Miami Herald - SUN OCT 04 1987
Joe Rhodes, Herald Staff Writer

He was reclining in the chair, his back to the door, waiting for the anesthetic to deaden his nerves, waiting for the drilling to start. All he could see was the light shining into his eyes, the masked faces hovering above him.

He could not see Rose Freeman.

She had stayed behind, separated by a waist-high partition. She had greeted him by name when he entered the office, had called him sweetheart and led him to the chair. She had broken the rules by doing that. Rose Freeman had not been wearing her mask.

She knows she's supposed to do it and she understands the reasons why. This dental clinic is for AIDS patients. That is why there is plastic on the furniture, why there is a large container lined with red plastic bags marked "CONTAMINATED MATERIAL." That is why Rose Freeman is supposed to wear her mask.

But she cannot bear to do it, not when they first walk in. She understands why the dentist has to cover his face, understands that it is for the protection of the patients as much as the staff. The patients, after all, are the ones with the weakened immune systems.

"I know if I get a common cold, I can live with it," she said. "It may give them pneumonia.

"But I'm the first person they meet and they've already been rejected so much. If I'm all draped up from top to bottom, it makes them feel like they're being rejected again. I want them to know they're not outcasts. I want them to know that I care."

So Rose Freeman breaks the rules. She lets the patients see her face.

Nearly two months

It has been nearly two months since the Broward Public Health Unit's Northwest Health Center, located at 624 NW 15th Way in Fort Lauderdale, began functioning as a full-service AIDS outpatient clinic, the first of its kind in the state.

The dental clinic, currently open only Tuesday afternoons and Thursday mornings, is just a part of what they do here. There is a rotating staff of 14 physicians specializing in the diagnosis and care of AIDS, AIDS Related Complex (ARC) and the myriad complications that accompany the disease.

There are pharmacists and nutritionists, social workers and counselors. There are representatives from private organizations as well -- Hospice Care of Broward County, Center One, Hospice Inc. and the Visiting Nurse Association. There are links to a vast referral network and rooms loaded with educational material. This is a place filled with answers.

"This is different in that it's not hospital-based," explained Jasmin Shirley, a state Department of Health and Rehabilitative Services epidemiologist, the woman in charge of all this. "This is more of a community setting, more personal.

"And I believe the patients appreciate that. I think it has encouraged more and more people to not sit at home, to access the care and treatment that is here. I believe our patients are spreading the word."

The money comes from a variety of sources, some from the county, which provided the building and most of the equipment, some from the state, which pays for the staff. The heart of it all is a four-year $1.6 million grant from the Robert Woods Johnson Foundation and Shirley is confident that a million-dollar federal grant will be awarded soon.

The building is not much to look at from the outside, a one-story cinder-block fortress hidden away in a hard-times neighborhood, protected by high fencing and barbed wire. The rest of the block is a scary place, cluttered with broken-down cars, patrolled by stray dogs with frightened eyes. Across the street is a restaurant, The Johnny Ace, that has boards over the front windows, signs on the back wall saying, "No Loitering. No Drugs."

The neighborhood is the reason this clinic was built. This used to be a general purpose public dental clinic, a place for low-income people, especially children, to get free dental care.

"Since the facility was here and not being fully utilized, it made sense to use it," explained Dr. Richard K. Ames, the dental executive director for the Broward County Public Health Unit and dental consultant to the Northwest Health Center. "It would have cost us as much $200,000 to rent another building. Now that money can go toward care."

In some ways, Ames says, the clinic's location and its specialized function can be a comfort, an out-of-the-way place where patients can go without fear, a place where "you don't have people sitting around trying to figure out who's got AIDS."

Shirley hopes the time will come when that won't be so important. "I do believe that once people get through the myths and the fears about AIDS then AIDS patients will mainstream with general care. I don't want to this to always be a separate facility."

They only expected 250 patients here in the first year but already there are 60 active medical files, 30 more in the dental program. To be treated by a physician at the clinic a patient must be indigent and eligible for Medicaid and have either the HIV positive AIDS antibody, ARC or AIDS itself.

In the dental clinic, anyone with an AIDS-related condition is eligible, regardless of ability to pay. Patients are charged according to how much they can afford.

The reason is that while there are a number of private primary-care physicians willing to treat AIDS, there are few dentists. Ames would like to have five dentists working at this clinic, but he is having trouble finding volunteers. Only two dentists work there now. A third is expected in a few weeks. The dental appointment calendar is already booked through November.

"I understand their reluctance," said one of the dentists working at the outpatient facility. He said he was proud of his work with AIDS patients, that he felt safe, that he understood the risks. Still, he did not want his name published, unsure what effect it might have on his regular practice.

He spent the morning filling a cavity for a patient who had nowhere else to go, an AIDS patient with a broken bridge and impacted wisdom teeth.

"No one else would touch me," the patient said. "They just said, 'We will not treat people with AIDS.' I have money, I have good insurance, but they won't treat you, no matter what. And there still is no place that I can have caps made, this bridge rebuilt. They're not set up for it here.

"But I appreciate what they can do for me. It's a relief to know there's at least one place I can go."

Needed the most

Rose Freeman did not have to take this job. She had 13 years' experience as a dental assistant, eight at the county facility. Rose Freeman had seniority.

"I could have gone over to the main dental clinic," she said. "And they've got people running over each other trying to get those jobs. But I wanted to work here. I thought this was where I was needed the most."

So she waited beyond the partition, where the patient could not see her, while the dentist did his work. She handed them what he needed -- the cement, the fillings, the instruments -- as he requested it. She didn't pass anything in until it was needed, another rule, another way to keep things as sterile as possible.

When the drilling was over, the dentist and his assistant removed the gowns and the masks, put them into the red bags with all the other contaminated material, with the plastic from the chairs. Anything that wasn't disposed was immediately sterilized.

Then Rose Freeman wrote down the patient's next appointment, told him it would be December 10. Such a long time. She had seen people die in less time than that.

"I look at them and I don't see death," she said. "I only see life.

"I was never afraid to work here, it always felt like something I was meant to do. When you talk with people and let them know you care, you give them a little bit more life, a little more strength. I had that to give."

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