While the clinic has the funds to administer 400 to 500 shots, administrators hope to distribute 1,300 flu shots.

"This is one of the most susceptible populations," said marketing director Jenn Hyvonen.

The flu can trigger a host of medical problems in homeless people and send them to an emergency room, visits costing hundreds to thousands of dollars, she said. A flu shot costs about $10.

The tenets of staying healthy can be hard for any diabetic: Eat meals and snacks at the same time each day; include lots of vegetables in your diet, fewer refined foods; check your blood sugar regularly; don't skip meals.

But the disease is even more problematic when access to medical care and food - let alone healthy food - is limited.

"It's hard to do when you're homeless - to keep your sugar under control," said Vonda Dewey, a diabetic for 18 years and on the streets for three.

Last week, she got a check-up and filled her prescription at no cost at downtown Salt Lake City's Fourth Street Clinic.

While Dewey sat on the edge of a medical table, nurse practitioner Amy Whipple placed a stethoscope over her heart. Then with her fingers, Whipple felt for a pulse in Dewey's neck, at her wrists, palms, calves, ankles and toes to make sure blood was flowing well.

"You've got corns on the bottom of your feet," Whipple said, crouching down and lifting Dewey's foot up, noting the callus can lead to complications and become painful. "There are pads you can buy. . . ."

"Yeah, I seen them, but I don't have no money right now, so I'm just going to have to deal with that," Dewey replied, adding the calluses do tickle and hurt.

As Dewey was leaving, Charles Carnes, also a diabetic, hunched over in his wheelchair on the other side of the clinic. It's back pain, he said. Carnes was hit by a truck about four months ago and is at the clinic to get pain medicine.

He's been a patient at the clinic since 1999 after losing his apartment and car. Once he gets the taxi voucher to pay for his ride back to The Road Home, he slowly shuffles his feet to pull himself through the clinic and out onto the sidewalk.

It's amazing how much pain they can tolerate, Whipple later says about clients she sees each day.

While some might want an appointment after the first inkling of a sore throat, others are so used to feeling bad, either from regular aches or just being tired, they can't tell when something is really wrong.

"The severity of disease that patients come in with, that they've let go for years and years and years, is unbelievable," Whipple said. "You and I would not have been walking around with this for years."

The types of illnesses she sees at the Fourth Street Clinic are another surprise to Whipple.

"A lot of stuff that I studied in school I thought, 'I'd never see this' - but I see it here," she said, adding, "I thought I'd need to go to a Third World country to see it."

That's why Jenn Hyvonen calls the clinic a "clearinghouse."

"We get the sickest of the sickest," said Hyvonen, the clinic's marketing and communication director.

Patients often come in with one problem, and in the course of a check-up, physicians can discover several illnesses.

Because of unsanitary living conditions on the streets, exposure to cold and wet weather and lack of a place to refrigerate healthy foods, Hyvonen said, "in order to really be well, you need a home."

The clinic works with area organizations to help patients find a permanent place to live because "once they're able to get into that housing," she said. "Their health goes up."

But she says illnesses can also lead to homelessness.

Without insurance, people let conditions go undiagnosed and untreated until they become so severe a person can no longer work and sustain himself or herself.

With the recent rise of home foreclosures and unemployment coupled with increasing costs for health insurance, Executive Director Allan Ainsworth expects more people on the brink of homelessness.

"We're definitely going to be seeing more patients than we've been seeing," said Ainsworth, who founded the clinic 20 years ago.

While in past years the clinic and its partners were making inroads into preventing chronic homelessness, this year, he said - "I see them getting worse for the first time in several years."

mariav@sltrib.com

Season of giving

Between now and Christmas, The Tribune will profile organizations that help people in need.

* To help the Fourth Street Clinic, contact staff at the facility, 404 S. 400 West, Salt Lake City. Find information online at www.fourthstreetclinic.org, or call 801-364-0058.

* To learn how to help others or to find help, please visit www.sltrib.com/giving.