Building Trust and Bringing Heal to L.A. River s Homele

One of the encampments along the river in South LA. Many of the inhabitants leave their belongings behind during the day in fear of getting citations for having tents in and along the river. || Photo by: Lucy Guanuna

Deborah has lived in and around the L.A. River in South Los Angeles for the past 15 years. She is currently living with a 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 her 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 wouldnt have came I would have just been sitting here longer and probably died because I probably wouldve lost my other kidney. They already took one out, said Deborah.

She didnt 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, said Deborah, crying, as she held her dog with red painted nails closer. Villanueva reached out and embraced her. They're tears of joy, said Deborah.

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 havent had that in years, said Deborah.

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 has been designated to bring primary health services to areas frequented by homeless and housing insecure individuals and families.

Inside the mobile clinic. || Photo by: Lucy Guanuna

The mobile clinic program rolled out in 2014, after St. John's received a federal homeless services grant through HRSA to convert the 40- foot school bus and an additional $650,000 in federal funding per year for operating costs.

If youre 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 thats 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, said Mangia.

Outreach worker, Ashley McKay, with Our Place Housing Solutions dispensing hygiene kits at an encampment along the river in South LA. || Photo by: Lucy Guanuna

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 is 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, said Mangia. 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, sexually transmitted infections and 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, said Mangia.

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.

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They also do Well -Woman Exams that includes 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. 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, said Garcia.

The mobile clinic offers three free visits to uninsured patients, but caseworkers at the mobile clinic enroll all eligible patients in public health programs. Most of which are eligible, said Garcia. Most homeless U.S. citizens are eligible for Medi Cal and those that are undocumented are eligible for the county indigent program, My Health LA.

St Johns' mobile clinic is making an effort to decentralize homeless services at a time when most shelters and services throughout the

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