The document discusses public health determinants and trends, including: 1) The Sullivan Center bridges gaps in access to care through mobile health clinics that provide services like flu shots and cancer screenings to underserved communities. 2) The Center accepts patients through programs like Mountain Lakes AccessHealth and Best Chance Network to expand access to those who cannot afford care. 3) The Center partners with organizations and programs to enhance services and provide learning opportunities for nurse practitioner students.

1. Public Health Determinants and Trends
I. Social Determinants in Health
One of the major things I have been able to experience while working at my internship is
the inequity of access to care in today’s society. The Sullivan Center has tried to bridge the gap
of the inequity. There were several ways that I witnessed this happening throughout my time
working there and each one had its own impact on the community. The first way that I saw the
center providing this care is through the use of the mobile health clinic. This clinic was taken to
rural areas such as farms and communities that may not have had access to doctors. In these
locations, many different services were provided such as flu shots for free to the migrant
workers while they were at work, and providing pap smears and mammograms for women who
could not afford them otherwise. By bringing this clinic to the workers, they do not have to miss
work and are less likely to have to miss work in the future from getting sick from the flu. This is
an example of focusing on the preventive care versus just the acute care. The screenings for
breast and cervical cancer are also an example of this principle because they can catch
something before it turns into cancer despite these women’s inability to pay.
The way the clinic is able to do these screenings for breast and cervical cancer was a
part of the Best Chance Network program, which I was able to work with several of these
clinics. With this program, to be eligible women need to be at least 25 and either have no
insurance or have insurance that does not cover these procedures. With this visit, they get a
complete physical as well as a follow up counseling or appointment if there is an abnormality
with one of the tests. By having this program, it eliminates some of the problems that arise with
a lack of insurance or a low income.

2. Besides just these programs, the Sullivan center is one of the providers that accepts
Mountain Lakes AccessHealth. This program is associated with Oconee Memorial Hospital and
often times finds its participants to be patients who have been admitted to the hospital. These
patients will receive health services under this program if they cannot afford medical services
due to a lack of income or a lack of insurance. Usually these patients have not seen doctors in
many years and cannot afford most of the medical services they need on their own. By being a
provider who takes these patients, the Sullivan Center helps to expand medical services to all
people, and not just those with the ability to pay.
II. Organizational Behavior and Governance
Because the Sullivan Center is a part of Clemson University, it relies heavily on the
partnerships that it has throughout the state of South Carolina. One of these partnerships is
with the City of Clemson. The City of Clemson workers are able to have certain procedures
covered through the center to allow them to not have to miss work, but also to keep them
in good health. This allows these employees to have much more available medical care as
opposed to having to wait for their primary care physician who may have a longer wait. This
allows the City to run more efficiently, but also allows more patients to be seen through the
center.
Another of these partnerships that helps the Sullivan Center be successful is with the
Migrant Health Program. Through this program, migrant workers are able to receive
services for free or little cost. This allows a very underserved population to receive care that
they would otherwise not be receiving. The center benefits from this by allowing the Nurse

3. Practitioner students enrolled in Clemson to be able to learn and provide these services.
These students get to see the different side of health care that they may not learn about in
the actual classroomwhich helps create more well-rounded future nurse practitioners.
Another partnership is with the state of South Carolina to work with the Best Chance
Network program. This program focuses on helping those who may fall in between
Medicaid and being able to afford their own insurance. The Sullivan center helps to
overcome this lack of coverage and funding that is present in some cases. In many cases
these people fall in between the cracks and do not receive any medical care until it is too
late, so this is a fundamental principle of the Sullivan Center is to provide care to all. One
way that could make this idea even more successful is if there were an equivalent for men
who do not have insurance. Men often do not receive yearly physicals due to an inability to
pay for the physical, so if they were able to create a program where they could also provide
a yearly physical for men, the preventive care aspect would continue to grow. While
focusing on women is very important, men are less likely to go to the doctor, so if men who
cannot afford to go to the doctor for their physical or if their insurance does not cover a
physical, than this would allow for them to go to the doctor. By doing this, the amount of
preventable deaths could decrease due to diagnostic tests.
III. Preprofessional Concentration
While working alongside Michelle Deem FNP, I was able to see her genuine care for as well
as professionalismtoward all of her patients. When patients were difficult, she was able to

4. take control of the situation and reroute it back to what the problem was. In one particular
instance, a patient had never been diagnosed with a mental disorder, but she often showed
the signs of having some form of a mental disorder. She came in for a follow up for her Wise
Woman blood work, but had been convinced that she had things crawling on her scalp. She
had come in complaining of this problem several times, but with examination there was in
fact nothing in her hair. In this particular instance, Michelle walked in on the patient putting
a flake of her scalp under the microscope waiting for Michelle to take a look at it. Michelle
took control of the situation by telling the patient that the reason for this visit was for a
follow up appointment on blood work and not in fact her scalp, but if she needed to have it
looked at than she would need to call her actual doctor. After saying that, she was able to
steer the appointment back to her bloodwork and how her lifestyle choices could have an
effect on her health. By not making the patient feel as though she were being discounted,
but just in the wrong time for that particular problem, she was able to gain the trust from
the patient. The patient became more likely to follow the advice that Michelle offered when
she did not feel like she was just being shrugged off as crazy. While Michelle did not
necessarily believe there was an issue with the patient’s scalp, she did not let the patient
know, which exuded professionalism.