"No physician, insofar as he is a physician, considers his own good in what he prescribes, but the good of his patient; for the true physician is also a ruler having the human body as a subject, and is not a mere moneymaker."

— Plato, The Republic

Anna Perkins was a dedicated healer. A well-educated doctor, she devoted her life to serving the rural Helderberg Hilltowns. She practiced the sort of medicine that valued knowing the whole person, not just treating an ailment in a regimented time-constrained office setting. Perkins made house calls, even if it meant putting on snowshoes to get there. She knew entire families and the all-important relationships that bound them.

When she died in 1993, she bequeathed her Westerlo home and medical office to continue serving the community. The Anna W. Perkins Helderberg Health Center has been run by St. Peter’s Hospital since shortly after her death. The building is owned by the Helderberg Medical Building Association, Inc., a not-for-profit group that Perkins signed her clinic over to in 1986.

In late October, St. Peter’s surveyed Hilltown residents about their use of the clinic. A hospital spokesman told our reporter, Tyler Schuling, that the clinic — staffed by a doctor, a practical nurse, and an office worker—has lost patients and money in recent years. At the same time, on Oct. 30, St. Peter’s Hospital broke ground on a new patient pavilion in Albany that will serve as the centerpiece for a $258 million hospital modernization project. Hospital executives and community leaders wielded gold-painted shovels for the symbolic start of the construction of what is billed as a state-of-the-art campus for the 21st Century.
A month later, on Nov. 29, St. Peter’s announced it will close the Perkins Center, one of three charity clinics it operates. "Annual losses at the Westerlo clinic have reached $160,000 in recent years, threatening our ability to maintain two other primary care clinics; one in the south end of Albany and the other in Rensselaer," said a statement released by the hospital. We certainly don’t begrudge city residents, especially poor city residents, health care. Many rural areas across the country face a shortage of doctors. Fewer patients make practices less profitable. Besides making more money, doctors in cities find cultural advantages and they can practice in groups, working more regular hours.

St. Peter’s officials told us that fewer than 5 percent of the Perkins Center’s patients were on Medicaid, indicating the need was far greater at the other two charity clinics. Rural residents are traditionally more reluctant than their urban counterparts to participate in government programs for the poor. The school superintendent at Berne-Knox-Westerlo tells us that, each year, about 25 percent of BKW’s students receive free or reduced-price lunches, indicating they come from poor families. He suspects more are eligible, but do not apply. It stands to reason that, if a quarter of the families whose students attend the local school are poor, more than 5 percent of the patients must be poor, too. Perhaps they’re too proud to apply for Medicaid, or perhaps they simply don’t go to the doctor.

We believe the need is there.

St. Peter’s will be sending letters to current patients of the Helderberg Center, telling them which doctors — in Bethlehem, Slingerlands, or Greenville — will accept them. There are no other doctors practicing now in Westerlo or in the neighboring Hilltowns of Knox and Rensselaerville. We believe the truly poor, without any readily available means of public transportation — will have trouble getting to these places and may neglect their medical care.
"Without them," says Cathy Rudzinski of the clinic, "where would the older people go"" Her mother, she said, is bed-ridden, and the clinic doctor makes visits to her house. "To get her to a doctor," Rudzinski said, "we would have to call an ambulance."

We received a letter this week from a patient who depended on the clinic — Shirley Fronk of Knox. At age 65, Fronk has no health insurance and suffers from a number of serious ailments. She depended on the discounted rates she paid for the $600 of medicine she requires each month.
"With gas prices so high, we were struggling to get to the health center in Westerlo, let alone all the way to Pearl Street in Albany or go to Rensselaer," she writes of St. Peter’s two other charity clinics. "The fat cat gets fatter and we who have given all our lives, 13 years as foster parents, volunteering all over, and doing the chapel at the Altamont Fair, can get nowhere."

Several dozen citizens formed a group, the Friends of the Perkins Clinic, to fight the closing, which St. Peter’s says now is irreversible. The group, for which Rudzinski is a spokesperson, has questioned the validity of the survey on which the decision was partly based and is asking St.Peter’s to continue running the clinic for six more months, rather than closing, as announced, in February.

The group wants to attract a new doctor with the patient pool intact. They argue, correctly, that it will be harder to find a doctor if the patients have been dispersed to other doctors off the Hill.
We applaud Robert Dietz, president of the Helderberg Medical Building Association, for his stance. "We have no intention of selling it at this time," he said of the Perkins clinic, stating the association will try to get a doctor to use the facility.

It may be an uphill battle, but it is one worth fighting. St. Peter’s owes it to the community and to the legacy of Anna Perkins to keep the clinic running for those six months so the group has a fighting chance of finding a dedicated physician.
As Councilman R. Gregory Zeh, on behalf of the Westerlo Town Board, wrote to the president of St. Peter’s Hospital, St. Peter’s has, as part of its mission, these two "key components": "We advocate for accessible health care and quality of life for all, especially the poor," and, "We respond with courage and integrity to needs for services in a rapidly changing health-care environment."

If St. Peter’s is true to its stated mission, as an advocate for accessible health care, responding to needs with integrity, it will give the Helderberg group at least half a year — even if it means losing $80,000 — to try to find another physician with the dedication of Anna Perkins.
"We really need somebody over there," said Dr. Margery Smith, who is made from the same mold as Perkins. Now retired, she was a rural physician who practiced for decades from her home in Berne. At 81, Dr. Smith is no longer licensed to practice medicine but said that she would help run the office in Westerlo or help in any way she can.

When Smith was practicing — and she filled in for Perkins when she was ill — she would discount her services for poor patients, taking a lower fee. Smith estimated that, each year, she didn’t collect between $10,000 and $15,000.
Hippocrates, the Greek physician who laid the foundations of scientific medicine, wrote in Precepts, "Sometimes give your services for nothing, calling to mind a previous benefaction or present satisfaction. And if there be an opportunity of serving one who is a stranger in financial straits, give full assistance to all such. For where there is love of man, there is also love of the art. For some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician...."

What Westerlo and the surrounding rural towns need is a doctor like Smith or Perkins — a healer who does more than earn a living from the practice of medicine, for whom it is an avocation as well as a vocation. There are joys to be found in country living and in serving a community that needs you. St. Peter’s must give the Helderbergs a chance to find such a physician.

— Melissa Hale-Spencer, editor