SIOUX CENTER – Nancy Dykstra walked through Promises Community Health Center on a recent day. As she navigated the office, home of the former bowling alley, Dykstra stopped by a patient room in the dental wing. Dr. Ed Alyo, the clinic’s newly hired full-time dentist, conducted an examination on a young patient.
On this particular day, Mother Nature was delivering another round of unusually lousy weather. As cold and snowy as it was outside, Dr. Alyo worked diligently on this young person’s mouth inside the warm, comfortable building. This patient needed plenty of work on his teeth; the Syrian-born dentist trying to explain to the patient’s parents what needed to happen.
This particular patient was at the dentist for the first time. As Dr. Alyo talked to the parents, Dykstra smiled; her heart warmed by those who were finally receiving much needed dental care at the clinic designed to serve those who could not receive it otherwise.
“For me, when you walk up front periodically and see patients who are getting served, who are coming in and who couldn’t get service if we didn’t have the doors open … it’s incredibly rewarding,” Dykstra said. “It’s so grateful you can do that.
“How can it get any better than the looks on people’s faces when you serve them?”
Dykstra’s efforts to help serve those who might not be able to otherwise have access to medial care, and for all of her years in public health, was recognized earlier this spring when she was given the Women Developing the Community Award during the 29th annual Women of Excellence banquet in Sioux City.
The executive director of the health center was nominated by Belinda Lassen and Pam Hulstein for work in helping provide health care to the underserved and socially disadvantaged in Northwest Iowa. Five other awards in different categories were handed out at the banquet.
“I was privileged and honored that some of my colleagues nominated me,” Dykstra said. “I was very humbled to be there and was incredibly honored to get the award.”
Throughout her professional career, working hard and serving others has been a hallmark of Dykstra’s. She first developed them growing up on a farm by Carmel as the second oldest of 12 children, learning both traits first-hand from her late father
“I was no stranger to work and my dad was an incredibly giving guy,” Dykstra said, fighting back emotions when talking about her father. “Our life was about giving and everything we had was a gift from God. It just seemed natural to give back.”
Like her father did to others, Dykstra serves the community through her role as the director at Promises.
“It just seemed natural to give back,” Dykstra said. “It’s a passion for people and the underserved. My dad instilled in me that he was always helping the underdog, the little guy. … If someone needed a hand, then you went out of your way to do that. When you work alongside and with people, you meet them where they are and you meet their situation the way it is and deal with it.”
Earlier in her career, she spent a number of years developing the home care and hospice programs for Sioux County in her role as Public Health Director. During that time, she created a model of molding public health care with private delivery and sharing management of those services for two of Sioux County’s hospitals – Orange City and Sioux Center (later joined by Rock Valley in an organization now known as Community Health Partners). She co-authored a rural health transition grant, which funded the reorganization of public health services in Sioux County.
“When you do care in the home like I did with hospice, you were on the person’s turf, in their world being respectful of their situation,” Dykstra said. “It’s why I like community work because you see how people live and walk. It’s just really relational. I’ve just come to really enjoy and appreciate meeting people where they are and coming to know what they need.”
Then came her move to working with Promises in a role where those strengths continue to shine.
As Sioux County’s demographics have changed over the years, so have the medical needs of its residents.
Dykstra recognized the shifts as more and more Latin American residents move to the area. Often, those people do not have the means or ability to afford quality medical care.
“The staff at public health would share stories about how their patients were really struggling to get primary health care, medical care, dental care, vision care, but they weren’t able to get it because they didn’t speak the language, didn’t have the money, didn’t have insurance,” Dykstra said. “The idea was we could get a community health center going.”
That’s where Dykstra and Promises Community Health Center comes in, taking care of their needs. The clinic serves all who walk in their doors – including those with and without insurance. For those without insurance, it offers a sliding fee scale that takes into account family size and household income. According to Dykstra, approximately 50 percent of patients are uninsured – meaning the clinic must come up with other funds to cover those costs.
“If you look at what community health centers are, their target is the working poor, those who are doing the jobs that are entry level and minimum wage or less and live at 200 percent of the federal poverty level and below,” the Hull resident said. “
For the first few years of the clinic’s operation, funding was been challenging. Thanks to an incubator grant from the state, it was able to open in 2008. However, it did not operate with full funding, operating primarily on small grants, community fund drives and private donations. Many volunteers helped in various capacities – either serving patients, helping work on the building or contributing financially. In the meanwhile the state incubator grant required Promises to operate if it had the federal funding in hand. The health center was funded primarily by small grants, community fund drives to go with private donations.
“We had some incredible donors that believed in the work and came through when we needed them to,” Dykstra said. “I can’t thank those people enough and say about good about those kind folks.”
The lack of secure, stable funding, however, loomed large in the back of Dykstra’s mind.
“There were certainly sleepless nights and concerns that was it going to come through and were we going to be able to keep the doors open and be here long term,” Dykstra said.
The clinic continued to pursue federal funds. They finally arrived in June of 2012, designating it as a Federally Qualified Community Health Center, with funding coming from Section 330 of the Public Health Service Act. Promises became the 13th federally qualified health center in Iowa and the only one in the state’s northwest corner.
With federal funding at long last secured, it gave Dykstra and the board of directors some much needed peace of mind.
“Going forward, we know we have that base,” Dykstra said. “We have to meet a lot of standards and do what we do very well, but it certainly makes operating, planning and recruiting a little easier and a little less stressful on the board.”
On the medical side, Promises has a nurse practitioner, a physician’s assistant, a medical director, who overseas their care and a nurse midwife who deals with prenatal care. Dr. Alyo is currently the only member serving on the dental side, but the clinic is looking to hire a dental hygenist. The clinic works with Creative Living, Compass Pointe and Seasons Mental Health for mental and substance abuse patients.
Going forward, the clinic has plenty of room to expand. At its location a block off of Highway 75 in an old bowling alley, it currently utilizes only half of the available space. The board is also looking at the clinic’s long-term goals.
“There’s lot’s of potential for where we are at,” Dykstra said. “That’s a good thing.”
For the present, the clinic will continue to serve all who come through its doors.
“The feedback from patients is affirming and so supportive,” Dykstra said. “For all of us, that’s what gives us the affirmation that this is all worth it.”