Street medicine gives relief to homeless

The Baltimore Sun

LOS ANGELES -- Friends call him Thurston Howell III, for his passing resemblance to the millionaire played by Jim Backus in the 1960s sitcom Gilligan's Island.

But Mike Huffman, 60, is no millionaire. The former computer program analyst and TV technician sleeps on a concrete slab at the beach in Santa Monica. He sometimes goes days without eating. And he forgoes medication for high blood pressure because he has no money.

A break finally came Huffman's way recently after a homeless outreach team received word that he was exhibiting signs of pneumonia. A worker from the Ocean Park Community Center, one of L.A.'s largest service providers, and a doctor from the Venice Family Clinic tracked down Huffman on Thursday at a gazebo south of the Santa Monica Pier, checked his blood pressure, took his temperature and whisked him to the clinic.

Street medicine, as this practice of making house calls on the homeless is known, is fast becoming a popular tool in attempts to help an often disaffected population known for its aversion to accepting help. Activists acknowledge that street medicine can serve only a fraction of those who need care, but successful programs in Pittsburgh and Boston have helped spark the movement.

"We potentially have saved many lives by doing this," said Christine Fratino, a Venice Family Clinic doctor who helped develop the "street med" program.

The lifesaving starts with steps that might seem small to those who have Band-Aids, pain relievers and hydrocortisone cream close at hand. To those living in alleys and parks, however, the street ministrations of Fratino and her colleague, Dr. Susan Partovi, can mean the difference between a day spent suffering from a wracking cough or sore rib and a day when the body, at least, is free of pain.

Like many other homeless health care programs, the Venice Family Clinic-OPCC effort, launched in January, receives federal funding. Nationwide, such programs serve about 650,000 homeless people a year, according to the National Health Care for the Homeless Council.

For the Santa Monica street medicine team, the day began at 7:30 a.m. in the parking lot behind the Ocean Park Community Center.

On Thursday, Fratino and Partovi, who usually alternate on the weekly outings, decided to team up. With them were Susie De La Rosa, an OPCC outreach worker who drove the van, and Bryan Sauter, a physician assistant from the Los Angeles Mission Community Clinic. Fratino had packed a large black backpack with ibuprofen, asthma inhalers, ointments, multivitamins, a temperature probe, a blood pressure cuff and plenty of disposable gloves.

The first stop was an alley. There, next to trash bins and a bank parking lot, Amelia "Bootsie" Skinner, 68, was using an outdoor faucet to rinse out clothing and wash her face. Skinner, who is missing many teeth, recognized the outreach team and smiled as she greeted them. At Fratino's request, she removed her fleece-lined moccasins, unwrapped the plastic bags around both ankles and pulled up the legs of her jeans to reveal swollen legs and feet. She lifted her right foot to show Fratino a cut on the bottom.

Fratino, 35, handed Skinner a tube of ointment. The doctor also offered an antifungal cream, but the older woman - who insisted she has a doctorate in psychiatry and once practiced medicine in Tuskegee, Ala. - rejected it.

But Fratino wasn't fazed. She said the fact that Skinner, who the doctors believe is schizophrenic, accepted any aid was encouraging.

The next stop was Palisades Park, where John "Teddy Bear" Cunningham, 43, sat on a bench, his legs splayed. Partovi took his blood pressure; at 158/96, it was too high.

One goal of the program is to encourage homeless individuals with skin infections, upper-respiratory ailments, high blood pressure, diabetes and other conditions to visit the Venice Family Clinic. Doctors say they hope that patients would then be willing to take advantage of other services, such as rehabilitation and counseling.

Partovi, 39, offered Cunningham, a former school custodian who has been on the streets for seven years, a ride in the van to the clinic. "OK," he said.

After dispensing Tylenol, vitamins and cream to treat the dry, cracked hands of Masako Ellis, a soft-spoken woman wearing hot pink lipstick, the team headed for the public showers under the Santa Monica Pier, an early morning gathering place for the homeless.

Just before they left, De La Rosa told Cunningham they'd return for him. "I'm not going anywhere," he said.

People who become homeless tend to have severe personal problems, said John Lozier, the Nashville, Tenn.-based executive director of the National Health Care for the Homeless Council. The homeless population's transiency makes it difficult to measure results, but Lozier said studies have shown that health care projects for the homeless are as effective in helping control some chronic medical problems as are more established clinics. Small steps work, Lozier said, adding, "We tend to get our gratification one person at a time."

At the public showers, the team members were greeted by several regulars, including Arthur Tarango, 56, who asked: "You guys got any pills?"

He had fallen off his bike and was in pain. Partovi examined his left arm and identified the problem: an inflamed tendon. Partovi walked off happily, toting several packets of ibuprofen.

Then the team set off in search of a man named Mike who might have pneumonia. Indeed, there was Huffman, struggling to breathe while suppressing a cough. He said he had injured a rib when another street person "popped me a good one, and I hit the pavement."

Huffman said he averages a fifth of vodka a day and has been in and out of Alcoholics Anonymous. He hadn't eaten in two days. An exam yielded distressing data: He had extremely high blood pressure (170/124), a temperature of 100.2 and, Partovi suspected, pneumonia or bronchitis.

De La Rosa drove back to Palisades Park with Huffman to pick up Cunningham, and the group headed for the clinic. A scheduler arranged for afternoon appointments for both men.

Later, Partovi reported that she treated Huffman for his high blood pressure and gave him medicine for pneumonia and rib pain. He agreed to return for a chest X-ray. Cunningham failed to show up for his appointment.

Martha Groves writes for the Los Angeles Times.

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