Rural clinician describes access gaps, screening practices and two patient cases from Grays Harbor

Lenka Cheikh, a certified nurse midwife working in a small Grays Harbor County clinic, described a practice in which roughly 70 percent of patients are Medicaid enrollees and men comprise a small share of reproductive‑health visits. She outlined routine care elements for male patients — blood pressure, diabetes screening, lifestyle counseling, STI testing, vaccinations and mental‑health screening with PHQ — and said clinics commonly refer patients to FQHCs or specialty care when needed.

Lenka presented two anonymized case examples to illustrate access challenges. In the first, a Spanish‑speaking patient with no insurance was enrolled in Family Planning Only (FPO) so he could be seen; what initially appeared to be an HPV lesion was evaluated and ultimately treated as cancer after referral and biopsy. In the second typical case a man assumed his partner was unfaithful because of symptoms, but testing identified a yeast infection caused by uncontrolled diabetes (a very high hemoglobin A1c), resulting in diabetes management being the appropriate intervention.

The clinician emphasized cultural and language tailoring for Spanish‑speaking patients, the importance of private one‑on‑one time for adolescents (HEADSS screening), and normalizing SRH conversations to reduce stigma. Lenka said her clinic sees about 1,000 visits a year, with high proportions of Medicaid and Spanish‑speaking patients, and noted rural areas face a lower provider‑to‑patient ratio than state averages, which complicates timely access to primary and specialist care.