As the Street Outreach Services van travels from its headquarters near 16th and Bryant to the 24th Street BART Plaza, Marlena Hartman-Filson manages to move swiftly and gracefully, organizing the small waiting room set up at the front of the van and the more intimate examining room in the back.
“We have anything you can get at Walgreens. People come every week to stock up on supplies,” she explains, as she fills the shelves and tidies the make shift doctor’s office.
Hartman-Filson is part of the current team from the San Francisco Community Clinic Consortium that rides the van four days a week to reach as many of San Francisco’s 6,436 homeless as they can – in recent years that’s been about 1,428 individuals at a cost of $250 per patient. On Thursday mornings, the van travels around the Mission.
Today’s team includes three workers: Hartman-Filson, a 24-year-old with platinum blonde hair and a bright smile, who, after a year on the van as an AmeriCorps worker, knows how to handle her patients’ flirtations and compliments with ease and remembers little facts about her clients the way a hairdresser or dentist might; Michael Ho, a recent grad from the University of Michigan who is applying to medical schools while he too works for Americorps; and Manuel (Manny) Gonzalez, the outreach manager with 15 years under his belt, who is behind the wheel as the van moves up the numbered streets to 24th.
Often, their target population only wants a bottle of water or a pair of socks. Other times, the clients need more extensive medical care including wound treatment or a prescription for antibiotics. These are small street-side interventions that can keep more expensive emergency room visits down. A 2013 study from UCSF found, for example, that emergency treatments for headaches, one of the most common emergency ailments, can cost the patient anywhere from $15 to nearly $18,000.
The team is without a UCSF resident this morning, but they can still manage wounds, administer pregnancy tests, monitor glucose levels, and provide eyeglasses. All of these services are possible through federal grants and a $399,882 annual budget.
When the van stops at 24th and Bartlett, a block away from the BART Plaza, Gonzalez gets out to check in with the regulars who hang out nearby and to let them know the van has arrived.
Unlike the AmeriCorps workers, Gonzalez seldom smiles and is much stricter with the clients, telling patients they need to wait their turn or threatening to cut off supplies if they can’t take care of them.
“I’m here to get whatever you guys are giving out,” says Charlie*, a man in his mid-30s wearing a plaid shirt and slicked back hair. His eyes can’t seem to focus as he remains just outside the doors waiting for his goods..
Hartman-Filson hands him a white plastic bag full of vitamins, ibuprofen and hygiene supplies.
“Do you have a primary doctor?,” Hartman-Filson asks while she still has his attention.
He does not but would like one and so boards the bus to give Hartman-Filson his information and make an appointment.
If the team can get a client like Charlie to establish a relationship with one of the Clinic Consortium’s doctors, the patient is likely to have a longer life and more effective health care.
Even with those benefits, however, it’s tricky getting someone to sign up and get to the appointments.
“The most difficult part is dealing with patients who have mental health issues, but you still need to help them,” Gonzalez says. “We are working with people who have been on the streets for 20 or 30 years, and they just can’t get off.”
Even when appointments are made, they are often missed. We quickly see an example of the problem when Jose walks up to the van.
He tells Ho that he missed an appointment the team had recently made for him. His phone died, he says.
“They make me appointments. They tell me where I can get a shower…If these people weren’t here, it would be bad for me,” Jose says, rocking back and forth slightly but smiling wide. “A lot of people look forward to seeing the van.”
Jose, who sleeps in one of the encampments near Cesar Chavez and Portero, has been coming to the van since 2011, when he was released from prison. “They know me by my first name here,” he says happily.
He’s open about his problems with substance abuse and willing to show the scars from wounds he incurred on the streets. He partially takes off his long-sleeve shirt to show his upper-left arm, where there is a chunk of flesh the size of an orange missing. It’s more or less healed now, but he explains how a man used a knife to carve out his skin and tissue after Jose failed to pay back a debt.
“Jose! Good News!,” Ho exclaims from the back of the van. He has successfully rescheduled Jose for a medical appointment.
“I promise I’ll be there,” Jose says, giving Ho his mother’s number in Hayward if there are any problems reaching him.
“She’ll come here and grab me to get me to go,” he explains.
“That’s what moms are for,” says Hartman-Filson.
After a quick stop at Arezmendi for a snack (a Thursday tradition), the van finds itself parked on the west side of Dolores Park, a hipster mecca on the weekends and a sunny spot to hang out in if you don’t have work or a living room on the weekdays.
Hartman-Filson is busy once again handing out supplies “Do you think I could put this on my resume as waitressing experience?” she jokes.
Then a man with a thick Brazilian accent, aviators and a graying ponytail boards the bus. His name is Fernando. Hartman-Filson questions him about his dental care as he’s been having problems with getting coverage.
Fernando became homeless a year ago when he was evicted from his rent control apartment in Noe Valley. He still works, cleaning houses three days a week When he’s not working, Dolores is his daytime spot. His health is generally fine, but he has had long-term dental problems since getting in a motorcycle accident that knocked out half of his teeth in 1998.
Fernando is currently registered for Medi-Cal, and Hartman-Filson is sure that this should cover his dental. The bureaucracy is confusing, but Hartman says she will look into it.
“I have to go back and ask why I am covered for pregnancy and not dental,” Fernando laughs.
Thirty minutes pass, and Gonzalez re-appears. It’s time to go again.
After a quick break at the office, the team grabs a small container of flu shots and heads to Martin De Porres, where the nurse practitioner from the Department of Health will meet them. They plan to be there from noon to 2 p.m.
Everyone on the team sticks around the van this time to help out with the line of patients needing help with lice, contagious diseases, and broken bones. The team has decided they won’t announce that they have flu shots until urgent care is done.
Ho fills out basic information about each person waiting in line while Hartman-Filson assists the nurse in the back, which has now been cordoned off by a thick, vinyl curtain for privacy. Gonzalez oversees it all, keeping a stern eye on those lingering outside, occasionally getting off to survey the scene.
When a man starts to pick lice out of his hair and catapult them at others with a flick of his pointer finger and thumb, Gonalez reacts quickly. : “You have to stop doing that,” he says. “You are scaring people.”
During this minor crisis, a man in a black sweatshirt meanders up to the van’s doors to ask for some ibuprofen. Even though it’s on a trolley inside, Ho slips him some, muttering at a half volume that he technically is not supposed to be doing this.
Then, requests for glasses start to come in.
A repeat customer in a 49ers cap asks Ho for a new pair. The team provides one free pair of eyeglasses a year to anyone who asks.
After scanning his chart, Ho hands him over a new pair of basic, wire rim glasses.
“Oh yeah,” he says immediately after putting them on.
“Only once a year, OK?,” Gonzalez reminds him.
Kevin, who is a regular at the soup kitchen and first approached the van about six months ago, calls the van a “lifesaver” as he patiently waits for a flu shot. The last time he visited, he received a pair of glasses. Before that day, he hadn’t been able to see properly for two years.
Kevin asks Gonzalez for some ibuprofen. While Ho has been slipping people over-the-counter pain meds and gauze, unable to say no to those who clearly need it, Gonzalez has been the hard-liner, insisting that everyone go inside the soup kitchen to get those necessities.
But it’s near the end of the day, and the last patient is getting vaccinated. No one else besides the reporter is in the front of the van. In this moment, Gonzalez bends the rules and hands Kevin some ibuprofen.
*Name has been changed for privacy purposes
San Francisco has only 436 homeless? Am I living in a time warp and its 1981? And how long does it take them to reach 1428 people (in a four day week?), a thousand ostensibly are not homeless, unless we are talking repeat visits? Very confusing. Fortunately only $250 per patient (per visit?).