Triad Health Screeners Take to the Streets
It was 10 in the morning on Sept. 27, and the doctor – several tons and purring – had pulled in at the corner of Washington and Centennial Streets in High Point. Parked behind a small grocery story was a touring bus outfitted with all the trappings of a full-service medical exam room: scopes, syringes, sterile gauze, blood pressure cuffs, etc.
Actually there was no doctor per se, no one dolled up in lab coat and stethoscope. Instead the van hummed with the activity of nearly a dozen red-clad employees from Piedmont Health Services and Sickle Cell Agency.
A gravel parking lot served as the waiting room for this mobile medical operation. In it swarmed about a dozen people – mostly men, mostly black – waiting to be screened for HIV, syphilis, cholesterol and diabetes. The agency, which serves the greater Triad area, visits this particular corner of High Point about two times a year. They chose this corner in particular for its high levels of drug activity and prostitution. Non-traditional testing sites like this busy pocket near downtown target the population at highest risk for HIV, syphilis and other medical problems, a population that rarely has access to regular health care.
“I’m going to get personal, but not too personal,” said Dee Spencer, a behavioral counselor, to the man sitting across a folding table from him.
“That’s fine with me,” the patient said.
“It’s fine with me, too,” Spencer replied.
This patient was an older man missing most of his top row of teeth. He wrote his name, address and phone number on an information card while Spencer recorded his medical and personal history.
Piedmont Health Services borrowed the medical bus from High Point Regional Hospital. Spencer and the other employees would be camping out on the corner for five hours, seeing patients on a first-come, first-served basis. The agency also keeps an office on Taylor Street where employees conduct weekly walk-in screenings. But the nontraditional sites tend to attract more business, Spencer said.
“This is the most effective way to get to our target population,” Spencer said of the rolling clinic. “We just go right into the community and offer these services. It’s hard to beat free.”
On that morning, the bus was indeed glutted with patients. Spencer and two other employees manned the intake table, and a short line curled from the phlebotomy chair to the front of the bus. In his four years at Piedmont Health Services, Spencer has not come across too many cases of HIV. Syphilis, he said, is the real problem.
“We’re really trying to eradicate syphilis because it just opens the door to HIV infection and other problems,” he said.
Many of the people who work at Piedmont Health Services come from Greensboro or High Point. And a lot of them have roots in the same kind of neighborhood they are visiting today.
Edward Harris, who did not get tested but instead wheeled through the parking lot on a bike outfitted with a makeshift stereo, described the corner charitably.
“I just know it’s a place to hang out,” he said.
Harris pointed to the various components of his sound system. The tuner/CD player sat in a plastic box nestled between the handlebars.
“That used to be a lunch box,” Harris said.
One of the men waiting to be tested was more blunt in his assessment of the surroundings.
“This is basically a drug area,” he said. “There’s lots of drugs and prostitution, and there has been for a long time. It’s the ‘hood.”
It’s a ‘hood within eyeshot of High Point’s lavish furniture showrooms. Regulars congregated across the street from the bus, on a street corner near a red brick building. The bus itself sat in a high-traffic area between the corner and the busy grocery store with bars on its windows.
The patient was part of a group from Alcohol and Drug Services in High Point. All of the men who reside at Open Door Ministries’ homeless shelter and participate in day treatment at Alcohol and Drug Services walked over to the nearby parking lot for testing.
Until a few years ago, Piedmont Health Services and Sickle Cell Agency was known as Sickle Cell Disease Association of the Triad. Its mission when it was founded was to screen people for Sickle Cell Disease – a painful, often dangerous condition that disproportionately affects African Americans – and provide counseling. Later the agency’s mandate shifted. Diseases like diabetes and HIV proliferated in poor communities, so the association expanded and started providing a broader array of screening and referral services.
In the mid- to late-1990s, Guilford County experienced a syphilis epidemic. Rates of infection soared between 1994 and 1996 while they declined nationally. The health department partnered with community agencies to track down those infected with syphilis and launched a county-wide public awareness campaign.
Guilford County is winning its war against syphilis. The rate dropped from 42.4 cases per 100,000 residents to just 8.7 between 1996 and 2004. But the disease is still six times more likely to occur among minorities than whites.
HIV infection rates are also higher in Guilford County than in the country as a whole, and blacks are disproportionately affected. In 2004, African Americans accounted for 86 out of 122 new HIV cases in 2004, according to health department statistics.
Studies have shown that Greensboro’s nontraditional testing sites actually succeed in reaching the population that needs its services most. Needle-drug users and people who engage in risky sexual behaviors receive screening at mobile clinics like Piedmont Health Services’ at more than twice the rate they do at conventional county health clinics.
Charles Johnson is smack in the middle of their target. The 49-year-old High Point native said he abused heroin several years ago and receives regular HIV tests to check his status. He’s tall, robust and quick with a smile. Johnson said his last HIV test in July came out negative.
“Our goal is always to test about fifty people,” said Kathy Norcott, assistant executive director of Piedmont Health Services and Sickle Cell Agency. “We usually average anywhere between thirty and forty people.”
Two weeks before the medical bus and its outreach crew pulls into the neighborhood, the staff fliers the community. They put them up in Laundromats, libraries and on telephone poles. Nontraditional testing particularly appeals to members of high-risk groups worried about the stigma of receiving an HIV test, Norcott said.
“Some people will drive over here specifically to get tested,” she said. “People will sneak away and get tested.”
In three weeks, Norcott and her staff will return to this site with test results courtesy of the NC Department of Health and Human Services. In the event of a positive HIV result, counselors will track down the patient and refer them to the health department and Triad Health Project. Community organizations in Guilford County responded to the area’s high rates of HIV infection by creating a web of patient services. Testing sites like this one are one portal into the system, which matches HIV-positive citizens with caseworkers from Triad Health Project, who in turn refer them to infectious disease specialists.
“We try to get them into care as soon as we possibly can,” Norcott said. “About a week after we’ve made these referrals, we go back to check on them, to make sure they’re okay after they’ve received such devastating news.”
Despite the stakes, the testing site feels more like a fairground than a public health project. Before the bus opened its doors, an employee loaded a rotisserie with hotdogs and filled a cooler with sodas. After they are tested, the patients wander over to his tent.
One gentleman, Larry Graves, held a hot dog in each hand and a soda between his elbow and body. He took a large bite, and, working the dog, talked about his life.
“I’ve been to the poor house, the penthouse, the Pentagon and the penitentiary,” he said.
His story began in High Point, and then moved to Vietnam, where he said he served four tours of duty.
“I’d be over there for nine months, and for three months I’d come back,” Graves said. “After Vietnam, I taught school in San Diego.”
He’s also a movie star, he informed me. Graves appeared in Critical Condition, a Richard Pryor film shot in High Point, and helped build High Point Regional Hospital. Past battles with drug addiction and homelessness have put him at risk for HIV and syphilis infection. He was screened for both conditions, and the staff checked his cholesterol.
“I think everybody should get tested,” he said.
Meanwhile, over at the table, Spencer struggled with one patient who joined the line before she finished her paperwork. She wore ratty jeans and an askew baseball cap.
“What do you need me to do?” she asked testily.
“I need you to sit down and finish your paperwork,” Spencer said. “That’s what I need you to do.”
Business at the testing site slowed in the afternoon, and by 2 p.m. the patients had retreated into the shade of the brick building across the street. The staff sat under a tent near the bus.
Staff members tallied 19 cholesterol tests and 38 for HIV and syphilis. In less than an hour, they would pack up and roll the bus back to the hospital. In two weeks, they will pop up again at a health fair in Winston-Salem, and in the meantime, they’ll operate from offices in High Point, Greensboro, Winston-Salem and Burlington.
“We like opening it up to the community like this,” Norcott said from a spot near the bus door.
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