Keeping the Music Alive

Jazz Fest Brings Musicians’ Clinic Anniversary

Twenty-one years ago this week, a jazz funeral for jazz funerals kicked off the official dedication of LSU Medical Center (now LSU Health New Orleans) Musicians’ Clinic. Led by the Algiers Brass Band playing a soulful dirge, a group of LSU Health medical student “pall bearers” carried a casket symbolizing the premature death of New Orleans musicians due to a lack of health care.

Following a performance by Rev. Lois Dejean and Johnson Extension and the Next Generation, the late Dr. Merv Trail, then LSU Health Chancellor, told the crowd including doctors, nurses, musicians, community leaders, elected officials and Mardi Gras Indians, “As Louisiana’s flagship medical center, we feel a sense of responsibility to the people we serve, particularly those who have been under-served. Members of the music community have historically done without or had inadequate access to health care. As a result, we and the world, have lost far too many far too soon. Music makes our way of life incomparably rich. And for all of our problems, we are truly blessed to live in this place. We are very proud that LSU Medical Center is the birthplace of health care for musicians in the birthplace of jazz.”

In partnership with the New Orleans Jazz and Heritage Foundation and the Daughters of Charity, LSU Medical Center and LSU Healthcare Network founded the first clinic of its kind in the country. Providing care to musicians on a sliding fee scale with a $10 minimum payment, for the first time, New Orleans musicians had access to health services tailored to their specific needs.

It grew out of a recognized need to provide low-cost preventative health services to the professional musicians in New Orleans. Musicians work in an environment that is often hazardous to their health. Occupational hazards include late nights in smoke-filled venues, singing and playing instruments – trumpet players suffer eye problems due to straining; guitarists and keyboard players often develop carpal-tunnel syndrome; singers lose their voices and suffer vocal chord problems; paraders have foot and back problems.

Unaddressed problems affect musicians’ ability to perform – missing teeth and dental issues can wreak havoc in the ability to play wind instruments. And musicians of all kinds experience loss of hearing, a sense that is vital in their profession. Other factors also contribute to poorer health – because they often have day jobs, sometimes more than one, it’s difficult to eat regularly, or healthy foods; they often miss out on sunshine and exercise. As for sleep, they don’t get much – they’re working when people are normally sleeping. All of this raises stress levels, and some have a special kind – performance anxiety.

Many local musicians are uninsured, often working unstable jobs and rarely receiving health care benefits. Before the Musicians’ Clinic, being forced to pay medical expenses out of pocket prevented many of them from seeing doctors when they had health problems, much less for regular preventive medical checkups. They simply did not have the money – at least not for their health. There was no contest between paying for medical care or buying a new instrument.

So, a committee of LSU Health New Orleans physicians, nurses, and administrators, as well as community and civic leaders, a representative from the Daughters of Charity and the New Orleans Jazz and Heritage Foundation, met to explore the possibility of creating a clinic specifically for musicians. A survey was designed to determine what types of services would be valuable to musicians, and it was distributed through direct mail, the musicians' union, and other places musicians congregate. There was an overwhelming response. A plan of services was devised,. It was decided that the services would be offered on a sliding fee scale basis. The Clinic would provide streamlined access to medical care from a single access point and offer preventive care such as health assessments and nurse practitioner and primary care physician services, health education and counseling, social services information and referral as well as triage and referral services to specialists or other appropriate care. After 18 months of planning, LSU Medical Center Musicians’ Clinic opened its doors.

Dr. Cathi Fontenot, one of the founders of the Clinic and its Medical Director notes, “Musicians didn’t tend to worry about chest pains or anything else until it affected their ability to sing or play their instruments. Some also had a distrust of ‘systems’.”

Since the concept was new and utilization was unknown, hours were limited to one afternoon a week at first. But it didn’t take long for increasing demand to expand the clinic.

Those first musician patients helped get the word out by sharing their thoughts and experiences.

“It dramatically changed my ability to work.”

“It’s great to have someone watching out for us instead of wondering how cheaply they can get us for a Saturday night.”"

“I think it’s a wonderful service they’re providing. Usually, they don’t recognize you till you’re dead and gone. They give you all kinds of awards – the key to the city – when you’re on your deathbed.”

“It doesn’t matter how successful you are; musicians live a hand-to-mouth existence; we need health care.”

“This town has a lot of aging musicians going on without health insurance. We’re losing too many players. If we can keep them a little healthier and going on, the community will certainly benefit.”

But the idea was to do more than address urgent problems. It was to get and keep our musicians healthy, and that included preventive and wellness care. Care is given to the entire patient whether treatment is music-related or for the common cold, diabetes, depression, or any other health need. Physicians and nurse practitioners thoroughly assess the musician's overall health status, and identify medical conditions. Treatment plans are devised, and if referral to specialists is appropriate, an extensive referral list has been developed. The staff also now includes an LPN, a social worker and patient navigator. And the musicians are all in.

John Lowery, a singer and drummer whose health care before was limited to emergency room visits after accidents says, “I got my glasses and special earplugs, but not only things related to music. I am well taken care of – it’s my blood pressure, heart, kidneys, liver–the whole enchilada. They make sure we are very healthy. If we don’t follow up, they do, and it gives me peace of mind.”

Lowery credits the Musicians’ Clinic with saving his career.

“I first went because I hurt my voice. I couldn’t sing for a year.”

Before he came back to New Orleans, a cup of scalding tea from a vending machine singed his vocal folds. “It was like a rope unraveling, like they were coming undone.”

It was a devastating injury. “Being able to sing means everything. The first thing I ever did when I was a little boy was sing. I was a vocalist first.”

And it meant he couldn’t work. But when he came home, he heard about the Musicians’ Clinic and made an appointment,

“They sent me to someone, a specialist who told me what to do. I did everything I was supposed to and after 4-5 months, my voice came back.”

His praise is effusive. “I think it’s the best thing that ever happened in a musician’s life besides being blessed with a talent. The Musicians’ Clinic is a jewel. It is heaven sent. Without it, a lot of musicians would probably be dead because of a lack of care.”

Singer Naydja CoJoe agrees. “It means my life. If I didn't have the Musicians' Clinic to take care of me, I wouldn't be able to sing. I wouldn't be able to do anything.”

CoJoe has been a patient for the past nine years. She says without LSU Health's Musicians' Clinic, she couldn't afford to go to the doctor.

At the Musicians’ Clinic, she sees whatever member of the health care team she needs.

“These people are priceless. They are irreplaceable. It is amazing how many doctors are under one umbrella. And they take care of you with their hearts.”

Both Lowery and CoJoe agree that the Musicians’ Clinic staff routinely go above and beyond. “They take the stress out of everything and treat you like family.”

Today, the Musicians’ Clinic is an even more valuable resource, despite the changes to the health care system over the last few years.

Catherine Lasperches, NP, the Clinic’s Family Nurse Practitioner says, “The clinic is valuable because even though we are able to enroll more patients in Medicaid thanks to the expansion, a lot of our patients who make too much for Medicaid cannot afford coverage through the Affordable Care Act. And since the ACA is not mandatory anymore, a lot of patients may choose to have nothing. We can help those patients!”

The Clinic has grown tremendously from about 250 patients at the start to more than 9,000 visits over the last five years. Patients have included a 102-year-old who had a weekly gig as a band leader, vocalist and trumpet player, as well as a well-known, colorful musician who would dress to the nines for appointments and show up with autographed photos for the clinic staff.

“Musicians are one of the city’s most valuable resources,” says Dr. Fontenot. “I don’t know why nobody paid this kind of special attention to them before.”