The Haight's Community Clinic

Three decades of free medical care for the city's poor and homeless

Glen Martin, Chronicle Staff Writer

SAN FRANCISCO

With her candid gaze, fresh, dewy face and Salvation Army clothes,
she looked like any freespirited 17yearold girl except for
the needle abscesses on the inside of her arms.

``You got any points?'' she asked Susan Poff, a nurse practitioner
with the Haight Ashbury Free Clinic. Poff was providing streetside
medical care at the edge of Golden Gate Park at Haight and Stanyan
streets conducting exams, writing prescriptions and handing out
delousing shampoo and condoms to the ragged youths and homeless
oldtimers who cluster at the corner.

No, Poff answered, she didn't have any points that is, clean
hypodermic needles. But she knew an organization that did, and she
provided the address.

``There's also a guy who comes through here from the needle
exchange program named Dirthead,'' said Poff. ``He always has
plenty.''

The kid thanked her, started to walk away, and then turned back.

``They're not for me,'' she stammered. ``They're for a friend.'' Un
consciously, she trailed a hand across the scarred, pockmarked
skin of her left forearm.

``I understand,'' said Poff, her voice studiously neutral.

A lot of things have changed in the HaightAshbury. Run down and
funky in the 1960s, it is now one of San Francisco's prime
neighborhoods, an upscale zone of gentrified Victorians owned and
lovingly maintained by wellheeled professionals.

But some things remain very much the same, primarily Haight Street
itself and its drugdependent, homeless and, in some cases,
psychotic denizens.

There are still plenty of head shops along the Haight. Pot dealers
still stand on the corners, whispering ``buds, buds,'' to
passersby.

And the clinic still stands ready to serve the area's medical
needs, just as it did when it was founded in 1967 by Dr. David
Smith, then a justminted physician who was conducting
pharmacological research at the University of San Francisco.

Smith was intrigued by the hippies' communal philosophy and
experimentation with LSD he knew Charlie Manson when the
notorious mass murderer lived in the Haight, and even wrote a
scholarly monograph on Manson's unique approach to group marriage.

But Smith also saw that medical care was sorely lacking in the
Haight. There were drug overdoses, sexually transmitted diseases,
infectious maladies related to poor hygiene and sundry wounds.

He felt that a small community clinic could help, though his
expectations were low appropriately so, considering a severe
shortage of funds.

``We paid our first electric bill with $100 I made from a
lecture,'' Smith recalled recently in the clinic's Clayton Street
office. ``We had absolutely no funding. Then (rock promoter) Bill
Graham read about us in a Chronicle article and staged a series of
benefit concerts. That kept us going until we started getting
grants. In a very real sense, we were built on rock 'n' roll.''

$U'e clinic was the nation's first free medical provider
specifically designed to serve countercultural youth. Today, about
300 free clinics operate in the United States, most based on the
Haight model.

While the clinic's motto remains unchanged medical care is a
right, not a privilege the original vision has expanded greatly.
The clinic's mother organization, Haight Ashbury Free Clinics Inc.,
now supports six different programs, each in its own building.

Besides the free clinic, there are a woman's center, two drug
detoxification and rehabilitation centers, a psychiatric program
for jail inmates and an urgent care program for people who overdose
at rock concerts.

``Our focus has shifted as the needs of our clients have shifted,''
explained John Bouffard, the free clinic's director. ``HIV and AIDS
are now a major part of our work, as are diseases associated with
an aging population, such as hypertension and diabetes.''

The clinic also is moving beyond its original primary care mission
to the role of comprehensive health services provider.

``We now offer a whole range of services, including physical
therapy, podiatric care and acupuncture, nutrition counseling,
pediatric care, street outreach and several medical
subspecialties,'' said Bouffard. ``We've also bought a new building
that will expand our available clinic space by five or six times.''

Smith said free clinics are filling a vacuum created by the
nation's health care policy or rather, by the lack of one.

``Free clinics like ours are now institutionalized as a response to
the needs of the uninsured,'' said Smith. ``In California, that's
25 percent of the population. We're not talking about a small group
of hippies anymore. We're talking working people, retired people,
people of all ethnic groups and races it's across the board,''

Smith makes no attempt to disguise his disgust with America's
health care system, which he describes as ``deteriorating.''

``Virtually everyone you talk to is disillusioned by forprofit
health care,'' Smith said. ``The rampant fraud, the refusal of
managers to care for the poor it's disgraceful. The problem is
that doctors have the responsibility under managed care, but not
the authority. The accountants have the authority. They say what
tests are conducted, what procedures are authorized.''

At the HaightAshbury Free Clinic, treatment remains free but
it's an increasingly expensive proposition. Government grants are
drying up, and private donations are more essential than ever,
Bouffard said.

The clinic's yearly budget for all six programs totals $12 million.
About 300 paid staffers and 500 volunteers serve 20,000 patients. A
total of 55,000 visits are logged annually.

``There are a lot of uninsured people out there, and their numbers
are growing,'' Bouffard said.

Many of those underinsured and uninsured clients, of course, are
members of the Haight's notorious street population. They bring a
special set of medical challenges to the clinic, many related to
substance abuse.

As they have since the Summer of Love, clinic staffers remain
resolutely nonjudgmental about the drug and alcohol habits of their
clients. They say they are there to treat people, not preach to
them in large part because clinic doctrine maintains that
addiction is a disease, not a choice.

``It's the single most important thing I've learned here,'' said
the clinic's drug treatment services director, Darryl Inaba, a
30year veteran of the clinic.

``Some people can use drugs recreationally,'' Inaba said. ``Some
can't. The evidence is strong that all moodaltering drugs affect
the same areas of the brain, and that addicts are particularly
susceptible to having these neurological areas stimulated.''

Inaba said that addiction is as much a medical disorder as epilepsy
or high blood pressure.

``It's important for addicts to know that,'' he said.
``Rehabilitation is impossible for people focused on guilt and
selfloathing instead of their treatment.''

Another thing Inaba has learned in three decades on the job is that
what goes round, comes round.

``It's just amazing,'' he said. ``When we started out, the drugs of
choice were marijuana and LSD. Then it shifted to heroin and
amphetamines, and then to powder cocaine, and finally to crack.
Today, we're back where we were in the late 1960s and early 1970s.
We've already gone through pot and hallucinogens again, and now
we're seeing lots of heroin and meth.''

To paraphrase the Grateful Dead, it has been a long, strange trip
for both the counterculture and the precedentsetting medical
facility that serves it. Praised for its good works by the city's
luminaries, the clinic's most fervent boosters remain its clients:
the working poor, impoverished immigrants, old homeless hippies,
the teenage runaways and street hustlers.

Like everybody else, these people sometimes need medical care. If
they don't get it here, they simply don't get it.

``We couldn't survive without them,'' said Deirde Anderson, a
homeless woman.

``They keep me supplied with bandages and topical antibiotics so I
can help take care of the kids out here,'' Anderson said. ``All the
other (social agencies) try to tell us what we need. The Free
Clinic is different. They ask us about our needs and then they
do their best to take care of them.''

(c) The Chronicle Publishing Company