Blanca Muñoz is the lady with the van. The assistant health educator from Stockton drives a bright turquoise RV with the Kaiser Permanente logo and Thrive emblem across California's Central Valley.
By 8:30 a.m. on a recent Wednesday, about a dozen patients are already sitting in neatly arranged chairs outside the CARES Resource Center in Turlock, which serves the town's homeless and low-income residents, waiting for Muñoz and her colleagues. By late afternoon the clinic's two health assistants, nurse practitioner and physician will have seen more than 30 patients. Some days, they see as many as 60. There is no hospital in Turlock and there are no free clinics. The closest services are in Modesto, a 15-mile bus ride away.
Manuel Rodriguez, 67, is back for a follow-up visit, concerned about his cholesterol and high blood pressure. Muñoz says he reminds her of her husband's grandfather. After drawing blood and taking Rodriguez' blood pressure, she translates for Michael Wong, MD. Having grown up as the eldest girl in a farm worker family, she interprets cultural context as much as language.
'I just picture my family members'
"I've done this all my life; I've translated for family members," says Muñoz, who emigrated from Zaculpan, Mexico, to California with her family when she was 4. "When I see patients, I just picture my family members."
The mobile clinic, funded by Northern California's Community Benefit program, is part of Kaiser Permanente's commitment to providing care to the underserved. The team performs blood pressure checks, cholesterol and diabetes screenings and dispenses over-the-counter medications and antibiotics. Many patients have not seen a health provider for years.
Muñoz visits six sites in the Stockton/Modesto area each month. "It doesn't feel demanding when I get to know the patients."
Rodriguez, who gets seasonal work in agricultural packing plants or picking fruit, sends most of his meager earnings home to his family in Mexico. "It's a big problem because we don't have Medicare, we don't have insurance, we don't have permanent jobs," he said.
Few options for care
"I wouldn't know where else to go for care," explained Rodriguez in Spanish. "I am very grateful."
Because the mobile clinic is limited in the services it provides, the clinic's emphasis is on prevention through education. Muñoz and her colleagues hope to keep patients from using the county's overburdened emergency rooms for routine care. Such visits drive up the cost of care, and poor patients often receive inadequate follow-up, they say.
"We provide them with education," said nurse practitioner Pam Burnside Dias, who also travels with the mobile clinic, "and with referrals to local providers who see the uninsured."
Rodriguez, who has been unable to lower his cholesterol and blood pressure by changing his diet, gets referred to a free clinic in Modesto, where he can receive prescriptions and follow-up tests. The voucher for his bus fare is covered by KP.
Muñoz, who used to work as a lab assistant, draws satisfaction from teaching patients to take charge of their health. She is working on her prerequisites for nursing school and hopes to start next fall, something she has dreamed about since she was a child. She says her relatives often call her for advice about their health and are looking forward to the day she has an RN attached to her name.
Meanwhile, she's the lady with the van who enjoys her challenging job.
"This is one of my favorite clinics," she says. "You can tell how appreciative people are."