Clinics That Roll Where Needed

Lacking health insurance, Cristobal Acosta’s parents hoped home care would heal his earache, sore throat and upset stomach. Once the symptoms had lingered for days, making it hard for the 3-year-old to eat and sleep, his worried father carried him to a clinic they’d heard about.

Inside the 38-foot van of Children’s Hospital of Orange County, Dr. Mark Colon gingerly touched the boy’s belly, probing for clues. He kept a watchful eye on the toddler while attending to other patients waiting one evening this week at Pio Pico Elementary School for one of the van’s twice weekly trips to the central Santa Ana campus.

The boy most likely had a viral infection, Colon told the elder Cristobal. He gave the father some over-the-counter pain relievers and prescribed a diet of liquids the boy could keep down and stay hydrated. Then, just to be sure, Colon suggested he bring his son back in a few days for another look.

The youngster is one of thousands of low-income Santa Ana children seen each year by CHOC’s two clinics on wheels. Dubbed Healthy Tomorrows, the 6-year-old program, which costs CHOC about $500,000 a year, has been in such demand that hospital officials have decided to add two more vans this month.

By the end of this year alone, CHOC hopes to have reached about 14,000 children--providing everything from sick-child care to immunizations and physicals--at scheduled visits to community centers and 40 elementary schools in Santa Ana and Anaheim, said Sally Gallagher, CHOC’s vice president of operations.

“I come here because they have very good service,” said Acosta, an assembler of bathroom fixtures for a Newport Beach company who isn’t eligible for medical insurance for several more months. “I’ve taken my children elsewhere and I had to wait four or five hours--and they weren’t as helpful.”

Mobile medical facilities increasingly are being used throughout Orange County to bring free and subsidized health care to the poor and uninsured. About 10 such vans operate with support from the county, United Way, the Orange County Children and Families Commission and the three St. Joseph Health System hospitals in the county.

The programs--especially those that target children and pregnant women--go beyond health care for people without insurance or transportation to one of 16 community clinics in the county, health officials say. The goal is to use the interaction that occurs in a health-care setting to sign families up for one of several subsidized insurance plans and help them find a pediatrician or prenatal care.

“The most important thing you do is not the taking care of the kids, but the education [about health care] that goes along with it,” Colon said. “Then you prescribe an antibiotic and reassure them that their child is OK.”

Of the roughly 90,000 children in Orange County, nearly 13% have no insurance, according to a 1999 survey by the county Health Care Agency and local hospitals. Most of the van programs try to match those children with available health services. Many are staffed by bilingual counselors who inform parents about the subsidized government and commercial insurance plans, ranging from MediCal to Blue Cross’ reduced-rate California Kids program.

“Providing the health service is a good thing, but probably an even greater service is providing an opportunity to assist the individual in finding resources to pay for future services while also finding a medical home,” said county Public Health Officer Dr. Mark Horton.

At Pio Pico, for instance, Luz Hernandez brought daughter Wendy, 13, to the CHOC van for a physical exam she needs to join Santa Ana High School’s cross-country team. Wendy also got two immunizations while her mother filled out paperwork to enroll in MediCal.

“We build trust with the patients and that makes it easier for them to make an application instead of going to the welfare office,” said Diane Dimas, a bilingual counselor who helped Hernandez with the application for assistance.

Mobile services are vital in low-income areas, health experts say. Typically, the family’s one car is being used by the breadwinner to get to work, and “it is enormously difficult [for the other parent] to travel across town in a bus for two hours and sit in a clinic for hours more” to get treatment for a sick child or immunizations for well child, according to Susan Zepeda, executive director of the HealthCare Foundation of Orange County.

“The costs for a wage laborer to take time off are much greater than for a salaried person with insurance,” she said. “Bringing the services to a convenient and well-regarded community site means a mom can walk over there with her child after school and get the child seen and treated.”

“If this weren’t here, it would be very difficult,” said Hernandez, who walked the few blocks to the school from her home.

St. Joseph Hospital in Orange operates three mobile clinics in central Orange County, with two serving agricultural workers, including the migrant barracks at the California Labor Camp in Irvine. The program will add a fourth mobile unit in the next two months, said Rocio Magdaleno, clinic director. Called Puente a la Salud, or Bridge to Health, the clinic’s vans offer medical, dental and vision services at schools and community centers in Santa Ana and Orange.

St. Jude Medical Center in Fullerton runs three vans in north Orange County, one each for pediatrics, adults, and maternal and prenatal care.

In South County, Camino Health Center clinic in San Juan Capistrano, a branch of Mission Hospital Regional Medical Center, acquired a van with county funds to provide primary medical care to adults and children in Lake Forest, San Juan Capistrano and San Clemente.

The demand for mobile services is so great that the Camino van, which serves South County on weekdays, is borrowed by St. Joseph Hospital on weekends for use by Puente. The CHOC program is run in conjunction with Santa Unified School District, Anaheim City School District and Magnolia School District.

The vans will be visiting elementary schools in those districts on a rotating basis. The vans will also make regular stops at the Boys and Girls Club of Santa Ana, the Corbin Family Resource Center and the Delhi Community Center, all in Santa Ana.