Rural clinics struggling

NEW SALEM, N.D. (AP) — Dr. Tom Kaspari says it's not true he works at the medical clinic here for free.

"I usually get jars of plum jelly or some salsa," he says.

It's enough for him. But it may not be enough to keep the New Salem Community Clinic in business. Even with a staff of volunteers, the clinic is in the red.

"I don't know how much longer we can stay open," says 89-year-old Milt Grube, one of Kaspari's regular patients who also serves on the clinic board of directors. "We need some federal money to keep afloat."

But getting money for the clinic seems questionable in a region with a dwindling population.

All across the country, declining rural areas are looking for doctors and nurses. But in North Dakota, one of the few states that has lost population, the challenge is especially daunting.

Grube, a retired farm-implement dealer, said many of the town's 800 residents are elderly, "I suspect like most other small North Dakota towns."

The number of rural clinics in the state fell from 80 in 2002 to 62 this year, said Bill Finerfrock, executive director of the National Association of Rural Health Clinics. The country as a whole lost only 100 rural clinics during that time.

Grube said the New Salem clinic had about 3,100 patient visits in the past year and a half. Finerfrock said a clinic that size probably needs at least 4,200 visits a year to stay afloat.

Sitting west of Bismarck, New Salem is the home of Salem Sue, a huge fiberglass cow statue standing watch along Interstate 94. The clinic is near a vacant 1970s-era shopping mall with a gravel parking lot.

Kaspari (pronounced KAS-per), 44, comes to the clinic every Wednesday afternoon and evening, dressed more like a cowboy than a doctor. He sees up to 21 patients with all kinds of ailments. Thank-yous and occasional jars of homemade goodies are his payment.

"It wasn't my plan to be here two years, but that's the way it's ended up," he said recently as a half-dozen, mostly elderly people waited in the lobby.

Grube said the town is fortunate and that Kaspari reminds him of "old Dr. Gaebe," who served the community a century ago. "People used to pay him with a half-dozen chickens or a pig," Grube said as he waited for a blood-pressure check.

If the New Salem clinic closes, the nearest doctors are in Bismarck, the state capital just 30 miles away. But even that distance can be a problem for many old people.