Fall 2001
Vol. 10, No. 1

Features

After visiting the MASH Village for the homeless, UNLV professors Pat Markos, left, and Dan Allen realized that establishing a medical clinic at the facility would provide much-needed health services to the homeless and also serve as a base for their research projects.

When UNLV professors Pat Markos and Dan Allen first visited the MASH Village for the homeless, they were pursuing a research interest. Within two years, they had become the champions of a medical clinic for the homeless and were counted among the clinic's founders. What happened in the interim demonstrated that, to the two professors, the plight of the homeless was ...

More Than An Academic Concern

BY LAURIE FRUTH

The lines form early outside the medical clinic at Father Joe's MASH Village. The clinic doesn't open until 7:30 a.m., but already patients are streaming into the center with complaints of earaches, fevers, and other ailments.

Some are here for the first time; others are returning for follow-up care. Their maladies are as varied as the circumstances that brought them to the Mobilized Assistance and Shelter for the Homeless, Las Vegas's service center for the poor and homeless. But they all have two things in common: a need for primary medical care and an utter lack of resources to pay for doctors, food, or even a roof over their heads.

Some 12,000 men, women, and children are homeless in Las Vegas — a number that UNLV professors Pat Markos and Dan Allen hope to reduce someday through their collaborative research on the psychological and medical needs of the homeless population. But their interest in the subject is more than academic: As two of the founding members of the free medical clinic at Father Joe's MASH Village, they are engaged both intellectually and emotionally with the people they are studying.

Their association with the clinic is part of a community partnership between UNLV, the MASH Village, Lake Mead Hospital, University Medical Center, and a host of social service agencies and private practice health care professionals. The partnership was established a year and a half ago, but the story really began four years earlier when Markos, an associate counseling professor, began taking graduate students in an advanced community counseling class out to the MASH Village.

"That's how I got started with the MASH Village," Markos says. "My students began doing one-on-one counseling with clients at MASH. To this day, this is the only counseling that is offered at the village."

Markos was pleased to be able to provide a service that benefitted both MASH residents and her counseling students — so much so, in fact, that she applied for and received a small grant to study the needs of the homeless population. But she really wasn't looking for additional involvement — that is, until she met Allen, an assistant psychology professor at UNLV.

"We got to talking, and I discovered that we had a lot of interests in common, particularly in the area of researching mental illness. Many homeless people are either mentally ill or have alcohol or substance abuse problems, so when Dan said he was looking for a clinical setting in which to gather data for his research on these conditions, I suggested he might want to come with me out to the MASH Village."

Ruth Bruland, executive director of the MASH Village, left, was thrilled that Allen and Markos were willing to help establish the village's medical clinic. The three are seen here in one of the clinic's exam rooms.

A short time later Markos and Allen met with Ruth Bruland, executive director of the MASH Village, to discuss possible areas of research. And it was during that meeting that the plans for the medical clinic began to take shape.

At the time, Bruland was all too aware of the critical need for health care services for the homeless. In fact, representatives from Lake Mead Hospital had already approached her with the idea of opening a clinic at the MASH shelter. The hospital offered to put up $120,000 per year to support the clinic — a good start but not enough money to adequately equip and staff a clinic to serve a population of nearly 12,000.

So Bruland began looking around for others who had the potential to help.

"And when I met with Pat and Dan and threw out the idea of a clinic, their eyes lit up at once," Bruland says.

Indeed, Markos and Allen were intrigued by the notion of a free clinic that could provide much-needed health services to the homeless and at the same time serve as a base for their academic research projects.

"We realized we could achieve two goals at once," Markos says. "We knew that research on the homeless population was desperately needed, and we also knew we wanted to help the MASH Village. It seemed like a perfect fit."

They quickly recognized that this sort of community partnership was exactly the type of project for which certain university-sponsored grants had been designed. But the two professors also realized that they would need additional funding from sources outside the university to make the project a success. They quickly set up a meeting with Randall Hempling, then the chief executive officer of Lake Mead Hospital, to pitch their idea.

"And he was very interested," Markos says. "He said he would give us $240,000 for two years.

We then went to the University Medical Center. They said they couldn't give us cash, but they would give us all of our lab work and X-rays for free. Once Lake Mead Hospital and UMC were on board, we were ready to apply for matching funds through the university's Applied Research Initiative program."

In November of 1999, Markos and Allen learned that they had received an Applied Research Initiative grant in the amount of $585,000 — news that left them feeling both overjoyed and overwhelmed. They certainly had plenty of experience in health care — she as a certified rehabilitation counselor and he as a psychologist, mental illness specialist, and former unit coordinator for a Veterans' Administration hospital in Pittsburgh. But neither had ever built a clinic from the ground up. So they contacted George Kaiser, then chair of the department of family and community medicine at the University of Nevada School of Medicine.

Kaiser agreed to serve as the clinic's medical director and provided them with a detailed list of the equipment and supplies they would need. With that list in hand and with the help and support of those at the MASH Village, the pieces began to fall into place.

Bruland persuaded the city of Las Vegas to allow MASH to purchase a double-wide trailer to serve as the clinic's temporary home and then hired a designer to draw up the plans for the clinic's exam rooms, waiting area, dispensary, and offices. The trailer was put in place, and the plumbing and electrical hardware were installed; calls were made to anyone in the community who had supplies that could be of use to the clinic. A part-time nurse practitioner was hired with funding from the grant, and volunteer physicians, nurses, and other health care professionals were recruited to work in the clinic.

On May 11, 2000, the clinic officially opened its doors, becoming the only free medical facility in Las Vegas to serve exclusively the homeless and uninsured poor.

Since that day, nearly 5,000 patients have taken advantage of the clinic's health care services, and the numbers continue to climb. Markos says the demand has been so great that occasionally the clinic has had to close the intake window in order to catch up with the 30 or 40 patients in the waiting room. But no one has been turned away or denied access to the qualified specialists, on-site pharmacy, or comprehensive medical care offered by the clinic.

Response from the local medical community has also exceeded all expectations. Bruland says that she has been approached by a number of physicians who want to give their time.

"But we don't have any place to put the gynecologist, the podiatrist, or other specialists who want to help us out. And while this is a wonderful problem to have, it does illustrate the tremendous amount of need that is still there," she says.

Bruland believes that the right donor is out there and that someday the double-wide trailer will be replaced by a larger, permanent building. In the meantime, she is very happy to have the free clinic up and running. And she is full of praise for the contributions of UNLV and particularly of Markos and Allen.

"Pat and Dan are 'doers' and were really the first link in what has become a very long chain of supporters," Bruland says. "Lake Mead Hospital was already poised to be a partner, and we knew UMC wanted to participate. But Pat and Dan pulled it all together."

"There is this sense that we are making a difference. And that's really the reason that Pat and I are working so hard out there." — UNLV psychology professor Dan Allen

Markos and Allen appreciate the accolades but are much too focused on the work that still needs to be done to spend much time patting themselves on the back. While they were pleased when the clinic opened for business, they realized that their work as academicians was just beginning. The two professors needed to satisfy the research requirements of their university grant by conducting three separate but related studies on the population served by the clinic.

The first study they launched, Allen says, was designed to track the types of medical illnesses suffered by the homeless and to determine how the provision of medical services affects the way this population accesses health care. He explained that prior to the opening of the free clinic, emergency rooms of local hospitals such as Lake Mead were filled with people who didn't really need emergency care but couldn't get services any other way.

"The problem," Allen says, "is that emergency room care is very expensive. And when patients go to the emergency room for treatment of primary care ailments like earaches or the flu, the hospital has to foot the bill for the care."

In addition, Allen says that emergency rooms are not designed to provide primary care and homeless patients were either not getting the care they needed or were not provided with follow-up care.

By tracking patients and their aliments as they come through the clinic, Markos and Allen hope to demonstrate that patients are receiving better and more cost-effective care than before the clinic was built.

The two are only halfway through their study, but early results suggest that provision of services via the clinic has indeed lessened the demand for expensive emergency care.

"We'd only been open for a few months when I was asked to make a presentation at the national Health Care for the Homeless conference," Markos says. "And we calculated that in the first year of operation, the clinic would save Lake Mead Hospital nearly a million dollars."

Allen says that in the second year of the study they will track patients who make return visits to the clinic; he is optimistic that the results will show the beneficial effects of follow-up care.

"The bottom line is that if we provide these services and keep people out of the E.R., then we all benefit. The hospital saves money, the patients have access to comprehensive medical care, and people who once would have gone untreated now receive the care they deserve," Allen says.

Another area of concern for Markos and Allen is the rapidly growing number of homeless women over the age of 50. Allen explained that homelessness has traditionally been considered a situation primarily affecting men. This is partly because men are more likely than women to abuse substances and to be military veterans — two key variables that often lead to homelessness; it is also partly because homeless women and children are less visible because they take advantage of available shelters. Whatever the reason, resources allocated to help the homeless have often been provided with men in mind, particularly in the area of health services.

So Markos and Allen have designed a second study to determine how and why older women become homeless and how their medical and mental health needs differ from those of men.

Markos suspects that most of these older women have been in and out of homelessness for years because of mental illness, addiction, or domestic violence. But she says that at least some of these women fall into the category of the working homeless — those who hold down full-time jobs but don't make enough money to pay for housing.

"So many people are lured to Las Vegas by the warm weather and availability of jobs," Markos says. "But when they get here they discover they need a sheriff's card and a health card just to get a job. And when they do get a job, they make $7 an hour. You can't live on $7 an hour if you have children to support."

Whether they are working or not, Allen says, the homeless have health care needs that differ from those of the general population.

"If you look at the leading causes of death in the general population, you'll see that cancer and heart disease top the list. But the leading causes of death among the homeless are quite different. These people die from poisoning, injuries, and diseases that result from being exposed to the elements," Allen says. "Add to that the list of health concerns that affect women — breast cancer, menopause, osteoporosis — and you see that we don't have a lot of information about this group of people in general and about older women specifically."

As if these two studies weren't enough to keep Markos and Allen busy, they have undertaken a third project. This project also focuses on homeless women but is concerned with the medical and psychiatric functioning of these women across the life span. The professors plan to evaluate 300 homeless women of varying ages to see if they can find differences among the age groups.

"We're optimistic that this information will help us determine when and how to intervene so that we can prevent future illness and continued homelessness," Markos says.

Markos and Allen admit that the last year has been exhausting, what with building a clinic, collecting data on three separate research projects, and continuing to teach classes at UNLV. During that time they also faced the added stress of worrying about a funding controversy that nearly resulted in the village having to close its doors.

"We were roughly a year into our research when the city of Las Vegas and the MASH Village entered some turbulent negotiations over funding," says Allen, adding that for a few weeks the two professors wondered what would become of all of their work. But they are pleased to report that the funding problem has been resolved, the village and clinic are still operating, and their research is continuing.

Despite all of the stress and the work, both Markos and Allen feel they are the lucky ones in the whole project — lucky to have been involved in a project that has offered them such rewarding experiences and has contributed so much to those in need.

Markos calls her participation in the program the perfect marriage between two loves: research and service to the community. Allen agrees.

"There is this sense that we are making a difference. And that's really the reason that Pat and I are working so hard out there."