With constraints in health care, an increasing number of families in Richmond's underserved communities seek medical attention from a special kind of delivery service. 

Mobile Medicine

It's minutes after 2 p.m. on Sunday, and the doctor is late.

Twenty-five years ago, no one would have noticed. The middle-class suburban neighborhood in Chesterfield County thrived. It offered all the amenities - good schools, shopping centers, manicured lawns - its Meadowbrook name implied. Then sprawl and a good economy prompted many to upsize, moving west to newer, more affluent suburbs. The neighborhood thrives still, though the population has changed.

The 37-foot medical unit on wheels buzzes loudly in front of St. Augustine's Catholic Church on Beulah Road. Already a crowd of mostly Spanish-speaking families has gathered. So far, Dr. Emilio Torres' tardiness has prompted only a few - probably first-timers - to ask whether or not the doctor will see them today. Most have been here before, or to other Care-A-Van sites, and know the routine. It requires patience and an early arrival. So they wait and multiply outside in folding chairs, on the curb, on steps and under dogwood trees in the church lawn.

Folks here know Dr. Torres will show up. He almost always does. Until then, only the Care-A-Van staff appears anxious.

For many families in this South Side neighborhood and others like it, scheduled trips by Care-A-Van staff and volunteers provide the only medical attention and referrals they receive. Most families here are vulnerable to a health-care system that largely excludes them because of insurance costs they can't afford or a language barrier that makes communication guesswork. For two hours on the fourth Sunday of each month, the Bon Secours Care-A-Van pulls into St. Augustine's parking lot to help make health care accessible to all the staff can handle. But recently, as word of mouth has prompted a sharp increase in turnout, Care-A-Van physicians, nurses and volunteers are finding it nearly impossible to meet the demand.

More than seven years ago, Dr. Emilio Torres, an obstetrician and gynecologist at Chippenham Medical Center and the Medical College of Virginia, saw a need in his South Side community for free health care. Together with Father Ricardo of Sacred Heart Catholic Church and Mary Pat Talafano, a registered nurse, a volunteer outreach was created at the Perry Street church. Since then, Care-A-Van has grown into a multiservice program with an operating budget of $200,000 a year, funded by Bon Secours Richmond Health System and private contributions.

The Bon Secours Care-A-Van hits the road six days a week, providing preventive care to children and adults in underserved neighborhoods in Chesterfield, Henrico, Hanover, Petersburg and the city of Richmond. Thanks to free vaccines from the Virginia Department of Health, last year Care-A-Van immunized 4,000 children and adults, and screened more than 1,000 adults for everything from hypertension to diabetes to prostate cancer.

Today it's mostly kids who need attention. "Some of the children have been excluded from school," says Eletta Hansen, director of the Bon Secours Care-A-Van program. At the end of September, many of the kids here haven't started classes because they haven't received the immunizations and physicals the state requires.

It's hot and humid, and the kids who aren't confined to mothers' laps explore the yard and the parking lot to find someone to pal around with.

"The demand has increased dramatically," says Hansen. "It has exploded in the past three to six months." Hansen attributes the growth to families spreading the word that free immunizations, screenings and checkups are offered, and there's a Spanish-speaking nurse and doctor on duty.

On average, Hansen says, Care-A-Van sees 40 people each afternoon. More than 60 wait today. The influx, Hansen says, is typical for all the van's stops from Carver to Creighton Court to Essex Village. But at the Sacred Heart Church and St. Augustine stops, where the communities are largely Hispanic, the challenge of meeting needs often is complicated by language barriers.

That's why Dr. Torres, from Peru, and Irma Teune, Care-A-Van's only Spanish-speaking registered nurse, are invaluable. "They see her here and they feel comfortable," explains Hansen. It's easy to see why. Small and peppy with a contagious smile, Teune somehow makes the heat and confusion bearable. "It's a trust they have in her," says Hansen. "When we don't have an interpreter onboard we have to limit our services because we don't understand what they're saying or what they need. One of the reasons they use the van is because they feel safe." In other medical environments, such as hospitals and doctor's offices, many may feel intimidated or confused. Here, they're among neighbors, friends and family - an inclusive community that speaks the same language.

Care-A-Van assistant Lorenzo Hobson holds the list. Everybody sees him first to sign up and receive a number in line. More than a dozen moms, dads and kids are cramped inside the van that has all the amenities - fax machine, photocopier, Sesame Street Band-Aids - of a regular doctor's office. Two examining rooms are in the back, and families spill out from each. Teune and registered nurse Sherry Hollister give shots as quickly and painlessly as they can. Hollister swabs the thigh of 1-year-old Ronald Daniel Martinez before the first of five vaccines - measles, mumps, chicken pox, polio, DPAT. After two screaming, teary minutes his tiny body is safe from viruses he'll never have to fight.

According to Hansen, most parents they see have some form of health record on their children. Others, Hansen says, have never taken their child to a doctor. Care-A-Van started providing physician- and nurse practitioner-administered physicals four months ago to meet the community need. Before, the program had been limited to immunizations, screenings and referrals by registered nurses.

Just after 3 p.m., a Volvo pulls up. A few recognize the car at once. Dr. Torres quickly emerges, greets expectant faces and disappears into a church room where he gets to work. Hansen and Teune race back and forth from the van to the church hallway where many have gone to keep cool.

Hansen tries to appear calm answering as many questions as she can. She pulls eight chairs from one room into the hallway so every mother has a place to sit. "Let me know how many of you can understand English." A handful of hands goes up, the others nod. She explains the process of who goes next. The look of those waiting is one of patience and appreciation. Dr. Torres examines 5-year-old Mohammad Solomon with his dad proudly watching. Yesterday, Mohammad received his immunizations from Care-A-Van nurses at the Fair Oak Baptist Women's Fellowship on Nine Mile Road. Today, he's back for his physical. Tomorrow will be his first day at Skipwith Elementary. He says he can't wait. Dr. Torres gives him a clean bill of health, pats his shoulder and stares deep into Mohammad's happy brown eyes. "You study hard and come back and maybe someday you'll be a doctor," he says. "Then you can help people in your neighborhood."

It's 4 p.m. and the nurses on the van haven't seen everyone. They've worked diligently and swiftly. Sweat shines on their faces more than strain. Only a few who have waited seem frustrated that they may have to return next time. "I feel sorry for these people working here," says Phyllis Hong who has waited on the van with her daughter, Angela Snow and grandson, Damien. They heard about Care-A-Van from people at Damien's preschool. He's been told he can't return until he gets his shots. "We tried to get an appointment with a doctor, but were told we couldn't get one for two to three months. I think next time, we'll make the doctor's appointment."

"This is our busiest site," Nurse Hollister explains to Hong. "You might want to try another [next time]."

Care-A-Van assistant Hobson pulls a flyer from the stack he has handy at the front of the van. "Here's a list of all our clinics." Eventually, Hong's grandson gets the shots he needs.

A two-hour whirlwind ends just shy of chaos. In the end, only one complaint. More important, 40 names have been crossed off the list. Still, Teune worries for the moms, dads, sisters and brothers she' s not able to get to. "So many come and they don't have insurance. They fall through the cracks." A family arrives long after the cut- off time and, today, Teune has to turn them away. "I told them to come back next month. Maybe if they had come at 2 p.m.," she starts, then thinks better of it. "I just can't see


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