By Paula Day

Atlanta Community Health Program for the Homeless begins its second year of health care services this month with high goals and some innovative approaches for meeting the health needs of the homeless.

The year-old program is an expansion of a volunteer effort which began with a simple response to human needs. Six years ago, Dr. Dwana Bush and Tim Porter O’Grady, R.N., began taking medications for skin care and foot problems in a tackle box to St. Anthony’s shelter for homeless men in southwest Atlanta.

From that unpretentious beginning came the Mercy Mobile Health Unit, based at Saint Joseph’s Hospital and staffed by volunteer medical personnel, which visited shelters from the homeless three nights a week providing basic medical care.

Now 13 full-time paid staff using three mobile vans make rounds to shelters and soup kitchens in the Atlanta area five days a week. Physicians, nurse practitioners, mental health workers and others have logged more than 9,000 patients’ visits in the first 10 months of service, 30 percent of which were for women and children.

In January, Decatur physician Sharne Sarah Sheehey became the first medical director of ACHPH. The goal of the program, Dr. Sheehey said, “is to go beyond band-aid medical assistance and provide homeless people with exactly the same quality of accessibility of medical care as any other person in the general population.”

In fact, at a time when house calls by physicians are rare, Dr. Sheehey pointed out, “We’re making home visits to the homeless.”

“The homeless population is changing,” she observed. “We want to switch from the makeshift caring for minor acute problems to care that includes health education and health maintenance. Treating disease is relatively easy. Promoting health is very challenging.”

Dr. Sheehey knows whereof she speaks. Before coming to ACHPH she worked as a physician at Central Health Center in Atlanta’s Central Presbyterian Church and as a volunteer in a clinic serving Hispanics. She has worked with the homeless population as a volunteer for the last five years.

ACHPH is administered from offices leased from ACHOR, a transitional living situation for women and children on Stewart Avenue in southwest Atlanta.

“The homeless population today is not the stereotype elderly male,” commented Amelia Broussard, R.N., director of ACHPH, who handles day to day administrative responsibilities. “We see a lot of women with children under four. Some have at least two younger children and we’re seeing more infants.” Frequently the women are victims of abusive situations, Dr. Sheehey said.

With the increasing number of women, finding a place for women to deliver their babies becomes a challenge.

“Doctors need to trust the prenatal care the woman receives since they’ll be liable if something goes wrong,” Dr. Sheehey pointed out. She hopes to be able to give the kind of prenatal care that will build trust with obstetricians. In the meantime she sees two basic options: “Set up cardboard delivery suites on the street and shame obstetricians or prepare a ‘hit list’ of hospitals and send the patients there.”

Finding privacy in which to give health care for the homeless is a challenge. Dr. Sheehey would like to provide routine medical care for this increasing number of homeless women. In the present shelter environment, this is not possible.

In response to those who point out that the homeless can go to Grady Memorial Hospital and not be turned away, Dr. Sheehey said women with children find it difficult to wait in line the whole day, which is normal for indigent patients at any large publicly funded hospital. There is also the possibility they will lose their place in the night shelter while waiting at the hospital.

While many of the homeless treated by ACHPH are from Atlanta are or are native Georgians others are newly homeless and from out of state. Persons from Ohio, Oklahoma and Texas make up a large proportion, according to Ms. Broussard.

The staff treat a variety of illnesses including pneumonia, bronchitis, infections of the ear and skin, viral flu and colds. In November 1988, they administered 380 flu shots, according to ACHPH records.

“We see a fair amount of substance abuse,” staff nurse practitioner Dorothy Galloway said. “We ask them if they’re interested in getting help and most are. They are a young clientele and are using cocaine.”

Rolland Marshall, a case worker, has been with ACHPH since its beginning as a substance abuse counselor. In addition to this growing problem, Marshall said they are seeing more persons with mental illness who “are always looking for shelter and so don’t have money” for their medications which are essential to keep their conditions stable.

Children’s diseases such as chicken pox and measles reach epidemic proportions in the shelters every March. The health care providers are trying to reach children needing vaccinations in order to stem this recurring problem, but as long as the children live in the close shelter environment, the epidemics will continue, Ms. Broussard pointed out.

For persons with chronic illnesses, diabetes and hypertension, for example, the goal is to make referrals to permanent health providers, Ms. Broussard said. These include community health centers, Grady Hospital, Central Presbyterian Health Center and Grant Park Family Health Center.

Original funding for ACHPH came from a grant of almost $1 million from the U.S. Public Health Service and matching funds and donated services from local sources. ACHPH is a consortia of public and community organizations including Saint Joseph’s Mercy Care Corporation, Georgia Nurses Foundation Clinics for the Homeless, DeKalb and Fulton County substance abuse centers and Georgia Department of Human Resources.

Between March and December 1988 the professional care-givers saw 4,500 new patients, according to Ms. Broussard. The daytime clinics function five days a week and go to several sites on a regular weekly basis. Volunteers still man a mobile unit several nights a week, brining the total number of sites visited each month to 28.

These mobile clinic sites include Antioch Baptist Church, Café 458, Hispanic Services in Chamblee and Grant Park, Open Door, the Phyllis Wheatley YWCA, Church of Redeemer, Salvation Army locations, Atlanta Children’s Shelter and Women’s Day Shelter.

Since the living situation of the homeless is unusual, the health care providers have had to develop some unique approaches to their care.

One challenge has been to keep medical records on their transient clients who may come to one site one week, another site the next. With the help of Robert Mead of Life Care Technology, they are developing a computer program for portable lap computers that will accept handwritten data and provide a print out on medical record forms. The program will allow any person whose handwriting has been identified by the computer to chart clients’ data without typing skills. Records on all the patients will be kept in a central computer bank, but they can be brought up by the lap top computer at any site. This will help the health providers be certain of previous and ongoing medications and medical histories. ACHPH will be the first to apply this technology.

Such simple things as providing food that will be nutritious but not need refrigeration has been another challenge for the staff. The federal government through the state of Georgia funds a WIC (Women, Infants and Children) nutritionist Diane Scagnelli, who travels with the clinic. She is developing vouchers for food packages that can be distributed through the mobile clinics. At the present time clients obtain the vouchers at designated health centers with limited hours, a task that is very difficult for “people existing in chaos,” Ms. Broussard pointed out. Some simple changes in the content of the food packages, such as substituting shelf milk and peanut butter, which do not need refrigeration, for cheese, and one-serving boxes of cereal for larger portion packages helps simplify the lives of those depending on the food for nutrition.

Getting patients to take their medication is another continuing challenge, according to Dr. Sheehey. It is hard to expect a person who does not eat regularly to take medicine with food, for someone without a watch or clock to take medicine at a prescribed time or for one without shelter to keep medicine safe and dry, she pointed out.

“Compliance is a big problem. You can give them the medication but that doesn’t insure they will take it.” One man, who kept his belongings and medicine in his pocket, rolled over in his sleep and covered his medicine with toothpaste, ruining it. “Their medications are constantly stolen. In wet weather they may become ruined,” she added.

Tim Porter O’Grady continues his involvement with providing health care for the homeless as a member of the board of Mercy Care. What began six years ago continues to grow. O’Grady said Mercy Care has a two-fold obligation: To see that ACHPH is fiscally responsible and adequately funded as well as to maintain it as an effective expression of the mission of the Sisters of Mercy.

“We’ve been able to give evidence of linkage with existing community services,” he said. “I believe that’s the key to the future. The model for serving the needs of the underserved in the future is this linkage.”