Sunday, October 12, 2003

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Liliana Ticlla arrives at the South Side clinic looking apprehensive and in obvious pain from the severe headache she'd been battling.

"I went for help to a hospital; I offered to pay, but they said they couldn't help me," says Ticlla of Mount Oliver, a Peruvian who has lived here for almost two years.

She was referred to the Birmingham Free Clinic on 9th Street, which offers Spanish-language services on Saturdays. She caught a ride there and sat in the tiny waiting area, speaking quietly in Spanish of her worries as she waited.

Then along comes Julian. Julian Escobar is a fourth-year medical student at the University of Pittsburgh, a warm, intelligent, never-resting, bilingual force of nature.

He sits down with her, looks right into her eyes, introduces himself and explains how everything is going to work. You can see right off that everything will somehow be OK. He and the other people who work at the Birmingham Free Clinic on the South Side are experts at helping uninsured and underinsured people get services and navigate the confusing health-care system maze.

It's even more confusing if you don't speak English. Allegheny County, with its small Latino population, has little in the way of medical services for Spanish speakers. Many hospitals have no one regularly available to translate, and forms are often not available in Spanish.

The Spanish-language clinic and related services are aimed at easing that problem. The clinic is just over a year old, created by Escobar and fellow student Melisha Krejci, 26.

Escobar, 27, knows the experience of negotiating a foreign medical system firsthand.

He grew up in Colombia, lived in Costa Rica for three years and arrived in the United States at 15.

His mother needed to see a gynecologist, and no one in the family spoke fluent English except his father, who was traveling for his job and couldn't help.

It was left to the teenage son to translate pages and pages of forms seeking his mother's medical history.

"My English was minimal. I could barely translate this stuff to begin with, and I didn't want to be asking my mom questions about when she had sex for the first time, STDs. It was completely traumatic."

He turned that experience into a series of projects he's taken on to help people caught in the similar situations.

In school at the University of Georgia, he knocked on doors in an Athens trailer park, offering to help people find services, pay bills, translate forms. He found a clinic that served homeless patients and starting taking Latinos there. When he was in Washington, D.C., on a National Institutes of Health fellowship, he worked with Latinos at an HIV clinic. When he got to Pittsburgh, he didn't find many Latinos at first, but eventually he and Krejci came across a study on the health-care needs of Latinos in Allegheny County.

"We started brainstorming," says Krejci, 26. "We wanted to start something that other medical students could continue" after she and Escobar graduate. They hooked up with the Birmingham Free Clinic, which has been operating for 10 years, offering free services.

The clinic is a small space donated by the Salvation Army in a building it owns, UPMC Montefiore donates office space, various other organizations donate free or inexpensive medicines and supplies, and the University of Pittsburgh Medical School rotates students -- some volunteer for the experience, others for credit -- through the clinic, which is open three days a week.

Latino patients often hear about the clinic through word of mouth, through the SALUD Web site or are referred there by other medical facilities, as Ticlla was. The clinic is open Saturdays from 10 a.m. to 1 p.m.

"The patients we get not only have the one problem, they usually have a ton of other problems," said Escobar. "The patients we see often haven't seen a doctor for years. They might not be legal -- we don't ask -- but other places do. Another factor is money. They hear how expensive [a doctor's appointment] is, so they don't go till they need emergency care."

The clinic handles everything from the brown recluse spider bite suffered by a man there the same day Ticlla was, to driver's license physicals, to management of chronic hypertension and diabetes. For cases that require more specialized care, the staff and volunteers have developed a network of contacts who can provide free or low-cost services.

"I wanted to create something here because it's so hard to navigate the system," said Escobar. "When my family came, we came in a privileged position. My dad had a job, unlike many people. We were educated. But we still had to struggle going to the doctor. You have to cross so many boundaries."

An index to Here, a weekly feature produced by Post-Gazette photographers and writers who roam the region to capture close-up slices of life here.

Lillian Thomas can be reached at lthomas@post-gazette.com or 412-263-3566. Martha Rial can be reached at mrial@post-gazette.com

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