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If More Room Is Needed For Clinics, The Mowing Shed Can Be Used From 8:00 A.M. Until 4:00 P.M. one person at an income not exceeding $75 per month far below the federal poverty guidelines. Not because there is no city bus service to the clinic. Not even that few physicians in Tyler accept Medicaid, often the only form of payment the poor can offer. What really makes health care inaccessible in Smith County, especially if you are, say, sick or disabled, is the building itself. The sick and infirm had better be in pretty good shape if they want to get into it. No handicapped parking at the clinic. No parking, period. With luck, you might find a space on a side street, behind the Youth Correction Center, or across the road near one of Tyler’s well-maintained parks. Tyler has always taken pride in its parks. Two ways to enter the clinic a steep dirt trail littered with tree stumps, loose rock, and hanging branches, or even a steeper, partially paved private drive, littered with chunks of asphalt and loose rock. And deep potholes. And though there are no warning signs, you need be aware of falling rocks from the building, which periodically crash onto the porch below. At the clinic, the obstacle course continues. A wedge of plywood serves as a wheelchair ramp the county’s attempt to comply with the Americans with, Disabilities Act. The space inside is divided by a makeshift partition, which makes the small place seem even smaller. Buckets line the floor to catch the water leaking through the roof when it rains and the cement floor has no covering, so women in heels often trip on rotting expansion joints. One dollar. That’s how much Smith County pays to lease this old fire station, abandoned by the city of Tyler years ago, to house the Tyler-Smith County Public Health District Clinic. Last year 27,000 people made their way through this clinic for adult health care, treatment for sexually transmitted diseases, and clinical care in neurology, HIV, tuberculosis, podiatry, general dermatology, diabetes and, until the unit was moved to St. Paul’s Methodist Church, pediatrics. Anyone is eligible for services at the clinic, with the amount of payment determined by income. “If a person is 100-percent poverty or less, they pay a buck or nothing, depending on what they have in their pocket,” Dr. Walker explained. “If over 200 percent, it’s four bucks, if 300 percent, it’s 15; if they’re over that, it’s 25 and that includes the doctor, the nurse, the lab, and medicine. Of course I’ve run into all kinds of problems with the state of our pay scale. And some local pediatricians have written complaints about our prices, telling us to raise the rates on our immunizations because they were losing their patients to us.” THE TEXAS OBSERVER 7