Dozens at a time lined up outside the door to the gymnasium on a cool and sunny Tuesday morning, waiting their turns to see the doctor or nurse practitioner.

Seacoast Church's Dream Center, now in its new digs on North Rhett Avenue, includes a free health clinic set up to serve residents of North Charleston and Hanahan who have no health insurance and don't qualify for Medicaid.

That's a lot of people: all those who have fallen through the cracks -- the indigent and homeless, substance abusers, the unemployed, the self-employed who cannot afford to buy an insurance policy, temporary or part-time workers, immigrant families and, increasingly, some who have endured sudden financial hardship, who once were members of the middle class but have lost what they had.

Nurse Practitioner Dawn Heyward visited with a woman complaining of abdominal pain.

Cheryl Robinson, who complained of high blood pressure, arthritis and a troublesome metabolism, was there to meet with Dr. Jepta Cobb.

In the reception area, patients sat at tables across from clinic volunteers who verified eligibility and collected information. One man came in not for medical care but to find someone with whom to pray. Butch Trentacosta, a lay minister at Seacoast and longtime volunteer, quickly obliged the man.

As the nation grapples with proposals for health care reform and recessionary times are swelling the ranks of the uninsured, churches and faith-based organizations in the Charleston Metro area are filling the gaps, opening and sustaining free medical clinics for those who have no insurance and cannot afford to purchase any.

Seacoast is one of at least three local churches providing health care. St. Andrew's Church in Mount Pleasant runs a free clinic on Tuesday evenings, serving at least a dozen patients each week, according to communications director Greg Shore. And the Church of the Holy Communion on Ashley Avenue offers medical services twice a week to uninsured, low-income patients.

Additionally, faith-based organizations such as Our Lady of Mercy Outreach's Wellness House on Johns Island and Harvest Free Medical Clinic on the old Navy base in North Charleston provide free medical care to qualified patients. East Cooper Community Outreach in Mount Pleasant and Crisis Ministries' homeless shelter downtown, each founded by or with significant support from area churches, also run medical clinics that offer free care.

Expanding the dream

Bill Bartoccini, executive director of the Dream Center Clinic, which opened for business in January, said the operation "couldn't be more timely given the economic situation."

He and Sam Lesky, pastor of Seacoast's North Charleston campus, estimated that more than half of the North Charleston and Hanahan population living in the vicinity of the church is uninsured.

Currently open two days per week in the mornings and evenings for a total of 12 hours a week, the clinic receives between 450 and 500 patient visits each month on average, Bartoccini said. Last month, 520 came. The goal is to expand the clinic's operating hours to four days a week, he said.

Patients pay a $20 fee upon registration and get one year's worth of health care and medicine (excluding cancer drugs) at no cost, Bartoccini said. The majority of patients complain about diabetes, hypertension, upper respiratory disorders and high cholesterol, conditions broadly associated with poverty. A dermatologist, two cardiologists and three ear, nose and throat doctors are on-site once per month; chiropractic services are available once a week.

About 370 people are registered volunteers, and the clinic has about 25 on-site at any given time during operating hours, checking people in, screening them, praying with them, conducting exams and doing consultations.

Without the clinic, many indigent patients would visit emergency rooms, Bartoccini said. The South Carolina Free Clinic Association reported that the average ER cost per patient in 2007 was $1,650, according to Bartoccini. Two years later, it's certainly higher, he added.

The clinic, then, is taking significant costs out of the health care system by providing patients with an alternative to the ER, he said.

Reaping the harvest

Three days a week -- Monday, Tuesday and Thursday -- Harvest Free Medical Clinic cares for those without insurance, many of whom have become regulars. Patients come from all over the Lowcountry and beyond.

Founded and run by Dr. Bob Freeman, the clinic is an expression of Christian mission, he said. He offers to pray with each patient he sees and said he views his work as an opportunity to glorify God and share the love of Christ.

The clinic, which got its start seven years ago in a double-wide trailer on Midland Park Road, moved to the old Navy base four years ago when Loy Stewart, chairman of Detyens Shipyard, offered Freeman space in a 10,000-square-foot building. Half of the building is the free clinic; the other half is the Detyens Medical Center, serving company employees and dependents.

On the free clinic side, Freeman sees about 85 percent of the patients himself, he said. Of the medications dispensed by the on-site pharmacy, 95 percent are generic.

"If patients don't pay anything, they're supposedly going to be more compliant," pharmacist Debra Gaskins said. And the clinic keeps its drug costs low.

About 40 volunteers work there, Freeman said. And they have access to state-of-the-art equipment, including a high-powered digital X-ray machine ($100,000) and a Basal Metabolic Profile machine ($10,000) that tests thyroid and kidney function.

The more in-house tests and labwork that can be performed, the less money gets sent into the black hole of the U.S. health care system, Freeman said.

"We try to be independent of anybody who adds cost to health care," he said. The X-ray machine paid itself back in about one year.

Freeman, who worked at the Medical University of South Carolina and the V.A. Medical Center for 30 years before being diagnosed in 2005 with Stage 4-B lymphoma and receiving chemotherapy for one year, said he approaches his work with a clear sense of purpose.

"To provide for the needs of the poor is absolutely a vital component of my faith," he said. "It's not a responsibility so much as it is an opportunity."

The staff at Harvest Free Medical Clinic had nearly 6,300 patient visits and wrote more than 25,000 prescriptions in 2008.

Small but committed

St. Andrew's Church started its free clinic in 1983, according to communications director Greg Shore. In 2008, the clinic saw eight to 10 patients during the night each week it was open to the public. This year, as many as 15 are seen in an evening, several of whom are new patients.

Staffed with a doctor, physician's assistant or second doctor and two nurses, the small clinic treats a lot of diabetes, hypertension and other ailments, but increasingly, people are visiting with acute conditions that require referrals, Shore said.

Patients tend to show up an hour before the doors open at 7 p.m. Tuesdays and are seen on a first-come, first-served basis.

The Church of the Holy Communion, an Anglo-Catholic parish on Ashley Avenue, runs a free medical clinic twice a week.

Dr. Bill Prioleau, a cardiothoracic surgeon who retired from Roper Hospital in 1996, took the helm at the prompting of his wife, Patsy, beginning a second career as a medical volunteer.

Today, he uses a small kitchen at the church and visits with about 70 regular patients and a number of walk-ins whose annual income qualifies them for free care.

Early practitioners of Anglo-Catholicism were ostracized by the Church of England and often left with little funding. As a result, Anglo-Catholic leaders took their theology to the slums, where expenses were low and need was great.

Holy Communion inherited this tradition, and it is in this historical context of service to the poor that the parish runs its medical clinic, according to its rector, the Rev. Dow Sanderson.

Charleston Outreach, an affiliate of the Charleston Baptist Association, operated a free health clinic at First Baptist Church in North Charleston for nearly 11 years. It closed in April 2008, partly because of the success of the nearby Harvest Free Medical Clinic, according to Executive Director Chuck Coward.

Now, plans are being laid to open a free dental clinic on Grayson Avenue in North Charleston, Coward said. The dental clinic will be a stand-alone nonprofit, the result of a collaboration among various area churches and charities, he said.

If all goes well, the clinic could open during the first part of 2010. At the moment, only tooth extractions are likely to be performed, "but if we can bring more players to the table, then the effectiveness of what we're doing can be significantly increased," Coward said.

'Hope and dignity'

The Dream Center Clinic, a large enterprise by most standards, has an annual operating budget of about $90,000, Bartoccini said. A stand-alone nonprofit, it raises money through private donations.

Like Harvest Free Medical Clinic and other providers, it negotiates favorable financial arrangements and third-party medical services with area specialists, labs and pharmacies.

Cobb, the doctor on duty on a recent Tuesday morning, moved to the Charleston area from Mobile, Ala., in August 2008. He said he knew of no free clinics in Mobile, and that the generosity of the Charleston region was something to behold.

Heyward, nurse practitioner, said she has volunteered at the clinic since it opened and sees the work as an opportunity to practice preventive medicine helping patients avoid the emergency room or hospitalization.

Doctors and administrators at both the Dream and Harvest clinics noted that it has been easy to form relationships between providers and patients. These relationships engender trust and help ensure that patients follow doctors' advice, they said.

Bartoccini described the clinic as a place informed by faith that promotes a "culture of caring."

"We don't have to work hard caring for people who come here," he said. "Our responsibility is to demonstrate to our patients that they are no different than we are. They are entitled to hope and dignity regardless of circumstances."

April Boshard grinned as she scurried through the parking lot of Seacoast Church, hefting a box of second-hand clothes for the needy.

Dressed in jeans and a sweater jacket, her red hair neatly pulled back from her face, Boshard looked like a suburban housewife putting in a few hours of community service at the church.

The truth was, she'd been sleeping in the woods just days before, her life as rough as anyone in the crowd seeking help.

Boshard, 36, has spent the better part of five years living on the streets of North Charleston, drinking and drugging away her days.

Then, five months ago, she reached out for help. But on the cusp of sobriety, she nearly lost her lifeline when the troubled Faith Haven sober-living program collapsed in Charleston last month.

She found herself at a crossroads, staring at the promise of a new life while confronted with the demons of her past.

"I had everything I needed right there, and it was just ripped out from under me," she said. "I didn't know what to do."

Boshard's long slide began one day in 2004 when she called police on her husband for beating up their 10-year-old daughter. He had taken care of everything in their lives, from grocery shopping to paying the bills.

When he was sent to prison for two years, Boshard didn't know how to function as a single parent with four daughters.

She started drinking to take the edge off, to make her problems disappear. Soon, she was drinking all the time -- missing work, missing bills, missing life. By the time the state took her kids away that year, she already was well on the road to self-destruction.

Boshard landed on the streets, chugging vodka, smoking crack, shoplifting to get by. When she wasn't in jail, she lived in a scrubby patch of woods off North Rhett Avenue, in a ramshackle camp tucked amid the pines. No home. No family. No future.

"Once you get to that point, you can't even see the tunnel, let alone the light at the end of it," she said.

Last spring, Boshard stumbled into Seacoast Church's North Charleston campus looking for some clothes and food. People there were nice. They wanted to help. For the first time in a long while, she felt a sense of family.

She returned to the church and came to a decision: It was time to get sober.

Then came Mother's Day. All the well-wishes and thoughts of her daughters. Once again, she turned to the bottle. She got "tore up from the floor up." Stumbling drunk, Boshard lifted a 12-pack of a beer from a convenience store. She was off to jail again.

By the time she left jail, Boshard had been clean for five weeks. She was determined to make it stick.

Friends at Seacoast helped her get into Faith Haven. She couldn't believe she got to live in a nice home, with her own room, a hot shower and space to put her things. So different from the woods and cold jails she had learned to endure.

She set her mind on going to meetings, working her program.

Boshard trembled with emotion at her graduation ceremony eight weeks later. She'd done it. Now if she could just stay on there a while longer until she got back on her feet.

She didn't hesitate when Faith Haven founder Wendy Johnston asked her to speak at a luncheon on James Island for potential volunteers and donors. Boshard believed in Faith Haven and wanted to help, so she got up in front of a roomful of strangers and told her story.

Some thanked her. Others cried. She hoped it would help.

Not long after that, problems surfaced at Faith Haven. The rent hadn't been paid on its stately mansion near Colonial Lake, and people had begun to question a long list of unpaid debts tied to Johnston.

Boshard and others had helped with fundraising, yet the home always seemed to lack toilet paper, gas to get to meetings and other essentials. Arguments erupted as residents questioned Johnston's decisions.

The program finally shut down in early October as Johnston was fired and hauled off to jail, accused of forging her board president's name on a vehicle purchase. Johnston has denied any wrongdoing and has insisted her intentions were always good.

Boshard and several other residents had left about a week earlier after a row with Johnston. She stayed with a community volunteer for a week or so and then bounced around between friends.

Desperate, disillusioned and out of options, Boshard finally returned to the North Charleston woods she had left months before.

She showed up at a homeless friend's campsite with her few belongings and a bottle of vodka. This is where she had started on her journey to sobriety. It seemed fitting it would end here as well.

Boshard drank until her world blurred and went dark. But when she woke, she pushed the bottle aside.

"I realized the answers to whatever problems I have are not at the bottom of a bottle," she said. "All I got was a hangover, a headache and a stomach ache, and all those problems were still there."

She stayed in the woods for about three weeks, bathing in rainwater and shooing away possums as she tried to sleep. But she didn't relapse again. She returned to Seacoast and spent her days attending services, healing and helping others in need.

"This is the only place I've ever felt I've belonged," she said. "Everything people do here is completely out of love, and you don't find that very often."

Taylor Middleton, who runs the Seacoast Dream Closet, gets choked up when she talks about Boshard's return and the work she puts in on the church's behalf. "I can't imagine her ever going away again," Middleton said. "She's an example for people to look at and realize that anything is possible."

One day last week, a family from the church gave Boshard a place to stay until she can afford a home of her own. She's now knocking on doors and looking for jobs.

Boshard also is trading e-mails with her oldest daughter, who's 19 and living with another Lowcountry family. The communication has been tentative, a reflection of the hurt and emotional distance between them.

Boshard is hoping to close that gap and be reunited with all of her girls someday. She knows it will take time, and that she has a lot to prove. But she's ready for the challenge.

"I just hope someday my daughter will be able to say she's proud of me," she said