Her first stop one morning was the building at 262 N. Hamlin Ave. where the grounds outside were littered with fast-food cartons and a used disposable diaper that had been wadded into a ball. In the corridors, there was a heavy, stale smell to the air. Alice Evans already had been up and down three flights of stairs to knock on a door that nobody answered.
But she was not about to give up. Not yet.
Evans, a public health nurse for the Chicago Department of Health, had come to check on a 22-year-old woman who had been living in a dismal two-bedroom apartment with 10 other family members when she tested positive for tuberculosis. The woman had a spotty record of making it to clinic
appointments, and Evans said she had once stopped taking her medicine just because she felt better, failing to understand that her disease is not so easily cured.
Both she and her 7-week-old baby were supposed to be on medication.
On the sidewalk outside the building, Evans looked oddly out of place in her regulation powder blue and white uniform and white nursing shoes as she talked with a woman in hair curlers through a screenless window and quizzed a young man buttoning his shirt as he bolted out of a door. It took a little coaxing, but Evans learned what she needed to know.
Grabbing her navy-colored cloth nursing bag, she waded through calf-high grass in a vacant lot and trudged up a set of rickety outdoor backstairs. At the top floor of a nearby tenement, she smiled at the young woman who was waiting for her as she stopped to catch her breath.
Finally, she found Michelle.
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Alice Evans is one of 70 registered nurses who work for the City of Chicago, one in a small cadre of field nurses whose job it is to take free medical care to people who do not always seek it. Their clients live in some of the city`s poorest neighborhoods and in the most troubled homes.
Because there are so few of them, these nurses struggle to manage caseloads of as many as 100 hard-to-reach clients whose medical problems include infectious diseases that require daily medication, high-risk infants whose mothers may not understand the importance of keeping clinic
appointments, and an increasing indigent population who see doctors only in a crisis that might have been averted with preventive medical care.
Last year, the city`s public health nurses logged some 30,000 home visits, doling out nursing and supportive services to an average of three people at each address.
But according to Jean Wood, the director of the city`s nursing program, the city is providing only one nurse for every 18,000 poor people. This at a time when other health-care agencies have cut back on home visits to the nonpaying population and to people for whom federal and state medical programs do not fully reimburse.
”We`re far from where we ought to be,” Wood said, explaining that the city is not even meeting 40 percent of the need.
There is no shortage of cases. In some parts of the city, like the West Side`s Austin neighborhood where nurse Alice Evans works, new referrals come in from city health clinics, hospitals, social agencies, and from birth certificates that the nurses sort through looking for health problems at a rate of as many as 200 a week.
Because of Chicago`s high infant mortality rate, nurses are asked to prioritize cases involving high-risk infants and pregnant mothers who need prenatal care. The goal is to visit the mothers twice during pregnancy and the infants five times in the first year, but Wood said that heavy caseloads mean many infants are visited only three times.
Since 1985, when she took over the nursing program, Wood has boosted the number of working field nurses to 70 from only 17. A city like Chicago, she said, should have about 153 nurses visiting homes. This year, Wood said she would like to recruit 13 more.
But whether she will see much of an increase is unclear.
Though Dr. Lonnie Edwards, the city`s health commissioner, complained last fall during city budget hearings that requests for adequate numbers of public health nurses had been routinely denied, he is not talking about the situation now.
Instead, a department spokesman sent inquiries to Patrick Lenihan, Edwards` deputy commissioner for planning, whose comments did not lend support to what Edwards and Wood have said.
”At this time, there is an adequate number of nurses to do an effective job,” Lenihan explained.
”I could never support that statement,” Wood said.
Public health nurses have a steadier work schedule than their counterparts in many institutional settings-no weekends, no holidays, no nights-just Monday through Friday, 8 to 4. But not every nurse is suited for this job.
A new contract is under negotiation, but the Department of Health`s current $22,800 starting salary for a nurse with the required baccalaureate degree is about $1,000 less than a nurse working in a similar capacity for Cook County and from $1,100 to $4,300 under the starting salary at various Chicago hospitals, according to figures supplied by the Illinois Nurses Association.
Each year, Barbara Izenstark, the public health nurse in charge of the city`s Uptown Health Center, oversees a new crop of nursing students who take a training rotation in public health.
Izenstark is troubled by some of what she sees. Not a lot of students seem to take to community nursing. And she has to field complaints from parents who are not happy about the kind of homes and neighborhoods their children must venture into when they train.
Out of a class of 100, Izenstark said only 4 or 5 nurses ever express a real interest in public health nursing.
”I guess that`s better than nothing,” Izenstark said.
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”I know you`re angry,” said Alice Evans as she sat on a kitchen chair and tested the baby`s reflexes. Michelle watched from the edge of a bed.
”You understand we`re not saying your child has tuberculosis,” Evans said in her gentle but firm voice. ”We`re saying she`s predisposed, and you must make sure that you give her the medicine every single day so that she has a fighting chance. Never run out of it,” Evans said, leaning over close.
”Never run out.”
”I think she`s got an eye infection,” said Michelle as she began picking at the corner of the infant`s eye with a finger. Gently, Evans tried to persuade her to do it a different way. ”It`s best to use a Q-tip to do that, or a sterile cotton ball so you won`t pass on your germs.”
Evans has been in nursing for more than 25 years, but she said some of her most valuable years have been the last 4 she has spent with the Department of Health. Though she is alone in dangerous neighborhoods and dark buildings where she has seen drugs and money pass hands, she has never met with trouble. She feels she is reaching the people who need her the most.
She has treated the newborn sent home from the hospital after receiving hundreds of thousands of dollars in lifesaving medical treatment only to discover that the mother had disconnected the monitor because she said she was irritated by the beeping noise alerting her that the baby`s breathing was erratic or had stopped.
She has counseled the 14-year-old mother who misunderstood her baby`s sucking reflex and thought it meant the baby was hungry for more than formula. So she was feeding the 3-month-old infant carrots from a jar.
And she`s grieved for the young woman who lost one baby to sudden infant death syndrome and was doing her best to follow Evans` advice and make all of her clinic appointments so her second child would have a better chance. But before the first birthday, that child, too, had died.
”I don`t look for the big miracles,” Evans explains. ”The nurses who do don`t stay in this job for long.”
As much as anything, she tries to make connections with young women like Michelle as a caring friend.
”Nobody touches your head, do they?” Evans said to the baby who started screaming the minute she reflexively caressed its head. ”Michelle, you won`t hurt the baby. She`ll like it. Look,” she said, rubbing. ”Like this.”
Evans asked enough questions to be confident Michelle was taking her medication and correctly giving it to the child. She asked to see the medicine bottles just to be sure. She took a few minutes to discuss birth control and basic infant care, and she listened to Michelle talk about why she was spending time away from her family and staying in an apartment with a friend. Then it was time to go.
But Michelle did not walk her to the door. When Alice Evans left her, Michelle was concentrating on stroking her baby`s head in small, tentative motions, trying to do it just like Evans had done.
