Nurse Makes House Calls on the Homeless : Services: County public health worker Evelyn Burge cares for about 4,000 indigents. Her one-woman project pays for itself, officials say.

Packing bandages, antiseptic and other medical supplies, public health nurse Evelyn Burge sets off on her daily rounds, making house calls on people without homes.

As she pulls up to her first stop, she is greeted by a small group of homeless men and women eager for attention to their various medical troubles.

“I’ve had doctors treat me like dirt,” said Carolyn Caron, a 55-year-old disabled woman, who for the moment lives in a Ventura shelter. “If it wasn’t for her, I just wouldn’t go for help.”

Burge runs the county’s Homeless Health Care Program, a lone nurse attending to the medical needs of an estimated 4,000 homeless people in Ventura County. She dispenses Band-Aids, medicine and advice to people reluctant to set foot in a doctor’s office. Before Burge launched the program in 1990, her clients’ only medical attention came when illness or injury forced them into a hospital emergency room.

In the past 2 1/2 years, Burge has built a large and loyal following among the “medically indigent,” treating people with serious illnesses and infectious diseases who have not been reachable by conventional means.

“She treats you like a human being,” said Caron, who has sought relief for foot and skin maladies. “I love her for that.”

Burge doesn’t keep office hours, spurns paperwork and carries no appointment book. Meeting with patients spontaneously at homeless hangouts, her unorthodox methods appear to be paying off. Only rarely does she have to ferret out the sick. Now, they come to her.

“I’ve never seen people more appreciative of a Band-Aid,” said Burge, 51, who left teaching 12 years ago to become a public health nurse.

Over the years, Burge has stretched a tiny budget to provide preventive care to hundreds of homeless who might otherwise have ended up in the emergency room at county expense.

“It’s like a miracle that she’s flying solo and doing as much as she’s doing,” said Nancy Nazario, coordinator of the county’s homeless ombudsman program. “She’s saving the county a lot of money and helping people who really need it.”

Nazario said no formal studies have documented the effectiveness of the one-woman health-care program.

“Let me put it this way,” Nazario said. “If Evelyn can prevent 10 emergency hospitalizations a year, she’s got her salary covered right there.”

The program’s impact has been much greater than that, said Nat Baumer, head of Ventura County Medical Center’s emergency room.

“Evelyn has made a big difference,” he said. “Someone who has a simple problem will go to Evelyn instead of coming in here, which would cost a heck of a lot more.”

If detected early enough, most medical problems of the homeless can be treated outside a hospital, Burge said. She completed the only countywide study on medical needs of homeless people in June, 1990, two months before the program began.

In that survey, all of the 235 homeless people interviewed needed some form of medical attention. The most common problems were trauma, alcoholism, mental illness and dental emergencies.

The study turned up two homeless people with the AIDS virus and one man with a full-blown case of tuberculosis. More than two-thirds of those interviewed were uninsured and almost 40% named the county hospital emergency room as their primary source of medical care.

“Before, when they got sick they would put it off, wait and see if it would just go away,” Burge said. “Now they come to me before things get serious.”

The Homeless Project is funded by a $40,000 grant from Proposition 99, the tobacco-tax initiative approved by voters in 1988. The grant pays Burge’s salary and covers some transportation and medical supply costs.

Out of the minuscule budget, Burge has patched together an informal health care network for homeless people. A thick black binder she carries lists a volunteer corps of about 70 physicians who provide services ranging from physicals and immunizations to oral surgery and chiropractic care.

Prescription medications she doles out are donations from physicians and samples she says she has “begged, borrowed and stolen.” At her urging, the county hospital recently made a four-day stint with Burge a mandatory part of its family practice residency program.

The glue that holds it all together is Burge herself, who has earned the trust of the homeless that is crucial to the program’s success.

Pat Disprow, 35, of Ventura first went to Burge two years ago with an ear infection. She had gotten medication from a physician, but her ear still hurt and she couldn’t afford to go back.

“I was getting discouraged,” said Disprow, who has no medical insurance. “I didn’t want to take the medicine any more.” Burge reassured her and Disprow continued taking the medicine until the infection cleared up.

“Now I tell everyone about her,” she said. “It’s nice to have somebody who comes to us.”

For her part, Burge maintains a firm but friendly distance from her clients, never forcing treatment or questioning other aspects of the lives of those she treats.

“I could care less what else is going on as long as they are trying to take care of themselves,” she said. That approach has built a level of confidence that keeps her patients coming back. She has been able to monitor their illnesses, one of the greatest needs in treating homeless patients.

“Since a lot of them don’t have regular addresses, it was hard before to keep track of them,” she said. “But I pretty much know where everyone is.”

If the patients don’t come to her, she’ll go find them, said Rick Pearson, executive director of Project Understanding, which provides food and other services to the needy.

“I consider the program vital,” he said. “For many of the folks who come in here, she is the only health-care professional they are likely to see.”

Burge makes several weekly visits to the site, to the Rescue Mission and Zoe Christian Center in Oxnard and to Catholic Charities in Ventura. And twice a month she trudges through the thicket in the Ventura River bottom.

On this particular afternoon Burge, clad in tennis shoes, slacks and a white smock, fretted over a string of regular patients who filed through her “office” at Project Understanding--a small, windowless room marked “Storage.”

An overweight woman with high blood pressure was gently advised to “lose a few pounds.”

A middle-aged man with a chronic cough was scolded for not giving up cigarettes.

A third visitor who stopped by to ask if he could cancel an upcoming dental appointment was answered with an emphatic “No.”

“You go,” she commanded with mock sternness. “If you don’t show up,” smack went her fist against her palm. Both nurse and patient laughed, but there was an underlying seriousness in Burge’s tone.

“Obviously I can’t do everything,” Burge said as the man sped off on his bicycle with a promise to return for the appointment. “I’ll say ‘You need a lab test’ or ‘You need an X-ray’ and they want me to do it right there, but I don’t carry an X-ray machine with me.”

Making sure her clients meet their appointments is a key element in making the program work, Burge says. She goes out of her way to ensure that her patients show up, often driving them to the appointments herself.

“They have to understand that if someone is contributing services, they need to honor that commitment.”

Her work at the site completed, Burge bustled about, gathering up her supplies. Does she consider the program a success?

“Yes and no,” she said.

“It is a success because we are helping those people who need it most. But there is always more that could be done.”