It’s about 1 p.m. on a Tuesday, and Dr. Julio Menocal has already seen 50 patients during the day.
He spent the majority of his lunch break dealing with two pharmaceutical company representatives, who came in with name tags pinned to their crisp suits.
The doctor sits behind his desk, his white coat loosely buttoned. His eyes are bloodshot.
He says he has only a few months of this left in him — leading his staff, paying the bills, seeing patients — but he can’t leave when there’s so much work to do.
Menocal is a savior for thousands of people on Frederick’s Golden Mile who can’t afford health care. He has made an impact, especially in the Hispanic community, where access to care is a luxury for some.
According to Census estimates from 2014, about 23 percent of Hispanic residents of Frederick County don’t have health insurance. In the majority white population, about 5 percent are uninsured.
But Menocal thinks 23 percent is a low estimate. For every one of those county residents counted in the Census, he believes there are four non-citizens who go uncounted.
There are about 32,000 patients in his territory area along the Golden Mile who qualify for medical assistance programs, including Medicaid. Menocal cares for about 5,000 of them.
But you have to be a U.S. national, a permanent resident or a citizen to qualify for Medicaid, and Medicaid doesn’t cover everything.
Diego Chavez, 22, moved to the U.S. from Guatemala 10 years ago. His parents took him here to get better care for the scoliosis he’s had since he was a child.
Chavez has never been able to walk and has had multiple operations to adjust his severely curved spine and realign his hips. He gets around in an electric-powered chair he steers with his left hand.
Scoliosis affected much of his physical development, pulling his head and limbs in different directions, according to his father, Marco Chavez.
“His head, before the surgery, looked like this,” he said, laying his hand on his son’s right shoulder, indicating that Diego’s ear was parallel with it.
While Diego attended West Frederick Middle School, a social worker at the school helped get his family in touch with the Shriners Hospital for Children in Philadelphia. The hospital paid for Diego’s treatment, but Marco had to take time off from work to get him to the hospital.
“They had to go several times a week,” said David Moreno, a support coordinator at The Arc of Frederick County, which assists people with intellectual and developmental disabilities. “It was a lot for them.”
The organization helped Marco’s family by providing gift cards for gas and groceries. The Arc also helped the family pay the rent on their Frederick apartment so they could afford a van big enough to fit Diego’s electric-powered chair.
Marco fixed computers through a home business to try to make enough money to care for his family and get Diego to his doctor’s appointments.
If it weren’t for The Arc, Marco said, “I don’t know what we would do.”
Diego does not have health insurance and has not had a physical checkup in years. He is living in the country on a deferred-action permit that does not let him take advantage of Medicaid.
“Diego’s an example of many, many families we have served,” Moreno said.
Though Diego has needed physical therapy since his surgeries, he and The Arc could not find a therapist willing to provide those services at an affordable rate.
“We wish there was more access for health. ... It’s not just [treating] a cold. There’s a real, desperate need,” Moreno said.
Maria Shuck is director of Centro Hispano de Frederick, which provides referrals, translation services and English-language classes.
Shuck is also a certified medical interpreter at Frederick Memorial Hospital who speaks Spanish and English.
At the hospital, Shuck often translates for many people who come from Central or South America and don’t have health insurance.
“They end up here, in the emergency room,” Shuck said. “A lot of times, it’s because they don’t have a primary care provider.”
When she started at her job 14 years ago, Shuck said, she provided translation services for about three to five patients each day. Now, she translates for 30 to 40 patients a day.
At Menocal’s office, staff will generally ask struggling patients how much they want to pay for their care.
“As long as you walk into the office, you don’t get turned away,” he said.
About 70 percent of his patients get financial help for their medical needs from the state through Maryland’s Medical Assistance programs. Most of those patients are children.
“The biggest challenge is getting someone who can accept them in their office,” Menocal said.
The doctor and his staff have struggled to keep the practice above water while they accept more patients who need financial help. They recently bought a new retina-scanning machine to check patients’ eyes, but it’s sitting unused in an exam room.
“Currently, we cannot use it, because we’re falling behind in payments,” he said.
That doesn’t stop him from pushing for a better quality of life for his patients. His fundraising efforts with The Community Foundation of Frederick County and Frederick County Public Schools helped get hundreds of tablet computers for elementary and middle school students who qualify for the county’s free and reduced-price meal program.
“We are hellbent on getting these kids computer literacy,” Menocal said.
He believes that reducing health disparities, especially for those who speak English as a second language, starts with education.
“An educated patient is a healthy patient,” Menocal said.
Shuck and Moreno agree. While Menocal wants to motivate children to educate their parents, Shuck said health providers should make information available in multiple languages as well.
“In the meantime, while these folks are learning this new language, we still need to offer services in a language they feel comfortable with,” Shuck said.
When provided only with materials written in a foreign language, Moreno said, people have fewer options for their health.
“Whether it’s in the health area or other types of resources, we see that without information, there’s no opportunities for choice for individuals or families,” he said.