As director of health services for Camillus Health Concern, Dr. Rosendo I. Collazo is one of Miami-Dade County's doctors to the homeless. The center, at 336 NW Fifth St., offers primary care services, HIV treatment, dental services, mental health services and case management.

We talked to Collazo, a Miami native, about the medical problems of homeless people and the challenges and rewards of his job. His responses have been edited for space.

Q: What are some of the most serious health problems facing the homeless in South Florida?

A: The homeless have the same prevalence of several diseases that the general population has: diabetes and hypertension and coronary artery disease and emphysema and asthma.

We see a lot more of the complications of diabetes as a result of years and years and years of not having any access to care to get good glucose control. In hypertensives we see a lot of people who have heart failure because of long-standing high blood pressure. High rates of mental illness and drug abuse complicate those matters.

Unlike in the general population, we see high rates of tuberculosis infection, not active tuberculosis. Rates of HIV infection are far higher. And the degree of psychosis and multi-substance abuse far exceed the general population.

Q: How big a problem are mental health issues and what are the challenges you face in treating those issues?

A: The problem is huge. The spectrum of mental illness, from the overtly psychotic individual to people with adjustment disorders and depression, probably affects more than 50 percent of the people we see. Often it can be managed with temporary medications and individual counseling. Sometimes we have to refer them for follow-up counseling.

On the other end of the spectrum, the people who have psychosis are a major challenge because you're dealing with lack of insight, disruptive behavior, often substance abuse. It's difficult to get them moving in the right direction and get them taking their medication. We try to treat people with a little sensitivity, a little compassion, a lot of respect. When you give them that kind of attitude and that kind of respect, when they see that you're actually regarding them as a human being, they start to buy into what you're telling them.

Q: What about drug abuse and alcoholism?

A: The drug abuse problem is very intimately associated with homelessness, both as a cause and as an effect. The addiction problem, whether it be crack cocaine or alcohol, keeps people from successfully accessing services that may get them out of the vicious cycle of homelessness. You've got to get them in a treatment program, but there are limited resources in this community for people who are homeless and uninsured.

Q: Why should the health problems of the homeless matter to the rest of the community?

A: There is a need to respond with compassion to people who are suffering, and when you get to know why people become homeless you see all kinds of things in their past. It's a blind lack of future direction, of planning and of just being bumped around from place to place, not because you're a bad person but because you lack certain skill sets so that when the you-know-what hits the fan, you fall through the cracks. That can happen to anybody. If we don't spread a little compassion and a little bit of caring for people who are beyond the scope of the little world that we live in, then we're totally lost.

Q: Is there something that you have learned working with homeless people that you wish the community as a whole knew?

A: The homeless individual is a person who, in general, is a very gracious person. They are extremely grateful for everything you do for them. People are very judgmental about the homeless, they think that they put themselves in the situation they're in, and that's true. But it doesn't mean you don't try to limit that, at least from the health care perspective, and get them well enough to move on. They're fine people. I wish people could see that.

Health Q&A runs biweekly.

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