Photo by Sam Yu Dr. John Jayman of Westminster was the dentist on duty for a recent Mission of Mercy clinic at the Frederick Church of the Brethren. Here, Jayman works on a dental problem for Griselda Torres of Walkersville.

All three had toothaches but no money, and they were hoping to see a dentist free of charge.

Health care may be available if you're poor in Frederick . But just try getting dental care when you're counting every penny.

Every other week, the Mission of Mercy's mobile health clinic arrives at the Church of the Brethren, on Second Street and Fairview Avenue, to offer health and dental care to those who can't afford it. For medical care, patients who haven't been there before are screened on a first-come, first-served basis. Once examined, they can make appointments.

Dental care is different, however. It's always first-come, first-served at the clinics. There's only enough money and time to offer tooth extractions and fillings. That means a tooth that could be saved with a crown or a root canal will probably have to come out.

It also means that routine cleanings that might keep teeth healthy are not available. So the poor have to wait until a tooth is in bad shape to get it treated.

Castrot and Salinas were joined by Edward Vaca, who also needed a tooth pulled.

"There's no money," he said. He works in a local restaurant, and sends money home to his children in Bolivia.

Jaime Starnes works in medical billing in Rockville. She has health insurance, but it doesn't cover dental needs. She is married, has four children, and pays $700 a month in day care alone. She needed to have a tooth removed.

"I waited too long," she said. She called Mission of Mercy, and was told to arrive at the Church of the Brethren before 4:30 a.m.

Even that might have been too late. She was eighth in line.

Life at the clinic

Doors open at the Mission of Mercy medical clinic between 7 and 7:45 a.m. By that time, Torres, of Walkersville , had been waiting five hours.

It was about 9:30 a.m. when Westminster dentist Dr. John Jayman was able to usher her into his dentist's chair to remove the aching tooth. Total waiting time: five hours. The root of her lower right molar had rotted.

"My hope is, one day we'll have funding for a dental van," he said.

Until then, valuable time is lost while a makeshift dental clinic is set up inside the church meeting room, which also doubles as the registration and waiting area for the Mission of Mercy clinic.

If a mobile clinic existed, Jayman said, "I could see twice as many clients."

"Getting it together and keeping it organized is a challenge," said Allen Harris, a volunteer who made sure Jayman had all the supplies he needed. "He has about four-and-a-half to five hours to see patients."

Fillings generally take longer than extractions.

"We need dentists in the community who could take our patients," said Linda Ryan, executive director of the Maryland/Pennsylvania clinics.

Funding shortfall

It costs Mission of Mercy about $20,000 annually to run the dental clinics for the organization's Maryland and Pennsylvania sites. Last year, 1,026 patients were seen. Most are adults, although a few children and senior citizens are seen. Low-income children and seniors get free dental care from the Frederick County Health Department, but sometimes transportation is an issue.

Mission of Mercy operates nine medical and seven dental clinics in central Maryland and south-central Pennsylvania. Four are in Frederick County, but as of Nov. 1, the Thurmont clinic will shift to Taneytown, and the Mount Airy clinic will close because of a drop in funding. These clinics exist on donations and grants from foundations.

The medical program locally costs $1.9 million annually.

The clinics are set up in churches and community centers. Three examining rooms and a small pharmacy are set up in a Winnebago that can be driven to each clinic. Patients wait inside until called for their appointments.

Donations and grant money to pay for these services dropped by $600,000 from 2007 to 2008. Last year, the nonprofit took in $4.7 million in grants, donations, supplies and in-kind services to support its clinics in Maryland, Pennsylvania, Arizona and Texas. Expenses to run the entire program total $4.8 million.

Gianna Talone-Sullivan, a pharmacist, and her husband, Dr. Michael Sullivan, a physician, founded Mission of Mercy 15 years ago in Emmitsburg . Spirituality, not religion, is dispensed along with care.

"We're not here to proselytize," Sullivan said. "We integrate spirituality and medicine. That's our goal."

Talone-Sullivan is known for her claims to have mystical experiences, but none of that is apparent at the medical clinics. Workers wear crosses, but do not discuss faith.

"We are experiencing a decrease in funding, and at the same time, there is more need than ever," Sullivan said.

Eighty percent of Mission of Mercy patients are employed, according to development director Jennifer Gerlock. The vast majority, however, cannot afford health insurance. Eighty percent also have chronic health problems, Ryan said.

"Minor problems become major," she said.

"They're here because they have no other choice," Sullivan said. He told the story of a patient who had an ordinary case of basal cell skin cancer, which can be easily treated by removing the lesion. She did not have the money to treat the lesion, and left it alone. Eventually, it became infected and caused blood loss.

Another patient was between jobs, and between insurance providers. She needed several prescriptions for a chronic health problem. Her own doctor required an office visit, which she couldn't afford. Mission of Mercy provided her with the prescriptions.

"The two words I have yet to hear in this whole health care debate are love and dignity," Sullivan said. The goal of the organization is for all patients to be treated with dignity, not judgment.

Clinic at Faith Baptist Church

"This is my first time here," said Brad Chesney, of Harpers Ferry, W.Va., at the clinic at Faith Baptist Church on Petersville Road, a few miles from Brunswick . He has a chronic shoulder problem. The clinic comes to Faith Baptist two Tuesdays a month.

Chesney saved up for the gas to drive the approximately 10 miles to the Mission of Mercy clinic. He said he worked in home construction in the Washington area until 51Ú2 years ago, when he fell off a ladder and injured his shoulder. Six months later, the company went out of business. His insurance continued to cover his treatment for a while, but eventually stopped the coverage. He's been unable to work ever since. His wife has a job, but no health insurance.

"I just want to work," he said.

The Faith Baptist clinic attracts people from Hagerstown, Brunswick , West Virginia and Pennsylvania. Dental patients start lining up early, with the first arrivals filtering in around midnight. Clinic volunteer Debbie McClain opens the church at 6:30 a.m.

McClain, of Brunswick , works full time for a nonprofit in Hagers-town. She alters her work schedule so she can volunteer.

Barbara Holder, 49, of Brunswick , had an appointment for 10 a.m. to get her leg checked. She arrived at 5 a.m. with her husband, who was hoping to get dental treatment. He was too late, however. Eleven others were ahead of him.

The Holders are unemployed. Barbara Holder suffers from back and leg problems, and gets treated at the clinic every couple of years. She once worked as a waitress, but now is physically unable to do the job.

"Dr. Sullivan and his associates keep me in my medicines," said Brenda Carey, 57, of Brunswick . A former bartender at the Moose Lodge, she cannot stand for long periods. She had health insurance until recently, when she separated from her husband.

"I've been a fortunate person," she said. "I've never needed anything. I don't know if any of us realizes how close you are to being on the street at any time."

Amenities

The clinics offer services that might be useful to patients. The Brunswick Ecumenical Assistance Committee on Needs offers breakfast, and sometimes the local food bank brings its food pantry to the clinic.

At the Frederick clinic, patients can speak to representatives from the Frederick County Department of Social Services and Head Start.

"We forge a lot of partnerships in the community," Gerlock said. "If we can bring services to people, we do."

The organization's goal is to not duplicate services. Mission of Mercy offers a prenatal health clinic. When Frederick Memorial Hospital opened its own clinic offering free exams to pregnant women, the hospital asked Mission of Mercy to continue with its clinic to ensure all pregnant women are screened.

"We do a lot of coordinating with the hospital," Gerlock said. "They do lab tests, x-rays, CAT scans, MRIs."

What Mission of Mercy is doing in Frederick , Gerlock said, is helping the whole health care community. "By going out to folks, we're making the whole system better."