Sharon Winget, a social worker with the Health Care for the Homeless Project, was misidentified in a photo caption in yesterday's Metro section. (Published 9/8/87)

As temperatures approached 100 degrees, Robert, a grizzled, 43-year-old itinerant, staked his claim on a grate in the park across the street from the Corcoran Gallery. Blasts of hot, stale air stirred the flies buzzing around Robert's pungent pile of newspapers, clothing, cola cans and hunk of salami.

Robert, who sometimes trades the grate for a bench on the Mall, is not inclined to talk much to strangers, nor are they apt to talk to him, but he readily pokes his head out from under his blanket when Sharon Winget climbs out of a familiar burgundy van.

On hot days, Winget, a social worker with the Health Care for the Homeless Project, brings ice, water or lemonade to Robert and offers him a ride uptown for a shower. Robert declines the latter offer, but while they chat, he usually allows Winget, and the doctor or physician's assistant with her, to examine his partially amputated toes and a cut on his leg.

"They don't have much, but they share what they have," Robert said of Winget and other team members riding the van.

Robert and hundreds of homeless people like him in the District receive free health care through the outreach efforts of Health Care for the Homeless. A staff of about a dozen tackles the health care needs of men and women living on the street and at five homeless shelters in the city.

The Health Care for the Homeless project has $1.4 million to spend over four years. It was funded here in 1984 by the Robert Wood Johnson Foundation and Pew Memorial Trust, which funded similar programs in 18 other cities. This year the D.C. program received more than $400,000 in local foundation grants and city contracts.

"We provide the highest quality of care for this population as possible, and we are truly a public-private partnership," said project director Phyllis Wolfe.

Most of the medication used in the project comes from the city and D.C. General Hospital; psychiatric care is provided by residents at St. Elizabeths Hospital, Wolfe said. Lab work at reduced rates is offered through George Washington University Hospital, and patients who need medical specialists are seen by private doctors organized through Washington's Catholic archdiocese.

Wolfe and other project staff members agree that as long as such cooperation continues, health services for homeless people will be available after the foundation grant expires in 1988.

"I think that the prognosis is very good. The key people from the public and private sector have been intimately involved with the board and are committed to helping in any way they can."

Health Care for the Homeless provides "great intervention that solves a problem that no one was addressing," said District Health Commissioner Reed V. Tuckson.

The project provides a safety net for persons with personal tragedies and forgotten aspirations. The physicians and nurses who are the backbone of the project work a maddening schedule at makeshift clinics in six shelters around the city: House of Ruth, Emery, So Others May Eat (SOME), Central Union Mission, Pierce Shelter and the Community for Creative Non-Violence (CCNV) men's shelter.

Although the clinics are only open a few hours each day, many of the services are still available in the early evening when the burgundy Health Care for the Homeless van, donated by the Disabled American Veterans, roams the city's streets and parks frequented by wandering adults. The staff looks for people with swollen or infected limbs, limps, hacking coughs and those who just want to talk.

Those with relatively minor problems can be treated on the spot inside the clinic on wheels. Others are funneled through a network of private doctors and city-run clinics for services ranging from neurological exams to prenatal care.

For the men who need some medical care but do not require hospitalization, there is Christ House, a sort of medical boarding house in Adams-Morgan that is run by several of the Health Care for the Homeless staff members.

For people living in shelters or on the street, where hygiene is usually poor, problems such as swollen legs with infected sores, asthma, and injuries from accidents and fights are common, said Dr. Janelle Goetcheus, the medical director for the homeless project as well as for Christ House and the Columbia Road Health Center. Weather and unsanitary living environments also exacerbate chronic conditions such as diabetes and hypertension, she said.

"We saw more frostbite this winter than I've seen since I've been in Washington," Goetcheus said. While the doctors treated many patients with second- and third-degree burns caused by hot air blowing from grates last winter, they say they have not seen as many cases of heat stroke as they had expected this summer.

In the past year or so, tuberculosis "has been one of the worst health problems, primarily because hospitals are not keeping these patients long enough to clear the bacteria from their lungs," Goetcheus said, noting that if they are unsupervised, it is very difficult to get these patients to take regular medication. "We usually have several TB patients at Christ House at any given time," she said.

Persuading patients on the street to go to Christ House, a hospital or even a shelter is no simple task, the project workers say. "These guys are extremely disturbed and frightened of violence or robbery at the shelters," said Dr. David Moore. He said a high percentage of the men and women he sees on the street and in the shelters have mental disorders but few are taking medication. He is particularly concerned that he sees a significant number of psychotic people who drink. "Sometimes I think {the alcohol} is their own medication to get the demons down."

The process of building trust and respect is essential but slow, says Winget, who tries to get her street clients to apply for Social Security and medical benefits. "Little things like bringing Robert a gallon of lemonade is real important," said Winget, a 28-year-old with long, blond braids and an easygoing demeanor reminiscent of a 1960s flower child.

Trust is also currency at House of Ruth in Northeast Washington, where physician assistant Doneby Smith tends to the aches and pains of women 19 to 90. "People usually have a medical excuse to come into the clinic," said Smith, but some are simply looking for "relationships with trustworthy people . . . . They will tell us things they won't tell the other residents."

Smith estimates that 70 percent of the residents at House of Ruth have some sort of substance abuse or mental problem and they are often referred to a psychiatric team for evaluation and treatment. She said she treats many women for sexually transmitted diseases.

The clinic staff, which includes a nurse and a social worker, sets up appointments at city-run clinics for pregnant residents, but because of the instability in their lives, it sometimes "takes three or four go-rounds before they actually get there," Smith said.

While Health Care for the Homeless has made a noticeable dent in the needs of an estimated 6,500 homeless people in the city, "the big deficiency we all see is in coordination of homeless family health care," Tuckson said recently.

The commissions for social services and public health are currently working to assess the health needs of families without homes and trying to determine the most efficient way to get services to them.

Much of the responsibility for the medical needs of children and family groups rests on Tuckson's health department, where some officials are concerned about duplicating existing services inside family shelters. Currently the city houses more than 300 families in temporary shelters around the city. Most are at the Pitts Motel on Belmont Street NW and the Capital City Inn on New York Avenue NE, and they must travel to city-run clinics for most health services.

Goetcheus said that because these families have "multiple problems," it is essential that services be delivered on site or "you're not going to reach the ones you really need to."