For nearly a dozen years, faculty have arranged for WSU nursing students to provide basic health care to the downtown population as part of their formal education. The students are assigned to work on a weekly basis with a specific organization or site for an entire semester.

Some go door-to-door weekly, visiting the elderly, ex-convicts, sex offenders, and others at the city's low-income hotels. Others walk under the city's bridges and along its riverbanks each Wednesday delivering socks, shots, and basic health care to the homeless. Some give foot clinics and pedicures at the women's drop-in center.

They are the eager, smiling student angels who arrive in downtown Spokane when school's in session.

"There's not a lot of nursing programs across the nation that send their students under the bridges of the city," admits WSU College of Nursing dean Dorothy Detlor. "But serving the under-served population has been part of nursing history ever since public health nursing began in New York City."

Public health nursing in the United States began in the late 1800s through the efforts of a few wealthy women in New York, Boston, Philadelphia, and Buffalo, who hired trained nurses to go door-to-door to care for the poor in their homes.

When students go door-to-door in Spokane, they are often shocked at the grim conditions in which many low-income residents live and the variety of untreated ailments they endure.

"We reach a lot of people that would not get served for a variety of reasons," says Carol Allen, a WSU College of Nursing instructor who coordinates the students' downtown work. "Some students are a little frightened when they start out . . . some of the people are a little hard to work with."

In fact, they travel in pairs, carry cell phones, and leave money and valuables at home when doing their downtown rounds. But few have had bad experiences. Most of the homeless and low-income residents just want to be treated with dignity and respect, says Allen. "For the most part these people are not accepted. Others don't see them, they look right through them."

In order to address their needs, the students must learn how to access a patchwork of community, government, and volunteer aid organizations. They must be able to assess the people they see in a holistic way in order to help them get the diverse array of help they may need.

The work is challenging. The grimy low-income downtown hotels can be particularly demanding at the first of the month, when most residents get their checks, and when some purchase their substances of choice. One afternoon at the Red Lion students came across a 61-year-old man with severe diarrhea, incontinence, and scabs on his face and hands. He had recently had hernia surgery and hadn't ingested anything other than beer for some time.

"He said he thought he might die, and his neighbors down the hall said we think he might too," Allen recalls.

The nurses suspected he was severely dehydrated, bleeding internally, and in need of paramedics. He was adamant about not going to the hospital. Finally, one male student convinced him to go. Because of cost constraints and lack of transport services, Allen drove the ailing man to the hospital in her van, after warning her students not to ever do what she was doing.

The students' real-world nursing experience wouldn't be possible without the back-up support of faculty like Allen. Most of the College of Nursing faculty members practice what they teach by dedicating their own nursing knowledge to helping the underserved.

For starters, College of Nursing faculty staff The People's Clinic, a grant-funded downtown health clinic that serves Spokane residents regardless of their ability to pay. Even the College of Nursing associate dean, Anne Hirsch, puts in her day a week as the on-site health care professional.

Founded in 1998, the tiny clinic tucked above the city's YWCA provides primary care, child exams, immunizations, mental heath counseling, breast and cervical health care, and sexually-transmitted disease screening and treatment, as well as on-site lab testing for those largely left out of the health care system.

Nurse-managed, the clinic serves approximately 250 patients per month, 10 percent of whom are homeless, and 51 percent of whom don't have insurance and pay a fee for service based on their income. Margaret Bruya, one of the clinic's founding faculty members, staffs the clinic once a week. This day, she's still wearing her white coat, long after the clinic has closed, cleaning, refilling the bowls of free condoms and toiletries, finishing her charts.

"There's such a need for primary health care in the under-served population," says Bruya. "There's thousands of people who don't have insurance and have hurdles and barriers they have to overcome to get health care."
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