It was 39 degrees outside on the first Monday in December, but it was warm inside the St. Canice Center in Nevada City, where 25 to 30 of Nevada County's homeless were settled in to stay for the night.
Rattling coughs echoed around the room, and registered nurse Jerusha Horlick met individually with those who had put their names on the list.
"We see a lot of coughs and flu this time of year because they all sleep near each other in the rotating church shelters," Horlick said. "We usually see about 15 patients every Monday night. There are the regulars, but there are new ones all the time."
Once a patient has been screened by Horlick, he or she walks outside and into a mobile medical van provided by the nonprofit Western Sierra Medical Clinic, which has brick-and-mortar community health clinics in Grass Valley - known as Miners Family Health Clinic - and Downieville. Their mission is to provide preventive, primary and urgent care to all community members, regardless of their ability to pay.
Inside the van on this particular Monday was nurse practitioner Susan Clayton, who is one of a rotating volunteer staff that includes three local doctors, one nurse practitioner and five physician assistants.
For returning patients, Clayton is able to pull up a file and provide follow-up care. Has your bronchitis gone away? Did you take all the medication we gave you? Are your feet still bothering you?
For new patients, Horlick, a case management nurse, plays a key role back in the church gathering initial medical histories and screening people in the hopes of connecting them with other community services.
The mobile clinic, said Horlick, has played a vital role in bridging a gap between the homeless and resources available to them. Many have trouble navigating the system on their own for reasons such as language barriers, mental health issues, dementia and simply poverty itself. A visit to a doctor's office could be intimidating, she said, and the van is part of the clinic's mission to be a low-resistant port-of-entry to the health care system.
"I've had three strokes and they've got me on medication," said "Chips," a 69-year-old guest at the shelter who has a medical file dating back several years. "Once you've been homeless awhile your mental outlook changes and your health deteriorates. There's a feeling of hopelessness. But at the clinic there's someone who says 'I care, I give a sh_t.'"
Over the years, efforts to treat homeless - and other county populations with limited access to health care - has been largely driven by primary care physician J.R. Lang, who is the chief medical officer and medical director for Western Sierra Medical Clinic.
"Dr. Lang started out as just a 'doc in a box,' - his mission has always been a simple one: to serve people who wouldn't get care otherwise," said Hospitality House Executive Director Cindy Maple. "I truly admire him for the role he's played in evolving this program. A typical homeless person's health is fragile. I'm convinced there are some who would not be alive if not for the clinic."
When the Downieville and Grass Valley clinics merged in 2010 under the umbrella of the Western Sierra Medical Clinic, Inc., the "safety net" health organization became eligible for additional federal funding due to the populations they serve. Lang played a key role in securing $150,000 of grant money for the purchase of the mobile van as an outreach tool. They were able finance the rest.
In addition to seeing patients on Monday nights at the various church shelters overseen by Hospitality House, the mobile clinic sees patients from 10 a.m. to 3 p.m. on Tuesdays and Thursdays in Camptonville. It is also poised to serve as an emergency vehicle for disasters and houses a lift for wheelchairs, an exam table, a place to do lab draws and has a restroom for urine samples.
"It's made a big difference from a public health standpoint," said Lang. "It's not uncommon to catch someone who is tipping over into a serious illness and we've sent them to the hospital right then. We've also caught cancers."
Seeing the impact the van is making when it comes to increased access to people in need, both Lang and Horlick say they are now determined to bring the mobile clinic to homeless encampments. Many there - who are known to sleep outside even in winter months - don't qualify for Hospitality House shelter due to issues such as substance abuse, outstanding warrants or simply owning a pet. Their isolation puts them at an even greater risk for serious health issues.
"I love this population - they don't have as much of a chance to succeed and I like seeing them get healthier," said Horlick. "Chips is a perfect example. If not for the mobile clinic he wouldn't be getting his preventive meds and at some point he'd probably be found dead on the street.
"But right now, he has a lot of people looking out for him."
To contact Staff Writer Cory Fisher, e-mail email@example.com or call (530) 477-4203.