SLO Noor Foundation Is Providing Free Health Care to the Uninsured Residents of San Luis Obispo

The SLO Noor Foundation accommodates over 7,000 patient visits every year.

The SLO Noor Foundation is a leader in providing free health care to uninsured residents of San Luis Obispo. The founder and board member, Dr. Ahmad Nooristani, is an Afghan-born physician who doesn't believe in obstacles. He has grown the Noor from a small office that saw a few patients a week, to a state-of-the-art clinic that accommodates over 7,000 patient visits every year, has an on-site lab and provides comprehensive dental and vision care. All with the help of over 100 local physicians, dentists and other providers who are volunteering to support their community.

Even after all the growth he’s achieved, Dr. Nooristani says that he's moving too slowly. He believes that the U.S. health care system must be reimagined, but, in the meantime, he's doing his best to help as many people as possible. As a result, he's starting a new free clinic, Savie Health, in neighboring Santa Barbara County.

We spoke with Dr. Nooristani to learn about the Noor. Our conversation with Dr. Nooristani has been edited and condensed for clarity.

If I had one wish, I would put the U.S. health care system in a box and then snap my fingers so that it would disappear. Because there's no fixing it.
—Dr. Nooristani

Can you share with us the origin story of the SLO Noor Foundation?

Dr. Nooristani: I graduated from medical school in 2008 and came to San Luis Obispo to practice. This is known to be an affluent area, but I was seeing too many people in the emergency room. We’re talking about young people, 45 to 55 years old, sometimes 30 and above, with different disease processes that didn't make sense. They were coming in with strokes, heart attacks and uncontrolled diabetes.

I wondered what was going on. Are these people just not taking care of themselves? Then I asked them if they were insured or not. And guess what? The majority of these people didn’t have insurance, hadn't seen a doctor for years, and the emergency room was their first visit to a physician.

So that got me thinking. I did some research and learned that some 16 percent of Americans were uninsured. I was in disbelief because I knew that they were uninsured people, but I didn't know the extent of it. And who it was impacting.

At that time, I was doing a project in Africa providing health care. I decided to pause my international work and focus on my own backyard. I started the process of launching a clinic to provide free care in 2009. It took a couple of years to go through all the red tape, but we opened our doors in 2011 and we've been growing ever since.

Initially, everybody said, "You're going to see mainly homeless people." Because of what you are, a free clinic. But I disagreed. I knew that homeless people could get insurance because they were extremely poor. It turns out, the majority of our clients were middle class people. These people make enough so they don't qualify for Medi-Cal, but they don't earn enough to buy any private insurance on the market.

A few years into our work, the Affordable Care Act kicked in. I thought: "Thank God. I'm closing the doors. My job is done. I'm here to serve the uninsured and now there's a solution.”

But, guess what? Our numbers went through the roof. After the Affordable Care Act, we still had about 10 percent of the population that was uninsured, among them undocumented people.

Noor means hope. It’s also part of your name. Can you tell us a little bit about the name you chose for the clinic?

Dr. Nooristani: Yes, "Noor" means “hope.” My last name means “land of hope.” To me, “noor" signifies hope and life. And what better name for a place that serves the population that doesn’t have hope and a place where people can go to get help.

It was important to me to give my neighbors a place to go. To give them some hope to live a healthier life, to live longer and to stay around for their kids and grandkids.

What services does the SLO Noor Foundation provide?

Dr. Nooristani: We started small, focusing on primary care. We started opening one or two days a week because I was the only provider. We slowly expanded and now we are open every day and we have 100 volunteer physicians from the community working with us. We've hired nurse practitioners, but all of our physicians are volunteers for right now. From the medical directors down.

We now have a fully operational dental clinic that sees patients four or five times a week. We also have a vision clinic, which is open several days a week. At the vision clinic, the entire cast and crew are volunteers. So we operate lean. But in a single visit, we do everything that we can. Every visit is technically three or four visits. For example, you come in for a regular checkup, we do your eye exam, but if you need a retina scan, we do it right then and there. Plus, if you need a lab, we can do one on-site. That’s how your one visit with us is transformed into many visits.

It’s actually incredible. We have done over $30 to $40 million of free care in the last decade. Because it’s not just the medical visits that we provide, but medication and labs, too. Every dollar we receive goes a long, long way.

You have a beautiful, state-of-the-art clinic space that you recently moved into.

Dr. Nooristani: Free is always associated with less, with low quality. And that's the last thing I want for my patients. I want them to walk in and to see the beauty and to experience the quality of health care that they’re receiving.

Our new place is nicer than any place I’ve been to or worked at. It’s a state-of-the-art building. And we've got really good pricing on it.

Our physicians are not spending an enormous amount of time trying to bill and get authorization, do all these unnecessary things that I do in my regular day job. At the Noor, we just focus on patients and our patients see and really appreciate that. Plus, because we have a lot of volunteer physicians, we're always in a good mood. We're there because we want to be. And that makes a big difference for our patients.

Has COVID-19 impacted your work and how?

Dr. Nooristani: During the pandemic, our work had become even more crucial. When COVID-19 first hit, a lot of facilities shut down and people didn’t have access to their regular physicians. The only places left were emergencies. Plus, we were already serving thousands of patients every year. This is a home for them. What were they going to go without us? So, we had to become accessible to all these patients, whether they are new patients or our existing patients, because once they ran out of medication, they had nowhere else to go.

What we did was become innovative and we embraced telemedicine. We could still see our patient population. We could still take care of chronic issues. If there were new patients, we still could do majority of the work, send them to labs and refill their prescriptions.

The Noor turned to telemedicine to treat their patients during the pandemic.

When a person has a visit at your clinic and then has to do labs, who pays for that? Because labs can be very expensive.

Dr. Nooristani: I look at things slightly different. To me, obstacles are opportunities. When I started this work, I thought, “OK, after a patient sees me, they need medication. Where on earth I'm going to get this medication?" So we had to come up with solutions. And we became creative. We reached out to the labs around the county and got contracts with them. They donate part of the cost. They gave us a deep cash discount. A lab that cost maybe 100 bucks costs us 10 bucks.

The Noor has used ingenuity and strategic partnerships to provide A through Z care for their patients, from free lab work to eye surgeries.

Is it easy to get an appointment to see a physician? Or is there a waiting list for an available slot?

Dr. Nooristani: When I started and was the only physician, the waitlist for primary was about six months, but now it’s two weeks. That’s because we’re open more days and, as the organization grows, we’re able to provide more services because we’re bringing in more providers. I think our waiting period is better than most of your regular physicians’ offices. By far.

Dental is a different ball game. The waiting period is probably six months to eight months. I’m not happy about it, but everything comes in with how much money you got. The more money we get, the more services we provide. The waiting lists are long because, for dental, you have to have more dentists to see a greater number of people. One patient could take two hours. So, you cannot schedule as many. So, you focus on emergencies, and, as you get more volunteers, you can take care of the follow-ups.

Racial disparities in health and health access have been further exacerbated by the COVID-19 pandemic. How do you address health disparities at the Noor?

Dr. Nooristani: It all starts with the way our program is designed. See, we're all human beings and we all have our own biases and opinions and how we think about different nationalities, different races, different religions. I’m from Afghanistan. You can imagine that I've gone through it all, and I didn't want anybody to feel that coming to the Noor.

That's why our processing system is very different. You pick up the phone. "Hello? My name is Joe." "Do you have insurance?" "No." "Okay. I'll see you here." That's it.

So no matter who it is, my only criteria for seeing you is that you don't have insurance because we only treat the uninsured. We don’t care if you have money, if you're poor, you're rich, you're Black or white or Latinx or whatever nationality. You're just another patient. So that's the beauty of it.

We didn’t want to create that environment where I'm asking a million questions, then based on who you are putting you on the list. No, we just eliminated all that. This is incredibly beneficial for undocumented immigrants. The more information you ask for, the more discouraged they get, because they're afraid, understandably. Our processing system has helped out so much. They trust us to come in and see a provider.

If you could snap your fingers and transform one thing about the health care system, what would it be?

Dr. Nooristani: If I had one wish, I would put the U.S. health care system in a box and then snap my fingers so that it would disappear. Because there's no fixing it.

What we're doing is putting Band-Aids in every corner of it. We don't have insurance for everybody. Even the Affordable Care Act, as great as it is, is expensive. It's about $1,800 to $2,000 a month with a $6,000 to $8,000 and sometimes $10,000 deductible. So, Affordable Care Act is not so affordable for a lot of people.

I wish everybody could get insurance. There's no reason to differentiate between those who are documented and those who are not. It doesn't matter—we’re all human beings. It should be a right to get health insurance when you step into this country.

People argue the most about the cost, but the cost is completely misunderstood. If I can take care of you for $12 a month and avoid your stroke and your heart attack, how much is that worth? We’re saving millions of dollars on the back end of it, because I don't have to see you in the emergency room with a stroke. After a stroke, you’re disabled. How much will that cost? It will cost hundreds of thousands of dollars to treat just one person, when we could have saved millions of others if we were just proactive.

Unfortunately, we are a reactive nation. We don't like to be proactive. And that costs us billions of dollars. So being proactive makes sense. Having insurance for everybody makes sense. That's the only way we’ll get out of this mess of a health care system.

Dr. Nooristani explains why the U.S. health care system cannot be fixed, but completely reimagined.