Hope Clinic’s new medical home for the county’s under and uninsured

On the second Saturday in February, about 100 people from Pamlico County gathered for the grand opening of the new location of Hope Clinic. Community members, donors, supporters, public figures and medical professionals shared refreshments while checking out the space off Highway 55 in Alliance.

Arranged like a standard primary care office, all the walls are an array of light blue and white colors. Photographs from around the county are displayed on the wall, including tractors, water towers and boats. For some, it was their first time coming into Hope Clinic’s space; others remember the clinic’s 27-year journey to where it is now.

Hope Clinic is a private nonprofit that provides free primary care for those who are uninsured or underinsured, in other words, people who make “too much” for medicaid but whose insurance provides inadequate coverage, often with outrageous deductibles.

Serving the county and the surrounding areas of Craven and Beaufort, the clinic started in 1998 as part of St. Thomas Episcopal Church’s outreach ministry in Oriental. About a year later, the clinic found a home in the county’s health department and became a nonprofit in 2004.

To date, the clinic has provided care for about 4,000 people. Hope Clinic, which falls under the free and charitable clinic category, fills a critical gap in counties like Pamlico.

According to the most recent county health assessment, 13.8% of people in Pamlico live below the poverty line. The state’s average is 13.3%. In addition, 13% of adults in the county under the age of 65 don't have insurance, which is higher than the state average of 11%. The county has a large wealthy retiree population that skews the economic data.

Yolanda Cristiani, a 30-year licensed practical nurse and Hope Clinic’s executive director, stayed busy on opening day – leading the event, officiating the ribbon-cutting ceremony, checking her daily emails, filing paperwork, hosting guests and leading educational discussions.

“I'm physically and mentally worn out,” Cristiani said that day. “But Monday morning, first thing, we're helping our patients and we have that ability now.”

Cristiani has served as director since 2020 and has been involved with Hope Clinic since 2013 when she and her husband moved from her hometown near Asheville to Pamlico for its quietness, fishing and lower cost of living. She started as a volunteer and held an assortment of jobs with the clinic, including pharmacy coordinator and nurse before becoming director.

For over 25 years, Hope’s operation had been in a small area within the county health’s department. Cristiani, who appreciates the health department hosting the clinic rent free for decades, also acknowledges the benefits of having its own location. “The patients are happy,” Cristiani said. “They have a medical home now. Not just a place they go to.”

While it was part of the health department, Hope Clinic was open only on Thursday nights, which typically became hectic. The nonprofit would see over 50 patients a night with limited medical providers and space. The pharmacy and providers were on opposite sides of the building.

In addition to now being able to spend more time with patients, Cristiani said, “It went from a very fast-paced environment to now we are more efficient.” She also said that the staff is more relaxed.

Samuel Dail, Hope’s volunteer medical director, said the clinic couldn’t be what it is today without the grounding of the health department. However, “having our own space and being able to expand hours and use our space to do more than just provide immediate medical care is so powerful,” he said.

Dail said he now plans on growing more programs and having the clinic open more days per week.

Since its opening, the new facility has since been hosting clinics almost every Thursday during the day. Hope also provides care every other Wednesday in its mobile clinics throughout the area, alternating between Oriental, Aurora, New Bern, Reelsboro and Arapahoe. The clinic also hosts a monthly late night clinic.

On days that the clinic isn't open, the staff is working on referrals, doing case management, operating the pharmacy, operating labs and running educational programs.

Crystal T., a past patient said she came to Hope Clinic when she was experiencing perimenopause, high-blood pressure and anxiety.

“This is not just a place where you come and you feel like you're being seen by somebody and rushed out the door. These people genuinely care about their clients,” she said after attending a mental health workshop hosted by a licensed clinical social worker and counselor.

Crystal said the care at the clinic is nonjudgmental, welcoming, heartfelt and important. “That's what makes these people that work here so much more special, because they're not getting a dime from you," she said. “They work from their heart; they don't work for the paper.”

Cristiani, who became a mother when she was 18, said her motivation to help others comes from her own experience. Although she was also working and going through nursing school, she said she was sometimes treated rudely for being a young mother in need.

“Everybody, when they walk through the (Hope Clinic) door, I don't care where they come from, what they've done, who they're with,” she said. “They're just as important as the next person that comes in and we should treat them all accordingly, with respect and dignity.”

Lindsey Potter, Hope Clinic’s case manager and lead for New Beginnings, a program dedicated to a holistic and whole-body approach to substance use problems, is also motivated by her own experience.

Potter, who was born and raised in the county, struggled with substance use from a young age. Once she moved out of the county and overcame her addiction through a tailored recovery approach, she was inspired to use what she had learned to help others who could benefit from it as well.

Potter said that her personal experience allows people to trust her more. “If you provide a safe space, a judgment-free space, most people want to tell you their story,” she said. “They want to ask for help.”

According to the North Carolina Department of Health and Human Services Division of Public Health data from 2024, Pamlico has one of the highest overdose rates in the state and the highest rate on the coast, after Tyrrell County.

Potter also said Hope Clinic provides resources to all people in need, such as those struggling with housing insecurity and food insecurity.

Joshua Rose, a county dentist for over 20 years, was born and raised in Pamlico, and has engaged with Hope Clinic since its inception. He said he donates to Hope Clinic because it's a great way of giving back to the community, citing the lack of industry and opportunity in the area, which contributes to poverty.

“If the choice is putting food on your table for your kids or yourself versus taking care of yourself, most people are going to choose basic needs and neglect their health,” Rose said. “The more access to health, the less ER time, less loss of wages, less loss of work, the better off we are as a society.… Having that ability for a clinic like Hope Clinic to help is very important for any area, especially a very rural area like ours that doesn't have a whole lot of access to health.”

“Free clinics have historically been considered for folks who are jobless, who are not working, who are uninsured,” Dail said. But, he added that “the health care market is such that even folks with good jobs and benefits may actually find it impossible to make ends meet when it comes to health care.”

Not getting regular primary care leads to worse health outcomes. In return, this leads to greater damages and emergency services that could’ve been prevented. “If you can treat somebody at that kind of point of contact before a disease gets uncontrolled, you're going to extend people's lives, save emergency room visits and costs of medicine by taking care of things before it becomes a major issue,” Rose said.

Rose also said that health care has become less personal over time as corporate structures demand more from physicians, leaving them less time for interacting with patients. It’s also difficult to recruit physicians, especially young ones, to a rural area like Pamlico. As a doctor, Rose highlights the importance of having access to physicians.

The county is designated by the U.S. Department of Health and Human Services as a Health Professional Shortage Area. Pamlico’s physician to patient ratio is 5.75 primary care physicians per 10,000 residents. The state average is 7.47 physicians per 10,000 residents.

Diana Silimperi, a Pennsylvania native who came to North Carolina in the 1970s for her bachelor's degree and doctor of medicine at Duke University, spent around 10 years of her nearly 40-year career living abroad as a public health pediatrician before returning to North Carolina to work in rural communities as a health expert. Pamlico is now where she lives. Silimperi said that the health care issues she saw in rural Kenya and rural Afghanistan have similar roots to the ones  in Pamlico. “There's all kinds of barriers to access,” she said. “The biggest ones are commonly geographic, approximal access to a quality provider, and then financial.”

Silimperi, who has supported Hope Clinic since 2007, said charitable clinics are an important part of the clinical system.

“(Charitable Clinics) exist in a lot of places and have a huge spread of influence in terms of the populations they're reaching,” she said.

In 2020, during the height of the pandemic, Silimperi started to get involved with Hope Clinic. As a current adjunct professor at Duke, she brings health care students to Pamlico every summer to introduce them early to the rural health care setting. This, she said, is an important channel by which to help in the primary care shortage.

Sophie Li, a Duke neuroscience major from Nashville hoping to go to med school and have a career in global health, is doing a summer internship with Hope Clinic. Having never lived in a rural environment, she said coming to Pamlico was out of her comfort zone. However, she said this experience so far has changed her outlook on health care and inspired her to one day return to a charitable clinic as a physician.

“It has opened my eyes to the people that are often forgotten in health care settings,” Li said. In addition, she said she loves Cristiani and admires the clinic’s physicians and staff.

Hope Clinic has nine staff members and 60 volunteers. Staff positions include nurses, case managers and pharmacy technicians. All of the physicians are volunteers.

Dail, who is native to and works in New Bern as a full-time family doctor, said that even though his schedule is busy, the idea of service was instilled in him by his family. “Serving and giving back to your community is something that's necessary for long-term success.,” he said in an interview just after Hope Clinic’s yearly regala. “ We're a community for a reason. Without each other, we have nothing.”

This year was a milestone for the clinic, as it brought in a record $27,000 in just “raise your paddle” donations from the regala. The previous record was about $10,000. Cristiani attributes the success to a well-planned event and the introduction of a new clinical space.

Cristiani urges people to get screened for eligibility. “When patients are ready to come to us, we have the facility, we have the volunteers and now we have the place where we can take them,” she said, adding that there’s “so much more than just medical care here.”

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