Parents, some in their teens, some careworn and aging, come each day with freshly scrubbed children to stand in line outside the Venice Family Clinic. They are there because they have heard, on the street or from friends, about the clinica familiar, the clinic where care is free.
Often, at day's end, some of the sick are turned away. An apologetic receptionist asks that they come back tomorrow, explaining that the lines are too long, the hours too short.
Facing a steady increase in the numbers of poverty-stricken families on the Westside, the Venice Family Clinic is struggling to keep up with the demand.
Last year, it turned away more than 1,000 needy people.
And with just one primary care doctor per 10,000 residents in Venice--compared to one for every 500 residents statewide--the critical need for care among the Westside's poor is not likely to let up soon.
"Responsibility for the poor has been abandoned by the government, and we are picking it up," said Fern Seizer, director of the Venice Family Clinic. "We are attempting to meet the need, but as fast as we expand, we fill up. The crush is incredible."
Since 1983, when the state cut off health care benefits for the "working poor" and turned the responsibility over to individual counties, the Los Angeles County Department of Health Services has scrambled to find money to care for the poor.
But, county officials and poverty advocates agree, there is not enough funding to meet the need. Dozens of free clinics and reduced-cost community clinics have stepped in to fill the void.
Founded in 1970, the Venice clinic recorded about 3,000 patient visits its first year. By last year, that number had swelled to 13,163, with a 25% boost in the past two years alone.
Last fall, when the clinic moved from its headquarters on Lincoln Boulevard to a larger facility on nearby Rose Avenue, it was immediately filled to capacity, Seizer said.
"We even began opening up earlier in the morning and on Saturdays, and the people just keep streaming in," she said.
Today, the clinic has a paid staff of about 20, including a full-time physician. In addition, about 140 physicians--many of them specialists at Los Angeles's top universities and hospitals--volunteer a few days each month to handle special cases. Another 800 volunteers help with everything from fund-raising drives to scrounging donated equipment, she said.
The clinic is affiliated with the UCLA Medical School, which assigns resident physicians and nurses to train there. It also also relies upon private donations and grants, and in-kind services from St. John's Hospital and Santa Monica Hospital.
Such help "means our survival," Seizer said, since only about 3% of the clinic's patients have health insurance, and 88% have incomes below the federal poverty level. Donations from patients average about $2.40 a person.
Of the patients who visited the clinic during the past year, 69% were Latino, 24% were white and 6% were black, Seizer said. More than 60% were women, reflecting the high number of single mothers who have sought help. About 70% were from the Westside, but many, probably unaware that there were free clinics closer to them, came from as far away as the San Fernando Valley and downtown Los Angeles, she said.
Most of the clinic's patients hold jobs--often as low-paid factory workers, housecleaners and handymen.
These are "not the kind of people who are just looking for a handout," Seizer said.
'You Have to Make Choices'
But, she said, "when you have almost no money, you have to make choices: groceries or the doctor?"
Lucrecia Rosales, 23, a Guatemalan who moved to Venice four years ago, said she came to the clinic last week after her regular clinic dropped its policy of charging the poor half-price.
Though her husband supports their family of four with his job as a cook, she said, "we don't have the money to pay for a doctor. We heard about the free clinic and came right away."
Ermilinda Cash, who waited at the clinic on a recent day with two of her three children, said she has not been able to find steady work since coming to the United States six years ago from Nicaragua, where she was a nurse.
Her medical needs are mounting now that her oldest son, who is 14, has been diagnosed as suffering from cataracts. And her youngest son, who is 3, "seems to pick up every childhood sickness that comes along," she said.
"We need the clinic, even with the long lines, because in the United States it's money," she said. "Everything is money."
As a result of such poverty, Seizer said, many Westside residents suffer from chronic diseases and acute illnesses rarely seen among the middle class and wealthy.
"We have incidents of women who have never had a Pap smear," said Mandy Johnson, the clinic's program director. "By the time they get their first Pap smear, they can have very advanced cervical cancer that should never have gone that far."
In fact, some diseases become life-threatening because of the lack of medical care, Johnson said.