy.

“I love what I do. I’m an intimacy junkie so I love interacting one-on-one with patients. Healthcare is never, ever boring and my work is so broad-based. There’s always more to learn and I love being a life-long learner.

“I’m always learning. It’s fun.”

Sylvester Brown Jr. is The St. Louis American’s inaugural Deaconess Fellow.