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Health care on wheels

on November 4, 2010

Steven Lawrence sits on the bus and waits for his test results. He was feeling “tired and sleepy” in the morning and couldn’t shake the feeling by the afternoon. Instead of going to the doctor’s office, Lawrence stepped into a small medical bus—about half the length of a standard school bus—to get checked out.

Three weeks ago, 49-year-old Lawrence and his wife joined the nearly 4,000 homeless in Contra Costa County after they lost their Richmond apartment. They moved into the Bay Area Rescue Mission (BARM) in Richmond, where they are served meals and given emergency shelter.

At a staggering 18.5 percent, the unemployment rate in Richmond is one of the highest in the state. Cynthia Belon, director of the county’s Homeless Programs, said that when people lose their jobs, staying housed is their biggest priority.

Many who may have had health insurance, said Belon, will not continue to pay for it and will instead choose to use emergency rooms on an as-needed basis. This disruption of continuity of care exacerbates chronic diseases, she said.

Alvin Silva (right), a registered nurse, gives Charles Anderst a flu shot. Silva asked all clients if they had received their flu and tetanus shots. (Photo by Anne Brice)

At 5’9″ and 280 pounds, 49-year-old Steven Lawrence is in poor health. His breathing is labored; his thoughts are disorganized; his energy level is rock bottom.

In 2009, Lawrence lost his Blue Cross Blue Shield health insurance when he was injured at his shipyard job. He received workers’ compensation for a few months, but has been unable to find another job. Living off savings and his wife’s small salary, he and his wife were getting by until the first week in October, when their money ran out.

“I’m pretty much on my own now,” he said.

But Kate Schwertscharf, manager of county program Health Care for the Homeless, says that the county health system provides a safety net for people who can’t afford health insurance.

Contra Costa County medical mobile clinics—buses outfitted with a county health team and supplies—make regular stops at shelters, soup kitchens, churches and other places in the county five days a week. Each stop sees anywhere from ten to 30 people, according to Schwertscharf, and the clinics combined receive about 10,000 visits per year.

Pat Hill (left), 67, has been working on the mobile clinic since it started in the early 1990s. "It's kind of an odd profession for someone as old as I am," she said, "but I actually really love it." (Photo by Anne Brice)

One health team—Pat Hill, a family nurse practitioner; Alvin Silva, a registered nurse; and Jonathon Perales, a financial adviser—provides basic health treatment and plugs clients into the county health system, so clients can receive continuing health care.

Clients step through the bus’s glass doors with a variety of ailments, from untreated diabetes and cardiovascular disease to respiratory infections and wounds.

Lawrence hasn’t  seen a regular doctor in almost two years. He sat back as Silva monitored his blood pressure and Hill tested his blood sugar levels.

“Your blood pressure is really high,” Hill said. “We’ll get you on medication for that. And you probably have diabetes. No more sodas, juices, or sweets.”

“How long will this last?” Lawrence asked.

“Forever,” answered Hill. “This problem isn’t going to go away. No sodas. No juices. No sweets.”

Lawrence made his way down the bus’s steps with orders to have a diabetes test the following day at a county clinic. Hill told him to bring his test results to the mobile clinic on Tuesday, when it would be parked at the Brookside shelter.

Along with basic health care, the mobile clinics provide flu and tetanus vaccines and tests for tuberculosis, required by most shelters of their residents.

The medical buses can be found at multiple locations Monday through Friday and no appointments are necessary.

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