In the parking lot of Tree of Life Baptist Church in Watts, a trickle of women sign up for their first mammograms. Outside the Los Angeles Mission on Skid Row, homeless men and women line up several days a week for treatment of ailments. In the playground of a Boyle Heights preschool, dozens of young children reluctantly sit for immunizations, physicals and blood tests.
The aim in each case is simple--deliver health care to needy communities. The difference is that instead of making patients go to medical clinics, the clinics are going to them.
Every day, mobile health clinics, which look like large recreational vehicles, lumber down city streets and set up shop in neighborhoods throughout South-Central Los Angeles to deliver health care to hard to reach, at-risk people. Long used as the only way to get medical treatment to people in remote areas, mobile health units are increasingly showing up in urban areas to help battle health problems.
In Los Angeles, as the calls for preventive care increase and public and private community clinics become so overloaded that they are hard-pressed to treat everyone who needs help, mobile health clinics have become more common stopgap measures. Funded by grants and donations from private corporations, the units provide free treatment in many cases and exams such as mammograms for nominal fees.
"I think these things are good and they're necessary because there was no way I would be able to get someplace far away to take (my son) for shots," said Maurice Ammons of South-Central Los Angeles.
Earlier this month, Ammons brought his son, Maurice Jr., to a pediatric mobile unit at the 112th Street School run jointly by the Watts Health Foundation and Charles Drew University of Medicine and Science. Maurice Jr. is a third-grader at the school.
"Having it right here at the school is great for me," Ammons said. "It's about time they started doing something like this."
The 40-foot-long mobile health stations are self-contained mini-clinics on wheels--most are complete with examining rooms, bathrooms, cabinets filled with medication and medical supplies, waiting areas and, in some, X-ray rooms.
But the traveling clinics are not panaceas for improving health care and may not even be adequate supplements because of their limited ability to offer extensive treatment, some critics say. These skeptics argue that the vehicles are only useful for tests and cannot offer the continuity needed for complete health care services.
Proponents, however, argue that the clinics offer more than basic screenings and blood pressure tests and are tapping into communities that would otherwise go untreated.
"We've found some special needs that can best be addressed through mobile health care, servicing certain communities that have not acculturated into traditional medical service areas," such as the homeless, low-income people and undocumented immigrants, said Dr. Clyde Oden, executive director of the Watts Health Foundation.
The Watts Health Foundation has been providing care from mobile units since 1987. The organization started with three converted recreational trailers pulled by small pickup trucks. Today, it has 12 mobile health clinics--the largest such fleet in the county--and travels to different sites every day.
"With mobile units we can go where the low-income and undocumented and uninsured people are," said Donzella Lee, vice president of administrative services for the Watts Health Foundation. "There are just people who won't seek health care for a number of reasons and mobile clinics are their only source of care."
Like the destitute in hundreds of overpopulated urban areas nationwide, Los Angeles' poor have a number of burdens in getting access to medical care, the most prominent being limited transportation, no medical insurance and no money to pay for a visit to the doctor.
Especially when it comes to immunizing school-age children, agencies that operate mobile units are getting contracts from the city Housing Authority and the Los Angeles Unified School District to get the job done at schools. That spares these agencies from having to track down parents to bring their children to clinics.
But although mobile clinics are touted as the solution to providing preventive health services in poor communities around the city, some argue that they are no more than window dressing, especially in regard to tackling serious health problems.
"You can't drive a truck out to a deprived area and expect people to utilize it in a meaningful way. It's superficial," said Howard Greenwald, a professor of health services administration at USC.
Greenwald said mobile units are only useful for episodic illnesses such as coughs, colds or common injuries. Unless they are equipped to store health records and thus allow continuity for patients, the mobile clinics are only minor supplements to larger stationary structures, he said.
Dr. James Mays, a community activist who runs clinics for low-income and homeless people in South-Central, agreed that mobile units are best suited for health screenings but inadequate for more in-depth medical care and follow-up examinations.
"I can see this being helpful, providing there are more community clinics," Mays said. "That's really what you need, more clinics, not more mobile units."
Proponents of mobile clinics contend that the units are not meant to replace stationary clinics, but instead serve as the first step in introducing patients to regular medical care.
"Quality medical care includes and implies continuity, and that's hard to do with mobile units," said Dr. Reed V. Tuckson, president of Drew University in Watts.
"Mobile clinics should be used as part of a plan for comprehensive health care coverage. The vehicles should be identifiable reminders and educational tools for improving health care," Tuckson said.
As health commissioner in Washington in the mid-1980s, Tuckson put mobile health units on the streets to treat the homeless and indigent pregnant women.
The March of Dimes sponsored some of the first mobile health clinics in urban areas in the 1950s to administer the polio vaccine. The March of Dimes reintroduced mobile clinics to East Coast cities in the early 1980s with its Maternal Outreach Mobiles (MOM) program. The idea caught on in Los Angeles about 1985 with the Watts Health Foundation.
Most agencies with mobile clinics started out treating homeless people and have since expanded their care to include immunizing children, treating pregnant women and AIDS patients and providing general care to day laborers. A few offer special services, such as dental care, radiology and mammograms.
At Tree of Life Baptist Church on Holmes Avenue in Watts, a large peach and white mobile clinic sat rumbling in the parking lot under a warm Saturday morning sun recently. A folding card table and two chairs sat next to a small X-ray screen that showed examples of healthy and cancerous breasts. Near the trailer entrance was a bucket of peach-colored roses, a gift for each woman tested.
Angela Lowe, 60, was dropped off by her son for her first mammogram. Lowe had known for years that she needed one, but hesitated because of a fear of pain and the inconvenience in getting to a clinic. But on this day, the clinic came to her because most of her time is spent at the church where her son is the minister.
In a small room with plush forest green carpeting and a small, dimly lit chandelier, Lowe sat before a state-of-the-art X-ray machine and placed each breast between two plexiglass shields. In 15 minutes, the test--which costs $25, compared to $50 in many clinics--was done.
"Mammograms are one of the most important tests for older women to get and they are not going in for them because they cost too much or they don't know about them," said Gerri Landry, radiology manager for the Watts Health Foundation and head of the mobile mammography unit.
"I think this is one of the most important mobile clinics the Watts Health Foundation is running," she said.
Other than the Watts Health Foundation's dozen mobile units, there are four other organizations citywide with mobile clinics--St. Vincent Hospital's mobile radiology unit, Charles Drew University's AIDS unit, USC School of Dentistry's dental unit and Centinela Hospital's pediatric unit. In addition, several other agencies are either applying for funding for mobile units or are waiting for them to be built and delivered.
Mobile units cost $100,000 to $300,000 to build and cost about the same to operate each year. That figure includes salaries for a physician, an assistant, a nurse and an intake worker, said Mark Helmar, research program specialist for primary and rural health care systems for the state Department of Health Services.
Because of the high costs of the units, more private businesses are funding mobile units for hospitals and private clinics. The Hard Rock Cafe, for instance, donated money to the Inglewood-based Centinela Hospital to get the health facility's mobile pediatric unit started for the first year. The company did not renew the donation and officials at Centinela have been putting together grants from various sources to keep the project alive.
In the meantime, agencies without the larger vehicles operate their own types of mobile outreach. Some agencies work directly out of vans or cars, while others, such as the Community Health Foundation of East Los Angeles, set up their services at different community-based organizations, such as Nuestro Hogar in Pico-Union.
For three years, workers at the Community Health Foundation hauled 100-pound chests of medication and supplies in their cars, setting up clinics out of their trunks, on the street or in offices to which they were invited.
Last year, City Councilman Richard Alatorre donated a used ambulance for the outreach work, but it cannot be used because its brake lights and headlights don't work. Foundation workers currently have occasional use of a van to bring materials and medication to different sites.
"We need to have transportation that is reliable and identifiable to people," said James Martin, a community outreach worker. "And it would be nice if we could treat people inside the vans and have bathrooms and access to telephones. Overall, it would increase the effectiveness of our unit."
The Community Health Foundation, which treats up to 6,000 patients a year with its mobile care operation, has applied to the state Department of Health Services for funding for a self-contained mobile health clinic.
Meanwhile, Altamed Medical Services, which is also based on the Eastside, will have its first mobile clinic on the road by January to perform HIV tests. Altamed will do most of its work through a contract with the county Department of Health Services, which is funding the mobile clinic.
Not everyone agrees that the self-contained RV-style units are the most effective mobile outreach clinics.
Linda Green, founder and president of Kids on the Move, a mobile outreach health and social services organization, prefers setting up her operation at different sites. Green, who founded the organization in July, 1992, contracts with the Los Angeles Housing Authority to immunize children and test them for lead poisoning at Head Start sites in housing projects.
Three days a week, Green and her crew of four medical assistants and four intake workers, who handle health records, travel to housing projects around the city setting up the tent clinics.
On a recent morning, at the back of the small playground at Los Ninos Head Start and Preschool in Boyle Heights, five green camping tents sat on patches of concrete and dirt, each one a makeshift examining room with two folding chairs and a small folding table.
In each tent was a different service, from blood tests for lead poisoning to immunizations and physicals. More than 35 young students in the school's Head Start program, accompanied by their parents, lined up near a rickety aluminum slide for checkups, a requirement for the federal program.
"We do thorough exams from head to toe and see several hundred children a month, so we do well that way, but we haven't had great success with all of our follow-ups," said Green, referring to treatments for ailments detected during checkups.
No official study has been performed on the success rate of mobile clinics, but those who run them and several people who use them say there is no better alternative right now.
"Mobile units are just one arm of greater outreach," said Rodolph Diaz, executive director of the Community Health Foundation. "You're reaching some of the most vulnerable and needy people in the communities."
Proponents of mobile units argue that they are treating thousands of people who would normally be ignored. The Watts Health Foundation treats about 60,000 patients a year in Los Angeles County through its mobile units, about 75% of whom live in South-Central Los Angeles. For other mobile clinics, the numbers range from 6,000 to 12,000 a year. Small stationary clinics, such as the county's Northeast clinic on the Eastside, see an average of 40,000 patients a year and offer similar services as the mobile units.
"This is like the neighborhood clinic," said Yvonne Caldwell, 39, who was being treated at the mobile health clinic run by the Watts Health Foundation behind the Los Angeles Mission. "I try not to come because who wants to be sick, but when I do it's convenient and gives good health care."
Caldwell, who lives in a Skid Row motel, complained of a cold that had lingered for a month. Her checkup was routine and brief--eyes, ears, nose, throat and lungs. The doctor, Santosh Sinha, asked a few questions, advised Caldwell to cut back on her half-pack a day smoking habit and urged her to try to lose some of the 35 pounds she has gained in the last year and a half.
Outside of the mobile unit, which crowded narrow Winston Street behind the mission, Kevin Block waited to get an inhaler for his asthma and medication for a flu.
"This is a real blessing for people who are out on the street because they can't prescribe drugs in the mission," said Block, 23. "They can only give you bed rest or send you to USC (Medical Center), but nothing else. It's good that these things started coming around."
Given the country's economic crisis and the grave need to provide medical care to the indigent, health care officials believe that mobile units could be around indefinitely and may be incorporated into health care plans in urban as well as rural areas throughout the country.
The use of mobile clinics is not clearly stated in President Clinton's health reform package, but there is a provision for allocations to supplementary measures, such as mobile health clinics, under the Public Health Service Enabling Program.
"Even with reform measures, people may not be able to get to resources," said Dr. Irwin Redlener, founder of the Children's Health Fund in New York.
Redlener's organization has funded eight pediatric mobile clinics in urban and rural areas around the country, including the unit run by the Watts Health Foundation and Drew University.
"In urban areas, there's so much need and so much money needed to improve things, I think these mobile clinics are going to be necessary."
On the Cover
Sherman Keller, a community worker with the Watts Health Foundation, comforts Tyquan Pollard, 5, who just received an immunization shot in the foundation's mobile medical unit.
Similar mobile units are becoming increasingly common on the streets of Los Angeles. Proponents say they bring desperately needed health care to underserved communities, but critics say mobile units should only be used to provide testing services rather than general care.