What started as a single storefront free clinic in Watsonville in 1978 has grown into the county's leading provider of health care services to the low-income families of Santa Cruz County.

Salud Para La Gente, which translates into English to 'health for the people,' will celebrate its 30th anniversary of incorporation as a nonprofit in fall 2010.

Those 30 years are filled with both triumphs and challenges. Among these heartaches was a funding crisis that threatened to close or significantly curtail the agency's services a few years ago.

However, that adversary was met with change and that change helped the organization blossom into a larger and more full-service health provider than ever before.

Salud's first clinic has grown into a primary health care network with 12 locations in both Watsonville and Santa Cruz, including seven school-based clinics in the Pajaro Valley Unified School District, the adult day health center called Elderday in Santa Cruz, and services including dental, vision and mental health care.

President and CEO Sister Julie Hyer attributes the organization's success and growth to its collaboration with other local agencies to bring individuals and families into the health care fold.

"We've really worked to identify where the real needs are. Early intervention can make a real impact on people's lives," Hyer said.

Productive Partnerships

Hyer and Sara Clarenbach, the agency's director of advocacy, are especially proud of the partnership Salud has built with the Pajaro Valley Unified School District.

Salud has operated clinics in two of the district's middle schools for a number of years, and this year expanded services at them to 20 hours a week.

In addition, this fall it added clinics at five Watsonville elementary schools, offering four hours each of weekly medical and dental services. Another success arose out of a grant from Driscoll Strawberries through the Santa Cruz County Community Foundation. In cooperation with growers, Salud offers health care talks and screenings to field workers, conducting before and after surveys.

Although the program just finished its first of three years, one of the participating growers, Reiter Affiliated Companies, has already created a clinic for its workers, Clarenbach said.

"It's quite a wonderful win-win situation," she enthused.

Salud also works with Watsonville Community Hospital to encourage people who visit the emergency room to find a "medical home" at a safety net agency such as Salud.

Salud has been designated a federally qualified health center since the 1990s and works closely with federal Medicare and the state's Medi-Cal programs, as well as private insurers and donors. This spring, Salud received $303,327 in federal stimulus money. The money is going toward hiring four more physicians.

Hyer and Clarenbach point with pride to Salud's ability to attract and retain doctors even after a federally mandated two-year commitment has ended.

Overcoming Challenges

Recent deep cuts to state health and human services funding have hit some of Salud's efforts, but perhaps its greatest financial challenges came when a 2006 county audit uncovered financial mismanagement. With more than $4 million in debt, the health agency was threatened with bankruptcy.

Instead, it recruited several new managers and turned its finances around. Former Dominican Hospital CEO Hyer joined the organization in 2008 as part of its efforts to reorganize.

"The board of directors was so committed to Salud and the patients and the programs, and the providers never lost the focus of giving care to the patients," she said, convincing her that the organization could survive.

In December, Salud qualified for a lower-interest loan of up to $4.8 million from a public bond program that will replace variable rate loans. The money is being used pay for improvements to its sites. Among those, Salud is adding 12 exam rooms to its Neilson Street clinic, for a total of 19 rooms.

The number of patients using Salud's services continues to grow.

In 2008, the agency recorded more than 102,000 visits and 18,000 patients, more than the emergency rooms at both county hospitals combined. For the first 11 months of 2009, it served more than 19,000 patients and had already reached the 102,000-visit mark, said Clarenbach.

The organization joined other providers to fight a state budget move that would only allow patients to participate in programs like Salud's Elderday three days a week rather than five.

Clarenbach explained that the participants in these programs suffer from conditions such as congenital heart disease and dementia, and without Elderday services would be forced into more expensive nursing homes.

A court stay has protected the program for the moment.

As Salud looks toward the future, its leaders worry that the "hideous debacle" of last year's state budget cuts will be repeated, leaving safety net services with even more demand and less money. However, they are positive about the move toward national health care reform.

"There is a place for community health centers at the table. We are the cornerstone of a new system," said Clarenbach.