Louisville Magazine

JUN 2017

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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34 LOUISVILLE MAGAZINE 6.17 A BIT DEEPER Wellness for the Workers By Anne Marshall Photo by Mickie Winters Inside the clinic treating Churchill Downs backside workers, who couldn't afford healthcare otherwise. A Latino man sits — back straight, hands on knees — in a red plastic chair, waiting and wor- ried. Recently, a sharp pain has been burst- ing into his chest and radiating into his left arm. e man's face carries the fatigue of daily 4 a.m. wake-up calls, of decades spent in the sun, of scruff that's turned sil- very-gray in middle age. Despite 80-degree weather outside, he's buttoned into a flannel shirt. Jeans cover his short, lean legs, a must around the half-ton racehorses he walks and cares for in Churchill Downs' barn area, known as the backside. Speaking Spanish, the native of Mexico unloads his symptoms to a translator, who leans toward him, lis- tens, nods and relays the message in English to Sara Robertson, a 39-year-old nurse practitioner and director of the Kentucky Racing Health Services Center. "He's saying he's in a lot of pain today," the translator says. "He's had this pain for three days." Robertson, who's "almost fluent" in Spanish, confirms: "Tres días pasado?" She types into her laptop, her cof- fee-colored eyes wide and curious, a slight frown tugging at her face, not like she's upset, just thinking. is is her first patient of the day. Today, like most days, patients are booked every 20 minutes. "If he's sitting on the couch doing nothing, does he get it?" Roberston asks. "Si," the man answers, adding that sometimes he's so startled he jumps up. "Does it alleviate the pain?" she asks in Spanish. He nods. Robertson's face rests in a state of hmmm. Over her shoulder, a poster-sized black- and-white print of a oroughbred hangs next to scopes and gadgets needed for exams. e Kentucky Racing Health Ser- vices Center, or the "racetrack clinic," was founded by the Kentucky Racing Health and Welfare Fund's board of directors. Un- cashed parimutuel tickets from all Kentucky racetracks provide funding, through an annual grant, to the clinic, now in its 11th year. Last year about $236,000 went toward the clinic's expenses. (e fund, a non- profit, doled out more than $1 million in health benefits for industry workers across Kentucky in 2016.) e University of Lou- isville's School of Nursing staffs the clinic. U of L's Latin American and Latino Studies program contributes translators. In 2016, the clinic served about 1,000 patients, including family members of backside workers. A visit requires only a $5 co-pay. Robertson estimates about 60 percent of clients are regulars or, she jokes, "ones we have tightly controlled." Whitney Nash, an associate dean at the School of Nursing and the clinic's first director, says that, initially, the clinic oper- ated as a safety net for backside workers, a population that nearly always lacks health insurance and can make as little as $300 to $400 per week. Over time, Nash says, the clinic evolved into "more of a primary-care center." It's certainly convenient. Located in the basement of an old brick former school building, the clinic is about one block from the track's far turn. e clinic's open year- around, with hours that suit early-morning and late-afternoon shifts at the barns. "Did he have a stressful weekend?" Robertson asks, looking to the translator for assistance. Really, she knows the answer, this being the Monday after Derby. "Sí," he reports, adding that he was "like a machine," his boss constantly giving tasks. "Next, next, next," the patient explains, chopping his thick, scuffed hands like a knife on a chopping board. He took some medicine in an attempt to relieve his aches. He pulls out his wallet, unfolding a piece of foil, a wrapper from medicine he bought at a nearby Latin market. Robertson inspects. "Some kind of Sudafed or Tylenol product," she mumbles. is patient isn't new, though he hasn't been seen in about a year. And he's been without diabetes medication during that time. But that's a separate issue from the one that he's battling today. She directs him onto the crimson exam table. e chest pain — sudden and short— doesn't scream heart problems. His blood pressure is fine. She begins a detailed physical exam: He squeezes her fingers, presses his shoulders up into her palms, raises his eyebrows up and down (a test for potential problems with one of his cranial nerves). Robertson determines his entire left side is weaker than the right. Perhaps he has suffered a stroke? She leaves the exam room for a bit and ponders. "You really don't want to send someone to the ER to go through all the stress and process if you really don't have to," she says, pausing. "at's what I'm trying to figure out right now." An ER trip would likely end with a bill of $3,000 to $6,000 given his vague but some- what troubling symptoms. She decides on a CT scan. e Kentucky Racing Health and Welfare Fund will foot the bill for the test. It will also cover the cost of medical spe- cialists and lab work and probably would've covered most if not all of an ER trip had Robertson deemed it necessary. Before she hands the man prescriptions and the referral for a scan, she looks at the translator to crystallize an important message. "Tell him he needs to come see me more," she says with a warm smile. Spend a day in the clinic and the ailments vary: heat rashes, warts, swollen limbs, wheezing, allergies, gas. "I need a back transplant," one older man groans, limping toward an exam room. A middle-aged trainer reports his wife told him he's been overly grumpy and it's time to refill his "cuckoo" pills. Robertson, who has worked here about 10 years, has picked

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