Deborah has lived in and around the L.A. River in South Los Angeles for the past 15 years. She is currently living with kidney disease in one of the many homeless encampments along the river with her Chihuahua and handful of people that call her “mom.”
It’s early in the morning and some of the people at the encampment are just waking up. Outreach workers call Deborah's name from the top of the embankment, near the road. They’ve come to give her and any others living at the encampment a ride to a mobile clinic stationed in a nearby parking lot of Robert White Park in Norwalk.
“I didn’t trust them at first, but they kept coming. If they wouldn't have came I would have just been sitting here longer and probably died because I probably would've lost my other kidney. They already took one out,” Deborah said.
“She didn't want to talk to me when I first came around. She just looked at me all mean, but we kept coming,” said Daina Villanueva, an outreach worker. “I was on a mission and when the doctor was on staff that day, I knew I would bring the doctor straight to her.”
“When they brought the doctor, I thought, okay. I’ll give them a chance because they went out of their way for me, so I guess they care. And they do. They do care,” Deborah said, crying, as she held her dog with red painted nails closer. Villanueva reached out and embraced her. “They’re tears of joy,” Deborah said.
She is now receiving medication and treatment the first and third Thursday of every month through a mobile clinic that’s operated by the Homeless Health Services program at St. John’s Well Child and Family Center, a community health center based in Los Angeles. “I now have a social security card, birth certificate and an ID. I haven't had that in years,” she said.
For two years, St. Johns’ team of outreach workers, medical staff and caseworkers have been using the mobile clinic to reduce financial, geographic and psychological barriers that prevent the homeless population from getting medical care. It brings primary health services to areas frequented by homeless and housing insecure individuals and families.
The mobile clinic program rolled out in 2014, after St. John’s received a federal homeless services grant through the Health Resources and Services Administration (HRSA) to convert the 40-foot school bus and an additional $650,000 in federal funding per year for operating costs.
“If you're really serious about serving the homeless population, they can’t be expected to travel significant distances with all of their belongings in a shopping cart to a clinic, you really got to take services to them and that's what we do,” said St John’s CEO, Jim Mangia.
"The mobile clinic frequented homeless shelters and religious organizations, but more recently has needed to go into more obscure areas throughout Los Angeles to serve homeless patients following the passing of an ordinance by the Los Angeles City Council in 2015 that made it easier for officers to confiscate homeless people’s property and dismantle their tents," he said.
In March, the city was sued by homeless advocates and homeless individuals who accused the city of seizing their belongings without due process or sufficient notice. The defendants’ tents, bedding, documents and medication were never returned and although an injunction was issued a month later that prevents police from seizing property without notice, it's limited to areas in and around Skid Row.
“After the ordinance was passed, many of our homeless individuals and families went deeper underground and we had a significant drop in patients accessing services as they became more fearful of being picked up and having their belongings taken by the LAPD,” Mangia said. “We had to innovate and find them where they were. More and more of our homeless patients were hiding under freeways and in the L.A. River.”
The mobile clinic offers comprehensive primary care, dental and behavioral health care and counseling services, in addition to screenings for chronic diseases and sexually transmitted infections, as well as help with substance abuse.
“Many health conditions affecting the homeless are a result of poverty and lack of a stable home. Hypertension, high cholesterol and mental health issues like depression and anxiety are all impacted by being homeless and by substance abuse and alcohol," Mangia said.
"Many come into the clinic with foot problems from walking a lot," said Jessenia Garcia, homeless and public housing coordinator at St. John’s. “They are constantly on the move.”
They also do Well-Woman Exams, which include Pap smears and other tests related to women’s reproductive health. “We have a lot of sex workers and we offer them female condoms to take their health into their own hands," Garcia said. "We have to build trust because they are usually apprehensive to admit they are sex workers, but once trust is built they can admit it and the clinic can better serve them."
The mobile clinic offers three free visits to uninsured patients, but caseworkers at the mobile clinic enroll all eligible patients in public health programs. Garcia said most people are eligible because most homeless U.S. citizens are eligible for MediCal and those that are undocumented are eligible for the county indigent program, My Health LA.
St John's mobile clinic is making an effort to decentralize homeless services at a time when most shelters and services throughout the county are concentrated in Downtown and Long Beach.
Following Mayor Eric Garcetti and members of the Los Angeles City Council’s declaration of a state of emergency on homelessness in 2015, city and county officials have pledged to expand services and outreach efforts and increase the number of shelter and housing vouchers.
Of the $100 million pledged by Mayor Eric Garcetti, only $15 million has been appropriated. A comprehensive homeless strategy was released by the city in January that identified $1.85 billion needed, but no additional funding has been designated.
Recent estimates show an 11% increase in homelessness citywide and a 5% increase countywide. While city and county officials scramble to secure funding and the need for services grows, homeless aid organizations are looking to expand their reach by taking their services to the street. For example, Exodus Recovery Inc., a Los Angeles-based homeless services organization, operates the Integrated Mobile Health Team, which provides housing assistance along with mental health, physical health and substance abuse services to people in Downtown, Boyle Heights and South L.A. Similarly, the Mobile Clinic Project, operated by UCLA public health, medical and law students, offers social and medical services to the West Hollywood's homeless population.
Garcia said St. John's services go beyond trying to meet the medical needs of the homeless. With the help of outreach workers from Our Place Housing Solutions, the team also does daily outreach to connect the homeless with housing and other services.
“The trouble is being able to gain the patient's trust. By us going to the same locations and having the same outreach workers and doctors all the time helps them come out. Then we’re able to connect them with more services too. We are one more link to get them to permanent housing,” said Becky Vanderzee, director of housing programs at Our Place Housing.
St. John’s has two mobile clinics that go to five locations throughout the county. "The mobile clinic sees about 20 patients on any given day, who are all entered into the Coordinated Entry System, a countywide system that connects homeless adults to services," Garcia said.
“One client is currently getting a housing voucher and we’ve linked a couple [of clients] to drug treatment programs within the past few months,” Vanderzee added.
The mobile clinic has also been able to provide medical clearances, including disability forms, needed by clients transitioning into housing. "A client has 24 hours to get a medical clearance before their housing voucher is invalid, so outreach workers go out and find clients and notify them of the voucher, then get St. John’s to sign off," Vanderzee said.
“An 80-year-old guy died yesterday. We did our best, but the clinic wasn’t enough. He needed housing," Garcia said. "That wouldn’t have happened if he had been housed."
For patients with referrals for specialty medical care, the mobile clinic is able to provide them with rides through Our Place Housing, who picks them up or gives them bus tokens. The organization also arranges transportation for patients through Access Services, a county program that offers services to people with disabilities.
Deborah needed additional care that wasn’t available at the clinic, but outreach workers were available to take her to a nearby health care provider where she could be seen. She said goodbye to everybody at the mobile clinic before getting into the car with the two outreach workers. Her dog was on her lap as they drove off.