There's no doctor in the house where Robert Ware gets his health care in Pigtown. And that's fine with him.
Once a week, Mr. Ware, a disabled 44-year-old house painter, visits the Open Gates clinic, in a former pizza parlor in the 900 block of Washington Blvd.
Nurses, not doctors, have total command of the Southwest Baltimore health center, which grew out of a soup kitchen. And the nonprofit clinic shows that a church-state marriage can work.
When Mr. Ware arrived Tuesday for his appointment, the staff as usual treated him almost like family. How are you feeling today, Mr. Ware? Let's take your blood pressure. Is the medication working?
His checkups may last 30 minutes or more. The cost to Mr. Ware is $5. "This place was set up to help people like me," he says.
Started 14 months ago, the Open Gates Nurse-Managed Health Center has treated more than 800 people for everything from sore throats to hypertension and diabetes. It has won the affection of Pigtown, the historic, working-class district near Camden Yards that has retained its pride but experienced rough economic times in recent decades.
The center, which is adding about 50 new patients a month, has earned the trust of once-wary residents who now speak of Open Gates as casually as they would the fast-food establishment three blocks away.
"It's a clean, efficient and friendly place that provides terrific service," says Arnold Sherman, president of the Southwest Community Council. The center, which relies heavily on private funds, was created to help those in Pigtown who are not indigent but lack adequate medical coverage. No patient is turned away; fees are on a sliding scale, often as little as $5 a visit.
"These people lead hard lives," says Carolyn Buppert, a nurse at the clinic. "We just make it easier for them to make ends meet."
Open Gates is a magnet for folks such as Mr. Ware, who says he has high blood pressure and a low income. He can't afford a doctor and says he doesn't need one.
"If the nurses can treat me, fine," he says. "They seem more like doctors anyway, except they spend more time talking with you )) here."
Brian Sanderoff, a Pigtown pharmacist who fills most of the clinic's prescriptions, says residents praise the center's nursing staff for the "old-fashioned" care at Open Gates. "Ninety-nine percent of them come in for their medicine and say, 'I love the attention; the nurses take time to talk to me.' "
"People heal more quickly when they think the practitioner cares about them as a person, and that's what they seem to get there," says Mr. Sanderoff.
The medical staff consists of six faculty members from the University of Maryland School of Nursing downtown. The clinic is one of about 50 nationwide with ties to schools of nursing. Open Gates had its roots in a one-room clinic run by UM nursing instructors and students to help people who frequented Paul's Place, the soup kitchen at St. Paul the Apostle Episcopal Church on Washington Boulevard.
Open Gates not only gives its nurses a window on urban medical problems but also provides the clinical hours these nurse practitioners need to remain effective teachers.
"Working here keeps your skills on edge," says Ms. Buppert.
The nurses deal with 90 percent of the illnesses. The other patients are referred to physicians. "It's often a judgment call, but nurses know the limits of their expertise," says Mildred Kreider, acting director of the health center.
The clinic also serves as a training ground for 50 UM nursing students, who assist during examinations, visit Pigtown patients their homes and lead educational seminars on such topics as smoking and teen-age sexuality.
In addition to the nursing school, the forces behind Open Gates include several Episcopal churches; community organizations; the UM School of Medicine, whose Department of Family Medicine handles referrals; private foundations; and the U.S. Public Health Service.
"We're an unusual marriage of church and state," says Ms. Kreider. "But our challenge is to become self-supporting."
The clinic obtained a three-year, $654,000 grant from the public health service, to study the effects of better access to health care, and at the outset received more than $300,000 from foundations. The annual budget for Open Gates is about $300,000.
The clinic has become a haven for noninsured patients such as Carol Rogers, a diabetic who has been treated at Open Gates for nearly a year. "I love coming here," says Mrs. Rogers, 46, a part-time housekeeper and grandmother of nine. "Just talking with [Ms. Buppert], I feel better about myself. She really hears me.
' "I call her my doctor."