“I remember that first night. We just hoped somebody would come through the doors. Now we hope that we can handle everybody that comes through the doors. We’ve had record-breaking nights this summer,” said Pavka. “There are more resources now than there ever have been, and we have more patients that need our help.”

Some Tuesday nights during the past summer, over 60 people walked through the doors of the church, which sits prominently on the town’s city square, to ask for help with health care. While the doors don’t open until 5 p.m., the people who lined up at 3:30 served as a visual reminder that the whole town of Hillsdale is affected by the economic conditions that fuel a frightening health care crisis.

“For some of our clients, it is really embarrassing to be here. Walking through those doors can be tough. I think it is important that we always remember and keep that foremost in our mind. People have sacrificed a lot of their pride to walk through those doors at night,” Pavka said.

According to the recently released 2006 census information, one million people in Michigan—and 47 million in the United States—have no health insurance. As the economy continues to shed workers, families continue to lose health care coverage.

“We have lost 2,000 manufacturing jobs in Hillsdale County since 2002,” said Pavka, who explained that Hillsdale Tool and Manufacturing, a five-plant company tied to the auto industry, is gradually closing its doors.

“Hillsdale Tool has been here forever and has employed lots of people over the years. They are down to their last 50 people,” she explained. “The people left have worked there for 30 years, and the people who worked there 20 years are long gone.

“The jobs have just been outsourced and that has happened over and over and over again with the automotive industries,” Pavka said. “I look at the agriculture this past summer, too, and realize this is going to be our next group of people with nothing. It has been a devastating summer.”

Another example of the local impact of global economics is literally in the church’s backyard. St. Peter’s sits on a hill overlooking the ghost-like remnant of a flour mill, an historic family-owned business that some people in town still call Stock’s. The name dates to 1869 when Frederick Willhelm Stock moved to Hillsdale and bought an existing gristmill. Stock’s mill became the largest family-owned plant east of the Mississippi River, according to city history.

As the taste for American doughnuts crossed the Atlantic Ocean with U.S. soldiers, so moved the ownership of the flour mill. After World War II, Stock’s mill was bought by DCA (the Doughnut Corporation of America) and became a subsidiary of an Irish company called the Kerry Group. The Irish company sold its American and Canadian affiliates to Pillsbury in 2000 for $100 million. General Mills bought Pillsbury at the end of 2001 for $10 billion, and then abruptly closed the Hillsdale operations in 2003.

“People who worked their entire lives there were left without benefits, without jobs, without pensions. And we’re left with a huge empty building—that probably is in and of itself a health risk. It is a big gaping hole in our community,” Pavka said.

The bakery’s demise had the same ripple effect that is washing through the automotive supply industries and through agriculture, creating a confluence of despair in south central Michigan.

“Some people are moving back into jobs but they are service jobs that pay $8.75 an hour with no benefits,” Pavka said. “The economy is just trashed here; it is bad all over and we just don’t have any resiliency. There is no Interstate and the things you think would draw industry just aren’t here anymore.

“It’s had a huge economic impact on our community. We’ve had people go from good paying jobs with insurance to nothing, overnight. And when we open the door on Tuesday night, they find us,” said Pavka.

Since 2002, over 3,000 patients have come to St. Peter’s for help with health care on Tuesday nights when nurses, doctors and a pharmacist see an average of 50 patients a night. The clinic averages nine new patients each week.

“Everyone sees a nurse before they leave,” said Pavka, who added that the clinic average during the first two years was only about 20 patients a week. “We are now doing dental referrals in partnership with the health department and local hospital.”

In what started as her part-time passion, Pavka is now at St. Peter’s 32 hours a week as the health clinic’s full-time director, grant writer and public relations coordinator. What five years ago was the church library is now her office.

The pharmacy, which initially was housed in a church closet with a few free samples and a padlock, is now a full-scale pharmacy with a computer. St. Peter’s buys most of the drugs it needs, and it offers a medication clinic every other Thursday morning that assists more than a dozen people with prescription drugs every time it opens. The clinic has dispensed $1.5 million worth of prescription medications in the past 18 months.

Once squeezed into a Sunday school classroom, the two state-of-the-art examination beds are now in small but private rooms. A refrigerator is full of insulin for the clinic’s once-a-month diabetic group, which is run by a physician’s assistant, three nurses and a pharmacist and involves 18 participants each month.

Much of the expansion of the clinic has come from Blue Cross-Blue Shield’s support for Michigan’s free health clinics. The support has made possible the hiring of the clinic’s first two part-time employees—a volunteer coordinator, who has served heretofore as a volunteer herself, and a patient care coordinator. The board, which is independent of the church, and the Friends of the Free Clinic are directly involved in significant fundraising and support.

The parish hall doubles as an expansive waiting area where entire families can sit together, read books and even enjoy nutritious snacks.

“The room is just packed. People don’t come to the doctor by themselves—a little known fact. I had no idea it was such a social thing. I think they also come because it is such a hospitable place,” said Pavka.

“It is an opportunity for us to welcome people into our space and to provide something that they don’t have in their lives. In this case it is health care. I think the act of welcoming is as important as anything we can do. Sometimes people come here and we can’t help them with their health care but we definitely try to not send them away empty handed. One of my core beliefs is that if they come here, we need to help them,” Pavka said.

“Somebody asked me, ‘Did you think you’d be seeing people who were this sick?’ And I said, ‘No, I thought we’d be seeing cuts and bruises and colds.’

“What we are seeing more and more is people who are sicker and sicker and sicker before they come here or people who have been in the hospital, had no insurance, and the hospital told them to go to the free clinic.

“We are seeing desperately ill people and probably three out of five are also being treated for depression,” Pavka said. “If they were making $12 or $15 an hour, they probably had a decent house, a nice car and payments for everything. Now they have lost so much of that and the sense of hopelessness shows as depression or anxiety.

“I can only imagine what that looks like: sleepless nights and not being able to eat because you are worried about how to feed your kids. That is what I see more than in the early years,” she said.

In the mix of volunteers who are on site whenever the clinic opens is Judith Schellhammer, a member of St. Peter’s ministry team. She is watchful for the ways the congregation can further assist the clients who come to the church for assistance. Other members of St. Peter’s volunteer in the kitchen to make sure the volunteers and medical staff get a meal before their shifts are over. They are all involved to help the ministry any way they can.

“Sometimes finding the right resources is challenging,” Pavka said. “So many of our clients are people who have not lived in poverty before. They were working at good paying jobs; they had health care benefits; they were living the life they dreamed. And then when jobs were pulled out from under them, all of a sudden they have to try to figure out how to navigate a system that is not very user friendly sometimes.

“I am part of what they call the Rapid Response Team,” said Pavka. “With South Central Michigan Works, we go into the factories and talk with the employees about what services are available when they lose their jobs. We hand out information,” she said.

“That is really tough. but it does get the word out and they get some written information to put in their folder. I’ve had so many people tell me that that’s how they learned about us. When they lost their job and pulled their folder out, they knew where they could come for health care.

“We aren’t the answer to the health care crisis in this country or in this state. I am very proud of the quality of care that we give here, but the problems are much greater than can be [addressed] in a free health care setting with volunteer providers,” said Pavka. “When I first started with free clinics in Michigan, we said we were going to work ourselves out of a job. What we have done is entrench ourselves as part of the safety net in the state of Michigan.

“Now that is scary,” she said. “It’s scary.”