The U.S. Con­gress is on vaca­tion, not work­ing on details on health care reform, but the health care debate has only got­ten louder. Mem­bers are back in their dis­tricts and are try­ing to talk to the pub­lic, instead many times they talk to oper­a­tives of one side or the other, only mak­ing the public’s true voice quieter.

For a story on health care, a reporter from the Guardian vis­ited a poor area in Kansas. Soon, the area will have only one doc­tor serv­ing it, as most med­ical ser­vices have moved to afflu­ent areas. How­ever, reporter Ed Pilk­ing­ton does find a Health care clinic that oper­ates via dona­tions instead of insur­ance reim­burse­ments. For many in this poor area of Kansas, it’s the only place they can turn to for health care.

Lee’s clinic, Fam­ily Health Care, is a refuge of last resort. It picks up the pieces of lives left shat­tered by a health sys­tem that has failed them, and tries to glue them back together. It exists largely out­side the para­me­ters of for­mal health pro­vi­sion, rais­ing funds through dona­tions and pay­ing all its 50 staff – Lee included – a flat rate of just $12 an hour.

Lee has just opened an out­post of her clinic in the out­ly­ing neigh­bour­hood of Quin­daro, an area of boarded-up houses and deserted fac­to­ries where work is hard to find and crack plen­ti­ful and a per capita income is $11,025. A third of the pop­u­la­tion is below the fed­er­ally defined poverty line.

And yet the local health depart­ment has decided the only health cen­tre in the area will be closed by the end of this year and moved 30 blocks west to a much more pros­per­ous part of the city where income lev­els are five times higher. Before long, one of the poor­est areas of Kansas – of Amer­ica – will be left with­out a sin­gle doc­tor, with only Lee’s vol­un­tary ser­vices to fall back on.

Even that is aca­d­e­mic. Many of the res­i­dents of Quin­daro were unable to see a doc­tor in any case – because they were unin­sured. In Kansas, any­one who is able-bodied but unem­ployed is not eli­gi­ble for government-backed health insur­ance as is any­one earn­ing more than 39% of fed­eral poverty lev­els. That leaves a huge army of job­less and low-income work­ing fam­i­lies who are left in limbo. “It’s the work­ing poor who are most at dis­ad­van­tage,” Lee says.

As a result, she sees the same pat­tern repeat­ing itself over and over. Peo­ple with no insur­ance avoid seek­ing med­ical help for fear of the bills that fol­low, until it is too late. “When peo­ple come in they are already very, very sick. They have avoided see­ing the doc­tor think­ing that some­thing may clear up, hop­ing they may be get­ting better.”

Beth Gaba­ree, who came in to see Lee for the first time this morn­ing, has expe­ri­ences that sound extreme but are in fact quite typ­i­cal. She has dia­betes and a heart con­di­tion. Until two years ago they were con­trolled through ongo­ing treat­ment paid for by her husband’s work-based health insur­ance. But he was in a motor­bike crash that pul­verised his right leg and put him out of work.

That Catch 22 again: no work, no insur­ance, no treat­ment. Except in this case it was Beth who went with­out treat­ment, in order to put her husband’s dire needs first. He receives ongo­ing spe­cial­ist care that costs them $500 a go, leav­ing noth­ing for her. So she stopped see­ing a doc­tor, and effec­tively began self-medicating. She cut down from two dif­fer­ent insulin drugs to reg­u­late her dia­betes to one, and restricted her heart drugs. “I do what I think I need to do to keep four steps out of hos­pi­tal. I know that’s not the right thing, but I can’t jus­tify see­ing the doc­tor when my family’s already in money trouble.”

The prob­lem is that she hasn’t kept her­self four steps out of hos­pi­tal. Her health dete­ri­o­rated and ear­lier this year she became bedrid­den. Even then, it took her fam­ily sev­eral days to per­suade her to go to the emer­gency room because she didn’t want to incur the hos­pi­tal costs. “It was hard enough with­out that,” she says.

After an ini­tial con­sul­ta­tion, Lee has now booked Gaba­ree for a new round of tests for her dia­betes and is arrang­ing for free med­ica­tion. “It’s won­der­ful,” Gaba­ree says. “I’m so blessed. I didn’t know you could get this sort of help.”

That she sees basic health­care as a bless­ing, not as a right, speaks vol­umes about atti­tudes among the mass of the work­ing poor. Also reveal­ing is the fact that Gaba­ree has absolutely no idea about the debate rag­ing across Amer­ica. She hasn’t even heard of Obama’s push for health reform, nor the Repub­li­can efforts to pre­vent it. “I don’t watch much tele­vi­sion,” she says.

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