When you're out of work and without health insurance, or you have a job and no insurance, what are you supposed to do when you need medical care?
That's a dilemma facing millions of Americans today. According to the U.S. Census Bureau, there were more than 49 million people without health insurance in 2010, a slight increase over the number from 2009.
And the problem doesn't just fall with the unemployed.
According to Erin Fish, medical director for the in the , their average patient is between 20 and 40 years old, employed but without health insurance.
"A lot of people are now using the clinic as their medical office because they either don't have medical insurance or anywhere else to go."
"These are mostly the working uninsured," said Fish of her patients. "Most come in because they have a medical need, whether it be high blood pressure or an acute illness and previously they may have been in to see a physician and paid, but they find that even that can become a financial hardship."
The need is especially stark when seen against the backdrop of Waukee, one of the fastest-growing cities in Iowa. Most of the city looks new: from its schools to strip malls to houses.
And most of its residents are perceived as affluent. The estimated median household income in 2009 in Waukee was $74,673, compared with a median income of $48,044 for the state as a whole.
Demand for Free Services Increases Even in Affluent Waukee
Fish has overseen operations for the Waukee Area Christian Services Free Clinic since it opened in June 2009. At the time, the clinic operated out of the nursery on the first floor of Westview Church in Waukee, providing medical services for patients free-of-charge no matter what the circumstances.
"It was a very temporary space," said Melissa Stimple, director of Waukee Area Christian Services. "Every week they would come in and have to move their stuff in and out of that tiny room just to see patients."
The clinic, which is only open Monday nights from 6 to 8 p.m., saw about three to eight patients each week soon after opening. Today, as the demand has increased, the clinic now treats between 10 and 18 people each week.
That increase was one of the reasons Waukee Area Christian Services began looking for ways to expand their space. In September, it opened up a larger, permanent clinic in the basement of Westview Church thanks to an "extreme makeover" project paid for by the Iowa Clinic Healthcare Foundation and Ryan Companies.
The project cost about $60,000 and includes a full reception area, three exam rooms, a lab and a doctor's station.The response, Stimple said, has been overwhelming.
Most Patients Are Employed But Uninsured
"This has been such a huge blessing," she said. "A lot of people are now using the clinic as their medical office because they either don't have medical insurance or anywhere else to go. We have a lot of new families and it's wonderful to be able to offer them a place of comfort and a nice place to be served."
Stimple and Fish agreed that with the demand for free medical care on the rise, they hope to be able to offer additional clinic hours and services, as well as more physicians seeing those in need.
"We are definitely short on physicians and those are honestly the hardest to find as volunteers," Fish said. "We just don't have enough at this point to be able to expand hours. We want to be able to do that in the future. Hopefully, sooner than later."
You can find more articles from this ongoing series, “Dispatches: The Changing Amerian Dream” from across the country at The Huffington Post.
Waukee Area Christian Services Free Clinic
Where: At the Westview Church, 1155 S.E. Boone Drive, Waukee
Phone: (515) 321-0894
Hours: Monday, 6 to 8 p.m., patient registration is from 5:30 to 7 p.m.