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Like
Spokane's pole dancers, strippers, and sex workers, some of whom
come in battered by pimps and customers. Or the children Bruya sees
with fragmented medical histories and parents who shrug their shoulders
when asked what immunizations they've had, or when their child last
saw a doctor. There are the 45-year-old women who walk into the
clinic who have never had a pap, never had a mammogram. The clinic
detected breast or cervical cancer in seven patients in October
2001 alone.
About
44 million Americans live without health insurance. More than 130,000
Spokane-area residents lack adequate insurance. Fourteen thousand
of them are children.
In
two years, the clinic has treated more than 5,000 clients, while
at the same time giving nursing students hands-on clinical experience.
When people can't come to the clinic, a woman named Loly Reyes-Gonzalez
takes it to them.
Reyes-Gonzalez,
49, is an energetic retired air force nurse who now works as the
clinic and outreach manager. She has brought one-day health clinics
to low-income communities all over Spokane for basics like mammograms,
insulin shots, or blood pressure testing. She laughs when asked
what vehicle functions as the mobile clinic.
"It's
my truck. I put everything in my truck. See that bag," she
says, pointing to a large black duffel bag. "That's the mobile
clinic."
Yet
despite the many nurses like Reyes-Gonzalez, who frequently stretch
the conventional boundaries of the profession, College of Nursing
officials lament that the public's traditional stereotype of the
nurse as a white-uniformed doctor's assistant won't seem to go away.
"The
most difficult part about it is the idea of the nurse as the 'assistant,'"
notes Dean Detlor. "The backbone of the whole health care system
across the country is the nurse."
Indeed,
nurses fill a broad range of positions across the health care spectrum,
both blue- and white-collar. They work in hospitals, health departments,
private law practices, insurance and pharmaceutical companies, for
starters. They are often key figures in clinical trials and medical
research. Increasingly, nurses are moving into leadership positions-as
in Tacoma, where the CEO of the multi-care health system is a nurse.
And at the WSU College of Nursing, many dedicate their energy toward
helping Spokane's poor.
Associate
professor Merry Armstrong recently landed a $99,800 Helene Fuld
Health Trust grant to provide health expertise to addicted women
who are also chronically homeless. The money will help develop an
addiction course and provide clinical and research opportunities
for students to work with homeless women in Spokane. Three graduate
students will be assigned to the downtown women's shelter to talk
with residents and assess how best to reach the population with
necessary health information.
"I
want to invite graduate students to work with this population,"
says Armstrong. "They are so needy, and yet the women are very
welcoming. You get a lot of bang for your buck."
According
to Armstrong, the city had no idea there were so many homeless women
before the downtown women's shelter opened in 1999 in response to
fears about Spokane's serial killer.
Homeless
women are a largely invisible population because they spend so much
time on the move, trying to find safe places to rest where they
won't be assaulted or raped. "Their safety is to always be
mobile," says Armstrong. "But clearly there's a lot more
homeless women here than anyone thought."
And
for those addicted to drugs and alcohol, there is a glaring gap
in health care services in Spokane, primarily as a result of a chronic
disjoint between the city's mental health and addiction counseling
communities.
Armstrong,
who wrote her doctoral dissertation on women who use drugs and alcohol
during their pregnancies, is hoping her grant will help establish
a way to deliver important, basic health information to homeless
women trying to get clean and improve their health long term.
"It's
a thousand-step process, it's the rest of your life."
Diana
Boyd knows that firsthand. The Bellingham woman was a heroin addict
for 35 years, until she kicked the habit a year and a half ago after
moving to Spokane for detox. She now suffers from chronic depression
and a myriad of other health problems from her many years of homelessness
and addiction.
"I
had hepatitis C. My teeth were falling out. All my time, energy,
and money went into my addiction," recalls Boyd, 51. "When
you're in that situation, you have no resources. You're out stealing,
turning tricks, whatever. You're at the mercy of the medical community,
and it can be so degrading."
To
show how far she's come, she displays her driver's license picture,
taken more than a year and a half ago, when she was still hooked.
In the photo her face is sallow, her eyes sunken, her mouth toothless.
She looks like a different woman now, tall and confident, unafraid
to smile since intensive dental work gave her back "a full
set." Armstrong's grant would provide hope for other women
like Boyd, who after living in transitional housing for a year,
is about to move out on her own and take a part-time job. She is
a regular at the Women's Drop-In Center, a safe harbor for women
in the heart of downtown.
The
center, on Howard, is a safe and welcoming place for women to go
in the daytime for support, advice, and friendship, not to mention
the basics like a snack, a shower, or something to wear. Pastries
and coffee are on the table, artwork about and by women covers the
walls, a phone in the corner is available for local calls.
With
an annual budget of $200,000, plus five staff and 20 volunteers,
the center serves close to 100 women a day. Some of them are homeless
women who stay in shelters at night but have no place to go during
the day. Some of them arrive bruised and battered, ready to leave
an abusive spouse. Some, like Boyd, stop by for support or to ask
health questions to the nursing students, who come every Wednesday.
"I
just started taking hormones for menopause," Boyd explains.
"I had some questions about it and the nurses were here one
day, so I asked them. We looked it up together. It was empowering
for me, it was like I was in on it."
"It
takes awhile for women to get to know them and trust them,"
says center director Mary Rathert. "But it fills an important
service. Often they feel comfortable asking questions to the student
nurses because they sometimes don't feel comfortable with the whole
medical system."
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