INTRO TEXT When Fran Alibozek of Adams learned she had colon cancer three years ago, she didn’t know which was more frightening, the fight she had ahead of her or the bill she’d undoubtedly run up in the process. Alibozek, who was 63 at the time, was working as a bagger at Stop & Shop, but only part-time, with partial benefits.

“I was in a panic,” she recalls. “I didn’t have time to think about the cancer. I just felt, what am I supposed to do? Die now, because I can’t afford anything?”

Alibozek turned to Ecu-Health Care, a nonprofit agency based at North Adams Regional Hospital. Ecu-Health had helped her out years before, when she lost her job at General Electric in Pittsfield, and with it, her health insurance. Back then, Ecu-Health enrolled her in its low-cost care program, which provides medical services on a sliding scale, thanks to 60 physicians–20 primary care doctors and 40 specialists–who agree to take patients for reduced fees. This time around, the staff found she was eligible for the state’s free care pool, which covers hospital care for low-income uninsured patients, and they helped her fill out the application. With her $4,000 hospital bill covered, Alibozek, who makes about $10,000 a year at Stop & Shop and receives $7,000 in Social Security, is paying off $4,000 in doctor bills in installments of $25 per month. Today, she’s not only healthy, but grateful.

“They were a great relief,” she says of the Ecu-Health Care staff. “It was a comfort knowing that someone is out there working for you.”

Alibozek is one of thousands of northern Berkshire County residents who have been helped by an agency whose tiny size–a staff of three–belies its impact on the health care of the region’s working poor. Ecu-Health was started in 1994, after a local minister, David Mangen, wrote an article in the North Adams Transcript about the challenges of meeting the needs of the region’s uninsured. Dr. Douglas Karrel, then an internist in Adams, read the piece and the two got together; soon they were recruiting area doctors to serve uninsured patients for reduced fees. “Ecu” stands for “ecumenical,” reflecting the organization’s roots as a joint venture between the clergy and medical communities.

Since then, Ecu-Health has served more than 7,500 residents of Northern Berkshire County. Its corps of volunteer doctors has provided nearly $1 million worth of health care to 1,900 patients, and it has referred more than 5,000 individuals to publicly funded health programs, including MassHealth, the Children’s Medical Security Plan, and the state’s pharmacy programs for the elderly and the disabled.

The Ecu-Health approach isn’t strictly charity.

“It’s been absolutely thrilling,” says Charles “Chip” Joffe-Halpern, a social worker who has been with the program since its beginning, initially splitting his time between Ecu-Health and the Visiting Nurse Association.”We were able to organize doctors’ charitable impulse.”

But the Ecu-Health approach isn’t strictly charity. Rather, it’s a double-barreled approach that provides direct care but also helps patients gain access to publicly funded health care programs they don’t even know they’re eligible for. Under Ecu-Health’s low-cost care program, volunteer doctors tend to patients while Ecu-Health staffers do intake interviews and handle paperwork. Clients receive a card, much as they would at an HMO, and pay their doctors fees ranging from $2 to $25 per visit. But every client who comes into the office looking for low-cost care is also screened for eligibility for public programs ranging from WIC to dental health.

“We said, instead of having doctors give out more free care, let’s get these kids and families enrolled in programs they’re eligible for,” says Joffe-Halpern. Though some 4,000 people in the region lacked private health insurance, he says, many were eligible for programs like MassHealth and the Children’s Medical Security program but had never applied. For that reason, outreach and education became the most important components of the job.

It’s a job Joffe-Halpern has taken to. In 1996, he talked editors at the Springfield Union-News, now the Republican, into writing front-page stories about the North Adams program. The agency also broadcast ads on the cable television community-access channel that featured, over the years, local pols like state Rep. Daniel Bosley, state Sen. Andrea Nuciforo, then-Lt. Gov. Jane Swift (a North Adams resident), and US Sen. Edward Kennedy.

“We spend up to $15,000 a year on media, and it’s not frivolously spent money,” says Joffe-Halpern. “It’s how you reach people.”

When it comes to reaching people, Joffe-Halpern is not above any stunt. Take the time he and the Ecu-Health crew tried to set a record for the number of people brushing their teeth at the same time. Their feat didn’t go down in the Guinness Book of World Records, but it certainly highlighted the lack of dental care among low-income children. “We were short by a mile, but we got great press,” notes Joffe-Halpern.

Ecu-Health operates on a budget of about $170,000 a year. The group receives $40,000 a year from the state’s Division of Health Care Finance, $50,000 from the Blue Cross Blue Shield Foundation, and grants from the United Way and assorted local health care groups.

The Ecu-Health Care model is also catching on elsewhere. Similar programs have been launched in Amherst­ Northampton, Gardner, and Martha’s Vineyard, and plans are in the works for a program in Athol. Joffe-Halpern says the program works best in areas with a strong community hospital that can coordinate care. Also required: a physician who has the trust of his or her colleagues who can sell the program to the local medical establishment.

Meanwhile, at Ecu-Health, business is booming. Last year, the agency received 3,161 inquiries, an increase of 15 percent over 2002; volunteer physicians provided more than $150,000 worth of free medical care to 672 area residents. The agency referred more than 553 people to the state prescription-drug program, an increase of 23 percent over 2002. But this kind of success the small agency in the Berkshires could do without.

“Our programs should never be seen as a substitute for universal health care,” says Joffe-Halpern. “I’d love to see the day when we don’t exist.”