Swope Health CEO Appointed to National Task Force Addressing Racism

Jeron Ravin, JD, President and CEO of Swope Health, was recently appointed to the newly formed National Association of Community Health Center’s (NACHC) Task Force on Addressing Racism.

Task force members are charged with transforming NACHC into an anti-racist, multicultural organization and developing actionable strategies to lead the health center movement and the country in addressing social and health injustices. In the midst of a national movement concerning racial justice, this Task Force, representing one of our nation’s largest health care delivery systems, will focus on developing tangible steps to undo the affects that systemic racism has on healthcare and health outcomes.

“Rooting out systemic racism in healthcare is a monumental undertaking,” said Ravin, “but it must be done and I am honored to help forge a path to health equity.”

The association represents more than 1,400 federally supported health centers, providing healthcare to more than 29 million people.

NACHC recognizes that the profound racial and ethnic health disparities in the United States are embedded in long-standing institutional and systemic racism. Furthermore, NACHC recognizes that racism is a public health issue and public health crisis.

The Task Force will consist of no more than 11 people who will reflect diversity in terms of race/ethnicity, geography, age, sexual orientation, and gender. Lathran Woodard, NACHC Board President and a representative from the Health Resources and Services Administration (HRSA) will serve as members of the task force.

Tradition in a Spooky Season

Traditions are important. Merriam-Webster defines traditions as “the handing down of information, beliefs, and customs by word of mouth or by example from one generation to another without written instruction.” In other words, traditions are what we gift the generations to come.

In the middle of this pandemic it may be difficult to find a safe way to partake in the customary traditions. We all have to do our part to stop the spread of COVID-19 and this gives us an opportunity to start new traditions. Those new traditions can keep you and your family safe this Halloween season.

You can start a new tradition with these yummy treats, the Crunchy Mummy – a combination of a Crunchy Pumpkin and Mummy cheese snack. This snack was prepared by Priscilla Perez Schmid, Clinical Registered Dietitian with Swope Health, based on recipes from the US Department of Agriculture. (Download the Halloween Recipes.)

“Traditions are a celebration of belonging,” Priscilla said. “It is a moment to enjoy that place and time that can describe some of our best memories.”

Additional resources:

And, if you are looking for options for a safe trick or treating event, remember TreatTown! Join us at Swope Health Central, 6:30 to 8:30 pm Saturday, Oct. 31, for our drive-through Halloween experience!

What new traditions will you build this spooky season?

Help yourself: Pantries offer healthy foods

The COVID-19 pandemic has strained many aspects of our life, including adding difficulty to keeping safe and healthy foods available at home.

If you are skipping meals to make do or if your family is hungry, one of the nearly 1,000 food pantries in the state of Missouri may be able to help.

Swope Health’s registered dietitian Priscilla Perez Schmid, MPH, RDN, LDN, recently had a conversation with Rebecca Collier of Harvesters, a community food network, about how food pantries in our community.  Their conversation answers questions about how food pantries work and how you can find a food pantry near you.

Harvesters has a service locator to help find resources near you and a calendar of public food distribution sites, many operated as drive-thru events.

Swope Health hosts regular food distribution drive-thru events on the first Saturday of each month with support from Sysco Foods, Total Man Community Development Corp. and Rep. Barbara Anne Washington and others. The next event is 9-11 am Saturday, Nov. 7 at Swope Health Central, 3801 Blue Parkway, Kansas City.

In addition, you can locate a nearby Food Pantry at feedingmissouri.org. Feeding Missouri is a coalition of six Missouri food banks working together to distribute foods.  The organization’s groups distribute more than 120 million pounds of food each year through a network of more than 1,500 community feeding programs.

Harvesters is a member of Feeding Missouri and a member of Feeding America, a nationwide network of more than 200 food banks.

You do not need to receive Food Stamp benefits to get help from a food pantry. You’ll be asked for basic information and a few questions about where you live. The pantries exist to provide relief from hunger. In the United States, the government estimates that one of every nine persons struggles with hunger.

information on finding a food pantry

Quality in Asthma Care: Swope Health Pediatrician is Part of Award Team

Dr. Ning Haluck, a pediatrician at Swope Health Central, leads a program to train clinical associates in best practices in caring for asthma in kids, which resulted in a national recognition for the program.

Dr. Haluck is part of the University of Missouri School of Medicine’s Asthma program, which won the American Board of Medical Specialties “Outstanding Achievement in Quality Improvement Award.” The award recognizes a focused program that successfully decreased the rate of uncontrolled asthma in urban areas.

Asthma in Missouri “We are working to lower the rates of asthma and the number of kids with uncontrolled asthma,” she said. “The approach was first to teach primary care providers the asthma care guidelines and then make it a standard part of our practice at Swope Health.”

Asthma is a chronic disease of the lungs that causes wheezing and difficulty breathing. It is a common long-term disease in children, affecting nearly 30,000 kids in the Kansas City area. Asthma can be controlled by limiting environmental triggers and with medications.

The guidelines Dr. Haluck teaches include simple steps to help kids better control their asthma. It starts with a questionnaire, based on standards from the National Institutes of Health, to identify problems. The clinical exam includes a check of lung function and gathering objective data on allergies or triggers for asthma. There’s also a step to verify the right kind of asthma medicine is provided – both long-term and quick-relief medications are available, and not all patients receive the same medications.

“Then, we spend time teaching parents and kids about asthma,” she said. “We coach kids on how to use their inhaler and make sure they understand how important it is to take their medication. We want them to get their asthma under control.”

Having asthma “under control” means no visits to an emergency room or urgent care center, and regular visits to a doctor twice a year. Students also get an “asthma plan” for school, assuring medication at hand at the school.

In the program at Swope Health, Dr. Haluck showed a 31 percent improvement in quality of care of asthma control from 2018 to 2019. More than 75 percent of the 200-plus kids were able to control their asthma.

Dr. Haluck’s efforts are part of the Asthma Care Accelerator in the Extension for Community Healthcare Outcomes (or ECHO) program. Dr. Haluck has presented her program research and outcomes at a national ECHO conference in 2019, and since then has been named co-lead of the 2020 Asthma Care Accelerator ECHO program. Her current efforts, in light of COVID-19, are in asthma telehealth best practices.

Now, Dr. Haluck is engaged in training an even broader community of healthcare providers through the University of Missouri Telehealth Network. In April, Dr. Haluck participated in a national ECHO conference on “Asthma Telehealth and Asthma Day.” The program teaches the same proven guidelines for asthma care, through use of telemedicine.

She noted that some of the steps – like checking lung function – may still require an in-person visit, but much of the standard can still be accomplished in a video visit. “I will ask the child to show me how they use the inhaler,” she said, “and I can coach them if I see them using it improperly.”

Dr. Haluck also keeps an emphasis on the Kansas City community, serving on the executive committee of BreatheUP, a consortium of local stakeholders dedicated to improving asthma control. The consortium’s  goal is to reduce the rate of uncontrolled asthma by 25 percent in the next five years.

In all her efforts, Dr. Haluck’s real focus is on taking care of children with asthma.

“All children coming to Swope Health are getting the same care as if going to a specialty asthma clinic,” she said. “We are helping kids stay out of the emergency room. We are providing preventive care and helping our patients get the prescriptions and care they need. That’s what we stand for.”

facts about asthma

asthma infographic NIH

Swope Health Supports LGBTQ+ Community

Swope Health has a long history of providing care to communities that have traditionally been medically under-served. From our founding 50 years ago to today, the Swope Health team has always offered health care and support for members of our community in need.

That commitment to care extends to the LGBTQ+ community – people who are lesbian, gay, bisexual, transgender, queer or questioning. Swope Health stands ready to meet your healthcare needs, from supportive counseling and behavioral health skills to gender-affirming hormone therapy.

Ryan StokesSwope Health’s Dr. Ryan Stokes specializes in gender-affirming hormone therapy. His interest in transgender health care started with his medical training at Truman Medical Center, where he trained with a plastic surgeon who specialized in gender-affirming surgery.

Dr. Stokes sees patients with gender dysphoria – the deep-seated discontent that appears when a person’s identity does not match the gender of the body. An example is a person who identifies and feels male but has a female body, or vice versa. Gender dysphoria does not go away and can lead to depression, anxiety and other illnesses.

Gender dysphoria affects people in different ways, according to the American Psychiatry Association. Some people may want to be present themselves with the gender they choose, and others may seek to medically transition (through hormone treatment or sex-change surgery) to the gender they identify with.

In these treatments, the goal is move a patient toward the ability to live comfortably as their true self.

“I love sharing in the moment when a patient hits their target comfort level, where they are able to feel their authentic self fully,” Dr. Stokes said.

He also recognizes the difficulty of the journey.

“The transgender community is definitely marginalized.  It can be difficult to find care. With the recent developments of transgender healthcare protections being revoked, they can be actively turned away for being a transgender patient,” he said. “As a person of color, I know how difficult it can be to face discriminations like these.”

Words matter

Dr. Stokes supports his patients on their gender-affirming health journey. He checks in with patients on hormone therapy frequently to ensure they are adapting well to medication changes, and watches for side effects. He also helps patients navigate their health insurance and payment systems and offers support to help patients be emotionally and mentally comfortable with the changes they experience.

“This takes a holistic approach, to make sure that the patient is ready in mind and body to fully transition,” he said.  It can take time for patients to fully inhabit their new gender presentation, especially if the experience has been traumatic.

Whenever Dr. Stokes meets a new patient he proactively makes sure that he uses the preferred pronouns of his patients. A typical introduction is: “Hi, I’m Dr. Stokes, I am a cisgendered male. What pronouns do you prefer?”

This attention to respectful treatment of the LGBTQ+ community also has been the topic of training programs for Swope Health associates, featuring Rae Bowerman, a consultant and trainer with Common Threads. Part of Bowerman’s program with Swope Health associates includes a discussion of the spectrum of sexuality and gender identity, using materials from The Trevor Project, a non-profit organization that provides crisis intervention and suicide prevention services for LGBTQ+ people under age 25.

Bowerman, who is completing a graduate school internship with The Transgender Institute, emphasizes the importance of using correct terms and pronouns as a sign of respect and an acknowledgement of human dignity. Dr. Stokes agrees and recognizes that the choice of language can make his patients more comfortable.

“My hope is that eventually the health care system will be a safer and more inviting environment for LGBTQ+ patients,” he said.  “I want it to be a safe and welcoming visit when they see me. I have the privilege to be there with them at their best, to see when they get to fully realize their true selves, and I want to be with them at their worst, to support and care for them when they face struggles related to forming who they truly are.”

Additional resources:

 

If you are experiencing gender dysphoria, there’s a safe place for you at Swope Health. Call 816-923-5800 to schedule a medical or counseling appointment. Telehealth options may be available.

Valentine’s Day opening for Swope Health West

It was a chilly morning on Valentine’s Day, but warm inside our newest clinic location at Swope Health West, at 4835 State Ave., in Kansas City, Kansas.

The outpouring of warmth came from dozens of Wyandotte Community representatives who joined Swope Health staff in a ceremonial ribbon-cutting to open the new clinic location. There were balloons and flowers, candy and treats, as well as tours throughout the expanded clinic.

Swope Health President and CEO Jeron Ravin welcomed the audience, which included representatives from the KCK-Wyandotte County Unified Government, El Centro, Wyandotte Health Foundation and other agencies and business partners. Ravin noted that the new clinic allows for an expansion of services for Wyandotte County patients.

Swope Health West Opening

The ribbon cutting, led by Jeron Ravin, with West Clinic associates and Dr. Kenneth Thomas, right.

Swope Health West

This new facility replaces the former Swope Health West location at 6013 Leavenworth Road in Kansas City, Kansas. The new Swope Health West has five exam rooms, plus a procedure room, all newly renovated and installed with new fixtures and equipment. The Community Care Network of Kansas provided more than $13,000 for some of the new medical equipment and supplies at Swope Health West.

Swope Health West Opening

The West Clinic has five exam rooms and a procedure room with all new equipment and supplies.

Swope Health Chief Medical Officer Dr. Kenneth Thomas also spoke at the ribbon-cutting, both to welcome the community and express appreciation for all the hard work that supported the creation of the new clinic. He introduced the clinic associates, including Dr. George J. Bures Jr. and Nurse Practitioner Kylie Gaustad.

Swope Health West Opening

Bertha Thomas, Clinic Manager, left, introduced the West Clinic staff: Dr. Jennifer Frost; Dr. George Bures; Nurse Practitioner Kyle Gaustad; Medical Assistants Jalyssa Marshall, Nastasha Garry, and Yuliana Loveland-Paez;  and Jeron Ravin.

Dotte

Dr. Thomas, who introduced himself as a “Dotte,” shorthand for native of Wyandotte County, spoke of his deep ties to the community. He emphasized the Swope Health commitment to quality healthcare for all.

 “This beautiful new facility is another example of our commitment to and investment in high-quality care,” Dr. Thomas said. “We want our patients to have an experience that demonstrates our promise to quality care, starting at the moment you enter the new Swope Health West. We want you to find a safe, clean and welcoming environment, with associates who are skilled and compassionate in caring for every person.”

To schedule an appointment at Swope Health West, call 816-923-5800. Hours are 8 a.m. to 5 p.m. Monday through Friday.

Offering Hope – A Cure for Hepatitis C

Larry H. of Independence had struggled with health issues for years. He had bad teeth and a damaged immune system, which led to his retirement. When a friend recommended Swope Health, he thought he’d try it for dental care.

He couldn’t have predicted the journey that followed.

In April, he sought dental care but learned he had high blood pressure that needed treatment first. While receiving care for high blood pressure, his provider did a routine screening for Hepatitis C based on his age. Baby boomers (born between 1945 – 1965) make up about 75 percent of those positive for the virus. Larry learned he also had Hepatitis C.

Hepatitis C

Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage and long-term health problems including liver cancer. There are an estimated 2.4 million people living with Hepatitis C, according to the Centers for Disease Control and Prevention. Many people may have Hep C and not know they are infected, as they may not have symptoms.

Rachel Melson

Rachel Melson, Nurse Practitioner, in the Outreach Clinic at Swope Health. She is the champion of a pilot program that assists patients with Hep C get treatment.

Enter Rachel Melson, DNP, Nurse Practitioner and Director of Outreach Clinic at Swope Health. When Larry was referred to Dr. Melson, she determined he would benefit from a new Hep C treatment. The only barrier was the cost – roughly $74,000 for a 12-week course of treatment.

Dr. Melson went to bat for him. She petitioned the drug manufacturer and secured the treatment for him at no cost.

“Thank God,” Larry said. “This helps me live a little longer.”

Swope’s Pilot Program for Treatment of Hep C

Larry was part of Swope Health’s Pilot Program for treatment of Hep C. Traditionally, patients required a referral to a specialist outside of Swope Health to receive treatment. For most, this created additional obstacles to their treatment, such as transportation, and the financial requirements of the outside agency. The Hep C Treatment Program was launched in Spring 2019 to provide treatment for hundreds of identified patients, many who have been referred but still had not gone to receive treatment for various reasons.

Dr. Melson led Swope Health efforts to establish an effective primary-care Hep C treatment program. Swope Health is committed to developing specialized services for patients and delivering these services on site – no need for additional transportation or financial considerations. Now patients can be screened, tested and treated for Hep C all on-site at Swope Health. Dr. Melson performs an evaluation including blood test to determine whether a patient requires treatment by a specialist. Unless a patient is too sick for treatment by a primary care provider – for example, if cirrhosis is present or if the patient has had an organ transplant – Dr. Melson will manage their treatment.

Since March, Dr. Melson’s Hep C Clinic at Swope Health has seen more than 100 patients. She leads a team that works closely with patients as a champion to help them get the medication they need and follow their treatment plan.

What Does “Cured” Mean?

Hep C Infographic“I am already able to say that we’ve cured patients, and we rarely get to use the word ‘cure’ in medicine,” she said. “But this is such an effective treatment that we have actually been able to cure Hepatitis C.”

In this case, “cured” means the patient has no active Hep C virus in the body three months after finishing the medication.

“This service gives us another way to connect with and help take care our patients,” she said. “I love being able to develop that trust and a stronger rapport with patients through education about their health including Hep C. The more we build that relationship, the more we can care for them in the way that they need.”

Larry said he appreciates what Dr. Melson has done for him.

“Rachel is a very good doctor and a very sweet person,” he said. “There are a lot of doctors who could learn a lot from her. Not just her smarts, but her mannerisms, her way of being people to people. She’s very caring.”

Now Larry is completing his last few weeks on the antiviral drug and looking forward to the end-of-treatment blood test.

“I’m feeling pretty good now,” Larry said. “I’d recommend Swope Health to anyone. And I have.”

Do you have questions about Hepatitis C? We encourage you to talk with your provider. Call 816-923-5800 to schedule an appointment at Swope Health.

About Hepatitis C

  • About 75 percent of people with Hep C were born between 1945 and 1965, commonly known as the Baby Boomer generation. Most boomers are believed to have become infected in the 1970s and 1980s when rates of Hepatitis C were the highest, says the Centers for Disease Control and Prevention (CDC).
  • Hep C is rapidly increasing, it’s growth tied to the opioid epidemic. The virus is now found in all ages, with sharp increases especially in younger Americans age 18 to 39. There is no vaccine to prevent Hep C.
  • The Hep C virus spreads when infected blood enters the body of an uninfected person. It can spread with shared use of needles, spoons, even razors or nail clippers. The virus stays alive and active on surfaces, making it easier to transmit. And once you have been infected, even if you have cleared the virus, you can be re-infected.
  • The current treatment for Hep C is an antiviral drug that is taken as one pill a day for 12 weeks. There are several types of antiviral drugs available, and these drugs cure more than 90 percent of people who use them.
  • The drugs, however, come with steep price tags. There is high demand, and the cost to bring drugs to market is expensive – up to $900 million to develop, test and market. Prices may come down as generic versions come to market and if more companies enter the market.
  • At the end of treatment, a blood screen determines if the medication has cleared the virus from the body. In most cases, there is a dramatic reduction in the active virus. Patients are tested again after three months to verify that the virus is still inactive – what is called a “sustained virologic response.”

Meet Priscilla Perez Schmid, our Registered Dietician!

Priscilla Perez Schmid

Priscilla Perez Schmid, Swope Health’s Registered Dietitian, shows a sample plate with healthy food groups and portion sizes.

Priscilla Perez Schmid is a Registered Dietitian who has joined Swope Health with the goal of developing a new service to assist patients with their nutritional health.

Over time, she plans to build a team of registered dietitians who will perform clinical assessments and make recommendations for treatment of conditions that might be helped with nutrition. She and her team will then help patients set goals for their eating habits to support better overall health.

“Food is our first and most basic medicine,” says Priscilla. “What you eat determines, in part, how healthy you will be. I want to help everyone understand how to eat healthy for better well-being.”

Priscilla will also set up ways to measure the effectiveness of the program, including incorporating measures from patients in the program.

“Patients should know that my priority is establishing a collaborative relationship with them,” she said. “Patients are the leaders of their own health, and I am here to help them on their path toward sound health decisions.”

Nutrition and Dietary Education Needs

Swope Health providers refer patients to Priscilla to support their nutrition and dietary education needs. She regularly works with patients who have diabetes, obesity or high blood pressure, assisting them with healthy food choices to better manage and improve chronic health conditions. She also guides them to resources for selecting, purchasing and preparing healthy foods.

“After diverse cultural exposure, I am sensitive to people’s differences in opinions and values,” she said. “I respect individuality and prefer to work on shared goals.”

Priscilla’s Education and Training

Total Diet Approach to Healthy EatingPriscilla has earned the credential of Registered Dietitian (RD) from the Commission on Dietetic Registration, the credentialing agency for the Academy of Nutrition and Dietetics, the world’s largest organization of food and nutrition professionals. She holds a Master’s degree in Public Health, with a specialty in Nutrition from Loma Linda University, and is licensed as a dietitian in Missouri and Kansas.

Before arriving at Swope Health, Priscilla worked as a clinical dietitian in acute and chronic healthcare at St. Mary’s Medical Center and DaVita Dialysis in Apple Valley, Calif. She grew up in west Puerto Rico, and after obtaining her Bachelor’s degree in Biology, she moved to the Washington, D.C. area, where she was a post-baccalaureate research fellow at the National Institutes of Health.

Fluent in Spanish, Priscilla is still adjusting to the Kansas City environment and indulging her curiosity by exploring the region.

“I love how green it is out here in Kansas City,” she said. She also admitted to an immediate fondness for Kansas City barbecue—though in moderation!

When not working, Priscilla enjoys painting, playing jazz flute and practicing yoga. She lives in Kansas City with her husband (a psychology doctorate intern) and her two big dogs.

Meet our CEO Jeron Ravin

Meet the CEO: Jeron RavinOn Aug. 26, 2019, Swope Health announced the appointment of our new President and Chief Executive Officer Jeron Ravin.

Here are some early questions we had for Jeron:

What attracted you to the position?

Without question, it was the chance to work at Swope Health. I have always found FQHCs at the intersection of mission-driven work and the fight for health equity. Swope Health embodies that.

What attracted you to Kansas City?

I’ve never lived in the Midwest. More importantly, it’s an exciting time to be in KC.  The city’s population has grown year over year. New development is sprouting up throughout the city, and KC has a rich history of music, great food, technology, and civil rights – things I have an ardent interest in.

Why do you think you are the right person for this job at this time?

I believe in leadership that is centered in integrity and collaboration. My career has demonstrated that this approach builds effective teams. Swope Health is at an interesting precipice. As the best, we now get to decide what our next level of care looks like. To me, this is continuously pushing the envelope to give our patients the very best–and changing lives in the process. Not only am I passionate about this approach but I have a history of achieving it.

What are you most looking forward to in your new role and as a new resident of Kansas City?

Working with the team here at Swope Health. I’ve been in community health for some time and instantly realized that Swope Health is special. This was clear to me after meeting the Board of Directors and numerous Swope Health associates. As far as KC is concerned, I’m looking forward to sampling the BBQ, art, music, festivals, snow, college basketball and Arrowhead Stadium.

What is your management style or philosophy?

Lead honestly, collaboratively, and unselfishly, with purpose and vision. Surround yourself with smart people and work with them to make a difference.

What are some of your hobbies? What do you like to do in your spare time?

Traveling. It’s a big world. I like to experience as much as possible. Live music and concerts are also something I really enjoy. I also read often and workout.

Swope Health is celebrating 50 years and many have said it is the perfect time for this change. What do you see for Swope Health in the next 50 years?

I see growth, and an opportunity to forge genuine connections with the communities we serve. I truly want Swope Health to become the healthcare provider of choice for all of the Midwest. Keep watching –I have a few things up my sleeve. J

100% Compliance: Audit Results for the VFC program at Swope Health Wyandotte

When we talk about Swope Health, we always talk about quality. It is in our mission statement and it is part of everything we do, every day. Here is an example.

VFC Program

VFC LogoSwope Health is a participant in the federal Vaccines for Children (VFC) program, which provides vaccines to approved providers to offer to children at no cost. The program works to vaccinate children who might otherwise not be vaccinated because of inability to pay.

The program, operated by the Centers for Disease Control and Prevention, has strict guidelines and controls, including annual site visits performed by state health departments to make sure providers meet all requirements.

VFC requirements include things you might not think about, like:

  • A Vaccine Accountability and Management Plan
  • Required annual training of clinic staff
  • Current Vaccine Information Sheets at every location, given with every dose
  • Complete immunization records
  • Strict requirements for storage, labeling and security of the vaccines, including temperature controls and procedures for disposing of expired or damaged vaccines

VFC Audit

Swope Health Wyandotte Team

The clinical team at Swope Health Wyandotte won praise for its high standards in a recent site visit by inspectors from the Kansas Immunization Program.

Recently, the Kansas Immunization Program sent a representative to perform a site visit – a kind of audit – of the VFC program at Swope Health Wyandotte. The investigator follows an evaluation framework to check in on each element of the program, gathering specific information, completing a questionnaire and interviewing clinic associates.

At the conclusion of the Wyandotte site visit, the investigator reported:  “As always, it is obvious the high standards your clinic holds.  There were no compliance issues discovered.”

Dr. Kenneth Thomas, Chief Medical Officer for Swope Health, noted the state is “very protective” of its vaccines and is strict in enforcing adherence to federal guidelines.

“This is a big accomplishment,” he said. “Our medical assistants and nursing staff are doing great work.”

Wyandotte Clinic Manager Irma Salinas, RN, agreed.

“I am so proud of the work the Wyandotte team has done and continues to do to care for our patients,” she said.  “I have received many wonderful comments about the compassionate care we are providing.”

Irma noted the team has been working hard on its processes – the step-by-step procedures that assure consistent and repeatable care for all patients.

“We know standard operating procedures are significant factors in providing more quality and efficient care,” she said.  “The last few weeks have not been easy, but each of us has demonstrated a strong desire to continue to make this the most outstanding clinic in Wyandotte County and beyond.”