On Monday, a man in his mid-thirties walked through the red doors of the Ryan NENA Health Center in Alphabet City, concerned he had caught an STD and anxious because he didn’t have health insurance.
A few weeks after some remiss behavior, he had been out drinking with friends when he was bothered by an itch and ducked into the bar’s restroom to notice an unsettling discharge. His first instinct was to visit an urgent care doctor. “They told me just the visit and the test would cost $225; the shot to get treatment was $350,” he told Bedford + Bowery under the condition that his identity be kept anonymous.
He searched the internet for a health center that wouldn’t entail such a big out-of-pocket expense, and found NENA. He walked in on Monday without an appointment and walked out two and a half hours later having had a consultation with a doctor, screening for STDs, and treatment for chlamydia and gonorrhea. “The doctor was so nice, not judgmental at all,” he said. All in all, his copay was $35.
Although New York City has successfully reduced the rates of HIV infection in the past years, it has, since 2013, seen an upsurge in other sexually transmitted diseases, according to Dr. Jeanne Marie Carey, the medical director of Ryan Health NENA. The infections are mainly chlamydia, gonorrhea and syphilis. “More than half of the sexually transmitted infections in New York City are in people who are 26-years-old or younger,” said Carey, underscoring the importance of routine screenings for STDs.
But the price of health care makes people avoid the doctor like the plague, and since it’s common for these infections to be present without any symptoms it’s easy for them to go unnoticed, and untreated, said Ryan NENA’s executive director, Leslie Pargament. “Someone might suspect that they have an STD and not get treated, hoping it will go away,” she said. “I do think being concerned about ‘how much will this cost’ and being stuck with a huge bill is certainly a reason that keeps people out the doors from either being treated for or screened for STDs.”
The NENA Ryan Health Center is one of several community-controlled and independent health centers spread throughout Manhattan, “from the Lower East Side to Hell’s Kitchen and up to to Harlem,” according to their website. They’ve provided medical care to underserved communities for over 50 years. The first one was established in 1967 in the Upper West Side. They withstood the economic crisis of the 1970s and when the HIV epidemic began in the 1980s, they quickly included a prevention and treatment program. Ryan NENA was created in 1988 when the Ryan network was asked to take over the operation of a struggling health center on the Lower East Side.
During an interview, Carey and Pargament shared impressions about how neighborhood trends are reflected in the type of patients who walk into the clinic. Some of it is certainly due to gentrification, they agreed, though in part it is also just a reflection of broader immigration fluxes.
It used to be that the people who would visit Ryan NENA worked mainly blue-collar jobs: porters or construction workers, as well as people who were unemployed or undocumented immigrants. “We’ve now seen more people who are in professions like music, artists. We’ve seen more of those people. I think it’s thanks to Obamacare,” said Pargament, who said members of this group “might have tried to tough it out” but were now able to purchase some insurance through the New York Health Exchange. “But again, we don’t turn anyone away,” she emphasized. “We’re a federally qualified health center, and our doors are open to anyone, regardless of their ability to pay.”
The health center has also seen an increase in people from Asian and African countries. Carey proudly shared that they have a language line with more than 140 languages available for live translations between doctor and patient. Almost half of the network’s patients are Hispanic or Latino, but the center has also employed “Bengali, Urdu, a whole smattering of languages, so it indicates to me that people are arriving and they are coming to us,” said Carey.
This Thursday at 6pm, Ryan Health will hosts its annual Caring for New York Gala at Capitale, on the Bowery, to help raise funds for the work it does. More than 400 sponsors are expected to attend the event where donations range from $750 for a “young professional’s ticket,” to $75,000 for that of a “health leader.”
Aside from such contributions, the NENA Center is financially able to provide low-cost medical care because most of its patients are insured in some way or another. Seventy-seven percent of its 10,000-plus patients per year are on Medicaid or Medicare, and 13 percent are enrolled with a private insurer. Because of its status as a federally qualified health center, Ryan NENA receives enhanced payment from the government and works closely with the Department of Health to apply for grants that help provide sexual health services like Pre-Exposure Prophylaxis, or PrEP (which lowers chances of HIV infection). It also applies for more local grants enabling it to care for the 10 percent of people who walk into the clinic uninsured, like the John Doe from our story.
On Monday, he looked around him as he sat in the waiting area of the NENA center. It wasn’t big; there must have been 20 chairs to sit in, tops. There were men and women, and they were a diverse bunch: white, black, “mainly Hispanic,” he said as an afterthought.
B+B asked if he knew how the Center obtained funding so that he could pay only $35, instead of the more than $500 he had been quoted before. He didn’t know. What would he have done if he had had to spend that amount? “I would have waited for my next paycheck before going.”
Correction, June 7: This post was revised to correct Jeanne Marie Carey’s title.