Saturday, Aug. 5, 2006 | Robyn Bourland treats the sickest of the sick. The homeless AIDS patients. The heroin addicts. Woman who are about to give birth but have yet to see a doctor.

It’s all in a (long) day’s work, says the clinic coordinator for the NMA Comprehensive Health Center downtown. Here, she oversees a staff that cares for thousands of patients every year, about 80 percent of whom have no money and no insurance. The clinic, which has been open for five months but celebrated its grand opening this week, is housed in the same building as the San Diego Rescue Mission, a shelter for the “homeless, abused, addicted and poor.”

Bourland offered us her most precious commodity – time – recently, to shed light on life at the clinic.

Tell me first about the clinic and what kind of services you perform here.

We are a full-service clinic. We offer services for all kinds of individuals – uninsured, insured – we have all kinds of different programs available here for different kinds of patients. We provide family practice, pediatrics, prenatal, HIV services – we oversee everything.

You’re combined here with the San Diego Rescue Mission. That must create a unique environment to work in.

Yeah. It actually is a perfect environment to work in. They have a lot of people that live there that haven’t seen a doctor for the last year, let alone maybe the last five to 10 years. They’ve been homeless, diagnosed with alcoholism, drug addiction and have several medical problems that haven’t been overseen by anyone. We work with them in getting them into our clinic or somewhere where they can be seen to get services for them and get screenings done: blood sugar, HIV, STDs, Hepatitis, we have a dental service that we refer them to at our ocean view clinic for a lot of the patients that haven’t had a lot of dental work done either. We refer out for anything we can’t oversee here.

What is the status of the majority of the people that come through here?

Unemployed, homeless, uninsured.

Can you tell me about doing this type of work as opposed to just working at a normal medical clinic?

It’s a challenge to work here. There’s no routine. We see several different problems per day with different patients that come from all aspects of life that come here. It’s a lot different than working in a regular clinic or hospital setting where you have the same routine of patients that you do pretty much the same things with.

What are some of the different things you would see here as opposed to a regular medical clinic?

Jungle rot trench foot.

A homeless patient may come in that hasn’t had a pair of clean socks to put on in the past year and they have bacteria growing in their shoes and now growing on their feet. That’s not a normal diagnosis you would see in a hospital.

And do you see that often here?

We had it last week.

I notice you have a full HIV clinic here. How often do you get people coming through here with HIV/AIDS?

We have an HIV specialist here that can see full scope HIV patients and AIDS. A large majority of the patients that come here, probably 75 to 80 percent have HIV/AIDS. This used to be an HIV clinic predominantly, but now it’s comprehensive, so were dwindling down to be split between HIV and AIDS and comprehensive health care coverage.

It seems like something that might take sort of an emotional toll on the employees here.

I don’t think it takes an emotional toll per se. I think that all of us that work here for CHC have a huge heart to be able to work with these patients. It does take a lot of understanding and patience ourselves to work with patients who have multiple diagnoses going on, be it mental problems, HIV or an STD or prenatal problems – some of them have been pregnant for eight months and they haven’t seen a doctor. It does take patience to work with our patients – you just have to have a big heart to understand them.

You said you see a lot of people with mental health problems. Is there a particular way you deal with someone like that?

With understanding and patience. And experience. With working with each other and learning how someone else might deal with it versus how you might have dealt with a regular patient in the past. Learning from our coworkers that have experience with patients with mental problems is really important.

Can you tell me of some instances that make this place such a rewarding and simultaneously difficult place to work at?

Having a patient come in that’s detoxing from heroin. That’s one of the most difficult patients to work with. But it’s amazing knowing that you’re actually an avenue – an access to health care by seeing this patient and having patience to work with him – and understanding getting through this difficult time. Seeing him and seeing that things are being done to help him, whether it be getting him a house in the Rescue Mission, or just getting him access to going to mental health, or getting his screenings done – finding avenues of different things for him to cope with detoxing. Going home after taking care of that patient makes me feel honored to be able to help these people that are less fortunate to me.

What’s the hardest part of doing this job?

Time. You only have eight hours a day to help take care of all of these people. You have to go home at some point and cut off your job from going home.

Do you find that difficult to do?

Well it’s confidential when you take care of patients all day. I can’t talk about what I’ve done with them or taken care of or seen. But just taking a shower and thinking about things, letting them go, and knowing that I get to go back to work tomorrow to deal with it.

So, you said earlier that it doesn’t take an emotional toll, but it obviously is a weight on your shoulders.

I don’t call it an emotional toll per se. But it is a weight on your shoulders. You just have to be open minded to dealing with all situations – taking them as they come each day.

And what’s the best way to do that?

Taking a warm shower. And then taking a nap.

– Interview by SAM HODGSON

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