There are no signs on the building saying there is a health clinic inside, but the tiny waiting room is packed. Children play with toys on the floor, teens flip through magazines, mothers hold sleeping infants.
Inside an old elementary school in southeast Atlanta, not far from the Federal Penitentiary, the Community Advanced Practice Nurses Women and Children's Clinic's anonymity is part of its attraction.
The clinic is housed in one of Atlanta's few night shelters for homeless women and children, a 170-bed facility run by the Union Mission. The clinic provides free primary care and mental health services, and is supported by the city of Atlanta, the Atlanta Women's Foundation, state and federal grants, donations and the financial acumen of an eight-member board of directors. The nonprofit clinic is under the medical direction of Dr. Beverly Taylor of Morehouse School of Medicine, who provides her services pro bono.
Working here has made clinic director Connie Buchanan, MS, RN-C, FNP, aware of how little she knew about the effects of homelessness and poverty on self-esteem and selfworth, she said. A former pediatric nurse practitioner at Egleston Children's Hospital, Buchanan took a leap of faith when she joined the clinic staff a decade ago.
A resident of Atlanta, she was disturbed and drawn to the needs of the homeless. "I couldn't understand how a city with so much wealth had so much poverty," she said.
The clinic was started at another site 16 years ago by the Georgia Nurses Foundation, Buchanan said. When the GNF changed its mission a decade ago, seven health care professionals who were working there at the time, including Buchanan, incorporated. The organization's nonprofit board now includes two physicians who give guidance and financial support.
The reality of caring for her patients changed Buchanan's professional and personal life.
"When I came here in 1994, I planned to be here for three years," she said. Instead, 10 years have passed. In that time, she has seen a shift in the types of people who populate the shelter and seek services from the clinic.
"When I first came, there was a lot of domestic violence and people who were just in between places ... they could get a job and get out. There wasn't the joblessness we see now," she said.
Domestic abuse victims still come to the clinic, but the number of mentally ill patients has climbed. So has the number of sexual abuse cases, she said.
The clinic draws not only shelter residents, but members of the transgender and gay community, as well as others who hear about the clinic through word of mouth. "A big component [of clinic clients] is youth," who haven't lived with a guardian in years, she said.
Buchanan and her staff juggle a full schedule. A typical day's clients might include children who need immunizations, a teen who needs to be tested for sexually transmitted diseases, a woman who needs a Pap smear or someone who is suicidal and must be taken to Grady Memorial Hospital for treatment. The staff, which cares for clients dealing with drug addiction, sexual abuse, schizophrenia, AIDS or hepatitis, sees the human condition laid bare.
Staffer Robin Bledsoe, RN, MS, CS, is a familiar face on Grady's mental health wing. The board-certified psychiatric clinical nurse specialist provides mental health services to the clinic's patients and takes those who need help with psychiatric disorders or addiction to Grady.
"Nurses and NPs [nurse practitioners] are suited for dealing with special populations. We don't treat everything with a medicine. Some things are treated better with education," Buchanan said.
"This population is extremely needy. We need to think of absolutely everything during our first encounter with them, because we may not have another."
That was part of the attraction for Lindy Grabbe, RN, MS, Ph.D. Grabbe, a Peace Corps officer in Kazakstan who also worked as a family nurse practitioner at the U.S. Embassy in Cote d'Ivoire in western Africa for six years, began volunteering at the clinic in 1999 and joined the staff in 2002. "I had heard of the good work Connie was doing," Grabbe said.
The clinic also is a good training ground for medical and nursing students. Buchanan frequently oversees students and makes sure they get not only a clinical education, but also a lesson in the reality of poverty.
"They have no idea about the gaps in health care," Buchanan said. "They can't comprehend it."
Buchanan, a native of western North Carolina, grew up in the poverty of Appalachia. But this population is different, she said. "The Appalachian poor - we took better care of each other - a neighbor would help you in a way that was dignified. That doesn't happen in the city."
Understanding where her patients come from is a learning experience for Buchanan and the other nurses, she said.
"When people think of homeless people, they think of bag people. That's not always the case," she said.
For Buchanan, working at the clinic has been an eyeopening experience.
"I had to accept I really knew nothing about poverty, about the challenges people go through every week," she said. "I can't make assumptions, because every day, [those assumptions] are totally wiped out. We are constantly challenged in our thinking here. We have to meet people where they are."