What Wanda Anderson gets from Lunenburg Health Service Inc., she would probably never be able to afford. 

Anderson, 69, is a retired high school cafeteria worker on a fixed income who suffers from diabetes, heart failure and lung disease. She receives $982 a month from Social Security but spends $300 on medication, $283 on housing in the town of Victoria and the rest on bills.
 
She relies heavily on regular visits from Deborah Craven, a licensed practical nurse with the local health service, a nonprofit agency that has aided rural Lunenburg County's low-income residents free of charge since 1947. 

"Just knowing she's going to come every Tuesday makes all the difference in the world, and I know I can call her any time," Anderson said. 

The agency operates on a financial shoestring, without federal, state or local government funding, and without billing insurance companies. 

How it manages that feat becomes clearer when you look at Craven's workload. 

Last year, she made 3,172 home visits to patients, saw patients in her office 1,313 times and drove 24,000 miles. She works under the direction of the patients' physicians. 

"That's pretty good coverage," said Bruce Chandler, Lunenburg Health Service's board chairman. 

Craven's stops, which typically range from 10 minutes to an hour, include visits to a retirement home, where she sees multiple patients. On a recent weekday, she saw four patients, including a husband and wife at one home, in the town of Victoria in about two hours. 

At Anderson's house, Craven asks Anderson how she's doing, checks her blood pressure and blood sugar, and answers questions about her health. 
"You need somebody else you can talk to besides your doctor, and you can't always get through to him. Deborah is always there," Anderson said. "She's a friend. 

"(Craven) is very loving," she said. "We can cry and tell our problems to her. I just can't say enough good things about her." 

Craven travels the county providing an array of free health services, including helping with newborn care, changing bandages and dressings, and filling insulin syringes. She has been with the service for seven years. 

Lunenburg Health Service continues to operate off the income from a trust fund formed in 1947 when Robert Williams, a local businessman, donated $200,000 to establish a service that would provide free health-care services to all Lunenburg residents, regardless of their ability to pay. 

That, Chandler said, is testimony to how frugal the group's board of directors has been through the years. 

"That's the only reason we've gotten this far," he said. 

The county's doctors are on the board of directors and often refer clients to the service. The group also loans hospital beds, wheelchairs, walkers, canes, bedside commodes and other medical items to any county resident in need. Many of the supplies are donated. 

"For many elderly patients, Deborah is their only daily contact with the outside world," Cal Spencer, a member of the organization's 15-member board of directors, said in an e-mail. "For patients who have no family members to care for them, Deborah fills that role." 

Cordelia Holmes' husband, Robert, died a couple of years ago, and she doesn't drive. 

"I'm scared of cars," the 90-year-old former dry-cleaning worker said, sitting in her living room. Her husband's cousins look after her, but she appreciates Craven's visits. 

"I try to keep her from having to go out all the time," said Craven, who uses the visits to check Holmes' blood pressure and blood sugar and see if Holmes has any concerns that need to be taken to her physician. 

Supporters say about 75 percent of Craven's patients are low-income and "fall between the cracks" without insurance or government assistance to provide for their medical needs. Many cannot afford the co-pays that would be required for a visit to their physician. 

"For many patients, we bridge the gap left by a lack of insurance or lack of ability to pay co-pays," Spencer said. 

At the Victoria home of Tommy and Ruth Jackson, Craven gives Tommy his vitamin B12 shot, then checks his blood pressure and separates his pills. 
"She just keeps me living, and I appreciate that," said Tommy Jackson, 82, a U.S. Army veteran and retired Virginia Department of Transportation truck driver. "She is just as good a nurse as a man wants, and I've had plenty of them." 

Tommy Jackson has heart and kidney problems. Ruth Jackson is in the early stages of Alzheimer's disease. 

The couple, who have been married 42 years, have five girls and a son and "just get along good together," Tommy Jackson said. 

But money is always a need. "That's one thing a man who is retired runs short of," he said. 

Ruth Jackson receives about $600 a month, and Tommy Jackson said he gets more than $700. But, he said, "with the cost of medicine and such, we don't have much." 

Jackson buys his B12 at the Wal-Mart in Blackstone ("It's cheaper down there"), and Craven gives him a shot every three weeks. That way, Craven saves Jackson a doctor's visit and the expense of paying for a shot. 

"So many of the things, if we weren't here, they'd have to go to a doctor or somewhere," Craven said. "We save a lot of low-income people a lot of money, a lot of expense." 

Escalating costs have prompted the board of directors to begin planning their first fundraising drive, possibly to be launched in July. 

Several years ago, the agency operated on $35,000 a year. That figure has climbed to $48,000, which includes Craven's salary and the salary of a part-time secretary. 

The rising cost of gasoline has "hurt us as much as anything," Craven said. 
Added Chandler, "Gasoline, heating this building, medical supplies — it's just all gone up like a rocket." 

The service will approach businesses, churches and civic clubs to seek financial assistance, but it wants to be careful not to leave the impression with its clients that they have to pay. 

"We don't want them to ever think they need to contribute to get service," Chandler said. "The service is free. 

"We want to keep this going another 100 years or so. If for any reason we didn't, there would be a lot of people unhappy."