In the Eye of an Epidemic : Patricia Thomas’ Job Is to Track Down People Who Have Syphilis; Most Aren’t Entirely Happy to Meet Her

She was a coked-out 14-year-old who weighed 89 pounds when Patricia Thomas caught up with her. The girl’s expensive drug habit had led her to random sex, which is where she got the recurring case of syphilis. She’d always fight the penicillin shots, sometimes needed weekly, saying she hated needles.

Thomas, the public health investigator who tried to get the girl’s venereal disease treated but eventually lost track of her, will always remember her face, although the name now escapes her. “She could tell you about guys from 7 to 70,” Thomas recalls from inside her car, staring at the girl’s house near the Watts Towers. “Her mother said there was nothing she could do, she just wouldn’t act right. . . . She just kept coking. I just couldn’t get it through to her that there was something else to do in life.”

Thomas is playing tour guide through the heart of an epidemic.

Los Angeles County is in the midst of an outbreak of syphilis whose rate is almost four times the national level. Officials say that in some areas, including parts of South-Central Los Angeles, the numbers are the worst since penicillin was introduced four decades ago.

And South-Central is Thomas’ beat.

Searching for Carriers

She works out of the Ruth Temple Health Center as one of two federal investigators who interview possible syphilis and penicillin-resistant gonorrhea carriers, then try to contact their partners. (Thomas is employed by the county but has been on loan to the federal program for the last five years, and is known in broader terms as a disease intervention specialist.)

Tracing partners in this part of town is the true test of an investigator’s skill. And Thomas, 37, considered a veteran after her five years in the field, has her own formula.

Detail is everything. She digs for any clues: where the person lives, hangs out, what kind of car he or she drives, what kind of clothes they wear, the names of friends or relatives.

“I had one guy who worked at a gas station and lived at a particular motel. I had no name, no general description, no nickname, and I didn’t feel good about locating this man. But I did go to the motel, and the manager knew him. It turned out he was still living there, and I was able to leave a letter for him.”

Another time, she says, “someone just gave me a name and said he hung out in a junkyard. And that’s where I found him.”

Once she tracked down a woman who had left her husband by driving him around until they saw the woman walking down the street.

“Sometimes it gets humorous,” she says. “Like when someone said, ‘She’s got ‘Butch’ tattooed on her left breast.’ Right, I’m going to pull down her clothes and look. Sometimes it’s a missing tooth, or a blonde streak, or one arm.”

The ones she can’t find, or those who deny they have any disease or insist someone is playing a cruel hoax on them, are sometimes written off, but not without a fight.

Her cases usually involve drug dealers, prostitutes, gang members and vagrants who feel little responsibility to society, much less to a public health investigator who’s trying to convince them they may have a communicable disease, she says. To track them down she uses diligence and intuition; to bring them in, she often has to scream, beg, cajole, threaten or get a court order. She’ll even use photos of hideous syphilitic rashes.

“Even the people who test positive for syphilis and know it will give us a phony address, or their mom’s address, or where they lived three years ago. And because these people have no attachment to the system, they don’t have a driver’s license, they don’t vote, so how can you find them?”

Sometimes she gets lucky. “There was a girl who had just had sex in the neighborhood. When we located her, she had her steady partner, plus all the guys in the neighborhood. So we just toured, and she pointed out all the houses where they lived. Out of the eight people she named, we were able to locate seven. There was one guy who sold incense on the corner that we could never find.”

But more than likely she’s trying to reel in a “strawberry,” a girl or woman who trades sex for drugs. “The going price is $2 and up,” Thomas says. “So when you go to the rock houses, you can transact buying your drugs, plus getting sex at the same time. You figure, if a girl is there for even an hour, she has the capacity to have at least six sex transactions, just for the coke. You can see how there’s a pool there, but it’s a transient pool. It’s not like a prostitute who has a corner or a territory. This person is moving all the time, going from rock house to rock house.”

These are “faceless women” who may be asymptomatic for up to six months and continue to spread the disease. “I’ve interviewed strawberries, and it’s hopeless. ‘How many men have you had?’ ‘I can’t count.’ ‘How many in a day?’ ‘I can’t count.’ ‘Ten, 15, 20?’ All they can tell you is, ‘I work this corner, as much as it takes to get my habit fulfilled.’ ”

Thomas explains it all in the sober tones of a clinician who’s seen too much to be shocked by anything anymore. She never used to think that husbands and wives would lie to each other about affairs; now she expects it. And those who burst into tears when she tells them they may have syphilis used to get to her. “I’d get home and really be out to dry. Now I just hand them a Kleenex and say, ‘OK, now who are your partners?’ ”

‘Real Concerned’

Yet Thomas hasn’t been hardened by either the daily dealings with the destitute or the endless bureaucratic hassles. “I’ve seen too many syphilitic babies not to be touched. I can’t think of anything that’s more pitiful,” she says.

“It’s not always that I’ve loved my job,” she adds, “but I’m real concerned about these people. They’re my people. And I know that if you get (an investigator) who’s less sensitive, a lot of people are going to fall through the cracks. And I just think, where did we fail these people?”

She’s kept burnout at bay with a strong born-again Christian faith that assured her what she was doing was right. It also offered an outlet for the frustrations that would pile up like cement blocks by the time she got home. Her religion is as unobtrusive as the tiny “Jesus is Lord” pin she wears on her pink and white striped blouse. Occasionally she’ll pray for the people who teeter on the edge of this particular abyss.

In 1985, the rate of infectious syphilis in the county was 24.3 per 100,000; today it stands at 55.6 per 100,000. Investigators speculate that the high concentration of cases in South-Central can be traced to a high incidence of drug use, and the practice of trading sex for drugs.

But several other reasons have been cited for the rise in numbers: Severe budget cutbacks; reduced manpower in finding the infected and getting them treated, the re-assignment of health workers several years ago to combat an outbreak of penicillin-resistant gonorrhea, poor blood screening in local jails, and health professionals leaving VD programs to work in AIDS programs.

In addition, in August 1986, the county imposed a $20 fee for the screening and treatment of syphilis. The fee was repealed last month but during that time, 40% fewer people were seen at health clinics while the rate of reported cases of infectious syphilis rose by more than 60%.

Yet there may be some relief in sight. Federal officials are adding public health workers this summer in the county, under a plan devised by the U.S. Centers for Disease Control in Atlanta that would also make Los Angeles a national training ground for investigators.

Stemming the Tide

And there is talk that the county and the state might provide more personnel for this particular fight. Last month the County Board of Supervisors voted to spend $2.7 million to try to stem the tide of syphilis, but the money has yet to be allocated for a specific use.

It was while working at a health center in Watts in 1985 that Thomas first noticed that the numbers and types of syphilis cases began to change.

“Until then,” she says, “I had been working with people 20 to 40 who were very promiscuous, and you could get their partners treated and that would end it. That year, we started seeing a lot more people involved with drugs, with nameless partners, and our caseload increased with people 17 and younger, as well as 50 to 60-year-old males. It didn’t make sense. And we weren’t able to provide the kind of investigation needed because of the time restraints we were given. You had to investigate, bring to treatment and close a case in a certain period of time.”

As the sole investigator in that district, Thomas’ caseloads often reached 80 or more. In her current post, she handles 15 cases at a time, but finding her patients and their contacts hasn’t gotten any easier.

Her car was stolen twice from the Ruth Thomas health center’s parking lot, and in the district she covers, bounded by Washington Boulevard and Florence Avenue, La Brea Avenue and Broadway, she has been yelled at, propositioned and threatened with bodily harm.

Thomas is angry at what she perceives as the lack of concern on the part of the county and the federal programs for the safety of the public health workers.

‘The Crime Increased’

“Up until ’86 we really weren’t having a big problem (with violence),” she says. “We were told to watch our back, and not be put ourselves in dangerous situations. Since ‘87, with the increase in gang activity, the crime increased. We had one nurse mugged; she was pushed down and her purse was taken. Another co-worker was robbed; she’s out on stress leave.

“Patients tell you they’re going to beat your brains out, but they haven’t moved to do that. I see it as time goes on and there is less money and more drugs, it’s going to get to the point where (the community) no longer respects our authority as part of the governing process of the county. I’m not afraid to confront my patients, but I am concerned about the areas I’m going into. Between the gangs and the police, I don’t who’s going to hurt me. The police don’t give you an agenda and tell you when they’re going to do a bust. If you’re there, you’ll get arrested, too.”

Robert L. Bartholomew, director of the Sexually Transmitted Disease program for Los Angeles County, says the threat of violence “is just the normal risk of doing business in Los Angeles. We have people occasionally lose cars, or parts of cars, but they are trained as to how better to protect themselves, and how not to get cornered in a situation. Primarily we are public health sales people, not the police, and we don’t pretend to be.

“Certainly we don’t have the staff for people doubling up. And I’m not so sure that would help. If you got caught somewhere, I don’t know that you’d be better off with another person there.”

Bartholomew added that the on-going negotiations for the program include more provisions for security for evening clinics, as well as beefed-up security for parking lots.

The techniques Thomas learned in college and at her first post in Long Beach for tracking patients didn’t prepare her for South-Central, which has its own set of rules.

“Knocking on the door, you do not say, ‘Hi! I’m the health investigator !’ ” she says. “Ain’t nobody care! You have much more success saying, ‘Hey fellas, Hi, I’m looking for Simone. Do you know Simone?’ If you sound like a friend, then they’ll really help you.”

Cruising through familiar neighborhoods, she explains the intricacies of her door-to-door searches.

“I try to find out first if the person I want is home, and more often than not I’ll ask them to come out on the porch. I usually stress it’ll be more confidential. I’ll even sit with them in my car rather than go in. I don’t want to be trapped in the house because I don’t know what’s going on in there. You try to do it as best you can and as quickly as you can, tell them what you need, get them to action and leave.”

If no one is home, she’ll leave a letter asking the person to contact her. If there is no response to that, subsequent letters carry harsh warnings of jail. Thomas can obtain a court order if she is sure someone is infected, but usually the threat is enough.

She points to boarded-up houses where she once thought no one lived, only to find families of squatters. Then she guides the car past a schoolyard. “High schools give us lots of work,” she says.

Dealing With Teens

With teen-agers Thomas has learned to be “more authoritative, but not judgmental. Teens are real lackadaisical. They’ll say, ‘I don’t know how I got here and I don’t know what you’re talking about.’ Most of them don’t know their body parts and they’re not really sure what they’re doing . . . I tell them, ‘You’re young, you’re going to have a lot more partners, let’s not ruin your life.’ I stress birth control. ‘You need to do something not to bring a child here because you’re a child.’

“I’ll talk, especially to the girls, about self-esteem. ‘Cause a lot of that’s what it is. They’re looking for someone to care about them, and they don’t get that at home. Sometimes they have sex for as little as food. I had one teen-ager who said, ‘I meet this guy on the corner every few days because he buys me food.’ ”

As a young child, Thomas first lived in the projects in Watts before her family moved to Compton, where she was then bused to an all-white school 12 miles away. She received an undergraduate degree in health education from Cal State Long Beach, then started work as a public health investigator to put herself through graduate school but dropped out after becoming disillusioned with the master’s degree program.

She became a health investigator in Long Beach in 1983, stayed there for a year and was transfered to Watts. Then it was back to Long Beach for four months, and back again to Watts, this time for an 18-month stint. “That’s when the caseload went crazy,” she says.

From Watts she bounced around to four different centers around that area before landing at Ruth Temple, where she has been for a year. In that time Thomas, who is divorced, also raised a son, Anthony, now 18.

Certain streets give her more business than others. Driving down one, Thomas says, “I go here and there and over there and that one I go to all the time. You can go down a street so much that everyone will know your car. People come out on the street and want to know what house you’re going to. There was one family in the project, I used to go there so often, they’d say, ‘Which one of us is it?’ They just took it in stride.”

Other streets are infamous for drug dealing. “I just tell them I’m not interested, it’s not my thing. And most of the time they don’t push. Some of them will claim you as their customer. And I say, ‘No, honey, it’s somebody else, but it was not me.’

‘You Can Be Dead’

“Apprehensive” is how she describes her mood when making calls in dicey areas. “You realize that if you mess up, you can be dead. All you’re trying to do is get in and get out. People assume that because you’re talking about the ghetto or the ‘hood that people expect the houses to be falling apart. But I keep telling them, it’s not the houses that attack you. It’s the people in the houses that do these things.”

She’s walked through and driven by police action, but “Thank God, I’ve always been able to get out of the area before the shooting starts. You hope something like a raid never happens while you’re in the house.”

Rarely is she able to team with another investigator, due to the scarcity of personnel and time. “Unless we deem it a crisis situation, we don’t go in twos,” she says.

Night work is also out too, even though many of her contacts only come out when the sun is down. Tracking people to sleazy nightclubs, motels and whorehouses is risky business, plus she says, overtime isn’t encouraged by the department.

Has she ever thought of carrying a gun? “No,” she answers quickly. “Mostly because I feel like if you had it, you’d use it. And it’s never arisen where I really thought I needed it. I’ve either been able to back away or talk my way out of any situation.”

Her car glides through winding streets as people stare through the windshield to see who is behind it. After putting in eight hours this day, three of them on the street, Thomas shows little sign of weariness. Suddenly, she glances up. “Have you noticed there are no street signs? The kids take them down. It’s really fun to try to find the addresses that way.”