About twice a month, King County’s Mobile Medical van comes to Renton. It opens at 4:30, but it’s often slow until closer to 6:30, when the church across the street begins serving hot meals for homeless people.
The inside of this RV has been retrofitted so there’s an exam room, a nurse’s station and a waiting area. A generator gives off a droning buzz as it powers this efficient little clinic.
Rebecca Callantine, 23, is one of the first patients to arrive one afternoon. She hopes to get an inhaler. But before the doctor sees her, Callantine tells the nurse that lately she’s been feeling lightheaded, even nauseous. It’s gotten more frequent since she’s been homeless.
Callantine came up from Oregon a year ago for a job, but that fell through. Since then she’s been struggling to find work and has been without a home. Callantine and her boyfriend sleep in their truck.
The expansion of Washington state’s Medicaid program under the Affordable Care Act has helped homeless people like Callantine access medical care, but having no home or stability makes staying well more complicated.
Diabetes runs in Callantine’s family, so the nurse checks her blood glucose, and asks how often she’s able to eat. Callantine and her boyfriend come to Salvation Army twice a month for free hot meals. In between, they rely on food stamps. They try to make it last two weeks. Three weeks, if they’re lucky. The nurse asks how they make it last.
“You only eat once a day, pretty much,” Callantine said. “You try to spend like $10 a day. You shop at the Dollar Tree – a lot.”
When asked what kind of food they get at the dollar store, Callantine answered chips, cheese, hot dogs – mostly junk food. They’ve given up going to the food bank because most of the items require a microwave oven or a can opener which they don’t have.
Asking about meals may seem trivial, but the answers are revealing. “That’s one question I routinely ask: How many times a day do you eat?” said Dr. Sarah Vanston, a family physician on the mobile medical van. “Which seems strange, but it really helps you gauge what type of medication you’re going to use and how you’re going to have them take it.”
In her practice, Vanston has to tailor her medical treatment to fit each person’s living situations. “Everything gets compounded when you live on the streets, your car, or in a motel. You’re in survival mode,” she said. “When you’re in survival mode, all these things fall by the way side. All you care about is where you’re going to sleep that night, is it going to be safe, and where are you going to get something to eat.”
Vanston said in many ways her patients lack the same necessities as people in developing nations: access to food, drinking water, a place to clean up and a roof over their heads.
“Sometimes the only thing you can do is bear witness to their experience. And that is really hard to do sometimes,” she said. “As somebody who’s trained to be a doer, that was one of the biggest challenges for me.”
Vanston has been seeing patients at the mobile medical van since the program started six years ago. She said treating homeless patients isn’t always straight-forward.
She recalled trying to prescribe insulin to a 60-year-old man to help control his diabetes. The medication goes bad if it’s not kept at a certain temperature, and the man was living in his truck. So Vanston spent some time brainstorming with the patient to come up with ideas to keep his insulin cool and usable.
Lacking basic necessities isn’t the only problem for the patients of the mobile medical van, said its program manager, John Gilvar. Many struggle with untreated mental illness or substance abuse, sometimes both.
“Just imagine if you have cognitive impairment or if you have schizophrenia, and you’re living literally in a storage container in the back of some lot somewhere, how can you follow all the directions, all the steps and then travel from office to office to get care?” he said.
Gilvar said Medicaid expansion has given patients more access to providers, including specialists. But some have many other underlying problems that Medicaid can’t address.
Back at the nurse’s station, the nurse notes Rebecca Callantine’s blood pressure and blood glucose. She then asks Callantine how she’s been feeling in the last couple of weeks, to screen for possible signs of depression.
Rebecca tells the nurse she’s getting frustrated about not being to find work. She said sometimes, it feels like businesses won’t even consider hiring them because they’re homeless. “Like the Sub shop, they’re like, ‘We’re not hiring.’ Well, can we at least get an application? ‘No, we’re not giving out applications.’ Seriously, you’re not even going to give out applications?”
The nurse listens. She said after the doctor, she’ll have Callantine meet with one of the social workers in the van. After that, Callantine plans to head over to the church for her only meal of the day.