Frank Scalise sat in the back of an SUV and examined the frayed and darkened skin on the top of Matt Danczek’s foot as traffic rumbled by.
“It looks like that could be frostbite. I think you have done some damage to your skin here,” said Scalise, a physician’s assistant who works for the Colorado Coalition for the Homeless.
“I’m used to standing outside when it is sub-zero,” said Danczek, 43, who lives in a tunnel below an overpass that crosses Interstate 70 in Denver.
Scalise advised him how to protect the wound, and told him to come to the coalition’s Stout Street Clinic for treatment.
It was the day before Thanksgiving, and Scalise, outreach worker Mike McManus and paramedic Carrie Thompson were making their weekly visit to homeless camps in Denver as part of the coalition’s Health Outreach Program.
The coalition launched the program two years ago as part of an effort to offer “full-spectrum care” to the homeless. The outreach workers can treat simple medical conditions, or steer their patients to the Stout Street Clinic or a mobile clinic the coalition operates where they can get more in-depth treatment.
They offer advice on how to get an identification card and hand out warm clothing. They also suggest that some seek medical treatment from the coalition, the Veterans Administration or any other medical facility where patients may already have had care.
In the back of the white Kia Sorento, plastic boxes are filled with bandages and other items for wound care, over-the-counter medicines and simple laboratory equipment.
They carry a laptop computer to access medical records.
And while they are prepared to treat simple medical problems, most of the care they offered this day came in the form of advice.
One of the men sitting on a guardrail by the South Platte River told Scalise that he has been advised to have a colonoscopy, but he is not eager to go through the procedure.
Scalise tells him he will be given drugs and won’t be aware of the test until it is finished.
For outreach workers like McManus, who doesn’t have a medical background, the job is about getting to know people, sensing when they are prepared to make a change and directing them to the services they will need to accomplish a transition, he said.
He tells them he can help them get identification cards they need to work, and he can help them with the steps they must take to get housing.
“A lot of our job is trying to get people to care about themselves and show them that little things are possible. These guys haven’t had anything positive happen for years.”
It can take years to win their trust. “I have known people for three or four years before they open up and say they hear voices,” McManus said.
Nicholas Espinoza, 74, collects and sells junk and lives in his 1997 GMC pickup truck. He told Scalise he was shot in the arm years ago and the limb is now very weak.
Scalise suggested he come by the mobile clinic when it stops outside Father Woody’s Haven of Hope, a drop-in center in west Denver. “We can examine it and give you some idea about physical therapy.”
Matthew Cooper crawled out of a small, one-person tent and struggled to his feet when the outreach workers approached the camp site he calls home in a weed-choked section of Phil Milstein Park.
He told them about a rat that has been pestering him.
He was in the tent the night before eating ham when it began to snow and he got up to cover his tent, he said. “He went right in after my ham, and I chased him back out.”
Cooper, 48, is arthritic and says he uses heroin to treat the pain. One shot is all he needs to stay pain-free for a full day, he said.
As he talked, he prepared a syringe and plunged the needle into a vein in his forearm. “It used to be I’d get high, but it is not the high any more,” he said.
Moments later, the pain in his hands and feet was gone, he said.
“Do you want to come and see me in the van? Maybe I can give you some medicine,” Scalise said.
Cooper agreed to come to the van, but he had another problem. Little bumps have been developing all over his body, he said. Inside the eruptions are “little, hard crystals.”
Scalise suggested he might have gout, a painful type of arthritis caused by a buildup of uric acid in the body. With gout, uric acid crystal deposits sometimes develop beneath the skin around joints.
Scalise and Thompson looked at Cooper’s arms, checking the skin near the elbows, where the deposits sometimes show up. They found nothing.
Cooper showed them a crack in the skin on his hand, then began digging at it with a knife, trying to find a crystal to show them.
“Leave one in there and let it grow, and when you come by the van next Thursday, I can see,” Scalise said.
Tom McGhee: 303-954-1671, tmcghee@denverpost.com or twitter.com/dpmcghee