Helping The Homeless: A Look at the Fourth Street Clinic
November 24th, 2008
America's declining economy is causing homelessness to rise in Utah. We take a look at a primary care facility for the homeless to get perspectives from physicians and patients.
by Jonny Glines
Watch DocumentaryLittle 4-year-old Kevin has digestion problems causing him to vomit on a daily basis. His mother, Olga Reyes, takes him to the doctor, but the Reyes are homeless and without money. Fortunately, there is a place where people such as the Reyes can receive health care. The family appears like any other in a doctor's office. 6-year-old Stefany giggles as the male physician performs standard exams. Her mother watches and smiles as she holds Kevin. However, one noticeable difference with the Reyes' is an extra glow of gratitude coming from the family.
At the Salt Lake Fourth Street Clinic, a place that Olga Reyes calls "her clinic," little Kevin can be treated for his sickness and his sister, Stefany, can receive treatment for her mouth pain. The clinic provides primary healthcare to the homeless, and for people like the Reyes, it may be their only option.
"I don't know where I would go," said Olga Reyes, using a Spanish translator. "The clinic is very good; they are very friendly and take good care of the patients."
Fourth Street Clinic Communications Director Jennifer Hyvonen later described the family's situation in a toy-filled pediatrics waiting room.
"A lot of the children we see have digestive problems," said Jennifer. Immediately, Kevin flashed through my mind. "If you can imagine being a parent and living in the streets or a shelter that's overcrowded, these types of illnesses are very contagious and it's very difficult for these parents to keep things sterile."
America's economic decline has shaken everyone. Those at the top of the financial totem pole lost some footing, but for those who were already barely hanging on at the bottom, it meant falling into homelessness. Since last year, homelessness has increased 22% in Utah and of that increase; families are the largest growing homeless demographic.
"We're seeing a lot of families becoming homeless as a result of foreclosures," said Dr. Allan Ainsworth, Executive Director of the Fourth Street Clinic. "It's not necessarily their own foreclosures, but they're renting property that has been foreclosed on."
Families are losing their jobs and being forced into the streets. One man I spoke with, who wished to remain anonymous, told me he once had a decent paying job at a furniture warehouse until uncontrollable seizures forced him to lose his job and eventually his home. Homeless, and without insurance, he claims he couldn't receive medical help for his condition.
"Everyone would tell me I was fine, but I kept having the seizures," he said.
It wasn't until he went to the Fourth Street Clinic that he could recieve the proper treatment to prevent his seizures. However, by this time, he had lost everything.
"That's one of the major causes of homelessness in America," said Dr. Ainsworth. "People are either underinsured or not insured at all and they or someone in their family has a medical catastrophe that pushes them over the edge."
Clinic workers say the homeless are often turned away at clinics, causing many to forego treatment until their illness worsens and they require care at an emergency room. Under the Hippocratic Oath, and by law, hospitals are obligated to treat patients during emergency situations, but with homeless patients, the hospital often ends up eating the bill, thus rising the cost of health care. Fourth Street Clinic workers say by ending this trend, it can lower the cost of health care for everyone.
"Through our volunteers and donations, we can provide a doctor's visit for about $130, which is half that of the national average," said Jennifer Hyvonen. "So this is the most cost effective way in that the patient is going to get better healthcare and have a better quality of life than they would if they went to an expensive E.R. We want to serve them now, so they don't have to go to an E.R. later."
Once the patient's health is restored, the clinic takes additional steps to prevent them from returning. The goal is to essentially "put ourselves out of business," which is commonly repeated by Ainsworth and his staff.
"We work with other agencies and partners in the Salt Lake area to get them into housing and get them other needed support," said Dr. Ainsworth.
"We found that it is much more cost effective to stabilize a person and keep them healthy, rather than treat them in times of crisis," said Hyvonen. Through the additional services, Hyvonen says "people are getting jobs and they're qualifying for federal aid."
Looking At the Other Side of The Clinic
Our first trip was very informative, but it was on our second trip that we were able to understand the emotional side of the clinic. We interacted with patients and clinic workers without the administrators' presence and listened to some interesting insight into Veterans who are unable to function normally in society.
On Veterans Day, it was both fitting and disheartening to see two homeless Veterans at the clinic seeking help. We spoke with on Veteran who served in Vietnam and the another who served in Korea.
"I was a sailor, I built bombs," Vietnam Vet Michael Zanta told us while sitting on a street bench in front of the clinic. As he reached down to pick up a gallon jug of chocolate milk, his jacket revealed a shoulder patch of the American flag, torn and with colors faded. I couldn't think of another article of clothing that could have been more symbolic of his story.
The fatigued war Vet told us he's back from Seattle, that he's "lived in Utah before, but has never really settled down anywhere." He says it's hard for him to keep and job or hold a home for very long due to post war stress syndrome.
"Over the years it diminishes, but it never really goes away. I can't really handle a stressful situation, that's why I've been through so many jobs," Zanta said.
For Zanta, coping skills were lost in the war. The concept of department store work being too stressful for someone that used to make bombs for a living, was for me, ironic. The thought stayed with me for the rest of the day.
Just ten yards from Zanta sat another Vet, waiting to be treated. We spoke with Gary Kingston, who served in Korea.
All of Gary's brothers served in the Vietnam War. He says they all came back heroin addicts. When his time came to serve in the Korea, Gary followed their examples and used heroin with other soldiers to cope with war trauma.
"I first started smoking it and then went to IV's," said Gary. He's clean now, but says it was his addiction that forced him into homelessness.
"That was 30 years of drug abuse, but I'm all better now," Gary says with a smile.
He sat in the corner, waiting for his wife (who is also homeless) as she was treated for diabetes. He was chipper and very easy to talk to, which surprised me when I learned he was in pain throughout the conversation. He removed his boot to reveal black and blue spots on his frost-bitten foot, an ugly condition he received from living on the streets.
As we walked through the clinic halls, we met compassionate volunteers. Some worked other jobs and volunteered their time on the weekends. Others were retired and wanted to stay active in medicine. Then there were some who were just starting their careers and turned to the clinic for experience.
These volunteers are vital to the success of the clinic. With the economic decline, the clinic is getting hit twice. On one end, the clinic is seeing increased demand, due to low-income families entering homelessness. On the other end, donations to the clinic have lowered substantially. When companies are losing profits and laying-off workers, they don't exactly see giving away free money to clinics as part of their business plan.
"We're very concerned about funding as people tighten up their wallets and purses," said Dr. Ainsworth.
For now clinic workers will have to make do with what they have and hold high hopes that more funding becomes availible.
The investigation showed me how easily a person can become homeless. My perception of homelessness went from the drunken man, laying in the gutter, and was replaced with images of single parents, children and war Vets.
I asked Assistant Physician John Humphries about the rewards he recieves from working at the clinic. His response was so systematic, that he made my question seem rhetorical.
"I'm working with human beings," Humphries said. "And to be able to help affect their lives in somehow in someway, with patient care and helping them with their medical needs is a huge reward."
