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sured and underinsured. Only about one-third of MMO expens- es are covered by reimbursement for services through Medicaid and Medicare. Essential program components such as free med- ical care for the uninsured, counseling, preventive dental sup- plies and case management depend on private donations and private and federal grants. As a mission-driven organization committed to "health care for all," Mobile Medical Office evolved from Dr. Ring's original vi- sion to become an integral part of what rural health providers refer to as the "rural health care safety net." Dr. Ring, a general practitioner who holds a masters degree in public health from Columbia University, still works for Mobile Medical, and is now part of a team of diverse health care professionals who provide a variety of services to meet patient needs. That diverse team in operation today includes the MMO sup- port staff shadowing the mobile clinic at the Serenity Inn: Carol McNeill, a mental health counselor, Phyllis Sovereign, a substance abuse counselor, and Les Rastorfer, who calls himself "an expert paper pusher," have all set up shop this day in the Inn. Rastorfer, a former Social Security Administration employee, says not many people who use the mobile clinic understand what assistance is available to them, nor how to access it. "How can people navigate the system with all the other issues they have?" he says, naming drug abuse and mental illness. "Many clients live in campgrounds, their cars, low-end motels, halfway houses or on the street. Maintaining the required paper- work is not an option." Already waiting for MMO services inside the motel lobby is Clara, a soft-spoken woman over 50, who has utilized the serv- ices for many years. "I live down the block," she says, indicat- ing another motel north along the highway. It is one of many low-cost motels informally catering to the transient population, but not at all like the Serenity Inn, which has strict rules of con- duct and only takes in people who are committed to rehabilita- tion. Clara was homeless for about a year, explaining, "I got mixed up with some bad people, so now I live alone." She is eager to talk about her seven-week-old Labrador pup, one of the reasons she is staying in the motel down the road … they allow pets, a rarity among the low-budget digs in the area. Paula Rhude, RN and certified family nurse practitioner, en- ters the lobby and asks Clara if she will be seeing her today. Clara says she's only there for a prescription refill (the Mobile Medical Office is certified as a small pharmacy), but Rhude asks her to come with her anyway. Conducting an informal intake as they cross the parking lot to the office, Rhude asks Clara questions to clarify her needs. Rhude knows Clara well; she acted as Clara's case manager while Clara went through cataract surgery. "She probably wouldn't have had the surgery if it hadn't been for Mo- bile Medical," says Rhude. Once inside the mobile clinic, Rhude, again in her role as case manager, makes appointments for Clara over the phone. She also may drive clients to appointments as part of her job. Many of the clients Rhude sees on visits to the Serenity Inn are not neces- sarily substance abusers; some suffer from mental disabilities and chronic homelessness, so Rhude is at the ready to coordi- nate care beyond the office visit. When she finishes her visit with Clara, Rhude uses a walkie- talkie to tell Ward that she's ready to see the next patient. Be- tween clients, Rhude is busy with tasks her medical assistant, who is out sick today, would otherwise perform. It's not uncom- mon, however, for everyone to chip in pulling patient charts or filing papers. Like other members of the Mobile Medical staff, Rhude does whatever it takes to deliver care. Rhude came to Mobile Medical Office two years ago. She spent most of her career as an RN in the San Francisco Bay Area work- ing in women's health. Though she enjoyed her work at what she described as "an upscale GYN practice," she wondered about women who couldn't afford health services and wanted to "do more." When she moved to Humboldt County, Mobile Medical Office's vision matched her growing concerns. "It's amazing," says Rhude. "Because of the way Mobile Med- ical Office is set up, someone can come in and be in pretty bad shape and I can get them access, right here in the moment, to a substance abuse counselor, case manager or social services." Rhude adds that there are misconceptions about the people she treats. "There is a lot of mental illness out there. You would be surprised at how many cases I see of people who've had head trauma. These people don't do well long term and end up with associated mental issues long after the initial injury. This often leads to unemployment and homelessness." Rhude says that what can be discouraging about working with a substance abusing or homeless population is seeing children who, without intervention, will likely go the same way as their parents. But Rhude believes that Mobile Medical Office provides the kind of intervention and education that can turn a child's life around. "I sometimes see Eureka and some of the outlying areas as a sort of informal refugee camp," says Rhude. "Because of decreas- ing jobs for low-skilled people, and increasing housing costs, more and more people are living in their campers. You have bands of nomadic people here moving from place to place." Though people come from other states because they hear health care benefits are better here, Rhude says, "It doesn't take them long to figure out that they can't afford an apartment in California." Rhude talks about a case that illustrates how difficult proper development can be for these nomadic children. "There was one situation in which the family lived in a camper and they had a child whose development would otherwise have been normal. But he couldn't go to a Head Start program because they were always moving and, because of the physical confines of the camper they lived in, he simply did not have the physical space to stretch and crawl. So he was developmentally unequal to his peers." Sometime around noon, the lobby of the Serenity Inn erupts 14 M A R C H 2 0 0 6 W W W . C A L N U R S E S . O R G C A L I F O R N I A N U R S E NP RHUDE sees many people with head trauma. "These people don't do well long term and end up with associated mental issues" leading to unemployment and homelessness.