The Community Free Clinic in Concord has an impact on hundreds of lives each year, and one of the newest team members helping keep the uninsured healthy has four legs.
Jacques, a gray toy poodle originally trained as a therapy dog, accompanies Grace Liem during Liem's patient visits at the clinic. Liem, 61, has lived in Concord about 10 years and has been a nurse since 1983. She volunteers as a nurse practitioner at the clinic a little more than one day a week.
Liem and Jacques have been working together at the clinic for three years.
If the dog senses something is off in a patient's physiology, he'll sit between their legs or paw at them. If everything passes the dog's "sixth sense," he'll lie by the patient's feet or, sometimes, in the chair next to them.
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The 16-year-old nonprofit clinic provides care to 300 new patients per year on average throughout Cabarrus County. Common conditions treated range from diabetes to thyroid issues.
The organization is one of those featured in The Charlotte Observer's annual Giving Guide. It is sustained through a variety of funding sources, including grants and contributions. Last week, representatives for the Barnhardt Fund in Cabarrus announced it is one of three charities and two churches that will benefit from the fund.
"When people come in here, we see them with multiple chronic problems and diseases," said Liem. "Nobody comes in here for a sprained toe."
Liem, who trained her live-in dog to sense anxiety in people, said she serendipitously discovered her dog could identify other conditions, such as high and low blood sugar, hypertension and thyroid conditions.
"He came with me into a room, walked right up to the patient, sat between the patient's legs and looked right at me," said Liem. "He was trying to tell me something."
That patient's blood-sugar level was discovered to be six times greater than normal.
"So this happened again, several times," said Liem. "And I thought, OK, something's going on here. And every time it happened, something would be abnormally wrong with a patient.
"Now he can sense any abnormality, really. He can sense the chemistry in the person. Once he learned to sense that change in a person's physiology, he was able to sense it in anyone."
One of Liem's theories of how the dog does this is that patients become ketotic - meaning they have elevated levels of ketone bodies in their blood.
Diabetics often have fruity-smelling breath from the ketones, said Liem, and when patients have elevated blood pressure, it affects their kidneys, which also can produce ketones. "The theory is (Jacques) can sense or smell what's being emitted," said Liem. "He is smelling or sensing something we can't so he's a terrific gauge, really."
Without free clinics, Liem said, health care costs would be exponentially higher locally and nationally, because those who can't afford care would go to the emergency room, even for acute conditions. And if they can't pay, costs would be passed on in the form of higher premiums for those who can afford insurance.
"We are a huge safety net," said Liem of the clinic. "I believe there will always be a need for people to get free health care. When you talk about health care, there has to be continual care, and the cost of one single emergency-room visit could probably pay for an entire day of visits for all the patients here; it's absolutely insane."
Patients praise the volunteer staff's friendliness, attention to detail and multifaceted exams.
Benita Brown, 53, of Kannapolis has been going to the free clinic for about a year to be treated for high blood pressure, diabetes, arthritis and swelling in her feet. A head-on collision, which resulted in multiple shattered bones in her arm and foot, caused her to leave her job at Stanley Tools because she couldn't stand or walk for long periods.
Without the free clinic, she said, she would be lost. It's hard for her to be active, she said, but her conditions are slowly improving.
"I have always worked, since I was 16," said Brown. "I'm not used to this. I'm the type of person to just go. And to come to this stage, when you have to depend on people to help you, it changes you. But it's beautiful. We're all like family. You can't ask for a better place."
And if you're considering seeking help, Brown simply recommends people go.
"If you need help, try to get it," said Brown. "You won't regret it. They found a lot of stuff that was going on with me that I didn't know about."
James McInnis, 50, of Midland has been going to the free clinic for about a year. He runs his own renovation business but doesn't have insurance. When the economy got bad, work slowed, he couldn't afford insurance and he stopped taking his medications for four months.
Without the clinic, he said, he might not even be alive.
"Their generosity is just overwhelming," he said. "I feel comfortable here. At first I thought it might be an in-and-out sort of thing, but they put more in it than I did in the beginning. I felt they were concerned more about me than I was and that moved me. I'm a diabetic and they've gotten that fantastically under control."
After being self-employed for years, not being able to pay does sting a bit, said McInnis, but he recommends others lay those judgments aside and take care of themselves.
"It ignites some feelings in me about being too proud, but I just wave those feelings,' said McInnis. "Everybody at some point in their life needs real health care, and this facility has offered me real health care. I'm not paying my way, but fortunately, they saved my life. I don't expect to be here long-term, but I'll never forget this experience."