For the Homeless, a Rare Chance to See a Doctor

Every morning, backpack hoisted high on his shoulders, John Hiller ambles from the West Los Angeles homeless shelter where he has been staying to a hiring hall some 20 blocks away.

Each evening, he makes the long trek back, usually in pain from bone spurs in his heels and wheezing heavily from the dust and physical labor that set off his asthma.

But on a recent night after returning to the cold weather shelter, Hiller found medical help.

He walked to the rear of the National Guard Armory on Federal Avenue, where the shelter is housed, past green cots occupied by 160 homeless men and women, to a makeshift doctor’s office set up by the Venice Family Clinic.

There, Hiller had his blood pressure checked and consulted with Dr. Myles Spar, who gave him pain relievers, a prescription for a high-blood-pressure medication and inhalers for his asthma.

“It’s hard on your body when you have to walk everywhere,” said Hiller, 47, an Army veteran who has been homeless since March.

“My backpack has everything that I own: clean clothes, sneakers, a big coat in case it rains. It can get heavy. But it’s great to have this medical service here.”

The medical service is part of a new initiative called the Homeless Mobile Health Program, launched recently at all 16 winter shelters in Los Angeles County as part of a two-year demonstration project.

The cold and wet weather shelters are open each night from Dec. 1 through March 15, providing a shower, two meals and a bed to about 2,000 men and women, many chronically homeless.

In recent years, the winter shelters have added services that help participants connect with housing, jobs, education and substance abuse treatment.

But until now, medical care was a largely unmet need for people often suffering from poor nutrition and for whom minor wounds, infections and even colds can develop into serious health conditions.

Authorities said they hope the new mobile medical program -- funded by a $600,000 grant from the California Endowment -- will help reduce costly visits to emergency rooms and link patients with long-term health-care services. Data are being collected in the hopes of finding a permanent source of funds for the program.

Dr. Robert K. Ross, president of the California Endowment, noted that the Woodland Hills-based philanthropic group “tends to shy away from writing checks to government entities.”

But in making this grant to a joint city-county agency, he said, “We’re taking advantage of existing providers in our health delivery system. I believe these kinds of investments are cost-effective to the health-care system and to county and state taxpayers, so this is a great project.”

“I feel confident this program will save lives,” said Mitchell Netburn, executive director of the Los Angeles Homeless Services Authority, the city-county joint powers agency that administers homeless services. “It’s stressful living on the streets, and if you have a disease that’s not being treated, it can make life seem even more hopeless.”

Also providing medical care are the Partners in Care Foundation, the Northeast Valley Community Health Corp., Pomona Valley Hospital, Azusa Pacific School of Nursing and the JWCH Institute.

Each shelter will be visited once a week for three hours. Some medical agencies see patients in fully outfitted mobile units, while others bring medical supplies into the shelters. Most teams consist of a doctor, a nurse practitioner and a medical assistant.

There is usually a waiting list for the medical services each Wednesday, said Jason Sabich-Robison, site manager for New Directions, an agency for homeless veterans that operates the West Los Angeles shelter.

“It’s hard for these people to get treatment during the day at hospitals where they have to deal with insurance questions or with clinics that are full,” he said.

The Venice team brought medications for pain and diabetes, cold remedies, bandages and other supplies for wounds, blood sugar monitors, vitamins and condoms to the armory, which also houses two National Guard batteries.

Spar said that he often sees skin infections from scabies and lice, chronic high blood pressure, diabetes and wear and tear on joints and muscles typical of people on their feet for long periods.

“Normally, we would recommend to people if they have a lot of pain to rest, but you can’t give that advice to this group,” the doctor said.

While the patients are grateful for the treatment, the working conditions at the shelter could be better, said Spar, who worked for the international group Doctors Without Borders at a tuberculosis unit in the Caucasus region of the former Soviet Union.

At the West Los Angeles shelter, his team that night was given a private room -- a stock room with spare cots and storage containers used by Guardsmen. Most nights they work in a corner of the general shelter area.

“It is frustrating because most times there is no privacy, which limits what kind of examination you can conduct,” Spar said. “We end up putting out fires, seeing the same people week after week. In terms of overall care, we’re just scratching the surface.”

Soon after the Venice medical team arrived that night, they faced an emergency when an intoxicated man, suffering from depression, began speaking of a plan to kill himself. He was rushed to County-USC Medical Center for observation.

Meanwhile, a steady stream of patients sought attention for a variety of ailments.

One young man complaining of headaches and pain in his eyes was treated for conjunctivitis.

Another man was treated for a severe fungal infection on his feet. That is not uncommon among homeless people who use community showers at the shelters and rarely change their footwear, Spar said.

Juan Lozano, 50, who had been at the shelter for a week and a half, described symptoms of a chest cold. Spar told him to increase his fluid intake and stop smoking.

Rhonda Radomski, 39, who got a prescription from Spar for migraines, said she fears the threat of violence that hovers over homeless women, but the reality of rampant illness is more worrisome.

“On the tail of one cold you get another one, followed by flu and then another cold,” she said resignedly. Homeless since October after moving from Montana, she said the rhythm of shelter life is hardly conducive to good health: “You’re in this warm environment all night and then back out on the street during the day and then back around people who don’t take care of themselves and pass along everything to you.”

Homeless people told Spar of other problems. Hiller, for example, said it was difficult to take the correct dosage of his anti-inflammatory medication because it was supposed to be taken with food, and he usually ate only two meals a day -- provided at the shelter.

Another patient, a 49-year-old woman who complained of debilitating back and leg pain, admitted to Spar that she had been self-medicating by smoking crack cocaine. But now, she told Spar, “I’m tired of being on the street, tired of being homeless.”

Spar told her he could help her find treatment for her drug addiction. She seemed skeptical that such an offer would help her.

At the end of the night, Spar recalled a recent vacation in Cambodia and how friends with him were horror-struck by the poverty there. Spar told them of his experiences in treating the homeless in Los Angeles.

“You don’t have to travel that far to see it,” he recalled saying. “Just go to skid row or South-Central.”