A doctor's office rolls out

Program: Through an outreach project, St. Joseph Medical Center takes medical care to Baltimore homeless in a staffed mobile home.

January 04, 2003|By Reginald Fields | Reginald Fields,SUN STAFF

Tony Davis is homeless, jobless, doesn't have a doctor, doesn't have medical insurance, but he does have ailments that could use a physician's touch.

Despite his circumstances, Davis is fortunate. He's getting the medical attention he needs and from an unlikely source -- a full-fledged primary care doctor's office on wheels that visits two Baltimore homeless shelters each week.

Davis, with bloodshot eyes, raspy voice and toothy smile, strolls into the huge white mobile home parked outside the Franciscan Center in Charles Village and looks for nurse practitioner Bill Gough, whom he has seen almost exclusively since first using the vehicle for medical care in May 2001.

"Without this program here and Mr. Bill, I would have nothing," said Davis, a recovering heroin addict who struggles with severe asthma. He considers Gough a friend, and Gough said the feeling is mutual.

Offering a variety of free services including prescriptions, the St. Clare Medical Outreach program of St. Joseph Medical Center has evolved from a screening and vaccination station into a rolling doctor's office -- with two fully equipped 7-by-7-foot patient rooms, pharmacy and trained staff on board.

Last year, the program treated 4,433 people, most of them homeless.

"Our mission is to help people with no medical benefits," said Gough, the program's manager. "We have a 75 percent return rate, which is pretty good because it says people are using our services. But it is also unfortunate because they can't get care anywhere else."

On Thursday, their most recent meeting, Gough chastised Davis for not taking medication prescribed during their last visit. Then he told Davis to get a haircut, a nonmedical tip Davis found as encouraging as the medical attention he received.

"He's a real nice guy, he'll go out of his way for me," said Davis, 37. "I think he cares, like saying get a haircut. But if you don't do things right, like if I start messing with drugs again, he won't stand for that, and he can't help you. I can't mess him up like that."

The mobile home visits the Franciscan Center on Thursdays and the Hispanic Apostolate in Fells Point on Tuesdays and Fridays, where most of the program's patients are seen.

Services range from offering flu shots, blood pressure screenings and prostate exams, to treating infections and dressing open wounds. And everything is free to patients, even the medications in the small, locked pharmacy in the center of the pink wallpapered mobile home.

The staff includes a doctor, nurse practitioner, registered nurse, an emergency medical technician, a social worker and a nun, who counsels patients spiritually and might pray with them. The doctor and nurses work in the vehicle while the others do nonprimary care tasks and medical counseling inside the shelters.

Not every patient is seen by the doctor and nurses if their ailments can be handled by the staff at the shelter. Of those treated by the program last year, 2,006 received primary-care attention aboard the mobile home.

The program started modestly in 1998, providing screenings for vision, hearing and other problems. It has grown into a $400,000 annual operation, paid for mainly by grants obtained by St. Joseph Medical Center, a Towson hospital owned by the Catholic Health Initiatives, and some private donations.

Though a St. Joseph project, the outreach program is called St. Clare as a stipulation from the Friess Family Foundation, which donated the mobile home.

For those who need more intensive care, for appendicitis and gall bladder problems, for example, the program can arrange for surgeons at St. Joseph to help.

Gough said that beyond offering medical care, the program aims to help patients feel better about themselves so that they might get a job and become more self-sufficient.

"We do see a lot of people who are at wits' end, and they don't know where to go," he said. "We just hope to help them get stabilized to where they can go to the clinics and get care when they want it. Because the disadvantage is we're not here 24/7."

As a nurse practitioner, Gough can make diagnoses and prescribe medications. But if he needs a more expert medical opinion, he can turn to Dr. Marcio Menendez. An internal medicine and cardiology specialist who ran a private practice for 34 years from offices in Govans and St. Joseph Medical Center, Menendez joined the program in 2000 after he retired.

While Davis and Gough were in one room, Menendez was in the other in the mobile home, seeing someone using the program for the first time.

Nicole Walker, 23, wants to be a paramedic, but when she recently took a physical she learned she had high blood pressure. She works part-time but has no medical insurance.

Menendez examined her and calmed her fears. At 5-foot-6 and 211 pounds, Walker must lose weight and come back in a few weeks for another checkup, the doctor told her.

"I know I need to lose weight, but it was just nice to be able to see a doctor," said Walker. "I think the program helps a lot of people that need it more than I do, and that's what's good."

Such appreciation from patients makes the job worthwhile, said Menendez, who sees many people with far more severe problems than Walker.

"The medical bug is something that when it stings you, it stays with you forever," said Menendez, explaining why he joined the program. "And I see patients, especially Hispanics who are new to the country ... who need help and are so needy. And you want to help."

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