Dr. Ed Spencer paused in the clinic's narrow hallway as he walked between a patient examination room and a light box on a wall displaying X-rays of an ankle.

"Most of the people here have interesting stories, almost without exception," he said. "Here" was the Utah Medical Assistance Program's clinic on the second floor of the Broadway Pharmacy Building, 250 E. 300 South, where 700 needy people find help every month."I think some are tragic stories and some are heroic. . . . It's a privilege for me to become involved in those stories."

UMAP is a state agency that serves as the last medical safety net for people who have fallen through the cracks in the system. Chronically short of money, it unabashedly relies on volunteers and gifts to supplement its funding.

The clients don't qualify for Medicaid or are waiting to qualify, and are low-income. Even though they may not meet the Medicaid criteria - for example, they might not be in the age range of below 18 or over 65 years - they still need medical care that they can't afford.

To get help from UMAP, patients must be needy, with physical conditions that are acute, life-threatening, infectious or likely to cause irreversible blindness. The program has clinics in Salt Lake City, Provo and Ogden.

Patients are referred through the Utah Department of Human Services' Office of Family Support.

Spencer, the longest-time volunteer helping the clinic, has a private orthopedics practice in the Salt Lake area. He comes in once a month.

About 80 percent of the people he treats for UMAP are victims of disease. Accident injuries account for the other cases. Most are spine or hip problems, although he helps with all sorts of muscular-skeletal system disorders.

"Some of them have injuries on the job and are not able to continue with their work. Others have had financial reverses," then became ill, he said.

"And others have brought things on themselves through alcohol abuse and a life of dissipation," Spencer added.

"A few of them are street people and a lot of them are in a (homeless) shelter." Some found refuge with relatives or are able to maintain their own housing.

Many patients are on work assistance, or have temporary employment. "Some of these are trying to get into a situation where they can become more independent," he said.

Serious injuries or illness render some people unable to work. But surgical correction is able to get some back onto their feet - at times, literally.

"The intent is to have them enter back into the loop of the meaningfully employed," Spencer said.

Andrea Hight, a health program representative for UMAP, has been searching out donations of funds, equipment and medicine for the program.

"Basically, I am the state scrounge," she said.

UMAP's state budget, amounting to about $3.3 million a year, has decreased or remained flat since 1987. Meanwhile, costs keep going up and the number of clients is increasing. For example, three years ago, the Salt Lake clinic rarely saw more than 200 patients a month, compared with today's 700 monthly.

Yet, she said, "We've been able to maintain our scope of services. We have not had to cut anything we've done because of lack of funding."

Volunteers and generous donors make up the difference.

"We have volunteer physicians, from family practice through specialities," she said. At rates set by Medicaid - which she said is about half of what medical workers normally charge - physicians have donated $42,400 worth of services since March 1.

In that same period, 1,235 patients received care through the volunteers. In Salt Lake City alone, physicians volunteered 571 hours of work.

In addition, chiropractors contributed $19,000 worth of time. "I think this really adds to our quality of care, since we give people options" to use the service of volunteer chiropractors, she said.

Drug company representatives donate money and medication. Some doctors perform usually expensive tests, such as one who checks for carpel tunnel syndrome.

Since March 1, UMAP has received more than $50,000 in donated goods, "and that's a conservative estimate," Hight said. "These include things like examination tables to go in medical rooms, dental equipment, crutches, splints."

Mt. Olympus Radiology and radiologists from the University of Utah read X-rays free of charge at the Salt Lake clinic, while FHP donates the taking and reading of X-rays for patients in Provo.

Until now, dental services provided by UMAP have been relatively basic - extracting infected teeth. But in February, the state plans to open a dental clinic with service for Medicaid patients who can't find a dentist.

"It will also provide dental care for our UMAP patients, because what we want to do for our clientele is to rehabilitate," she said.

Pulling a tooth can leave an unsightly gap. But if it can be saved instead, "this also helps them become more employable."

Hight estimated that FHP has donated at least $20,000 worth of dental chairs, X-ray machines and equipment.

"The Church of Jesus Christ of Latter-day Saints has contributed $8,500 in cash to purchase equipment and donated instruments and equipment that we didn't have from anywhere else. They've pretty much filled in the gaps for us."

Starting on Jan. 9, the UMAP clinic will be open in the evenings until 8 p.m. for urgent care. "This will give Medicaid and UMAP clients an alternative to (hospital) emergency rooms," she said.

What good does UMAP do? Hight illustrated that with the story of a woman who was having trouble locating a doctor to check on lumps in her neck. She ended up going to the UMAP clinic, where the lumps were found to be cancerous.

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"Our volunteer oncologist saw her the same day - surgery the next day." The oncologist has been helping the woman with follow-up treatment, Hight said.

Asked why he volunteers his time month after month, Spencer had a simple explanation.

This kind of medical practice is rewarding, he said. Offering service to the poor "gives a feeling of happiness and satisfaction . . . .

"It's a step away from the commercialization of medicine that's coming on us."

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