Until April, Nyla Jackson hadn't visited a doctor for nine years. As a single mother working as a waitress, she doesn't put in enough hours to get medical insurance, and her paycheck can't cover medical bills.

But after she began suffering from nose bleeds, Jackson became worried and contacted the county Health Department to find out if any medical assistance was available. And that's how she found out about the free clinic on Wednesday evenings in Columbia.

"I love it. I've been here three times. The doctors are great," said Jackson, 35, of Columbia, who has received free exams, blood tests and medication at the Cedar Lane clinic, which is run by the Health Alliance for Patients in Need, a group of local health-care practitioners and other volunteers who provide medical care regardless of ability to pay. "I commend them immensely for their time. Every time I see them, I give them a personal thanks because without them I wouldn't be here."

Clinic officials hope to be able to help hundreds more county residents such as Jackson with the help of a two-year $264,000 grant recently awarded by the Horizon Foundation of Howard County.

The clinic, which opened a year ago, operates in the Johns Hopkins at Cedar Lane medical facility in space the facility donated to the group. The volunteer alliance established the clinic to provide a place to treat patients, who previously had to travel to the participating doctors' various offices, according to Gary Milles, alliance founder and the clinic's medical director.

Staffed for three hours each week by one doctor, two nurse practitioners and nurses, the clinic has a patient roster of about 300 low-income county residents and a waiting list of about 50. Pharmaceutical companies keep the clinic stocked with "tens of thousands of dollars" of free medication samples, and other local medical services provide free lab tests and other support, Milles said.

Most of the clinic's patients, who often are referred by social service agencies, are county residents who can't afford insurance and who don't have access to primary medical care, he said.

"A lot of these people who come in have never seen medical care," Milles said. "The degree of intensity of illness is immense--much higher than expected."

With the grant money, the clinic is expected to expand its hours to two nights each week beginning in January, which will allow it to double its capacity to about 600 patients. The clinic also plans to hire a full-time administrative coordinator and to develop a computer program to consolidate record keeping. The money also will be used to establish a fund to buy medications that can't be donated, such as those for cancer treatment.

The capacity-building grant was the first of its kind given by the Horizon Foundation, which was established in July 1998 when Johns Hopkins Medicine merged with Howard County General Hospital. As part of the merger, Johns Hopkins provided more than $60 million to be used to promote and enhance the health of county residents, according to foundation President Richard M. Krieg.

The clinic was chosen to receive the first capacity-building grant because it is the only facility in the county that provides medical services to the growing number of low-income residents, he said.

"We have a very affluent county, and that sometimes masks low-income people," Krieg said.

According to foundation officials, there are nearly 5,000 subsidized housing units in the county, and the U.S. Census Bureau estimated in 1995 that more than 8,000 county residents were living in poverty. Also, the immigrant population is growing at a rate exceeding that of other residents.

"The clinic is a godsend," said Adriane Weaver, a community health nurse with the county health department who volunteers at the clinic. "There is definitely a need. We have patients that need to be seen yesterday."

In addition to the clinic's grant, the foundation announced last week that it was providing $450,000 to fund a model project designed to help the county's elderly residents remain in their homes as long as possible. The one-year grant will be divided among three private social services agencies and the county's Office on Aging, which will coordinate the Aging in Place Initiative.

The initiative, devised by the agencies, will develop a coordinated program of home repair and modification, prevention of falls and other injuries and community-based services designed for older adults living at home, according to the foundation and county officials.

On Oct. 20, the foundation announced it was awarding 13 community health innovation grants totaling $200,000 to county nonprofit groups, including the Grassroots Crisis Intervention Center, Domestic Violence Center, Howard County General Hospital and the Foreign-Born Information and Referral Network.

Krieg said he and other foundation officials have been holding meetings across the county to learn about health issues and needs.

"We will have an uncharacteristic approach to identifying problems and solving them," he said. "We'll be looking very carefully at what problems exist in the community, and how are they susceptible to intervention."

The foundation expects to award an average of $3 million in grants each year and to become an important resource as a catalyst for change.

"It's really going to be a boon to many programs," Krieg said.