Sheila Beckham took over as chief executive officer of the Waikiki Health Center five years ago, at the peak of the recession, so she’s seen the clinics’ target population swell and, in particular, homelessness increase. Most recently, there’s been the strain of many of the poorest families and individuals falling out of Medicaid coverage because of problems the state encountered with the enrollment renewals.

But it’s been a time of great expansion as well as stress for the center and its seven major programs, the newest being the $1.8 million Makahiki Street clinic that opened to dental and medical patients in February.

There is a whole menu of initiatives, ranging from the medical Care-a-Van to Youth Outreach and the Next Step homelessness shelter in Kakaako. Last year the center, first established in 1967 as the Waikiki Drug Clinic, served more than 8,600 patients.

The public still thinks of the center as a Waikiki institution, and because its flagship clinic is still on Ohua Street there, the Waikiki community remains home base.

Beckham, 61, was director of preventive health at the Waianae Coast Comprehensive Health Center before moving to Waikiki, so the homelessness problem was not unknown to her. She’s seen tremendous success stories along with the human tragedies of the streets, and that’s what keeps her fueled for the job.

There’s the homeless teen who’s now a college freshman, living in the dorm. There’s the Makahiki janitor, who was part of the neighborhood homeless community nearby before moving to Next Step and getting job training.

Beckham freely sings the praises of the center’s staff. And the clients of the programs, who make up more than half of the center’s board of directors, are an interesting group, she said — humans as well as pets.

"They bring birds, they bring rabbits into the clinic, and they’re taking them around with them, because that’s their family," she said. "It’s really kind of a colorful place!

"The people that work here, we try to pay wages that are more competitive, but they don’t make what they make in the private sector," she added. "And yet they’re here. And they work long hours, and they’re there for our patients."

QUESTION: There was some concern about people on Med-QUEST losing their coverage because they didn’t re-enroll in time. How is your clinic coping with that?

ANSWER: We are getting separate lists from the different insurance companies … We have an eligibility worker who goes through every person, for every provider that’s here, goes through that whole list every day and targets the ones that she can see will have their insurance expire and should be getting their renewal.

In most cases, they did not get their renewal forms. It’s real possible that people threw it away. They don’t know what it is. What they’re having to do is start all over and enroll like it was a first-time enrollment, which takes much longer. …

Q: When did the mission first move beyond Waikiki?

A: I think the gradual growth occurred when we took on the Youth Outreach program (in 1989), when we took on the HIV program. That still is at Ohua. …

We really started to see a lot of growth when I got there. And I’m not going to say that it’s all because of me, but I tend to do that. (Laughs)

Q: When was it that you came?

A: Jan. 1, 2008.

Q: So, when you came, what was your impression? What were your goals?

A: My impression was: "What did I do? It’s kind of dumpy." (Laughs) Then the next year we had funds from the federal government, ARRA (stimulus) funds, to be able to renovate. So we renovated Ohua …

We had to close in the lanai because we were growing so fast we had to add more exam rooms, create the pharmacy …

We really began to take off then. The growth in staff, we had less than 65 employees in 2008, and we have 160 now. And our budget has more than quadrupled in that time.

Q: What is your budget?

A: It’s about $14 million. …

There’s a need, and for me there’s a passion. I always wanted to do something a little bit differently. I think I learned from one of the best (at Waianae), Rich Bettini, but I always wanted to put my own brand on things. And my approach is different, but our outcomes are very similar.

We have an extremely tough population. The other health centers may have some homeless, or some HIV patients, or some of who we see. We have a really, really high-risk population. …

Q: From where you sit, has the challenge of homelessness increased since you came?

A: I think that right away in 2008 we began to see an increase. And part of that is the economic downturn. We literally had older couples, husband and wife that both worked for Aloha Airlines, that both became unemployed. These are people that may have lost a mortgage, that have been out on the street.

We had so many clients that may have been working at that point — two jobs, but they were making it. And then all of a sudden, prices go up, they lose one of the jobs, or they get a little sick and they have no benefits. So we began to see the increase then. …

Q: When did you take over Next Step Shelter?

A: Halloween night, 21/2 years ago.

Q: Weren’t you a partner that just came in for some services?

A: It used to be that way, and we did the case management. In fact, the medical school came over, and the medical students did the vans. Then we were asked to take it over totally.

This was not part of our normal scope. But we said yes. We began doing it and we’ve grown in those areas. We built an exam room so we would be able to provide medical services for them.

Q: Right there?

A: Yes, because so many of those folks are quite isolated. … We have a behavioral health provider as well. We also do job training, and we’re trying to expand that. … We no longer have the medical students coming in. There were some liability issues. …

Q: So, Next Step is open 24/7 on the weekends, but clients have to leave during the day weekdays?

A: Yes, and the reason is there isn’t adequate funding. That whole thing is funded by the state. There isn’t enough funding to be able to pay to keep it open every day.

Because we’re a federally qualified community health center, we cannot use our health center funds. … So we either need to get more money to have it be open longer or we can’t do it. And that’s not something that funders wants to fund.

Q: A shelter? Really not?

A: Most of the time, no. But I think that we could probably do quite well getting people help through Housing First, or housing people. …

Q: How much has the homelessness issue overwhelmed your mission?

A: No it hasn’t … Those are the most vulnerable people around. It is our mission to always reach out to folks.

Our Youth Outreach focuses on kids that are homeless. And the kinds of things they have to do to get extra money, and the families at the shelter, and the unsheltered adults at Care-a-Van. I mean, this is who we are, it’s one of the primary groups we serve. …

Q: Do you get to see improvement in people’s lives? Or does doing this work feel like bailing out the sinking rowboat with a teaspoon?

A: We see it, that’s why we continue to do what we do. We don’t see it en masse, but we see it with individuals. We see it with the Youth Outreach folks who have gotten GEDs (graduate equivalency diplomas). …

Q: You really take a broad view of what is health, don’t you?

A: The health centers do that, yeah. But we all have unique approaches. … Sometimes you’re fiscally driven, sometimes you’re driven for sustainable growth, sometimes you’re driven by the creation of jobs, of working with the community.

Q: What drives you?

A: I’m totally passionate about improving quality of life for people. I’ve got a bunch of soapboxes that I stand on, and won’t shut up about.

I have been so fortunate in my life and I want to be able to share, in a tiny amount, the forgiveness that I think needs to be there for people. Sometimes people make mistakes, and I think we need to be there to say, "It’s OK, we understand, let’s try again." That kind of thing.

And I’m talking about clients as well as staff. I think just really being able to help people understand how they can improve their situation, without preaching at people, it’s facilitating opportunities.

Q: What soapbox represents the most urgent need?

A: Well, I think the need is tremendous for housing. I’ve said it before, but obviously my voice isn’t loud enough. I can make it be quite loud.

One of the things I think is really, really critical is that we address these issues as a large community.

I’m not pointing fingers at the hotels, either — but I kind of am. Basically, they have a responsibility in this. They can’t just say, "Get the homeless out of here because my tourist dollars are dropping."

Why can’t each hotel give one room? I keep saying this, and nobody listens. Maybe they give the laundry room, and they put a toilet in there. And house one person. Or house a couple. If everyone did that, to me, that would be a 100 percent improvement in what the businesses face. …

I know that they pay their dues. But why can’t we assess an additional $100 — whatever, something small — among all of the businesses, or hotels, or both. And have that pool of money used to provide housing or services or establishment of another restroom that is going to be open.

I mean, I think we have to work in partnership. There are not enough state and city dollars. …

Q: Do tourists ever come into the health center?

A: Absolutely. … A lot of Japanese tourists, a lot of snowbirds come, and they’ll use our facility during certain hours.

This (Makahiki Street clinic) is the prettiest one. So we’ve talked about possibly marketing the dental or medical clinic. Trouble is, this is hard to find for someone staying in Waikiki, so we have to concentrate on that.

But it is in our long-range plan to be able to expand the service to tourists and reach out.