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Health care hits the streets
By SHAWN RHEA, Courier-Post Staff
The white van piloted by M.D. Pinkston may be nondescript, but it’s a familiar and welcome sight for many of the city’s homeless residents.
Pinkston, an outreach worker for the Project Hope medical clinic, pulled the large vehicle into the Volunteers of America Men’s Shelter parking lot on Atlantic Avenue. Several residents rose from picnic benches and made their way over to the van. Pinkston, 57, climbed out and greeted familiar faces.
“How you doing, man?” he asked, then shook a few hands and began giving out crackers, soap, socks and other valuable wares. The giveaways aren’t the primary reason for Pinkston’s daily rounds, but they’re a means of connecting. Pinkston’s work involves helping his homeless clientele get the regular medical care they desperately need.
Pinkston’s work is part of a growing intersection in health care where medical providers rely on grass-roots workers like Pinkston to help them reach populations that, due to language barriers, lack of money, inadequate education, cultural differences and geography are marginalized by the health-care system.
These outreach workers are known by a variety of names, including health promoters or advocates, patient aides, case coordinators and promotoras in Hispanic communities. But more often they’re being identified as community health workers.
Their jobs range from educating clients about home-based health care such as managing diabetes, hypertension and asthma to following up with medication compliance for diseases such as HIV and tuberculosis and getting clients in for treatment and testing.
Larry Fuller is one of those clients.
Fuller, who is diabetic, has been living on the streets since September. The 50-year-old said this past winter he showed up at a local hospital complaining of swollen feet, but emergency room staff members turned him away because they believed he was trying to get out of the cold.
“I’d been without my insulin for three weeks,” Fuller said. “It took me two hours to walk from the VOA to (a nearby) hospital because my feet were swollen so bad.”
Fuller feared without treatment the diabetes would cause him to lose his feet. Fortunately, a Project Hope outreach worker happened to visit the VOA the following day. Fuller said the worker took one look at his extremities and “took me to the clinic right away. He didn’t mess around. They took care of my frostbite and gave me my medication.”
While Pinkston wasn’t present the day Project Hope made contact with Fuller, he has since become a lifeline, checking in with Fuller regularly, making sure he has his insulin and blood pressure medication and even transporting him to the clinic when he needs medical care.
“He was in bad shape when I first met him,” said Pinkston, whom clients know as Doc. “But we have a community advisory board (made up of homeless residents) that’s kind of like a support group, and it’s helped him.”
While the research is limited, a growing number of studies finds community health workers have been able to improve patients’ hypertension and diabetes management, increase prenatal care visits among low-income expectant mothers and lessen the frequency of emergency room visits for some manageable illnesses. Locally, there is anecdotal evidence.
Evelyn Robles-Rodriguez, director of the oncology outreach program at Cooper University Hospital, said a staff of two health workers has been responsible for increasing patient screens through the New Jersey Cancer Education and Early Detection program from 225 patients in 1996 to currently 1,300 annually.
“It’s the outreach workers who know where to go to talk to clients,” said Robles-Rodriguez. “They’ve taught me how to access the community.”
Deb Bokas, director of social services for the Osborn Health Center at Our Lady of Lourdes Medical Center in Camden, is in contact with 23 health workers on a regular basis. She said many of Osborn’s clients don’t speak English, and since some also are undocumented residents, they fear seeking care could lead to deportation or other troubles..
“One of the things they do is get people into care early,” said Bokas. As part of her job, she works in conjunction with the Southern New Jersey Perinatal Cooperative to provide prenatal and pediatric care services to expectant mothers and infants.
“I can call a community health worker and say there’s a mother that has a new baby who she hasn’t brought in for a checkup, and they will go out and get through the door and convince the patient that it’s a positive thing to come in.”
For 24-year-old Iris Rodriguez, connecting with her clients means having the courage to approach strangers and engage them in conversations about HIV prevention and sexually transmitted diseases. Rodriguez’s goal is to get young, sexually active women practicing safer sex, and to get them in for HIV testing if they don’t know their status.
In the city
Rodriguez, who works with Hispanic Family Services, visits playgrounds, nail salons and any other place in Camden where she’s likely to find young women, ages 13 to 24, who need to hear her message on HIV and STD testing and prevention. She hands out condoms and testing referrals to young girls who want to be tested. She’ll go along for the test if a young woman needs her support.
Until a year ago, such work was foreign to Rodriguez. She trained to be a medical technician. But since she grew up in Camden, is young and Latina — a background she shares with those she’s trying to reach — that made her a good candidate for the work.
Since becoming a health worker, Rodriguez has taken several state-run HIV-prevention education courses. And while the training has helped her understand the health-care part of her job, learning the people part has been a work in progress, she said.
“About three months into this job, I went to Cooper to do a workshop at their (HIV) early intervention program,” she explained. “I had just finished when (the program coordinator) said to me, ‘I don’t know what you’re doing, but keep it up, because three girls went right in to be tested.’
“That made me feel really great, because I knew I’d gotten through to somebody.”