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Health Care for the Homeless Bethesda Mission Medical Clinic John, a tall man with a dark tan, sits patiently outside the Mission's medical clinic waiting to see a doctor. This makeshift "waiting room" is really not a room, it is a staircase leading up to the second and third floors of the Men's Shelter building. Clients must sit on the few chairs that are provided or make room for themselves on the stairs. "The pain shoots through my knee," states John, a former Mission guest. "In January, I fell off a piece of heavy equipment. When I hit the ground I landed on my feet but my knee snapped back. I've been coming to the clinic since April when I moved in, and I won't be able to work again until the end of August." Others sit in the waiting room alongside John. Mary Jane, a young mother with two school-age children, has a cold which she says, "seemed like it was there forever." Henry, sitting off by himself, did not participate in the casual conversation taking place between those waiting in the stairway. He did not respond to anyone unless he was called by name. Henry was waiting to see the psychiatrist. Some did not want to discuss why they had come to see the doctor. "Some mornings I can't get out of bed," said Mr. Harman, an elderly gentleman who walks with the assistance of his cane. He no longer resides at the Mission, but came to the clinic hoping that someone would be able to prescribe medication for his aching arthritis. "I have arthritis in my thighs and have tried several different medications to take away the pain. Recently I have gotten arthritis in my fingers."
John is examined by Dr. Gallagher Many homeless persons, like Henry, suffer from emotional disorders. Dr. Susan L. Thornsley, a psychiatrist who volunteers her services to the medical clinic once a month, states that generally most of the people she sees at the clinic fall into two categories. "The men generally have serious mental illnesses such as bi-polar disorder (manic-depressive) or schizophrenia. The women have problems equally as serious, but also have more social problems. They frequently have been abused, suffer post-traumatic stress disorder, and are depressed. Additionally, they are stressed because they are homeless." Emergency medical technicians, nurses, student doctors, residents, and practicing physicians, most of whom are employees of the Hershey Medical Center, volunteer their time and energy to the medical clinic each Tuesday evening.
Pat Pauley checks a patient's temperature Most homeless people tend to place less priority on their personal health. If it were not for Bethesda's clinic, many would not seek medical attention until a problem became so unbearable that they were forced to seek care from a local emergency room. Some who are eligible for Medicaid elect to join a local clinic's health plan. But those who cannot get medical assistance or cannot secure the funds to purchase medicines are the folks who most likely ignore their medical problems. "On the average, 16 patients are treated each week at the Mission's clinic for a variety of ailments," said John Scarpato, the Mission's Director of Social Services. "Most of these patients are guests of the Men's Shelter," he explained. "but we serve some women and children from our other shelter and an occaisonal former guest." Scarpato indicated that the weekly clinic had been in operation since January of 1992, and (at the time this article was written - mjm) had seen over 1000 patients. Colds, flus, and other related seasonal illnesses seem to top the list of problems. Some patients have simple rashes, poison ivy, and assorted allergies. Others have alcohol-related illnesses, seriously-advanced veneral diseases, heart disease, and terminal diseases such as AIDS and cancer. "Sometimes I just need to listen and reassure them; the man I last examined thought he was having a heart attack," states Maria Sgambati, a medical student who has come to the clinic six times previously. "I am challenged to get a good history and examine them carefully because I can't just send them off to get an electrocardiogram or other expensive testing." Scarpato feels that "a visit with a dedicated, caring health progessional who is not rushing the patient through the exam often 'breaks the ice' for the homeless individual who has not recieved health care in a long time. This seems to have a positive effect on the guest for follow-up in addressing health care, as well as other issues in their lives." Bethesda's medical clinic was begun with the assistance of a few dedicated physicains: Scott Wietzel, M.D., Andrew Sumner, M.D., and Tony Gerard, M.D. Tragically, in the summer of 1991, Dr. Weitzel was killed in a plane crash. It was through his initiative that guests of the Mission began receiving professional health care. Dr. Sumner was largely responsible for getting the clinic started on a weekly basis and has coordinated and recruited Hershey Medical Center doctors, nurses, and students. Dr. Gerard has seen patients at the Mission for several years and is currently specializing in health problems at the Women and Children's Shelter. The clinic has also been greatly blessed by the support it has received from the community. "If the doctor does not have the right drug here, he will write a prescription and we will help him get it filled free," said Scarpato. He pointed out, however, that there is a compelling need for the services of a dentist and a podiatrist -- specialties which have been difficult to recruit. Two hours after the clinic opened, John, Mary Jane, Henry, Mr. Harman, and the others have gone. The stairway "waiting room" is now empty and the doctors are collecting their things to go home. As they begin to leave, these dedicated professionals are asked why they keep coming back. "I get much more [from] coming here than I give," said Thornsley. Pauley said she "believes in giving back what's been given to me." Dr. Gallagher thought for a moment and said that "coming to the medical clinic is one of the more satisfying ways of practicing medicine that I have experienced. Most of the time it seems we have to practice medicine [here] like in the old days, where you just go with your best diagnosis without doing all the testing that we usually do. I think it makes me a better doctor." What more could we ask than for everyone, both caregiver and patient, to benefit from this experience? Taken from the 1993 NewLife, Bethesda's newsletter.
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Dr. Bryan Gallagher, this evening's
attending physician, said a number of patients he sees suffer with chronic pain. "It
doesn't disable them that much but they've never had someone to talk about the pain with.
The fear of what the pain is, is probably producing more concern than the actual pain . .
. they need to know what to expect in the future and whether there is medicine to help.
That's probably just as comforting as the medicine itself."
"I enjoy helping people; that's why I
got my Emergency Medical Training certification," said Pat Pauley, a regular clinic
volunteer, as she worked confidently and with compassion measuring John's blood pressure
and taking his temperature. "Many people can't afford medical treatment or they feel
frustrated in a place where they wait for hours . . . so they just avoid treatment. Here,
people are treated with diginity."
