Health Care’s Special Delivery

When 10-month-old Angel Chavez came down with a tenacious pain in his ear, his mother knew he needed medical attention. But where to take him? For Maria Sancen, the choices boiled down to the county’s Hubert H. Humphrey Health Center a few miles away or the elementary school across the street from their home in a South-Central Los Angeles housing project.

Once again, she chose the school--not a hard decision for her to make.

Sancen has been taking Angel to the well-child clinic at the Holmes Avenue Elementary School since he was born. She has also brought in three of Angel’s siblings, two of whom go to the school. Along the way, Sancen has gotten to know Helga Magar--the nurse who runs the clinic--on a first-name basis.

“I like to come here because they treat me good,” said Sancen, 35, holding the squirming Angel in her lap. After making sure that his ear infection was under control, Magar gave Angel vaccinations for polio, diphtheria and hepatitis.

So went another small, undramatic episode in the ongoing effort in Los Angeles County to get health care to the needy.

Schools and churches have become the new testing grounds for distributing health care at the community level. Fed by grants from private foundations, support from the county Department of Health Services, and large amounts of volunteer help, these programs are using familiar local institutions to treat the sick before they become candidates for hospital emergency rooms.

The budding neighborhood health care programs are still relatively few and occupy only a small niche in the vast mosaic of health care programs. But sponsors consider them hugely successful and predict more and more will be created.

The idea is to attract people to medical care where they live, whether that is a housing project or on a street in Hollywood.

The draw at the First Presbyterian Church of Hollywood are the pitchers of hot coffee and plates of spaghetti dinners served up by church volunteers to hundreds of poor and homeless on Sundays. Basic medical care is a byproduct on those Sundays when the mobile clinic is available.

One Sunday during a heavy rain, dozens of sick street people, mostly men, lined up outside the mobile clinic, which is operated by the Greater Hollywood Health Partnership, a consortium of 18 churches.

One of the men had been released from jail just two days before and was living in an abandoned house. Drenched by the rain and suffering from a bad case of the flu, he said he would have just toughed it out if it wasn’t for the clinic.

“I have been sick since I got out of jail,” he said, talking on the condition that his name not be used. He said he knew he could go to County-USC Medical Center, but that would mean hours in the waiting room. “I won’t go to the county unless it is an extreme emergency.”

That’s the point.

“When I worked in hospitals, we were focused on illness,” said Marsha Nickerson, a clinical nurse specialist at the Hollywood mobile clinic. “Here we are getting to people before they have to go to the hospital.”

The Greater Hollywood Health Partnership, supported by $700,000 in foundation grants and sponsored by Queen of Angels-Hollywood Presbyterian Medical Center, centers its program on the diverse congregations that worship in the 18 churches in the Hollywood area. Medical staffers can speak with Koreans, Russians, Armenians, Latinos and other immigrants in their native languages.

The clinic moves from church to church, hitting each every few months. But ongoing programs, using church volunteers, have been set up to provide blood pressure and cholesterol screenings, tests for prostate cancer and breast exams.

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In South-Central L.A., a sister program, also supported by foundation grants, operates under the umbrella of the Southern Area Clergy Council. On Sundays when the health services are available, worshipers can be immunized, screened for hypertension and HIV, and receive training on how to spot prostate cancer symptoms.

The Rev. Lonnie Dawson of the New Mount Calvary Missionary Baptist Church said clergy have more success convincing their congregants to get flu shots than do sophisticated ad campaigns.

“It is amazing how hesitant people in general are about going to hospitals or doctors for any reason,” Dawson said. “But when pastors and volunteers from the congregations get involved, the number of people who will volunteer for screenings or flu shots increases dramatically.”

Dr. Caswell Evans, in charge of public health programs for the county, agrees. “One of the concerns we have in public health is to reach the hard-to-reach and often invisible segments of society. Churches and schools provide an excellent bridge to accomplish that.”

Fire stations, with their staffs of highly trained paramedics, are also being discussed as sites for health programs. Councilwoman Jackie Goldberg, who represents the Hollywood area, said she would like to see some of the city’s 103 fire stations play limited roles--such as immunization sites.

Schools agreed to play a larger role in health care several years ago.

Under its partnership with the county, the school district provides locations and employs nurses like Magar. The county, in turn, supplies physicians to back up the nurses. The county also fills prescriptions and provides equipment and other support services. It’s a relatively low-cost way for the county to meet health needs at a time when it is downsizing. Last year 2,500 county health worker jobs were eliminated because of a gaping budget deficit.

Despite the county’s help, school administrators so far have set up just three well-child clinics like the one at Holmes Avenue school. Administrators would like to expand the program to other schools but say money is a problem.

Magar said that even though money is limited she makes do.

The clinic operates out of one room, plastic chairs lining one wall in a makeshift waiting room. Just behind an assistant’s desk is a refrigerator to store medications. A step or two away is an open examination room divided by sheets to give the children privacy.

Boxes of toys and books are laid out for the children. The books and toys are gifts from her nursing students at Cal State Northridge. Magar gives the donated books to her young patients.

When she finished with Angel, she put a hard-to-tear cloth book, “My Busy Book,” in his hands.

“I love this. If I have a child with an ear infection, I can do a follow-up in two weeks and see that it is better,” said Magar after Angel and his mother left. “Many times they go without care. It is too difficult, too complicated, to get out of the projects to get to a clinic, so they just sit and hope it will get better.”