LA CROSSE, Wis. — Sandy Brekke turns to a famous definition of success when she reflects on the achievements of St. Clare Health Mission in La Crosse on the occasion of its 25th anniversary.

"To know even one life has breathed easier because you have lived. This is to have succeeded," wrote Bessie Stanley, more than a century ago, words often ascribed to essayist and philosopher Ralph Waldo Emerson.

"That's what embodies this place," said Brekke, a critical care nurse by profession who has been the mission's executive director for a dozen years. "You get to see what you do can lift a burden for someone. That's what life is all about."

"I get to see it in the volunteers — to see people who do that as their life's mission," Brekke said during an interview with the La Crosse Tribune in the long, one-story facility.

The volunteers — totaling about 300 now and tallying 2,000 to 3,000 over the life of the mission — have undertaken a monumental mission. Since the first crew cared for eight patients during the mission's first evening on June 24, 1993, other corps have welcomed almost 18,000 medically underserved people. The clinic has charted more than 86,200 clinic visits for treatment of ailments ranging from abrasions to warts.

"We hold very strongly to the Franciscan tradition" of ministering to those in need, Brekke said.

The mission operates on St. Francis and St. Clare's virtue of poverty — relying almost solely on individual donations and organizations' fundraising events to cover its budget of about $300,000 a year, Brekke said. It also receives county disbursements to help pay for medications for outpatient mental health clinic clients, as well as in-kind services from the hospitals, she said.

"About 80 percent of our budget goes to medications that we provide for our patients who are unable to pay for their prescriptions," she said.

Sandy Locher is a retired nurse. She's been a volunteer from the outset, as have several others.

"The mission is just a jewel — a wonderful thing to have," the 82-year-old said.

The clinic on the perimeter of Mayo Clinic Health System-Franciscan Healthcare is open for walk-ins from 5 to 7 p.m. Tuesdays and Thursdays, as well as appointments at follow-up clinics for people with chronic conditions from 8 a.m. to noon on alternating Wednesdays.

At the mission's peak, the volunteer corps saw as many as 65 patients a night, often staying as late as 11 p.m., Locher said.

"That was not sustainable, especially with professionals who had to go to work the next day," she said.

Reduced hours dropped the patient load to about 35, and even that began declining after President Barack Obama's signature health care legislation, the Affordable Care Act, expanded coverage to poorer people. However, the patient count has begun to increase again amid the uncertainty about Obamacare under President Donald Trump and the GOP Congress's efforts to repeal the law, Brekke said.

St. Clare was established in 1992, after representatives of health and social service organizations huddled and developed a vision to provide free health care for poor and uninsured individuals and families.

The mission founder, the late Sister Leclare Beres of the La Crosse-based Franciscan Sisters of Perpetual Adoration, also established the facility's predecessor, the Indochinese Screening Clinic, in 1984. That clinic was created to serve the waves of Hmong people who settled the region in the 1980s, especially to provide immunizations for children who never had been vaccinated.

St. Clare and the screening clinic operated jointly for a time, until the screening clinic closed in 1998 and the mission became the sole occupant of the building.

What now are Mayo-Franciscan Healthcare and Gundersen Health System were key elements to setting up the mission, said Joe Kruse, the southwest Wisconsin regional administration chairman of the Mayo system who was on the planning committee.

"We were kind of nervous" about starting the mission, Kruse said, but "people were incredibly helpful, and both health systems were equally supportive. We were pretty confident of the staffing, with volunteer doctors and nurses, that it was doable."

They were less certain about what might happen if a patient needed a referral for a chronic illness, he said. The anxiety dissipated when Gundersen and Mayo agreed to handle some referrals as charity care, he said.

The mission has access to specialists in virtually every medical field for patient appointments at the clinic, which is one of two facets that set St. Clare apart from free community clinics elsewhere, he said.

The other is the clinic's pharmacy, which can fill many prescriptions but does not carry narcotics.

"It doesn't do any good to see a provider and not be able to get medicine," Kruse said.

Virtually everyone connected with the mission — both then and now — insists they are standing on the shoulders of Beres, who retired as director in 2003 and died at 88 in November 2014. So revered was she in the community that she was named the Tribune's inaugural person of the year in 2002. Mayo-Franciscan dedicated a resource center in its La Crosse hospital in her honor in April 2016, an occasion during which Kruse became choked up and said, simply, "I miss her."

Brekke recalled, with a reflective smile, that Beres had organized the clinic so well that "the main thing I had to do was not screw it up."

These days, volunteers credit Brekke with being the St. Clare Health Mission's anchor — even on days when the organized chaos in the clinic hints that the volunteers have taken over the building. The narrow hallway echoes with their banter and teasing during patient lulls. The usual staffing level is two doctors and two or three nurses, along with a lab tech, social worker, intake workers and lay people in a variety of roles.

Those roles sometimes include maintenance, such as the time several volunteers and even a few clients showed up with smiling faces on a November Saturday in 2012 to grab paint brushes — Brekke herself concentrated on neat trim lines — and other tools to put the finishing touches on a yearlong renovation of the clinic.

"At my age, I have to talk myself into coming in," Locher said, adding jokingly that she had practiced her profession "when they poured burning boiling oil in the wounds and used leeches. But when I get here, I'm energized."

A few feet away, Dr. Michael Garrity was reviewing paperwork as he observed that the volunteer vitality in the clinic is infectious disease.

Motioning toward the 86-year-old Garrity, Locher said with a laugh, "We're gonna pickle him, prop him up in the corner."

"How do you know I'm not pickled already?" countered Garrity, a retired Prairie du Chien family practitioner who has been a fixture at the mission for 16 years. He once traveled the 120 miles back and forth once a week but now does so twice a month for the Wednesday morning continuity care hours.

Locher and Garrity jousted about his age — he said it's the same as his IQ, and Locher parried that it actually is higher than his IQ.

"See the abuse I take?" Garrity said, with mock indignation. "The Wednesday group here is pretty much a group. The people here — it's a happy place to be."

The repartee is a spirit-booster when a patient takes a turn for the worse or an especially sick person comes through the door, Garrity said.

"One of the main things is that most volunteers are still actively practicing," Garrity said. "If I see a patient who seems to need an orthopedist or a neurologist, I know they will see somebody in person. If it's an emergency, they can get it. Many clinics don't do referrals for evaluation."

Garrity, who signed on as a volunteer on the advice of niece Sheila Garrity, the retired director of the La Crosse Community Foundation, is such a clinic advocate that he persuaded one of his former nurses to volunteer too.

"Now we're back working together," said the nurse, Nancy Stuart, a retired diabetic educator. "He loves this place, and I get to keep teaching about diabetes."

Garrity agreed, saying, "Patients I have now I've had for years."

The caring nature of the volunteers impresses Garrity, who told of a young man who was living in substandard conditions and subsisting on a poor diet.

"Two gals went to the apartment he shared with two other guys and found that there was no refrigerator and he was sleeping on the floor," the doctor said. "They got him a refrigerator and a futon. The care people get here is meaningful and personal."

Dr. Kathryn "Kitty" Howells, a La Crosse family practitioner, said she volunteers at the clinic because "I think everybody should be able to have health care, and our system doesn't always allow that."

Howells, who works in Mayo's Women's Health Center and was seeing patients at the mission Wednesday, was too tight-lipped to tout herself, so Brekke did, saying, "This is what Kitty illustrates about medical care: It needs to be a relationship, and Kitty spends a lot of time with her patients."

"I like to work chronic care follow-up because I like having relationships with people," Howells said.

Howells will leave Mayo-Franciscan at the end of July in anticipation of a new job with Indian Health Service, which provides health care for the Navajo Nation in the Southwest. She noted the irony that she is moving from a location with plenty of doctors but insurance gaps to one with ample insurance benefits but not enough doctors.

Some mission clients with vision problems, particularly diabetics, are able to receive care from the Family Vision Center in La Crosse, which began offering exams and eyeglasses several years ago in cooperation with the La Crosse Lions Club's eyeglass initiative.

Family Vision contacted the mission about putting a vision clinic in the mission, said owner Dick Foss, who is active in Lions International. There was no room, so Family Vision agreed to see a limited number of patients a month at the office, he said.

Richard Cody was the Lions Club's sight chairman, Foss said. After Cody died, the club continued the service as a memorial to him.

Initially, the program accommodated eight or nine people one night a month, with Family Vision optometrists rotating exam duty, he said. The number of patients slowed with the Affordable Care Act, so now Foss handles the exams, which are worked into his schedule.

"It's worked out well," he said. "I don't even know if they are St. Clare patients until we're almost done."

The Lions cover just basic glasses in the program, and people with glaucoma receive eye drops, he said.

"St. Clare's a really nice place, and a lot of nice people are involved," Foss said.

Two needs that Brekke and volunteers long to accommodate are dental and psychiatric care, they said.

Having not only survived but also thrived for a quarter-century despite uncertainty at the beginning, the mission "is a great success story, showing creative thinking and the value of working together," Kruse said.

An AP Member Exchange shared by the La Crosse Tribune.