Pediatrician Andria Ruth listens to the heartbeat of 7-month-old Javier Ramirez at the Eastside Neighborhood Clinic, during one of Javier’s “well-baby” visits, a program offered by Medi-Cal that covers check-ups of infants.  (Lara Cooper / Noozhawk photo)

[Noozhawk’s note: This article is part of a Noozhawk special project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communcation & Journalism. On Thursday, Day 4.]

[Click here for a gallery of photos from the series.]

It’s midafternoon on a Thursday, and the waiting room is bustling at the Eastside Neighborhood Clinic in Santa Barbara.

Many of its visitors are young children — some toddlers looking at cardboard books, others kindergarten-age watching Disney videotapes on the clinic’s television.

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They’re waiting for their appointments with Dr. Andria Ruth, a pediatrician with the Santa Barbara Neighborhood Clinics.

Ruth is busily seeing patients, moving in and out of examining rooms, speaking fluent Spanish with most of the families she encounters.

Physician’s assistant Melissa Ellis is shadowing Ruth, and sees patients as well.

Ruth often asks Ellis, a PA in training, what she thinks the symptoms could mean before the pair go in together to examine a patient.

This time, that patient is 7-year-old Jeamy Lynn Cruz, who is waiting with her mom, Adriana.

Jeamy has some peeling and irritation on her eyelids. She had gone to an ophthalmologist for treatment, but was sent back to the clinics because insurance would not cover the visit.

Reviewing Jeamy’s records from past visits to the clinics, Ruth notes that she’s had allergy problems, which could be the reason for her current symptoms.

She recommends some allergy medicine and also gives the little girl a bottle of sunscreen after learning she has a summer camp coming up, during which she’ll be playing outside often.

The clinic has digitized most of its medical records in preparation for the health-care reform law, and Ruth says they allow a consistency in patient care that didn’t exist before.

The next patient Ruth and Ellis see is 7-month-old Javier Ramirez, who has come in for a “well-baby” appointment, the periodic visit for infants that is covered by Medi-Cal.

Pediatrician Andria Ruth and physician's assistant Melissa Ellis examine the eyes of 7-year-old Jeamy Lynn Cruz at the Eastside Neighborhood Clinic. Cruz had an allergic reaction and was brought to the clinic by her mother, Adriana. (Lara Cooper / Noozhawk photo)

Pediatrician Andria Ruth and physician’s assistant Melissa Ellis examine the eyes of 7-year-old Jeamy Lynn Cruz at the Eastside Neighborhood Clinic. Cruz had an allergic reaction and was brought to the clinic by her mother, Adriana. (Lara Cooper / Noozhawk photo)

He’s a responsive and active infant, and Ruth and Ellis swoon and coo at him as they talk to his mom, Norma Ramirez.

Is he overweight? the woman asks Ruth, explaining that she has an 8-year-old son “headed that way.”

Ruth responds that he’s a healthy weight, and answers her questions about what he should be fed. She encourages Ramirez to purchase organic vegetables if she’ll be making her own baby food for Javier.

The visit gives Ramirez a chance to ask questions of Ruth, unrushed, and talk about upcoming visits for immunizations and the like.

After Ruth closes the door, she commended Ramirez.

“She’s asking all the right questions,” she said.

The new health-care system launching next year places importance on treating children like Jeamy and Javier in a preventative way, using a primary-care doctor like Ruth.

Ruth, who has been with the clinic almost a decade, says that as the economy worsened over the last several years, she began to see an increase in children without health insurance.

From her perspective at the clinic, Ruth says that concerns her because “kids come in sicker and further along in their illness.”

Ruth admits she’s a little bit spoiled because most of the young patients she sees are covered by Medi-Cal, the state’s public-health insurance program that covers qualifying low-income families with children, people with disabilities, pregnant women and seniors.

Most of the time, Ruth can recommend care and procedures that are covered by insurance.

Still, “the number of children that are uninsured in Santa Barbara County is a problem,” she said.

Ruth says that uninsured children she sees primarily come from two types of groups: parents who are working but don’t have health insurance, and children living in the United States illegally.

In the past three years, she says she’s seen more people in the first category.

It’s a diverse group: children of women who have recently gone through a divorce often don’t have health insurance; young moms going to school trying to get their degrees; and families as well if they work for small employers or in low-wage jobs.

As the economy deteriorated, Ruth says, she saw fewer new immigrants show up in the clinic.

The most common diagnosis among Medi-Cal patients Ruth sees is actually dental disease.

Weight related-obesity and diabetes come in a close second. Type-2 diabetes in children “used to be so uncommon, and now I see children with it every week,” she said.

The cost of having their children seen by a medical professional continues to be an obstacle for many people.

“Sometimes people are so afraid of the cost of health care that they don’t come in at all,” she said.

Across town, that’s exactly what Dr. Chris Flynn sees every day as he treats children in the Santa Barbara Cottage Hospital emergency room.

Parents may wait to bring in their children until their diagnoses are more advanced.

Flynn sees a 3-year-old girl with croup, a barking cough, and after looking at her records, it’s clear that the girl’s mom is using the emergency room as a primary-care facility for her child, and comes in when the little girl has another health issue pop up.

Flynn says that treating patients in an acute setting like the emergency room is the most expensive way to see them, and least beneficial to their long-term health.

Ruth notes that a visit to the neighborhood clinics is based on a sliding scale pegged to the parent’s income.

“It’s not free but the cost is usually something that is approachable,” she said.

Partnerships are a big part of that — for example, Direct Relief, the Goleta-based nonprofit humanitarian aid organization, sends a huge number of supplies to the clinics.

As she rotates through her shift, Ruth will have seen about 20 child patients by the time her day is through.

As for the what the Patient Protection and Affordable Care Act will bring for some of her youngest patients, Ruth says she wants to see health care become more evenly distributed among them.

“I feel strongly that health care should be the same for each patient regardless of their ability to pay or their payer source,” she said.

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Noozhawk staff writer Lara Cooper can be reached at Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

Other stories in the series:

» Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

» Without Health Insurance, Many Put Off Critical Treatment

» Health-Care Providers Face Significant Challenges Serving Uninsured

» Emergency Rooms Strained by Growing Load of Patients

» Mental Illness Places Escalating Burden on Emergency Rooms

» Demand for Services Expected to Jump with Affordable Care Act

— Noozhawk staff writer Lara Cooper can be reached at Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.