Since the day the clinic quietly opened a month ago, men have been coming, nursing aching teeth and bad shoulders, worrying about HIV and high blood pressure. Some haven't seen a doctor in years. Others are so sick they have to be taken away in an ambulance.
When the Baltimore City Health Department renovated part of its Druid Health Center on North Avenue, doctors expected it would take a while for patients to hear about the new Men's Health Center. Instead, dozens and dozens of men have been showing up. The only one of its kind in the nation, the free clinic serves uninsured men ages 19 to 64, providing primary and dental care, substance abuse counseling, and even links to jobs. About 600 men have been helped so far.
"I never dreamed they would open a place like this. They took care of me," said Baker Parham, 56, a tailor from Sandtown-Winchester who said he hasn't seen a doctor in 30 years. He has six teeth left, and they're all rotten. But doctors discovered his blood pressure was too high to pull his teeth, so they have to take care of that first.
About 55,500 city men have no insurance, studies show. Roughly half are working, but they are often in construction or other jobs that don't offer health benefits. Some are between jobs. Others are mentally ill or drug-addicted.
But, unlike the many public and private programs for poor women and children, little help is available for men.
"It's sort of like the lifeboats on the Titanic, women and children first. They're a more vulnerable population in general. But men, as it turns out, are vulnerable too," said Dr. Richard Levinson, associate executive director of the American Public Health Association.
Nationwide, men's health is garnering more attention, after a major report released in March by Commonwealth Fund found that a significant number of men don't get routine checkups and that many ignore symptoms when sick or in pain.
More than half of men had not had a physical or blood cholesterol test the previous year, the study found. Only about a fifth of men said they seek care or medical advice without delay. And even when they do visit the doctor, men are often too embarrassed to discuss health concerns.
In Baltimore, other barriers exist as well. Doctors and patients say many men have run up big bills for clinics or emergency rooms where they say they've been treated poorly. Others fear they'll be research subjects at local hospitals. Meanwhile, physicians who used to offer care for little cost in private offices have retired or been driven out by the new economics of health care.
"The old safety net is gone," said Dr. Wallace Johnson, medical director at the new center. "But we won't turn anyone away."
Originally, the city Health Department planned to offer men's health services a few hours a week, said Hakim Farrakhan,the agency's deputy commissioner, but after two surveys, officials realized how extensive the need was.
They also considered the domino effect of these men's poor health.
"These men are citizens. They are members of a family, and they have an impact on that family," said Farrakhan,who spearheaded the effort. "Through healthy men, we can begin to build healthier families."
Getting these men in good shape may take some doing.
Chronic conditions such as diabetes, hypertension, and prostate problems are getting picked up at the clinic. In the first week, one man had appendicitis and had to be taken to the hospital. Three other patients had blood pressure so high that they were close to strokes. Some men have needed minor surgery.
"These people are walking around with some serious medical problems," said nurse George Brubach.
Men are coming in with the flu, nosebleeds, ear infections, back injuries, depression and ulcers. Many need physicals so that they can get jobs, Brubach said. And others, declaring they're fine, are towed in by wives and girlfriends.
One of the recent visitors to the clinic, Tevon Chapman, 19, was a case in point. "If it isn't life-threatening, and it isn't going to kill you, give it a few days, and it might go away," the West Baltimore man said, summing up his health care strategy. Sitting opposite him in one of the clinic's exam room, his girlfriend, Chanel Cooper, 19, shook her head in frustration. "You never want to go to the doctor, whether you're sick or not."
But Chapman liked the male emphasis of this clinic. The nurse and physician's assistant are both men, and organizers are trying to get ESPN in the waiting room. Chapman, who was recently laid off as a pipe fitter at a sprinkler company, came for a physical.
In the next room, Robert Prince, 56, took out his wallet, and with shaky hands, pulled out four folded, worn prescriptions that have never been filled. The West Baltimore construction worker, who was laid off in December, said he is getting unemployment benefits but can't afford health insurance. So he hasn't been taking the blood pressure and other medicine he needs.
"You're on your own," Prince said. "You're by yourself."
The clinic has some sample medicines they get from pharmaceutical companies and has established agreements for those patients who need to see specialists. But about 20 percent of the clinic's patients may qualify for some help through existing state health programs, Farrakhan said, so staffers try to identify these people and get them signed up.
But, because few public or private health programs exist for these men, there is usually no way for doctors, nurse practitioners or other providers to get paid for treating them.
Funded by grants
Baltimore is funding the $1.3 million center by rounding up private grants from the Robert Wood Johnson Foundation, the KelloggFoundation, and Vision for Health, a Sandtown-Winchester coalition, Farrakhan said. About half the money is coming from old welfare money, through a new program that helps families.
With help from the city Health Department, two more men's clinics are planned in the coming months. The Men's Center in East Baltimore, which offers counseling and job training, will expand its limited health screenings, and the Park Heights Community Health Alliance, a coalition of 80 groups, including Sinai Hospital, will launch an 18,000-square foot new clinic, as well as open 25 homes for recovering addicts.
Seeing social worker
At the North Avenue clinic, while many of the men are initially hesitant and not sure what to expect, roughly three-quarters will wind up sharing their struggles with social worker Maria Lucas. Some men have even come to Lucas and confessed that they hit a wife or girlfriend. They tell her they want help.
Whether they're referred to a mental health professional or a neurologist, each of these men is assigned to an outreach worker and can be linked to services including job training, food pantries and drug treatment. Several men have recently gotten eye exams and glasses.
But more than anything, just having a place to go when they are sick is a relief for many.
Neil Cole-El, 32, a custodian, wanted a physical, but everywhere he called said it would cost $100 or more. Then he heard about the new clinic, got an exam there and even a referral to a specialist for the leg pain that's been bothering him. Now, Cole-El says he's spreading the word.
"This is something that we need in the city," he said. "I got in, I got seen, they listened with sincerity, and they got me to the next step of solving the problem."