Byline: PAUL GRONDAHL - Staff writer
They shuffle into the cramped, makeshift examining room, seeking healing.
They are hurting and homeless and, in brief increments of human misery and physical ailments, they present Dr. Evan Ashkin and students from Albany Medical College a chance to chip away at everything they see as wrong with the health care system.
On a recent Tuesday night, at a weekly volunteer medical clinic run by Ashkin in the homeless shelter operated by the Interfaith Partnership for the Homeless on Swan Street, the patients offered a primer on primary care.
In the course of three hours, the doctor and his students had seen an array of conditions, some not generally found in a suburban group practice: Hypertension, crack addiction, gonorrhea, chlamydia, asthma, pregnancy, the AIDS virus and a skin rash.
None of the patients has yet reached the age of 40.
And that's only the physical side. The volunteer medical personnel must also cope with mental illness, suicidal despair and addictions of all kinds.
'Sometimes, I don't know if I'm doing good or harm here,' Ashkin allows, sounding tired and edgy at the end of a 14-hour workday. 'On one hand, our presence allows society to ignore these people and relieve pressure from the cooker so it doesn't boil over and force the issue.'
This isn't a take-two-aspirin-and-call-me-in-the-morning medical clinic.
The guy with gonorrhea -- he reports waking up in the morning and 'feeling like my penis was falling off' -- has a history of schizophrenia. His medication was stolen. His sex partner is probably infected, possibly also with HIV, the virus associated with AIDS.
'In a perfect world, we'd take him and his partner to get tested, because they're at risk for HIV,' Ashkin says. 'But this is an imperfect world. We do the best we can do, encourage him to get tested and give him the 800 number for free testing.'
There's a woman who is in her first trimester of pregnancy and also in treatment for a crack addiction. She hasn't decided yet if she's keeping the baby, which may have suffered damage from the drugs. The woman is given prenatal vitamins and a strong lecture on quitting smoking during pregnancy.
The Tuesday night clinic offers a unique education for Jane Williams, a fourth year Albany Med student, who is making her first visit to the homeless shelter.
'They need doctors down here, and the people get the peace of mind knowing they'll be treated and not turned away,' Williams says. But there's something else at work for Williams, giving up several hours of her scant free time.
'My mother was a single parent who had to struggle to raise us and she had to go on welfare for a while,' says Williams, who grew up in Syracuse. 'I know what it's like a little bit to be without a home, to not have a car to get to the doctor, to not have health insurance. There was a point when I was on the receiving end. Now, I'm giving somebody else a hand like somebody did for me.'
Williams feels a range of emotions about the people she examined at the clinic. 'I empathize with them, but I also feel sad knowing I can't do anything to get them out of their situation. It's depressing.'
Ashkin sometimes succumbs to the feeling of futility, too, but in the final analysis, he is encouraged by the progress of the Clinton health plan that would provide health coverage for millions of uninsured Americans.
In the meantime, though, the homeless, sick and uninsured line up in the cafeteria, waiting for medical care.
Les, a man in his mid-30s, complains of a skin rash on his shoulders, crotch and feet. His eyes dart around the room and he rubs his hands together anxiously, as if washing them. Ashkin asks if his hands itch. Les, who asked that his last name not be disclosed, says it's just nerves.
Ashkin allows Ethan Berke, a third-year medical student, to make the diagnosis on the feet. 'Athlete's foot?' he asks. Ashkin nods. Berke gives the textbook advice of keeping the feet clean and dry.
'I've only got one pair of socks,' Les says. 'But I'm going to wash them every night in the sink.'
As Les buttons up his shirt and prepares to leave, his shoulders slump and he fights back tears as he tells Ashkin about breaking up with his wife of 10 years, struggling to hold onto his job as a cook, nowhere to turn but the shelter -- the sad details of his once secure world caving in.
'It's just so much pressure, coming at me from everywhere, you know?'
'Do you ever feel suicidal?' Ashkin asks.
'Yeah, I've been getting real depressed lately,' Les says, looking at his hands as he rubs them back and forth. 'I've thought about killing myself.'
Ashkin moves around the examining table, puts his arm around the man's shoulder and looks straight into his eyes. 'Now, you promise me, if you start feeling suicidal, you'll call someone,' the doctor says.
'Yeah, I will,' Les replies. 'I've been thinking about how I should see a psychiatrist.'
'Good,' Ashkin says. 'We can show you how to get a Medicaid card. You needto get some help, to talk about this with someone, OK?'
Les nods, a slight grin brightening his face.
'Good, now we'll see you next week and see how it's going,' Ashkin says.
Les shakes Ashkin's hand and leaves.
'The people who come to this clinic feel abused, alienated and forgotten by the health care system,' says Ashkin, who teaches family medicine at Albany Medical College and is a family practitioner with its family health center practice. Ashkin started this volunteer clinic one night a week a year ago, along with Stephen Winters, executive director of the Interfaith Partnership for the Homeless.
'Many of them have Medicaid cards, but they don't use them,' Ashkin adds. 'They have no transportation to get to doctors' offices. Even if they could get there, they feel stereotyped as homeless and out of the world they know where they feel safe.'
It's a downward spiral as the homeless, refusing to visit a doctor, continue to neglect serious ailments even as they abuse their bodies with drugs, alcohol, cigarettes and poor diets.
Last year that Ashkin had to dial 911 while examining a patient.
'The man was having heart failure and I had him rushed to the hospital by ambulance,' Ashkin recalls.
The clinic also has provided early diagnosis for people suffering from pneumonia, tuberculosis and other lung ailments, Ashkin says.
Hypertension is common. Anthony Hughes, 37, was found to have significantly elevated blood pressure. He is on medication now and monitored weekly at the clinic.
'It's been taking it down some, but we're still watching him and working on adjusting the meds,' Ashkin says.
'I'm lucky to have the clinic here,' says Hughes, an unemployed laborer, who has been living at the Interfaith shelter for the past few weeks after transferring from the City Mission. He says he wound up homeless after serving a jail term for beating up a man Hughes says sexually molested his younger sister.
Hughes stopped in at the clinic for the first time a few weeks ago after feeling faint and dizzy. He had no idea his blood pressure was so high.
Valerie Scott, 39, fell and injured her leg. Nothing was broken, but she says the pain flares up in cold weather. Doctors examined her, but gave no medication. Scott is in treatment for crack and alcohol addiction.
'We need a clinic down here,' she says. 'It seems like everyone down here is recovering from some addiction and they're sick and coughing besides.'
Don, 33, is wheezing and short of breath. He has asthma, is allergic to cats (the shelter has a cat), an abrupt change to cold weather makes it harder to breathe and he's almost out of asthma inhaler. 'I've been nursing this Primatene along, because I can't afford to buy any more,' says Don, who asks that his last name not be used.
Don, who lives in Key West, Fla., is an unemployed laborer who came to Albany to visit a friend. 'It didn't work out and I'm stuck here now, with no money,' he says.
Ashkin gives him three free inhalers, including a new steroid system for severe cases of asthma. Then Don admits to the doctor he's a smoker. Ashkin frowns.
'I know, I know, I should quit,' Don says. 'At least I switched to lights.'
Then Ashkin bluntly asks Don if he uses a condom. 'Well, yeah, I mean, unless it's with my girlfriend in Florida,' Don says.
Ashkin moves in close, within inches of Don's face. 'You're willing to bet your girlfriend hasn't had sex with anyone else?'
Don's face turns red. He squirms in his seat.
'Because if you're wrong, you're dead wrong,' Ashkin says. 'I used to work in San Francisco, where I saw hundreds of people die from AIDS. I've never seen a worse death. If you get the HIV virus, you will die and it will be an awful death.'
Ashkin pauses. The room is still. Don doesn't seem to breathe. 'Don, don't mess with it,' Ashkin says, finally. 'Wear a condom every time. Otherwise, you're risking your life. And you don't get a second chance with AIDS.'
Afterward, Ashkin says he gives his cautionary condom warning hundreds of times a year. 'You can tell the ones who won't listen, but I think a lot of them hear the warning and that it's making a difference.'
Ashkin is making a difference in the lives of his students. Berke and his roommate, Mikael Bedell, also a third-year student, credit him with their choosing to go into family practice medicine instead of a higher-paying specialty.
'Most of us in medical school grew up in upper-middle-class families,' Bedell says. 'I feel that this is the best place I can be as a student to broaden my experience and understanding of medicine. We're not getting any extra credit or anything for this. We're here because we want to be here.'
Ashkin gives the initial nudge toward family practice.
He's 33, wears a beard and gold earring and speaks in a youthful exuberance that connects with his students. He grew up in suburban affluence in Croton-on-Hudson, Westchester County, and did his medical training at Tufts University.
'But my family had a strong social conscience that rubbed off on me, and I always wanted to work somehow with poor people in the inner city,' Ashkin says.
His residency was in family and community medicine at the University of California at San Francisco, where he saw firsthand the ravages of the AIDS epidemic. His wife, Cheryl Baker, a physician assistant, plans to become a doctor of medicine and is in her third year at Albany Med.
Ashkin came to Albany Med as a full-time faculty member two years ago and he oversees the college's mandatory program that matches third-year students with monthlong internships in family practice.
Ashkin thinks the effort is paying off at Albany Med, where growing interest in family practice reflects a national trend back to general medicine and away from specialties.
The other volunteer physicians from the Albany Med family practice center who rotate with Ashnick, who staffs the clinic himself every other week, are Gene Bont, Patrick Caulfield, Mary Jo Fink and Neil Mitnick.
Two years ago, in a class of 130 students at Albany Med, there were just seven in family practice, Ashkin says. Last year, there were 14. This year, there are at least 22.
'We're approaching 20 percent of the class and I'm greatly encouraged by that,' Ashkin says.
Family practitioners have watched their salaries rise about 40 percent in the last four years and earned, on average, $112,000 annually in 1991, according to the American Medical Association.
'It's still a lot less than a specialist can earn, but it's no longer a disincentive anymore and you can't make the argument that it's not enough to pay off college loans,' Ashkin says.
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Times Union/JACK MADIGAN
