Docs in a Box

These medicos make house calls, even when there's no house to call

Imagine that sneezing, coughing, fever and just plain achy allover feeling. You know it's the flu coming on. You want to take some medication and crawl into bed until you feel better.

Now imagine that you have no medication nor money to buy it. You don't have a bed nor a home to put it in. You're on the street.

If you're homeless—whether because of screw-ups, addictions or just bad luck—being sick makes you even more vulnerable to the dangers of the street. Things improve around the holidays when lots of attention is paid to the less fortunate and the shelters dish hearty and healthy meals. But in January, most people go on with their comfortable lives and the homeless go back to scrounging—even harder to do when you're sick as a dog.

Homeless Outreach Medical Service (HOMES) is a joint program between Parkland Memorial Hospital and the city of Dallas that sends mobile units offering medical care to people at homeless shelters and havens for battered women and children. The successful service has such a low profile that few outside the shelters and soup kitchens know anything about it.

That changed during the Katrina evacuation, when several of the vans were parked at Reunion Arena, and last August the program received a donation from the Crystal Charity Ball allowing it to buy a state-of-the-art mobile medical unit for $379,000.

The homeless often present different medical problems than the run-of-the-mill patient, such as spider bites and physical attacks. They have higher rates of substance abuse and mental illness than the general population and may not understand how and when to take their medications.

Many have diabetes, a disease which is very difficult to control if you are homeless. Diabetics have a tough time making sure they give themselves insulin on time and keeping the drug from overheating in the summer. Failure can mean the loss of a foot or leg. People with high cholesterol and high blood pressure must subsist on the meals served at shelters, usually high-fat, high-sodium foods that fill people up, but few fruits and vegetables except around holidays. They're at risk of heart attacks and strokes.

If they end up in the emergency room, their belongings might be stolen or thrown away along with their medications.

And on the more mundane side, what do you do with a man who has severe athlete's foot and only one pair of socks? Staffers spend a lot of time coming up with creative solutions. Nutritionist Kathleen Shaw rotates among the vans to give training on what kinds of foods to eat when they do have a choice.

But the cough-and-cold season and a visit to the Austin Street Shelter illustrate the program's one major deficiency.

The big blue doctor's office on wheels, the oldest of the five HOMES vans regularly in use, pulls up in front of the shelter on Tuesdays and Thursdays. On a recent Thursday, a handful of people were standing and sitting on the sidewalk, bundled up against a wet chill, by the time the van arrived at 8 a.m. A side window opens. Shirley Henderson, a stylish woman wearing gold jewelry and fur-trimmed boots, leans out.

"You here, Annie?" calls Henderson, a financial counselor who handles the patients' paperwork. She's as peppy as if she is herding patients at the office of a North Dallas OB/GYN. "You're next."

"Annie" hauled herself onto the 40-foot mobile medical unit and sat in the "waiting room," a bench seat in about 10 square feet behind the driver. Henderson, whose back is to the windshield, sits next to him. Wearing mismatched clothes, Annie is a small woman anywhere from 40 to 70 years old. Her tangled hair is swept back, her skin is red and weather-worn and most of her front teeth are missing. She's coughing, trying to cover her mouth while gripping a coat and a tote bag.

"Where have you been?" asks Henderson as she taps on her laptop computer. "I've been looking for you." Annie needs some medical tests and hadn't appeared that morning on time. "Did you fast like you were supposed to?" Henderson asks.

Annie mumbles an answer; she's deaf and reads lips. But Henderson understands her. She writes up the necessary paperwork and then sends Annie a few steps to the nurse. Darla Page, a cheerful, round-faced woman in bright scrubs, takes her vital signs. Then Annie walks down a short hall and is seen by Susan Chaney, a nurse practitioner.

"I told them to put you up a plate," Henderson says as Annie gets ready to leave.

"What are they having?" Annie says.

"Chicken, dressing, green beans, candied yams," Henderson says.

"The good stuff," Annie croaks.

"You go eat and lay down," Henderson says.

"I can't rest," Annie says. "Not till 2:30." The shelter does not allow people a cot until that time.

The nurse practitioner writes a note asking the shelter managers to allow Annie to claim a cot as soon as she eats. Annie goes off with some antibiotics and instructions to drink 10 to 12 glasses of water a day.

But the nurse has nothing to give Annie for her cough and allergies.

No Tylenol.

No decongestant.

No cough syrup.

No over-the-counter medications at all. It's not in the budget. The patients can't get them at Parkland unless they are admitted.

Annie will continue to cough, spreading her germs to others in the shelter.

This Christmas, the 40 members of the HOMES staff did their usual holiday party. By tradition, they exchange white elephant gifts with each other and collect necessities such as OTC meds and socks. Some will sweep through a dollar-store to pick up pain and cough medications, sanitary pads and vitamins to build up a stockpile to hand out to their homeless clients.

Some, like Annie, are citizens of the street. Other patients are like the mother and four children who visit the brand-new van during a Thursday night clinic at Family Gateway. Aunesha, Christi, Porcha and Derrick are seen by nurse Debbie Phillips and Dr. Susan Spalding, a pediatrician who oversees the HOMES program.

The clinic does a lot of immunizations and physicals for children who stay at the Vogel Alcove, a day care for the homeless. There are children suffering from abuse or neglect, but for the most part, Spalding sees the usual childhood complaints: ear infections and lots of colds and fevers.

On this Thursday night, a father with a pre-teen autistic daughter comes aboard. The girl has a runny nose and congestion. After making sure the girl has no other symptoms, Phillips has to explain that they have no cough syrup, Children's Benadryl or even cough drops. He shrugs and eases his daughter outside.

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