A 10,000-MILE CHECKUP : For Many North County Poor, Health Care Comes on 4 Wheels

Their parents had brought them:

Danny Perez, 5, for anti-measles shots and other vaccinations before he could enter school.

Pedro Cervantes, 7, for a checkup for possible after-effects from his treatment of a bee sting.

Saul Sanchez, 10, for an exam to determine if he was too small for his age.

None of their families had insurance to cover this kind of treatment. None had cars to get to a clinic. A handful came by bus, but most walked to the Maple Community Human Services Center in Fullerton to wait for the mobile health van from St. Jude Hospital and Rehabilitation Center.

The van with its staff of three, assisted by occasional volunteers, dispenses treatment to children in exchange for donations that their families can afford. In a report this month in the American Journal of Medicine, the van was hailed as a cause for optimism in what the author, Dr. F. Allan Hubbell, otherwise viewed as a crisis in health care for the poor in Orange County.

The study of north Orange County residents, funded by St. Jude, found that 37% of the poor--compared to 27% nationwide--lack medical insurance and fail to get basic medical care, such as vaccinations.

The van has chalked up more than 10,000 miles in bringing medical care to the people who need it the most--those too poor to afford treatment or unable to find transportation to a clinic, hospital or the state Department of Health Services office in Santa Ana that processes Medi-Cal forms for the state insurance program.

Joan Furman, a registered nurse and executive director of the hospital’s program providing medical care for the poor, said: “Our basic feeling is that health care is a right, and it’s not a privilege.”

The hospital, owned and operated by the Sisters of St. Joseph of Orange, has operated the 36-foot van for a year. Initially, the hospital estimated that the van would treat 1,500 children in that time. The actual total: 5,835.

Only one similar medical van operates in the county, according to health officials. Run by the nonprofit Orange County Community Development Council, it hits the road one day a week in South County, tending mostly to homeless adults, said the council’s executive director, Clarence W. (Buddy) Ray.

St. Jude’s van operates four days a week in North County, shifting its location daily. On Tuesdays it heads for the Maple Center, where Danny Perez, his mother and sister arrived at 6:30 a.m., an hour and a half before the van.

His mother, Consuelo Perez, said the family had health insurance, thanks to her husband’s job making batteries, but it didn’t cover immunizations or routine physicals. For more serious treatment, the family would still have to pay a $100 deductible before the insurance took over, she said. Asked to contribute what she could, Perez paid $6; the shots would have cost her $90 or more at a private doctor’s office.

Perez brought her 14-year-old daughter in case she needed a translator. She didn’t because the three people staffing the van full time speak Spanish.

By the time the van rolled up to the Perez family, more than 30 children and two dozen adults were waiting. Tugging at mothers’ skirts, laughing and shouting, the children were the beneficiaries of a $200,000-a-year program run largely on donations.

Jennifer Young, the nurse-practitioner who conducted the exams and dispensed prescriptions and advice--to be reviewed later by a doctor--said as many as one-third of the pregnant mothers she sees have had no medical care in the first three months of their pregnancy. She said much of her work is in educating parents on the importance of preventive medical care.

Sometimes, though, medical ailments spawned non-medical problems.

Pedro Cervantes, a restaurant busboy with a weekly salary that seldom tops $180, said his 7-year-old son, Pedro Jr., suffered a severe reaction when he was bitten by a bee a few weeks ago. Neighbors called an ambulance to take the boy to a hospital. While Young checked on Pedro Jr. to see if there had been any after-effects, the father mentioned that the ambulance bill had been $162 and that the hospital charged about the same.

Young started telephoning from the van and told him that there was a chance a government program for the poor would pick up the bill. Smiling widely and thanking her profusely, Cervantes said he would check back to do what was needed to get the bill paid.

Rosa Ramirez, 39, of Fullerton, needed help with housing as well as an examination for Francisca, the 9-month-old asleep in her arms. Ramirez receives food supplements through the Women, Infant, Children medical program funded by the federal government. But she was looking to live somewhere other than the house she and her 11 children share with two other families, who have nine children of their own.

Ramirez said she put down a $1,200 deposit on a house, but it was returned when the owners refused to rent because the family does not have a bank account. Young looked through a resource book and came up with the names of two housing agencies that might be able to help.

Then it was back to medicine.

After laying Saul Sanchez, 10, on the examining table and thumping his chest, listening with her stethoscope and checking blood pressure, Young told him to open his mouth.

“ O muy malo !” she exclaimed. “Look at the size of the cavities. I don’t know how the children tolerate the cavities.”

Saul’s mother came from Mexico a year ago, following her husband because “life is better here.” Saul lived with his uncles in Veracruz until he finished school in May, then came to La Habra to join the rest of the family. His mother, Flora, rode the bus for half an hour to the van “to see about Saul because he is so small.” Saul is 10 years old and not even 3 1/2 feet tall; his brother, three years younger, is five inches taller.

Young found nothing wrong with Saul but referred him to a pediatrician for further study; she has a list of doctors who will accept Medi-Cal payments or treat a patient for free, and in some cases she has driven a child to the doctor’s office herself.

Furman said about 80% of the children seen in the van have cavities. They are referred to the nonprofit Gary Center in La Habra, where they pay relatively small amounts for treatment. In addition, a grant will allow the hospital to sponsor a University of Southern California mobile dental van to treat children at the Gary Center next month at a cost estimated to average $100 per child, paid by the hospital and free to the kids.

Hospital workers and volunteers also donate used children’s clothing, dolls and toys the van ferries from stop to stop. Mothers at the Maple Center eagerly picked through four bags bulging with dresses, shirts and trousers, hunting for whatever would fit their kids.

One woman who brought her 5- and 3-year-old children for checkups said she tries to pay a few dollars when visiting the van, “but there are times when I can’t. Then I feel so bad, so terrible.”

The woman declined to give her name, saying her husband did not know that she was at the van. He doesn’t like it when she goes, she said. “He says, ‘I’ll pay for it,’ but we can’t. I mean, I could use the money (to pay a donation), but it would come out of the food budget, and I can’t do that.”

A day later, at Featherly Regional Park just north of the Riverside Freeway in Anaheim, Norman Lofton waited outside the van while his 7-year-old daughter, Jennifer, was inoculated. He told of suddenly finding himself unemployed and living in a trailer in the park while hunting for work and housing: “It’s hard to imagine being in this situation.”

Although most campers park just past the entrance to Featherly, the county requires the van to set up shop a mile away, off to the side, where most people have no idea the van exists. Dr. Royce Hutain, the van’s medical director, called the location “the South 40” and said county officials told the hospital that they didn’t want the van to be too visible, lest it attract homeless people from other parks or encourage people to stay in the park longer.

After seeing only one child in the first half-hour, Sister Teresa Dolores, a nun who helps Young on the van, and driver Salome Negron began walking through the park, looking for any children obviously needing treatment and just spreading the word the van was there.

Cathy Johansen, camped near the entrance but without a car for the day because her husband used it to go to work, loaded 3-year-old Elizabeth on a bicycle and took her to the van, then biked back to the campsite, dropped off Elizabeth and picked up Christopher, 2, and brought him back.

“I don’t see why they don’t let them park (near the entrance),” she said.

The reason, according to Ernie Schneider, head of the county Environmental Management Agency, is that Featherly “is a park, it’s not a medical facility. . . . I don’t want to seem cold and callous about it, but I think the total of the homeless in there is a small percentage of the campers.”

The county does supply the medicine used for vaccinations. Parents too poor to get prescriptions filled get their medicine free at St. Jude Hospital, where several doctors have also donated services ranging from thorough examinations to surgery.

The van stops at the Chester Whitten Center in Placentia on Mondays, the Maple Center on Tuesdays, Featherly Park or the Gary Center in La Habra on alternate Wednesdays and at St. Angela Merici Catholic Church in Brea on Thursdays.

Furman said St. Jude Hospital had hoped to expand its van service to adults, but the demand for children’s medical care is so great that treatment now is nearly always restricted to those 18 and under.

On some days, the van treats as many as 70 children. The more likely tally at a stop like the Maple Center is 35 to 40; at Featherly, eight or 10.

No matter what the number, the work is satisfying, said Young, who has two children of her own, a quick smile and instant rapport with her patients. “You get immediate rewards in this job, when you see a kid come back the following week and they’ve actually improved or you keep them out of the hospital.”