A slight man with a stethoscope and black medical bag regularly walks through Tucson's downtown public library, helping patrons with issues that have nothing to do with books.
Daniel Lopez is not a librarian, but one of the nation's first library nurses. He checks the feet of diabetics, takes blood pressure, gives out condoms and intervenes in medical emergencies.
Lopez is Pima County's novel answer to a common issue in public libraries across the country - a growing number of patrons living without shelter, health insurance, medical care or computer access. They come to the library looking not only for resources, but also for safety and protection from the elements. The shaky economy and high unemployment have further fueled the need.
In response, some urban libraries have hired child psychologists, social workers and language teachers. Others bring in teachers to help kids with homework. No other public library system in the country is known to employ nurses, says the nation's largest library association.
"We are branching out from the library-science degree and filling positions with other expertises that apply as well," said Marcia Warner, past president of the Public Library Association, a division of the American Library Association. "We serve all populations, and some populations have different issues. It's just part of serving the public."
"One more enhancement"
The national association encourages libraries to create programs for homeless and other disadvantaged patrons because public libraries are about equal access to information for everyone, Warner said.
"We don't just serve middle-class people. We serve all populations," she said. "We don't think twice about having security in urban libraries. This is just one more enhancement."
Local library officials had been wanting to to address social service needs among patrons for several years but weren't quite certain how. Then in 2010, when the San Francisco Public Library took the unprecedented step of hiring a social worker, Pima County officials were inspired to take similar action.
"It was like a light bulb went off," said Karyn Prechtel, chief librarian for the Pima County Public Library's Joel D. Valdez Main Library in downtown Tucson. "It seemed brilliant. I was able to meet with the people in San Francisco, and we went from there."
The library partnered with the county Health Department to do something similar and decided a public-health nurse would be the best local solution.
"So many of our customers are uninsured and a lot are telling us they can't afford their meds, that they can't manage their diabetes. The problem is really complex," Prechtel said. "A public-health nurse can potentially influence the health of the community. That is thinking big. But they can talk about problems they see and we can all work on solutions together."
"The Nurse is in"
On a typical Monday, Lopez moves through the downtown library, gently approaching patrons to let them know what he does. Some patrons, knowing Lopez's schedule, seek him out.
On Wednesdays, he works out of the Woods Memorial branch, 3455 N. First Ave., on Tucson's north side. Employees there put up a sandwich-board sign when Lopez is working. It says, "The Nurse Is In: Blood Pressure Screening, Health Education, Community Resources."
Some of the people he talks to are homeless; some are addicts. Many have no health insurance. Mental health issues are common.
Patrons like Dan Russell, 65, have chronic health conditions. Russell, a retired cook, goes to Woods every day to read the newspaper. He has high blood pressure, and Lopez helps him to monitor it between quarterly visits to his doctor.
On one recent Wednesday, Lopez helped a young mother at Woods as she scanned the jobs board. She works in a convenience store but wants to find a job where she feels safer. When Lopez asks whether she has health concerns, the woman says she is covered by the state's Medicaid program for the indigent, but that she hasn't been able to get a doctor's appointment to get her daughter immunized. Lopez gives her information about a county immunization clinic.
All are facing hardship
There's no general demographic profile of those who need services, downtown librarian Prechtel said. The commonality is that all are facing some sort of individual hardship, and all come to the library because it's a safe place where they know they can get information, she said.
"Public libraries have always served the poor and people who are disenfranchised. We've always had customers who need extra support," she said.
The library nurse program is jointly funded by the county's library system and its Health Department and costs $67,300 per year - the annual cost of one full-time public-health nurse. Five Pima County public-health nurses divide the equivalent of one full-time position among them. The five nurses work weekdays at six local libraries.
During his downtown shift, Lopez encounters a man in his 30s sitting in the children's area with his daughter. The man, who is living in a shelter, is happy that he just got a job, for $8.25 per hour. He'd been looking for a long time. But the job doesn't include health insurance, and he's afraid his income will be too high to continue qualifying for Medicaid. A diabetic, he worries he won't be able to afford his medication.
Lopez, who started his job in July, gives him information about local community-health centers and mobile clinics that offer care on a sliding scale. It's important to continue with medication, Lopez cautions.
"If you manage your diabetes," he tells the man, "you can avoid amputations."
No health insurance
Lopez encounters people without health insurance on virtually every shift. A lot are unemployed. Dental care is a big worry. Many of them skip it to save money - but that can invite infection and other illness. Some of the people who are most confused are those who have recently lost jobs and have never been unemployed before.
"A lot of what I do is education," Lopez said. "The stethoscope is mostly so people recognize me."
He has helped people with detoxification, psychiatric crisis, injury and acute illnesses. The nurses also prevent people from using library restrooms for bathing, librarian Prechtel said.
Lopez's rounds at the downtown library include a visit outside to the many homeless men who regularly congregate there. Several know him by name, though it has been a struggle to earn their trust.
One of Lopez's key contributions to the downtown library has been preventing 911 calls. The main library has about 10 of them per month, usually from angry people, said Prechtel.
"We don't want to call 911. We call when we don't see any other options. Usually it is a mentally ill customer who is not doing anything criminal but we can't manage them," she said. "We've already seen our nurses intervene in episodes before the behavior escalates. That is critical."
Prechtel says the program will be constantly evaluated as economic conditions and health care change, but she suspects there will always be a place for public-health nurses in the library.
"It is new thinking," the Public Library Association's Warner said. "We are so used to passing out information, but we don't always do such a good job with following up on that information, making sure people are getting the help they need."
Tucson-area library branches staffed by a nurse:
• Joel D. Valdez Main Library, 101 N. Stone Ave.
• Woods Memorial, 3455 N. First Ave.
• Martha Cooper, 1377 N. Catalina Ave.
• Sam Lena-South Tucson, 1607 S. Sixth Ave.
• Santa Rosa, 1075 S. 10th Ave.
• Eckstrom-Columbus, Pima Community College 29th Street Coalition Center, 4355 E. Calle Aurora (temporary location)
"A lot of what I do is education.
The stethoscope is mostly so people recognize me."
Daniel Lopez, registered nurse
Contact reporter Stephanie Innes at firstname.lastname@example.org or 573-4134