The eyes of the neighborhood followed Sister Marian Schubert as she walked up the dusty street.
A group of young men huddled around a parked car, a woman with waist-length black hair leaning over a balcony railing and children playing in a dirt-filled courtyard all watched the sister in her white nurse's uniform walk through the Buena Clinton neighborhood in Garden Grove.
Schubert was paying a house call on a child who had missed an appointment at La Amistad de Jose Neighborhood Health Service that afternoon. She wanted to check on a tuberculosis test administered there several days before.
After examining the wide-eyed child and finding the test normal, Schubert explained to the mother the importance of keeping appointments.
Speaking to the woman in Spanish, she asked: "What is the purpose of the TB test if you don't bring her back to check on it?"
She asked the mother to bring a urine specimen from the child to the clinic in the morning for additional tests.
With her mission accomplished, the sister headed back to the clinic at 1506 Clinton St. in Santa Ana.
"If she doesn't bring the sample in tomorrow, there's not much more we can do about it. Where does the responsibility end? You can't force people to take care of themselves," she said.
The frustration voiced by the sister is a problem plaguing La Amistad health clinic, which opened last month to serve the poor residents of Buena Clinton, considered Orange County's worst slum.
The clinic's staff includes a family practice doctor, a nurse, medical technician and receptionist who treat patients for a sliding-scale fee. Sponsored by the Sisters of St. Joseph, the idea was to bring health care to the neighborhood. But providing health care to Buena Clinton's estimated 7,000 mostly Mexican-American residents has not been that simple.
"The social problems out there are interfering with providing optimum medical care," said Dr. Claudia Vellozzi, the center's medical director.
"We are playing by the rules of the rest of Orange County. Out there is another set of rules," she said.
The clinic has treated about 150 patients, mostly children and older people, Vellozzi said. But many do not return for required follow-up visits or take their medicines.
The staff is debating whether to start discharging patients from the clinic after they miss three scheduled appointments, a common practice among doctors, Vellozzi said.
"The mothers with their children are good, but they don't take care of themselves," she said.
One particularly frustrating case was a woman who refused to sign consent forms for surgery the morning of the operation. A surgeon and anesthesiologist had donated their time that Saturday morning for the woman, who decided she did not want the gall bladder surgery.
The woman was discharged as a patient. "We can't take that kind of responsibility when she has a serious problem a month from now and ends up in the emergency room," Vellozzi said.
Many of the clinic's patients have never before been to a doctor except for an emergency. Unlike most Americans, these people experience childbirth, heart attacks and other painful physical problems without seeing a doctor, Vellozzi said.
Because they have never received continuing medical care, routine tests often turn up a variety of illnesses--most commonly diabetes and hypertension in adults.
"They (the patients) either have nothing wrong with them or everything," Vellozzi said.
The common ailments among children are ear infections, which can cause hearing impairment if left untreated.
Next to the clinic, rooms are being renovated to offer classes in English, prenatal care, nutrition, and drug and alcohol counseling, Schubert said.
"We know there is a drug problem out there, we just haven't seen it yet," Vellozzi said.
Food will also be given out to the needy through schools run by the Sisters of St. Joseph. Students will be asked to donate food that will be collected and brought to the clinic for distribution.
On a recent afternoon, while three scheduled patients did not show up for appointments, a stout Mexican immigrant brought his daughter, Betrice, 7, to the clinic because she had been complaining of a headache and had vomited twice.
The Ramirez family has been living in Buena Clinton for six months.
"This is very good for the people who do not have work and have no choices," he said. Ramirez read about the clinic in a Spanish-language newspaper.
With her younger brother sitting quietly in a chair, the girl was examined by the doctor.
Vellozzi, Schubert and the medical technician, Sister Martha Marie Linhares, speak basic Spanish, but only the clinic's receptionist is fluent.
But the language barrier was not a problem for the child, who remained calm as the doctor and medical technician took a throat culture and blood sample.
Ramirez, who did not wish to give his first name, coughed throughout the appointment but has no plans to have himself examined. "I don't need to see her. It's just a cold," he said.
For the staff, working in Buena Clinton is a challenge and more rewarding than treating patients in a hospital setting, they agreed.
"This is why I got into medicine; to serve the people that need it," Vellozzi said.
But the afternoon was slow; the schedule was full but the office was empty. With some free time, Schubert volunteered to make a house call.
"I like visiting the people in their homes. Working in a hospital was OK, but this is where my heart is," Schubert said as she began walking down Clinton Street.