NORTH HOLLYWOOD — When you live on the streets, the search for a hot meal, a blanket and a bed makes a visit to the doctor seem like an unwarranted luxury. So you ignore the simple ailments--head colds, cut fingers--and wind up with pneumonia or some other deadly infection.
Maybe you know you're diabetic or suffering from tuberculosis. But what can you do? You've got to eat first, and you've got no time to take care of illness, much less pay for treatment.
Expectations change sharply, however, the first time you meet Wallace (Doc) Cooper, the Harley-riding, leather-jacketed physician's assistant at the Homeless Health Care Project in North Hollywood.
After just a few moments listening to Doc Cooper, once homeless himself, you can tell he's been where you have. For the first time in years, you have regular health care, enough medication, people like Cooper watching over you.
For the 20 to 25 homeless patients treated every day by this small clinic based at the Valley Shelter on Lankershim Boulevard, that knowledge makes all the difference.
"They know what being down on your luck is about, and they don't frown at nothing," said Cletis Harris, 31, a Valley Shelter resident. He came to the clinic for treatment of an ingrown hair on his face that had become infected because of lack of attention.
"I can sum it up," he added. "They care."
Operating since 1988, the clinic serves about 1,800 homeless patients a year with funds from the U.S. Department of Health and Human Services under the Stewart B. McKinney Act. Its annual budget of about $750,000, administered by the nonprofit Northeast Valley Health Corp., pays for its seven-member staff as well as medicines, thermometers and other supplies.
Of the 70,000 to 80,000 homeless people in Los Angeles County, as many as 8,000 seek shelter and services in the San Fernando Valley, according to Bob Erlenbusch, executive director of the L.A. Coalition to End Homelessness.
By offering office visits twice a week and taking the clinic on the road to other shelters around the Valley, the Homeless Health Care Project provides sorely needed medical care that is otherwise unaffordable or too far from shelters.
"You either have Homeless Health Care Project or county facilities, and either one of the county places takes money to get there," Erlenbusch said. "And by the time you get out there, it's an eight-to-10-hour wait and then you lose your place at their shelter, so the problems compound."
Several Homeless Health Care patients said they have tried county hospitals or clinics and found their staffs to be impersonal or brusque, attributes they say they have never encountered at the Homeless Health Care Project. Sandra Lopez, for instance, is a regular patient now, along with her daughters, Alice and Diana Ovando, 8 and 4.
"I went to other clinics, and the doctor would shine the light in their eyes, look in their mouth and ears, listen to their chest, say my children were fine and that was it, out you go," said Lopez, 31, who moved with her daughters to the Valley Shelter three months ago after living in a ramshackle North Hollywood trailer.
At the clinic, Lopez said, pediatrician Lisa Guerra takes time to answer her questions in Spanish and encourages her to bring in her children for regular check-ups. What's more, Guerra is the first female doctor she has met, someone who makes her more comfortable when she has questions about her family's health.
Lopez's comment encourages Guerra, who passed up more lucrative opportunities to work with poor, Spanish-speaking patients.
"I'd like to be a doctor who can completely explain to people what's going on with their children," she said. "I feel that this population deserves to have good medical attention just like anybody else."
But providing quality care to people with no permanent address is often a difficult task.
The drug and alcohol abuse that runs rampant among the homeless exacerbates chronic medical conditions such as diabetes, hypertension, heart disease, bronchitis and AIDS.
A typically nomadic lifestyle doesn't help, either, Guerra said. Patients often run out of medication when they're on the streets or never come back for follow-up exams.
"I feel I have to address all their problems at once," she said, explaining that while a normal physical exam takes about 20 minutes, one with a homeless client can take more than 40.
"You have to go over them from head to toe, because sometimes we see them and then they're gone."
Funding also limits the kind of care the clinic can provide. Working from a small warren of offices, the staff has to make do without the amenities of a private hospital.
Director Henry Aldrete, for example, has been known to mop the floors after spending his day on the telephone or typing out grant requests in an attempt to raise more money for the clinic.