At Paul's Place, partnership with nursing school promotes good health

He moved to Baltimore to take a job as a property manager, but when the company he worked for collapsed, Ganesh Boodram said, he found himself living in the streets.

Homelessness was cruel to the Boston native. He was hit by a car, shattering a shoulder. Despite his skills as a handyman, few would hire him. He rarely got to see his grown daughters.

Things got so bad not long ago, he said, he decided to take his own life. Then he walked into a small health center in Southwest Baltimore.

At the Nurses' Clinic at Paul's Place — an unusual collaboration between Paul's Place, a social-services agency in Pigtown, and the University of Maryland School of Nursing — he felt such a powerful welcome that he changed his mind.

"They said, 'Don't think about something like that. We're a family. We'll take care of you.' I wouldn't be alive if it weren't for these people," said Boodram, who now stops in once a week for counseling, conversation and a renewed sense "that I still have a place in this life."

For 28 years now, the Nurses' Clinic has paired the mission and manpower of Paul's Place, a nonprofit that offers a range of social services to low-income Baltimoreans, with the skills of nursing students from the University of Maryland, most of whom are "paid" in course credits.

The result is a low-cost, patient-centered model of community health care, a fast-growing area of medicine that defines health care as treatment of the total patient, from offering blood pressure tests and advice on filling out forms to providing the kind of regular counseling and chat that can reinforce a patient's sense of well-being.

"We're not a primary-care provider, but we offer essential services — triage, screening, referrals, case management and more — and we work to make sure clients have insurance as well as a relationship with a primary-care physician," said Kelly Flannery, R.N., an assistant professor of nursing at the University of Maryland who doubles as the clinic's health director.

While few cases are as dramatic as Boodram's, most involve issues that reflect what ails many poor, urban communities — asthma, substance abuse, hypertension and a lack of access to healthy foods.

In most cases, Flannery said, she and her team of volunteers end up helping patients realize "how to play an active role in their own treatment plan."

The clinic, which is open every Wednesday, is one of a growing number of nurse-managed health centers in the United States, a trend that experts say mushroomed during the 1990s when it became clear that there was a shortage of primary-care providers serving vulnerable populations.

Many such clinics focus on training nursing students, in part to build interest in working in community-based care.

"This country won't succeed in its implementation of health care reform without more of these types of clinics in underserved communities," said Tine Hansen-Turton, CEO of the National Nursing Centers Consortium in Philadelphia, which seeks to address health care disparities in the U.S. through research and policy initiatives.

There are about 500 nurse-led clinics in the country, Hansen-Turton said, and more than half are affiliated with nursing schools.

On a steamy June afternoon, Paul's Place, located on Ward Street just south of the B&O Railroad Museum, is a beehive of activity.

Its oldest service — the hot lunch program, which was served out of the back of a car starting in 1982 — is in full swing, with dozens of guests cramming a cafeteria for the free meal available every weekday.

The menu includes hot dogs, green beans, potatoes and juice, a neighborhood favorite, according to Deputy Director Sadie Smith, though she prefers the lower-fat entrees the agency often serves.

A free clothes market is open upstairs, serving a dozen or so customers, as is a class in which volunteers are helping guests learn how to lower their electric bills. A dozen more guests tap away in a computer lab.

The Nurses' Clinic, the second-oldest program Paul's Place offers, was founded in 1986, when volunteers ran it out of a closet at St. Paul the Apostle Church. Now located in the brightly colored after-school program room, it is staffed during the academic year by graduate and undergraduate students at the nursing school, only a few of whom have their R.N. degrees. (When school is out of session, the staff consists of retired nurses and other volunteers.)

Over the course of two hours, about a dozen clients check in and wait their turn.

Three nurses welcome each in turn, offering health screenings, checking dietary intake, even helping solve transportation problems, all in a conspicuously unhurried fashion.

One man with high blood pressure hasn't exercised as much as he was supposed to. Flannery persuades him to join the clinic's walking group.

At times, the screenings reveal major problems — uncovering cancer, for example — in which case nurses refer patients to one of a growing number of medical clinic partners, such as Total Health Care Inc., or to available specialists or primary-care physicians.

That alone is a much-needed service, as about 50 percent of the clinic's clients have no other interaction with a health care provider, Flannery said.

Boodram still has problems with his shoulder — he lifts his shirt to reveal an awkwardly protruding bone — and discomfort in three vertebrae, issues for which the clinic has referred him to primary-care providers.

When he's hired to do odd jobs such as painting or hanging drywall, the injuries can make it harder to work. "I'm in pain every day of my life," he said.

But that's nothing, he added, compared with the emotional pain that can rear its head.

He's not sure he'll ever conquer that, but coming to the Nurses' Clinic every Wednesday provides a balm he said he can't live without.

"The people here are so kind-hearted," he said. "They find out what your needs are and meet them. In this community, [this clinic] is the best thing that has ever happened."

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