To Halve and Halve Not

So you live in Montgomery County, Maryland. Congratulations! You live in one of the wealthiest counties in the entire United States, with a median household income of about $95,000 a year. Pretty sweet!

Don’t pop those champagne corks just yet, my friends. There’s the matter of that beige little word “median” in there. No, it doesn’t mean “average”, although that would be awesome in this case. It’s the mid-point, which for our purposes means half of county residents fall below that $95K income and half above it. Still pretty good, right?

Well, maybe. Consider this: according to the 2012 Self-Sufficiency Standard[1], a family of three (one adult, one pre-school child, and one school-age child) would need an income of $77,933 per year to be able to live here without financial assistance. We’re not talking living the high life — just the bare minimum for rent, food, transportation, medical care, and other essentials.

Let’s say our family’s adult works in a service job where he or she earns the minimum wage. In Montgomery County that means $9.55 an hour, not too shabby or at least not as shabby as it is lots of other places. That person would have to work 8,160 hours in a year at such a wage to hit that self-sufficiency income level. Uh oh. That’s about 157 hours a week, leaving a whopping 11 hours for a person to eat, sleep, take care of those two adorable kids, and deal with everything else other than work. In other words, impossible, at least here on the planet with the yellow sun where days are only 24 hours long. Sorry to force math and physics on you but it is the only way.

There’s more. You’ve probably seen references to the “Federal Poverty Level” and wondered just what that’s all about, so here goes. It’s a complicated calculation made by the federal government to establish just what we mean when we say someone is “living in poverty” in this country. It’s too complicated for me to explain, actually, so go look it up yourself at Anyway, for 2016, the Federal Level of Poverty for our little family of three is $20,160.

That $20,160 is only about 26% of that Self-Sufficiency Standard level of income needed to just get by in MoCo. Think about the sheer impossibility of living on $20,160 or less, in a county where more than half of the residents make more than $95,000 a year. Market costs for housing, food, clothing, childcare – everything – tend to be aligned with that top half. Being poor in such an expensive place means making daily trade-offs: pay this bill or that one, but not both. Buy food or medicine, but not both. And the stakes are so much higher when you live in poverty. You get too sick or for too long, or your car dies and you can’t afford to fix it to get to work, and you might lose your job. You lose your job, and you could easily lose your home. Hard to believe, but here in Montgomery County, one of the wealthiest places in America, nearly 70,000 people may be one illness or job loss away from financial catastrophe for their family.

At the Mercy Health Clinic, the majority of our patients are living at or below 100% of the Federal Poverty Level like our imaginary little family (except ours are real). For some of these patients, their income is so low that even a subsidy isn’t enough to help them buy health insurance through the health exchange; others lack the documentation to do so. That’s why Mercy exists, to provide free, top-quality health care, prescription medications, medical oversight, and health education to these most vulnerable of our neighbors.

To learn more about poverty in one of the wealthiest counties in America, click here Then come back and click here to support the Mercy Health Clinic. I promise you’ll feel better even after all this math.

— Pam Saussy, Board Member


[1] Healthy Montgomery;

Smile for the Birdie

Welcome to March, the month when winter turns to spring at last and our thoughts turn to – Colorectal Cancer Awareness! Not what you were going for, eh? I know it’s kind of gross to think about what could be happening in there and back there. If only we could simply ignore that part of our plumbing and hope for the best.

But alas we cannot. Colorectal cancer is the third most common type of non-skin cancer in men and women, behind prostate and lung cancer for men, and breast and lung cancer for women. It is the second leading cause of cancer death in the U.S. after lung cancer. While the rates of colon cancer incidence and death among people age 50 and older are decreasing (yay!), its incidence is increasing among younger people. Family history is a key risk factor, but others include excessive alcohol use, obesity, physical inactivity, cigarette smoking, and possibly diet.

To reduce your risk of colorectal cancer, you should:

  • Be physically active for at least 30 minutes five times or more per week;
  • Maintain a healthy weight and waist size;
  • Don’t smoke;
  • Limit alcohol use (two drinks per day for men and one drink per day for women);
  • Eat high-fiber foods like fruit, greens, beans, and whole grains;
  • Eat less red meat and cut out processed meat;
  • Get screened.

The good news about colorectal cancer is that it is highly treatable when caught early – 90% of cases are preventable and treatable when detected early. Screening options include the fecal occult blood test, which entails testing a stool sample for blood which might indicate bleeding somewhere along the gastrointestinal tract; additional tests would be required to determine the source of any bleeding detected. (Despite sounding vaguely Goth and possibly cool, “occult” just means “hidden”. Sorry it’s not more interesting.)

Another type of screen is the fecal immunochemical test (FIT), which tests for blood in the lower gastrointestinal tract. Mercy Health Clinic has made the FIT screen a standard practice for all patients aged 50 to 75, and can refer patients for a free colonoscopy if necessary. Your support of MHC helps keep these services available for uninsured adults in Montgomery County.

Speaking of colonoscopy, perhaps your own doctor has recommended you get one. Now, don’t make that face. Many people put off getting that first colonoscopy, dreading the notoriously fidgety prep and positively clenching at the idea of someone putting a camera up there.  Seriously, relax. Sure, the prep is a pain in the, um, neck, but it’s nothing you can’t handle, I promise. As for the camera, get over yourself. You’re not Kanye, for Pete’s sake, and your gastroenterologist has seen it all before anyway. And remember: screening for colorectal cancer is a walk in the park compared to being treated for colorectal cancer.

You can learn more about colorectal cancer at

— Pam Saussy, Board Member

Don’t Go Bacon My Heart

It’s February and that means it’s American Heart Month! It’s also when we celebrate Valentine’s Day, when we do exactly the opposite of what we should do and surprise our most beloved pooh-bears with fat-saturated chocolates and romantic dinners that probably aren’t salad. The point being that we tend to do what’s not good for our heart health, on the very day that we should be thinking about how we can hang around longer for our loved ones.

Here’s the unromantic truth: heart disease is the #1 killer of both men and women in the United States.Most of us know that by now from news stories and a constellation of major and not-nearly-so-major stars that support heart health big-time. I’m not quite sure why we need celebrities to validate taking care of our hearts, but if DJ Earworm says it’s the thing to do, I’m all for it. (Go ahead, I’ll wait while you look him up.)

Another fact from the Centers for Disease Control: chronic conditions such as high blood pressure, high cholesterol, and diabetes are major risk factors for heart disease. Obesity/overweight, smoking, and excessive alcohol use are also risk factors. Think you’re not at risk? You can be slim and work out regularly and eat all the right stuff most of the time and yet still need to be vigilant about heart disease due to hereditary factors. Heart disease can sneak up on you without warning; sometimes a heart attack is the first symptom. You think you’re doing fine and then boom! you’re having a heart attack. (By the way, despite what your Facebook friends may be posting, that thing they put in your heart to hold the vessel open is a “stent”, not a “stint”. You want the life-saving one, not the limited-effort one.) Keep in mind too that “heart disease” isn’t just one condition. It includes not just the familiar (and top killer) coronary artery disease but also heart valve problems, arrhythmias, heart muscle disease, and other less well-known but still serious disorders. You can learn more about heart disease at

One additional risk factor that might surprise you: poverty. Individuals with low incomes and low education levels are much more likely to suffer from hypertension, high cholesterol, heart attack, and stroke.2

Many risk factors for heart disease can be managed with a combination of proper diet, exercise, health education, healthy habits, and medical oversight and intervention when needed. For adults living in poverty and without health insurance, like some 50,000 in Montgomery County, Mercy Health Clinic provides specialized care, medications, health education, and other services at no charge – truly healthcare from the heart.

This Valentine’s Day, do something good for your heart and support the Mercy Health Clinic. To donate or volunteer, go to

— Pam Saussy, Board Member


1 Centers for Disease Control and Prevention, National Center for Health Statistics.

Serious Medicine

What do you think of when you think of “safety-net clinic”? Maybe a dingy church basement, with a few sparsely furnished exam cubicles partitioned with rolling curtain dividers. No privacy. Harried, overworked doctors and nurses. Minimal and outdated equipment. Sad patients taking a number, waiting hours to be served. That’s still better than nothing when a person is uninsured, right?

I’ll admit to having that vision in my head when I first heard about the Mercy Health Clinic. I knew a bit about the Clinic’s work from having attended a couple of fundraisers, but until I joined the Board I hadn’t seen the place in person and in action. When I took my first tour of the clinic, I was delighted to find something much different than what I had envisioned.

The cheery and bright waiting room is staffed by welcoming staff and volunteers. While eligibility interviews are done on a walk-in, first-come, first-served basis two days a week, medical services are provided on an appointment basis – just like any other doctor’s office. Patients are escorted to one of several private exam rooms – just like any other doctor’s office. The rooms are sparkling clean and equipped with modern, up-to-date medical equipment and supplies. Doctors and nurses, whether paid or volunteer, are credentialed with current licenses and certifications, and cover a wide array of medical specialties. Interpreters help bridge language divides.

What about the patients? Here’s a great example of what Mercy can mean to a patient. Julio came to Mercy Health Clinic over the summer after being discharged from a local hospital. He had sought emergency care after feeling ill for several days with significant lower extremity pain, and was admitted to the hospital. He was informed that he had diabetes — news to him — and a severe leg infection involving the bone (osteomyelitis), which might require amputation. Julio had delayed seeking help because he was uninsured with no financial resources and didn’t know where to turn.

The physicians caring for him in the hospital recommended an eight-week course of intravenous antibiotics and provided him with a two-week course prior to discharge. At that point, Julio was still in need of six weeks of the IV antibiotic therapy and was referred to Mercy Health Clinic. This therapy entailed an IV catheter placed into his heart, as well as medication that would have exceeded $4,000 in total cost, home nursing care and weekly primary care visits. Mercy Health Clinic collaborated with partner organizations and homecare nursing agencies to secure the necessary resources to successfully complete his therapy course. Upon completion of his treatment, Julio’s vascular surgeon noted that the intervention saved his leg from having to be amputated. Because of the care he received through Mercy, Julio is a productive and happy individual, working full-time without pain or disability.

Make no mistake – this is serious medicine, not “better than nothing” medicine. Not all Mercy patients require this kind of dramatic intervention, but when they do, it’s there for them. Mercy Health Clinic never turns a patient away. Go to to learn more or schedule a tour to see what we mean by “quality health care from the heart”.

— Pam Saussy, Board Member

I Hereby Resolve

It’s getting close to the New Year, and you know what that means. Yes, it’s time to come up with our New Year’s resolutions, those polite fictions in which we swear that this will be the year we’ll lose those five pounds (which have become ten since we first resolved to lose them), eat right, drink less, make new friends, and stop wasting time playing Candy Crush. And read more. All those things that will make us better human beings. I told you they were fiction.

This year I’m going to take a different approach. All those good-for-me things should be on my to-do list anyway. Instead, I’m going to try some good-for-someone-else resolutions.

First, I resolve to help get the word out about the Mercy Health Clinic. I’ve been on the board of directors for about a year now, and have learned a lot about the people who come to Mercy for health care, folks who can’t afford or don’t qualify for insurance. Many patients’ lives literally depend on Mercy Health Clinic. I’ve also learned a lot about the people who provide the care, busy professionals who could step back and leave it to others but instead step up. There are heart wrenching and uplifting stories here, and if you heard more of them I think you’d want to help, too.

Next, I resolve to reach out more often to people who are important to me, and not just on Facebook. I was reminded rudely this month that we don’t get to keep our dear ones forever or even as long as we think we will. An old friend from a long-ago workplace, with whom I’d once been very close but hadn’t seen in years, now lies in a coma on life support after an accident. Her prognosis is not good. She and I had moved to different cities and saw each other in person rarely but when we did, it was as if no time had passed. We laughed and cried together as easily as we did back then. And now I’ve very likely run out of chances to see her again, to tell her how much her friendship meant to me during a most turbulent period in my life. So in B’s honor, I’ll try to not take the length of life’s highway for granted.

Finally, I resolve to be kinder and look for the best in people. This could be hard, I admit. I’m a cynic and voracious news junkie, and it could be tough to stay upbeat while breathing in that miasma of toxic rhetoric every day. My strategy (besides cutting down on my miasma consumption) will be to surround myself with good, decent people doing good, decent things for people who need help. Come to think of it, I think I have this one covered.

Best wishes to you all for a happy and safe holiday season and New Year. See you in 2016!

— Pam Saussy, Board Member

Voir, Dear

Back in the winter of 2001, I was summoned for jury duty. Now, I’m one of the few people I know who actually enjoys jury duty. Not only do I think it’s our civic duty and privilege to serve on a jury of someone’s peers, it’s interesting to experience first-hand what it means to live in a nation of laws, without actually getting arrested.

Anyway, I was in the generously named “Jury Lounge” at the courthouse when an announcement came that they needed to seat a jury for a long trial, possibly going 25 days or even longer. Folks who wanted to be excused from that particular trial were invited to approach the desk to make their case. Talk about a stampede. I was left sitting in the dust among only a few of us who apparently had thought to ourselves, “sign me up!” envisioning Atticus Finch arguing some high-profile case.

Long story short, I made it through voir dire and onto that jury. The case was not as inspiring as it was sad: a woman with diabetes had died and her family was suing the manufacturer of one of the drugs she’d taken (which soon after was taken off the market). Jurors were given thick notebooks and for the next 28 days we learned all about diabetes. We listened to hours of testimony from experts and viewed gruesome photos of damaged organs. The lawyers had charts of statistics and “boxes and boxes of documents” as one of them kept boasting. I’ll spare you the unhappy details of this case but the bottom line for me was learning how absolutely destructive diabetes can be. (See what I did there, after teasing you with the Atticus Finch thing? But it’s November and that means National Diabetes Month. Stay with me – this is important.)

The American Diabetes Association reports that

  • Nearly 30 million children and adults in the United States have diabetes – nearly 10% of the population.
  • Another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes.
  • African Americans and Hispanics are almost twice as likely to have diabetes as non-Hispanic whites.
  • Someone is diagnosed with diabetes in the U.S. every 19 seconds. ADA estimates suggest that by the year 2050, as many as 1 in 3 Americans could have diabetes.
  • The total national cost of diagnosed diabetes in the United States is $245 billion.

The health impact of diabetes goes way beyond simply needing to take a pill or inject insulin. Did you know that diabetes nearly doubles the risk for heart attack and of death from heart disease? It’s the leading cause of kidney failure and of new cases of blindness among working-age adults. One in 10 health care dollars is spent treating diabetes and its complications, and one in 5 health care dollars is spent caring for people with diabetes.

So how do we stem this rising tide of diabetes? The fact is that diabetes can be prevented with proper diet, exercise, and weight control, even for patients whose genetics and family history might indicate otherwise. I’m sorry to have to bring this up the week before Thanksgiving. If it’s any consolation, I am in this boat myself as diabetes runs in my family, so I exercise, eat right (more or less), and work with my doctors to keep an eye on my numbers.

It’s hard enough for me, but for the most vulnerable among us, these outwardly simple steps can be overwhelming. The Mercy Health Clinic cares for many patients struggling with diabetes and other chronic health conditions. Mercy provides lab tests, insulin and medications, and health education free of charge to uninsured and low-income patients, along with massive doses of compassion and support to keep patients on track. This is the Mercy difference in providing health care from the heart.

My 28 days of jury service may not have resulted in a triumph of justice, but they did leave a lasting impression on me about the devastating effects of diabetes. You can learn more about diabetes while avoiding all the courtroom drama by checking out the facts at:

— Pam Saussy, Board Member


On a More Humerus Note…

It’s October, and Halloween is soon upon us. Since we’re on the subject of skeletons (and we are, it turns out), I’d like to note that October 12 – 20 is Bone and Joint Health National Awareness Week. Not so scary at first glance, but the facts about bone and joint health are downright frightening:

  • More than half the American population over the age of 18 – 54 percent – are affected by musculoskeletal (bone and joint) conditions, according to The Burden of Musculoskeletal Conditions in the United States.1
  • One in three (33%) people over the age of 18 required medical care for a musculoskeletal condition in each of the years 2009 to 2011, a 19% increase over the last decade.2
  • Musculoskeletal conditions can lead to significant disability plus diminished productivity and quality of life. Treatment and lost wagecosts associated with musculoskeletal diseases in the U.S. alone was estimated at $874 billion in 2009 to 2011 – equal to 5.73 percent of gross domestic product (GDP).3
  • Bone and joint conditions are the most common cause of severe long-term pain and physical disability worldwide affecting hundreds of millions of people. 4
  • 1 in 2 women and 1 in 4 men over age 50 will have an osteoporosis-related fracture, with 20% mortality rate within 12 months of a hip fracture.5

I don’t know about you, but that last one kind of freaks me out. Bone and joint conditions include common things like arthritis, fibromyalgia, back pain, osteoporosis, and trauma. “Trauma” includes very serious things like those hip fractures mentioned above, but also stupid things like trying to do something with a skateboard that seemed perfectly reasonable when you were twenty, but which turns out to be decidedly unreasonable when you’re 50. We’ve all been there, or likely will be at some point.

If you find all this a bit frightening — and you should — now imagine being one of the 65,000 uninsured adults in Montgomery County without health insurance and facing a serious musculoskeletal condition. Now that’s scary, given that such conditions can not only impact one’s ability to work and support one’s family, but can be truly life-threatening.

The good boos — er, news – is that the Mercy Health Clinic provides uninsured adults in Montgomery County with specialty care including rheumatology and orthopedics, in a warm and compassionate environment that is decidedly NOT scary. Your support of the Mercy Health Clinic helps ensure that our uninsured neighbors in the County get the care they need to keep their bones and joints healthy.

Bone up on joint and bone conditions and what to do about them by checking out the US Bone and Joint Initiative at And have a happy and safe Halloween!

— Pam Saussy, Board Member



4 Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization 2003;81:646-656.


No Bran Muffins Required

Like many people, I have high cholesterol. Unlike some of those people, however, I have my cholesterol under control through a combination of diet, exercise, and medication. Hyperlipidemia (the medical term for high cholesterol) runs in my family; my parents had it, my siblings have it, I have it. Mine was diagnosed back in the 1990’s when I was in my 30’s. I had never smoked and wasn’t overweight. But there I was, baking bran muffins to beat the band. I’m not much of a baker but as it turned out, no degree of culinary skill was going to enable me to eat sufficient bran muffins to make a difference in my body chemistry. So I’m one of the over 30 million adults in the U.S. who take a cholesterol-lowering medication. More on that later.

September is National Cholesterol Education Month, so in the spirit of education here are a few facts courtesy of the Centers for Disease Control (CDC):

  • Cholesterol is a waxy, fat-like substance that your body needs. But when you have too much in your blood, it can build up on the walls of your arteries and form blockages. This can lead to heart disease, heart attack, and stroke.
  • There are two kinds of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is also called “good” cholesterol. LDL is called “bad” cholesterol. When we talk about high cholesterol, we are talking about “bad” LDL cholesterol. Anyone can have high cholesterol, including children.
  • Seventy-one million American adults have high cholesterol, but less than half are getting treatment to lower it, and less than one-third have the condition under control. 1

What does it mean to have one’s cholesterol “under control”? According to the CDC, it means having a total cholesterol level under 200 mg/dl (milligrams per deciliter of blood), high-density lipoprotein level (HDL or “good” cholesterol) over 60 mg/dl, and a low-density lipoprotein level (LDL) or “bad” cholesterol) level under 100 mg/dl.  Simply put, you want more of the good and less of the bad.

A tricky aspect of having high cholesterol, and likely one of the reasons why so many people don’t have it under better control, is that it has no symptoms. You need to be screened with a simple blood test to find out if you have high cholesterol and then consult with your doctor on how best to treat it. For some folks, changes in diet and exercise will be sufficient. For others like me, genetics (that family history thing) make controlling high cholesterol difficult without medication.

Speaking of which, there are literally dozens of medications targeting high cholesterol, not to mention supplements and diets.  I’m not advocating any particular therapy or medication here, as that’s best worked out with your doctor.

By the way, low-income people without health insurance are at higher risk of having undiagnosed high cholesterol, which places them at higher risk for heart disease, heart attack, and stroke.3  These health crises are much more expensive to treat than to prevent in the first place, and supporting Mercy Health Clinic in tackling high cholesterol is a great place to start. No bran muffins required.

— Pam Saussy, Board Member


1 Source:

2 Source:

3 Source: Health Affairs, 2009.


Just a Little Pinch

August is National Immunization Awareness Month. “But I got all my shots when I was a kid!” you say. Not so fast. Childhood shots don’t necessarily last forever (that is, confer lifelong immunity) and sometimes you need to get boosters. For instance, if you’ve got a chronic illness, work with children, will be living in a dorm with lots of people, or are traveling to another country, you might need to give your immune system a jump-start. The Centers for Disease Control (CDC) advises people to protect their health by getting vaccinated against infectious disease.

I’m traveling to China next month, and was advised to get Hepatitis A and B series, as well as a typhoid vaccine and a tetanus/diphtheria/pertussis (Tdap) booster. It’s a bit unnerving to consider that water quality and public sanitation issues over there might put me at risk, but I was surprised to learn that (perhaps typhoid aside) these shots are recommended for most adults even if they’ll be staying stateside. Yeah, food service workers are required by law to wash their hands after using the restroom, but do they? What about these E.Coli infections that people can get from salad bars? Sometimes it seems like a miracle that we don’t get sick more often than we do, but it wasn’t all that long ago that people died from diseases which, today, are routinely prevented with a simple shot in the arm.

Who should get vaccinated? Adults with chronic diseases such as asthma, Chronic Obstructive Pulmonary Disease (COPD), diabetes, or heart disease should get vaccinated. Adults who will be in close contact with the very young, the very old, people with weakened immune systems, or people who can’t get vaccinated themselves should get vaccinated.

Everyone should get a flu shot each year (and no, you can’t get the flu from a flu shot). Other vaccinations, such as for Hepatitis, shingles, pneumococcal disease, or Human Papilloma Virus (HPV) might be required at different points in an adult’s lifespan as well.

Of course, there are always exceptions; depending on your personal health profile, particular vaccinations may not be right for you, or you may need a particular form of vaccine.  Don’t disregard vaccinations out of hand, though — get the facts and protect yourself. The CDC has more information at about who should get vaccinated, for which diseases, and when.

— Pam Saussy, Board Member

Rx: Laughter

Life around Mercy Health Clinic is a study in human emotions. Many patients arrive in a state of of pain and anxiety. After treatment we see a shift to gratitude, hope, and joy.

And yes, we see a fair amount of humor.

One day I was visiting the Clinic and I stopped for a hallway chat with one of our volunteer physicians. Somehow we got on the topic of the strong doctor-patient relationships that are formed over the course of treatment. This particular physician is an OB/GYN. He told me that late one Sunday night he got a phone call from one of his female patients. It went something like this:

“Hello Doctor, I’m calling because I’ve got this awful pain.”

“OK, tell me more; where does it hurt and when did it start?”

“It started on Friday. I was having trouble with this one tooth, so I scheduled a dental appointment and my dentist worked on it. However, it’s still giving me a lot of pain and I don’t know what to do.”

“I understand. What did your dentist say when you told him it was still hurting?”

<Confused pause>

“…Oh, I never called him. I didn’t want to bother him.”


We shared a belly laugh over this story, and I could tell that this physician could not have been more good-natured about the incident. To him, it was just part of the fabric of Mercy Health Clinic, and one of the many things that kept him coming back to volunteer with us. To me, it spoke so highly of the trust and regard that our patients have for our outstanding providers.

And so we tip our hats to the caregivers of Mercy Health Clinic. Your knowledge, wisdom, and good humor lift us all. Together we’ve built a medical home for our patients that offers dignity, comfort, and sometimes even healing laughter. 

Christopher Perez
Chairman, Board of Directors