As measles rages, one clinic leans on years of hard-won trust to keep vulnerable people safe

Main Street is bustling on a Wednesday afternoon in late September. Cars mix with horse-and-buggy carriages on the road, many coming and going from the weekly Sale Day — a market spread over 10 acres with livestock, fruits and vegetables, flowers and other goods for available to purchase. Lively conversations in English and Pennsylvania Dutch fill the barn where a produce auction stretches until lunchtime; bids for a pint of bright red cherry tomatoes run from 90 cents to $1.30.

As dozens of people mix and mingle through the afternoon — Amish and other Plain people, so named for their simple way of dressing, as well as “English,” as they refer to folks outside of their community — there are no direct indications that a measles outbreak is raging in the area. Only one woman has a mask on, which she says she’s been wearing any time she’s left home since the start of the Covid-19 pandemic. One vendor is closed for “unexpected family obligations,” and one regular auction attendee is mourned after her recent sudden death after having “flu-like symptoms.” Tourists are visiting from Brooklyn.

But less than a mile away at the Central Pennsylvania Clinic, measles is front and center.

A turn off of Main Street quickly opens up to an idyllic rural valley, filled with lush farms set to a backdrop of rolling green mountains. An unlined road leads across a babbling river to reveal a striking gray building up on a hill, a massive barn raised in the traditional style that uses only wood pegs — no nails — to hold the structure together.

The front door is locked, with a photo and description of measles hanging in the window, along with a notice asking visitors to “ring doorbell for service.” Dr. Katherine Mascia swings the door open with a big smile and a quick question: “Any measles symptoms today?”

Beneath the genuine smile is true heartbreak. A massive measles outbreak in the area — now the deadliest and nearly the largest the United States has had in decades — is bringing significant pain and suffering to the families she cares for.

“In the five years that I’ve worked here, I don’t think we’ve had so many patients admitted to the hospital all within the span of a few weeks,” Mascia said. “We might usually have maybe one patient who’s admitted for their complex care needs, but to have so many all at the same time, it’s really unprecedented.”

Michelle Gustafson for CNN

About 1,000 measles cases have been reported by the Pennsylvania Department of Health since the outbreak started in April, nearly surpassing the record number recorded in South Carolina during an outbreak that started last year and that became the largest in the US since 1992. The clinic’s home of Mifflin County is one the hardest-hit, near the epicenter in neighboring Lancaster County.

The patients who the Central Pennsylvania Clinic serves are especially vulnerable to the severe effects of a measles infection. The nonprofit is centered around caring for children and adults with genetic disorders that are especially common among the Amish and broader Plain community, a group that also tends to have lower vaccination rates than average.

The Plain people are known for their ​caution toward government and other nonreligious authority.

But as measles tears through many of their hometowns in central Pennsylvania, the national conversation has become paradoxically politically charged.

Leaders from the federal government and the Pennsylvania government have clashed over the response , with much of the debate centered around the five deaths that have come during this outbreak. Disputes over the definition of what counts as a measles death and how news of the deaths is shared with the public have disrupted public health response plans.

Meanwhile, the Central Pennsylvania Clinic’s staff is focused on how to best keep everyone safe and healthy. They’re leaning on the clinic’s well-forged foundation of trust. It has taken persistence and patience — sometimes years — for the clinic to build those relationships, and the strength of that trust has faced some of its greatest tests over the past few months.

When Pennsylvania reported a measles-associated death in an 18-year-old in Mifflin County, Mascia said, the clinic started to get tons of calls — from patients they knew and other members of the broader community — who just wanted to know what happened. They weren’t paying attention to what government officials were arguing about on social media, she said. They wanted a clear understanding of how the young person died.

“I’m quite honored that they’re calling us and asking those questions. It helps me feel like they really trust us,” Mascia said. “But it puts pressure on us, too.”

She said she reached out to the county coroner directly to get a formal statement on the cause of death, and she references that statement when patients have questions.

“We want to keep that line of communication open with the community, and it’s so important to provide accurate information and be consistent with the messaging,” she said.

Central Pennsylvania Clinic leaders have been thinking about and planning for a measles outbreak in the community since the start of the West Texas outbreak in January 2025, Mascia said. Their patients are vulnerable, and their offices, while incredibly well-equipped in many ways, are not built to treat measles patients.

“We don’t have advanced ventilation systems, and we don’t have negative-pressure rooms, so if a person who is infected with measles comes in, our entire building is compromised for two hours,” Mascia said.

Pennsylvania requires a throat swab, a blood sample and a urine sample to confirm a measles case — arduous tasks for both ill patients, who often had to take a taxing horse and buggy ride to the clinic, and for clinic staff who have to work within the constraints of their facility.

The rear entrance to the clinic building, which also hosts a federally qualified health center, has become a makeshift triage center for people with suspected measles cases. The back parking lot is large enough for cars and buggies to spread out, and clinic staffers meet families at the door, where they can lead the patient into a small storage barn to collect urine samples.

It was important to have a logistical plan to keep operations safe, Mascia said, but she pointedly explains that the most critical way to protect their patients is to raise vaccination rates.

The measles-mumps-rubella (MMR) vaccine is extremely effective. One dose is 93% effective against measles, and the recommended second dose bumps that protection up to 97% — and the immunity is lifelong. Extensive research has also demonstrated the vaccine’s safety .

Childhood vaccination rates have been falling nationwide, with a record share of parents opting to exempt their new kindergartners from the required shots last school year.

Vaccination rates tend to be lower among Plain people, but it’s not because of an inherent opposition, experts say.

There are certain shared values within the community, but there are also varied individual beliefs and opinions about vaccines, as there would in any broad group of people, Mascia said. Consistency in the clinic’s messaging around vaccination has been the key to raising coverage rates.

If the patients sense any type of coercion from doctors or if they feel forced into a decision about something like a vaccination, they’ll completely disengage from all health care – an outcome that would be particularly troublesome for the vulnerable patients they care for.

“We share that it’s our strong recommendation that everyone be fully vaccinated,” Mascia said. “And if they’re not interested, we repeat our recommendation and say ‘we’re here to help if and when you change your mind.’”

In the Amish and broader Plain community, the experience of a neighbor and advice from a family member carry significantly more weight than findings from a study published in the most prestigious medical journal or recommendations from the leading clinical society, said Dr. Helge Hartung, who joined the Central Pennsylvania Clinic last year.

The Central Pennsylvania Clinic has uniquely carved out space for opportunities to build that kind of rapport – but it takes time.

Two hours are blocked off for new patient visits, and every visit after that is scheduled for an hour. The main exam room ​is extra large, with space to fit the whole family — the average of which includes seven children — for conversations that affect every member. There’s time and space to answer questions, Mascia said, and her well-informed patients come with many of them.

“What I’m seeing are families trying to weigh all the information that they are getting from us, from the community, from other sources,” she said. “They are families truly trying to make the best decision for their child.”

A few years ago, the federal government stopped providing MMR shots to the clinic through Vaccines for Children, a federally funded program that provides routine immunizations at no cost to children who might not otherwise be able to afford them. The government told Mascia that it was withdrawing because of the lack of demand for the shots, she said. But cost is a key consideration for many of her patients when making health care decisions, and she worried about the families who did want to get vaccinated but couldn’t afford it after this change.

The state government has since stepped up to help keep the clinic’s small in-house pharmacy sufficiently stocked with MMR vaccines, and the timing has been critical.

Mascia says she hasn’t pushed the issue of vaccination much more than usual since the measles outbreak started — just the standard consistent messaging — but the requests from families have noticeably increased.

The Pennsylvania Department of Health has hosted nearly 200 pop-up vaccination clinics where workers have given thousands of MMR doses since the start of the measles outbreak this spring.

Government-sponsored programs like this would typically deter most Plain people, but the Central Pennsylvania Clinic has built up enough trust in the community that simply hosting vaccination events in the clinic building has been enough to drive significant turnout.

More than two dozen people were vaccinated at a pop-up clinic it hosted in mid-August, and 73 more were vaccinated at a second one in mid-September. Interest in the September pop-up spiked significantly after the death in Mifflin County was reported.

“That shows me that this community does care about preventing those serious consequences,” Mascia said. “They want to do what they can, and they know that our strongest tool is through vaccinations.”

Vaccinating a hundred people within the Belleville community “is considered very successful,” the state health department said.

“One of the most important strategies for building trust is recognizing that a successful response must include the people who Pennsylvanians turn to in their daily lives for guidance, like primary care doctors, pharmacists, faith leaders, and community leaders,” the state health department said in an email to CNN. “The Central Pennsylvania Clinic has been an integral part of the Belleville community for more than a decade, caring for the medical needs of these Pennsylvanians and creating lasting relationships. Their partnership in hosting these vaccination clinics provides a layer of trust that DOH can build upon to help residents understand the unmatched protection available through the MMR vaccine.”

The Central Pennsylvania Clinic also aims to meet patients where they are — both philosophically and physically.

Doctors and nurses regularly make house visits to see patients whose health conditions or financial situations make it difficult to travel to the offices. But patients have increasingly requested home visits because fear of infection during the measles outbreak has made them afraid to leave their homes.

Clinic staff is happy to travel to patients’ homes to administer MMR vaccines when requested, too. Sometimes the visits are coordinated to be at a certain hour or to a certain part of the property, to avoid raising eyebrows among neighbors.

Hartung, who leads the clinic’s home care program, knows a family who skipped going to church for more than month to avoid possible measles exposures to their vulnerable infant. As soon as the baby turned 6 months, they requested a home visit for an early vaccination.

“The first thing the mother said was, ‘Now we can go to church again,’” Hartung said. “If they’re missing church, it goes to show you how significant the fear and concern is.”

But the measles outbreak has added even more layers of complication to the home visit operation. Instead of mapping the most efficient route between homes, Hartung is now planning his home visit schedule based on the patients’ vulnerability to an infection. It adds dozens of miles and significantly more time between appointments.

“In a normal time, we might do it by distance, a straightforward route. Now we’re really looking at the most vulnerable sequence, just in case there is a measles encounter that we didn’t anticipate,” he said. “We, of course, are all vaccinated, but we always worry that we might actually become a vector, so we plan that out the best we can.”

Hartung says he knows that he’s gained a patient’s trust when they start calling him by his last name. When formal titles are dropped, it’s a sign that he has found his way in.

“When they’re very formal, it could go either way,” he said. “It’s great to hear, ‘Hartung, what do you think?’”

Mascia recently needed to send a young patient to the emergency department, where the family learned that the closest newborn intensive care unit was full and had to be diverted to another hospital system. There have been only a few other times that patients have been diverted to a different hospital system due to a lack of available beds, Mascia said, but the typically rare event has been happening much more frequently during this measles outbreak.

And in recent weeks, Mascia says, there’s been a marked increase in patients cancelling appointments or simply not showing up to the clinic.

“Sometimes it’s a sudden, eerie kind of stillness,” she said. “Whenever there’s a missed appointment, I’m always concerned that something really severe happened. Right now, you just have to assume the patient has measles.”

The clinic almost always has the time and space to reschedule or fit in a new appointment, but missed appointments aren’t always rescheduled, and gaps in care can lead to serious consequences for her patients.

“It’s very important to keep on top of these conditions to make sure patients have the best possible outcomes,” Mascia said. Young children can rapidly outgrow dosages for important medications or miss the chance to manage a condition with physical therapy before needing surgery.

Measles has also kept the broader community away from fundraising events that are critical to keeping the nonprofit up and running.

The vast majority of the Central Pennsylvania Clinic’s operating budget comes from direct community donations, many of which happen at large auctions that take place a few times throughout the year. Plain families will put handmade quilts, baked goods, farm equipment and sometimes livestock up for sale and gift their earnings back to the clinic.

Clinic executive director Louise Yoder said that a few of the most recent auctions were a bit less successful – and measles was one of the main reasons why.

“People are sick and not wanting to go to events like this,” she said.

Part of the clinic’s goal in providing culturally competent care to the community is an understanding that finances can be restrictive for many patients.

The team works with local hospitals to negotiate special rates for their patients who are Amish or members of the broader Plain community, a group whose philosophical beliefs keep them from enrolling in formal health insurance plans. But the measles outbreak is raising the stakes.

“With the sheer number of hospital stays and ICU admissions that we’re seeing because of measles, I do wonder about the financial toll on this community,” Mascia said. “It concerns me.”

Like other medically underserved populations with barriers to care, the clinic’s patients often wait to seek care until their condition is very serious.

“We’ve received many, many calls from sick measles patients, and sometimes you wish they would have called you sooner,” she said. “It’s just heartbreaking. It’s a preventable illness, and to just see so much suffering, that’s the most intense part.”

九月下旬的一个星期三下午，主街熙熙攘攘。汽车与马车交错行驶，许多人都是从每周一次的集市日来回赶路——这个集市占地十英亩，出售牲畜、水果蔬菜、鲜花和其他商品。谷仓里，人们用英语和宾夕法尼亚德语热烈交谈，农产品拍卖会一直持续到午餐时间；一品脱鲜红的樱桃番茄的出价从90美分到1.30美元不等。

午后，数十人熙熙攘攘地聚在一起——阿米什人和其他一些因穿着简朴而得名的“平民”，以及他们用来称呼社区外人士的“外来者”——没有任何迹象表明该地区正在爆发麻疹疫情。只有一位女士戴着口罩，她说自新冠疫情开始以来，只要出门就一直戴着。一位摊主因“突发的家庭事务”而暂停营业，一位常来参加拍卖会的女士在出现“类似流感的症状”后突然去世，人们正在为她哀悼。一些游客来自布鲁克林。

但不到一英里外的宾夕法尼亚中部诊所，麻疹却成了关注的焦点。

拐过主街，眼前豁然开朗，一片田园诗般的乡村山谷映入眼帘，郁郁葱葱的农田点缀其间，远处是连绵起伏的青山。一条没有路标的道路穿过潺潺的河流，通往山顶一座引人注目的灰色建筑——一座采用传统风格建造的大型谷仓，它完全使用木榫而非钉子来固定结构。

前门锁着，窗户上挂着一张麻疹的照片和说明，旁边还有一张告示，请访客“按门铃寻求服务”。凯瑟琳·马西亚医生面带灿烂的笑容，打开门，迅速问道：“今天有麻疹症状吗？”

那真挚的笑容背后，隐藏着深深的悲痛。当地爆发的大规模麻疹疫情——如今已成为美国几十年来最致命、规模也几乎最大的一次——正给她照顾的家庭带来巨大的痛苦和折磨。

“在我在这里工作的五年里，我想我们医院从未在短短几周内收治过这么多病人，”马西亚说。“通常情况下，我们可能只会收治一位病情复杂的病人，但同时收治这么多病人，这真是史无前例。”

CNN记者米歇尔·古斯塔夫森报道

自4月份疫情爆发以来，宾夕法尼亚州卫生部已报告约1000例麻疹病例，几乎超过了去年南卡罗来纳州疫情爆发期间记录的最高病例数。那次疫情是自1992年以来美国规模最大的麻疹疫情。该诊所所在的米夫林县是受灾最严重的地区之一，靠近邻近的兰开斯特县疫情中心。

宾夕法尼亚州中部诊所服务的患者特别容易受到麻疹感染的严重影响。这家非营利机构致力于为患有遗传性疾病的儿童和成人提供医疗服务，这些疾病在阿米什人和更广泛的平原社区中尤为常见，而该群体的疫苗接种率往往低于平均水平。

平原民族以对政府和其他非宗教权威保持谨慎而闻名。

但随着麻疹在宾夕法尼亚州中部许多他们的家乡肆虐，全国范围内的讨论却出人意料地变得充满政治色彩。

联邦政府和宾夕法尼亚州政府领导人在应对疫情方面存在分歧，争论的焦点主要集中在此次疫情爆发以来出现的五例死亡病例上。关于麻疹死亡病例的定义以及如何向公众发布死亡消息的争议，扰乱了公共卫生应对计划。

与此同时，宾夕法尼亚中部诊所的工作人员正全力以赴地保障所有人的安全和健康。他们依靠的是诊所长期以来建立的信任基础。诊所用了数年时间，坚持不懈地建立起这些关系，而这种信任在过去几个月里经受了最严峻的考验。

马西亚说，宾夕法尼亚州报告米夫林县一名18岁青年死于麻疹后，诊所开始接到大量电话——既有他们认识的病人，也有社区其他成员——大家都想知道到底发生了什么。她说，他们根本不在乎政府官员在社交媒体上争论什么。他们只想弄清楚这名年轻人究竟是怎么死的。

“他们打电话来问这些问题，我感到非常荣幸。这让我觉得他们真的很信任我们，”马西亚说。“但这同时也给我们带来了压力。”

她说她直接联系了县验尸官，以获得关于死因的正式声明，当病人有疑问时，她会引用该声明。

“我们希望与社区保持畅通的沟通渠道，提供准确的信息并保持信息的一致性非常重要，”她说。

马西亚表示，自2025年1月西德克萨斯州爆发麻疹疫情以来，宾夕法尼亚中部诊所的领导层就一直在考虑并计划应对社区内可能发生的麻疹疫情。他们的患者属于易感人群，而且他们的诊所虽然在很多方面设备齐全，但并非为治疗麻疹患者而建。

“我们没有先进的通风系统，也没有负压病房，所以如果有麻疹患者进来，我们整栋楼都会在两个小时内处于危险之中，”马西亚说。

宾夕法尼亚州要求进行咽拭子、血液样本和尿液样本检测才能确诊麻疹病例——这对患病患者来说是一项艰巨的任务，他们通常不得不乘坐费力的马车前往诊所；对诊所工作人员来说也是如此，他们必须在诊所设施的限制下工作。

诊所大楼的后门（该大楼内还设有一家联邦认证的医疗中心）已临时改造成疑似麻疹病例的分诊中心。后方的停车场足够宽敞，可以停放汽车和婴儿车，诊所工作人员会在门口迎接家属，然后引导患者进入一个小型储藏棚采集尿液样本。

马西亚表示，制定后勤计划以确保运营安全非常重要，但她明确指出，保护患者最关键的方法是提高疫苗接种率。

麻疹-腮腺炎-风疹 (MMR) 疫苗非常有效。单剂疫苗对麻疹的有效率达 93%，推荐接种的第二剂可将保护率提高至 97%，且免疫力终身有效。大量研究也证实了该疫苗的安全性。

全国儿童疫苗接种率持续下降，上学年选择让新入园的孩子免于接种疫苗的家长比例创下历史新高。

专家表示，平原地区的民众疫苗接种率往往较低，但这并非因为他们天生反对接种疫苗。

马西亚表示，社区内存在一些共同的价值观，但就像任何广大群体一样，人们对疫苗也存在各种不同的看法和意见。诊所在疫苗接种信息方面保持一致性，是提高接种率的关键。

如果患者感受到医生的任何形式的胁迫，或者感到被迫做出诸如接种疫苗之类的决定，他们将完全放弃所有医疗保健——这对他们照顾的弱势患者来说尤其麻烦。

“我们强烈建议每个人都接种疫苗，”马西亚说。“如果他们不感兴趣，我们会再次提出建议，并表示‘如果您改变主意，我们随时乐意提供帮助。’”

去年加入宾夕法尼亚州中部诊所的赫尔格·哈通博士表示，在阿米什人和更广泛的平原社区中，邻居的经验和家庭成员的建议比发表在最负盛名的医学期刊上的研究结果或领先的临床协会的建议更有分量。

宾夕法尼亚中部诊所独辟蹊径，为建立这种融洽关系创造了机会——但这需要时间。

诊所为新患者预留了两个小时的就诊时间，之后每次就诊都安排一个小时。主诊室非常宽敞，足以容纳整个家庭——平均每个家庭有七个孩子——以便进行与每位家庭成员都息息相关的谈话。马西亚说，诊所有足够的时间和空间来解答疑问，而她的患者们都非常了解情况，每次就诊都会提出很多问题。

她说：“我看到的是，各个家庭都在努力权衡从我们这里、社区以及其他渠道获得的所有信息。他们真心实意地想为孩子做出最好的决定。”

几年前，联邦政府停止通过“儿童疫苗计划”（Vaccines for Children）向诊所提供麻疹、腮腺炎、风疹（MMR）疫苗。该计划是一项联邦资助项目，旨在为那些可能无力承担疫苗费用的儿童免费提供常规免疫接种。马西亚说，政府告诉她，停止提供疫苗的原因是疫苗需求量不足。但费用是许多患者在做出医疗保健决定时的重要考量因素，她担心那些想接种疫苗却因这项政策变化而无力承担费用的家庭。

州政府随后加大了力度，帮助诊所的小型内部药房储备充足的麻疹、腮腺炎、风疹疫苗，而时机至关重要。

马西亚表示，自麻疹疫情爆发以来，她并没有比平时更积极地宣传疫苗接种问题——只是沿用了标准的宣传方式——但来自家庭的接种请求明显增加了。

自今年春季麻疹疫情爆发以来，宾夕法尼亚州卫生部已举办了近 200 个临时疫苗接种诊所，工作人员已接种了数千剂麻疹、腮腺炎、风疹 (MMR) 疫苗。

像这样的政府资助项目通常会吓退大多数平原居民，但宾夕法尼亚州中部诊所已经在社区中建立了足够的信任，仅仅在诊所大楼举办疫苗接种活动就足以吸引大量民众参与。

8月中旬，该机构举办了一场临时疫苗接种活动，为二十多人接种了疫苗；9月中旬，又有73人参加了第二次接种活动。米夫林县报告死亡病例后，人们对9月份的临时接种活动表现出了极大的兴趣。

“这表明这个社区确实关心如何预防这些严重后果，”马西亚说。“他们想尽自己所能，而且他们知道我们最有力的武器就是接种疫苗。”

州卫生部门表示，在贝尔维尔社区为一百人接种疫苗“被认为是非常成功的”。

宾夕法尼亚州卫生部在发给CNN的一封电子邮件中表示：“建立信任最重要的策略之一是认识到，成功的应对措施必须涵盖宾夕法尼亚民众日常生活中寻求指导的人员，例如家庭医生、药剂师、宗教领袖和社区领袖。中宾夕法尼亚诊所十多年来一直是贝尔维尔社区不可或缺的一部分，为宾夕法尼亚民众提供医疗服务，并建立了长久的合作关系。他们参与举办这些疫苗接种诊所，为州卫生部提供了一个信任基础，有助于居民了解麻疹、腮腺炎、风疹疫苗（MMR疫苗）提供的无与伦比的保护。”

宾夕法尼亚中部诊所的目标是在思想和身体上都为患者提供合适的治疗。

医生和护士通常会进行家访，为那些因健康状况或经济困难而难以前往诊所的患者提供服务。但由于麻疹疫情爆发期间，患者担心感染病毒而不敢出门，因此要求上门诊疗的患者人数也越来越多。

诊所工作人员也乐意应患者要求上门接种麻疹、腮腺炎、风疹疫苗。有时，为了避免引起邻居的注意，上门接种的时间或地点会事先约定好。

哈通是诊所家庭护理项目的负责人，他认识一个家庭，为了避免体弱多病的婴儿可能接触到麻疹病毒，他们一个多月都没去教堂。孩子一满六个月，他们就申请了上门接种疫苗。

哈通说：“那位母亲说的第一句话就是，‘现在我们又能去教堂了。’如果他们都想念教堂，那就足以说明他们有多么恐惧和担忧。”

但麻疹疫情的爆发让上门诊疗工作变得更加复杂。哈通不再像以前那样规划最便捷的路线，而是根据患者的感染风险来安排上门诊疗的日程。这导致诊疗路线增加了数十英里，每次诊疗之间的间隔时间也显著延长。

“正常情况下，我们可能会采取保持社交距离这种直接的方式。但现在我们必须关注最易感人群的传播途径，以防万一出现我们意想不到的麻疹病例，”他说。“当然，我们都接种了疫苗，但我们始终担心自己可能会成为病毒传播者，所以我们会尽最大努力做好应对措施。”

哈通说，当病人开始直呼他的姓氏时，他就知道自己赢得了病人的信任。当正式的头衔被省略时，就表明他已经走进了病人的心。

“如果他们态度非常正式，结果就很难说了，”他说。“听到‘哈同，你怎么看？’就太好了。”

马西亚医生最近不得不将一名幼童送往急诊室，但家属得知最近的新生儿重症监护室已满，不得不转诊至其他医院系统。马西亚医生表示，此前因床位不足而将患者转诊至其他医院系统的情况屈指可数，但在此次麻疹疫情爆发期间，这种原本罕见的事件发生的频率却显著增加。

马西亚表示，最近几周，取消预约或干脆不来诊所就诊的患者人数明显增加。

“有时候，气氛会突然变得诡异而压抑，”她说。“每当有人爽约，我总是担心是不是发生了什么非常严重的事情。现在，你只能假设病人得了麻疹。”

诊所几乎总有时间和空间重新安排或安排新的预约，但错过的预约并不总是能重新安排，而护理方面的空白可能会给她的病人带来严重的后果。

“密切关注这些情况至关重要，以确保患者获得最佳治疗效果，”马西亚说。幼儿可能很快就会出现重要药物剂量不足的情况，或者错过在需要手术前通过物理疗法控制病情的机会。

麻疹疫情也使得更广泛的社区无法参与对维持该非营利组织正常运转至关重要的筹款活动。

宾夕法尼亚中部诊所的绝大部分运营预算来自社区的直接捐赠，其中许多捐赠来自一年中举办的几次大型拍卖会。一些普通家庭会拍卖手工制作的被子、烘焙食品、农具，有时甚至牲畜，并将所得款项捐赠给诊所。

诊所执行主任路易丝·约德表示，最近几次拍卖不太成功——麻疹是主要原因之一。

“人们生病了，不想参加这样的活动，”她说。

诊所致力于为社区提供具有文化适应性的医疗服务，其目标之一是理解经济状况可能对许多患者造成限制。

该团队与当地医院合作，为阿米什人或更广泛的“平原社区”（Plain Community）成员的患者协商特殊收费标准。这些群体因其哲学信仰而无法加入正规的医疗保险计划。但麻疹疫情的爆发使情况变得更加复杂。

“鉴于麻疹导致的住院和重症监护病例数量如此之多，我确实担心这会给社区带来沉重的经济负担，”马西亚说。“这让我很担忧。”

与其他医疗服务不足、就医存在障碍的人群一样，该诊所的患者往往等到病情非常严重时才寻求治疗。

“我们接到了很多很多麻疹患者的求助电话，有时候你会希望他们能早点联系我们，”她说。“这太令人心碎了。麻疹是一种可以预防的疾病，看到这么多人遭受痛苦，这才是最让人难过的。”