Posts Tagged ‘boston health care for the homeless program’

Four years ago, we attended our first International Street Medicine Symposium in Boston (MA). I was wide eyed, excited and in hindsight- mostly clueless about the real world of street medicine. Street medicine in the Lehigh Valley did not exist yet, I had never been on street rounds and had only read about such legends in this area of medincine such as Dr. Jim Withers and Dr. Jim O’Connell. I met like minded people and heard tales of incredible collaboration between civil services, shelters, providers and consumers. I saw demonstrations of how humility combined with leadership can change an entire city and its citizens. And I do mean all of them – the housed and unhoused, the voting and non-voting, the overachieving students and the retired sunset-riders who directly or indirectly reaped the benefit of the Boston Healthcare for the Homeless Program (BHCHP). In the subsequent years, we travelled to Dublin, Ireland then San Jose, California and most recently- Geneva, Switzerland. Each conference provided new insights, new data, new frameworks, new friendships. As Dr. Pat Perri, chair of the Street Medicine Institute said at the most recent conference in Geneva- it is like meeting aliens from the same planet.

As I sit on my flight returning from Geneva, I am struck by the lecture I had the privilege of hearing yesterday by Nick Maguire (Southampton, UK). He is a psychologist with a brilliant mind and a wicked English sense of humor who has a way of making sense of the behavior chaos that we observe on a regular basis on the streets and in the shelters. His points were so profound to me that I have hardly been able to think of much else. But as he started his lecture, he told us how much this conference means to him. As he says, it is a bucket filler when the world is so often full of bucket emptiers. We come to this conference and are renewed with our sense of purpose and inspired by the brilliant minds from all across the globe that have so committed themselves to such a worthy cause. People who have left lucrative positions in pursuit of a meaningful contribution. People who risk arrest by providing medical care on the street. People who accept that possibility that everyone you know professionally and personally might think that you are crazy for doing this type of work.
As Nick was speaking, I glanced over my right shoulder and saw Jim Withers sitting toward the back of the room as he so often does and thought about how it feels to know that your vision is being shared and LIVED by so many people. Inspiration can be a fickle thing- there one day, and then gone the next. Sometimes people act on their inspiration but, action can also be fleeting. It is inspiration that makes us come back from church camp when we were kids and throw away all of our excess toys, cd’s (back when we used such antiquated objects to listen to music) and other items we deemed unnecessary once we realized that living a simpler life for a week wasn’t so bad after all. But three months later, there we are in our rooms with piles of newly accumulated junk that we forgot we had decided we could live without. Fleeting. But to inspire and then foster inspiration that changes the trajectory of how people LIVE is something quite different. And for me, the International Street Medicine Symposium is like inspiration on Arnold Schwartzeneger dosed steroids.

Thanks Street Medicine Institute. Bucket filled. Lid applied. Pressing on.

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Snowpocolypse. Snowmaggedon. Holy -Snow-Batman! Whatever you call it, the snowfall over the last weekend was historic. But something else was happening in Allentown while we were all watching from our windows and marveling at this weather phenomenon.

On Saturday morning, with 9 inches of snow already on the ground, the Warming Station in Allentown sent it’s overnight guests to the streets because they are only operational at night. If it had not been for a local pastor, these people would have been left to try to find a public building to shelter in, a business that was trying to remain open that would allow for loitering or an abandoned building that perhaps no one would be looking for trespassers in. And what about the people who were not at the Warming Station the night before who may not have known about the good Pastor and his open doors?  How could a Warming Station staff street their guests who would need a plan to endure another 10-20 inches of snow before the Station opened again?

It really made me think about whose ‘problem’ the homeless people really are.  Why are there only a few who will take responsibility or, dare I say, ownership over  ‘their’ problems? Are we societally too stoic, compartmentalized and self-determined so that we believe that those who face a blizzard alone and homeless should have thought about that before they ‘made all their bad choices’? Are we worried about becoming too involved, caring too much, knowing too much only to find that there are too many one-way, dead end streets in our society? Do we fear the futility that comes with knowing without being able to act?

It would be easy to blame the operators of the Warming Station for streeting these people in the face of an impending Blizzard. These stations are opened on the heels of a public health concern.  Who wants to have citizens of their town freezing to death on their streets? But it is also a public service based on the principles of justice and beneficence. So how could people be left to fend for themselves in these harsh conditions? Dr. Jim O’Connell, founder of Boston Health Care for the Homeless Program, and a Harvard trained physician issued guidelines on temperature associated health risks to the homeless. The bottom line is that while water freezes at 32 degrees, human flesh is at risk for freezing at just 40 degrees. Often the greatest risk occurs when the ambient temperature is warm during the day and then drops drastically at night. From a business standpoint, a warming station could say they don’t have funds to pay for staff to be there during the day. They don’t have a food source there. Maybe they don’t have permission to keep the building owned by the Park and Rec Department open during the day. There are a hundred other reasons that they could come up with and some might be true. But the truth of it is, it doesn’t matter. These are people and they needed shelter. Could there have been a solution? A work-around?

The gravity of this current snow situation for the homeless is likely not to be understood for some time. But with each challenge must come insight and solutions to minimize risk the next time around. First, is the issue of the Code Blue designation. The Code Blue designation is issued by Lehigh County Emergency Management when temperatures dip below 32 degrees. The Code Blue status is supposed to be posted on the Lehigh County Emergency Management website but currently does not indicate a Code Blue listing. Today is a high of 26 and a low of 9, certainly we meet criteria. ‘Code Blue’  isn’t a searchable term on their website and it is difficult to find any information about what this designation really means. Anecdotally, I can tell you that local shelters loosen their admission criteria and put people any where they can as a temporary measure. The most current listing of Code Blue places available on the internet is from 2014 and basically contains a list of local shelters. Shouldn’t this designation allow for other buildings owned by the City to remain open as a public health measure? And why is the temperature cut off 32 degrees when data supports danger starting at a temperature of 40 degrees?

Second, those who are in the business of providing shelter as a public service should be held accountable for their actions. Many of these shelters and warming stations receive monetary support from citizens, government, grants etc. who expect that they are providing the service of warming and shelter.  You are accountable to your stakeholders. Is the city of Allentown responsible for sheltering these people or are they relieved of their responsibility because they funded another entity to provide this public service?  Take the example of our local hospitals. Healthcare workers slept in the hospital and shoveled on-ramps on 78 in order to get to work because the hospitals take their responsibility of being prepared for patients despite weather or any other natural disaster. The hospitals require it and the healthcare workers abide by it because of their moral responsibilities to their patients. Another example is the accountability of disaster preparedness where organizations accept risk for the greater good. Successful organizations balance between risk and preparedness with the ethical principles of justice and nonmalifecence. These preparedness documents should be well thought out and easily implemented. Just as in disaster preparedness, when running a winter shelter, one must be prepared for winter weather.
Finally, there is the humanistic aspect. In times of trial when human lives and dignity are on the line it is ALL of our responsibility to care for those in need.  If you’ve accepted the public commission to care for the most vulnerable, you can’t abandon that post in the worst of times. At the same time, if you haven’t accepted that post in an official matter you aren’t absolved of your moral responsibility. This weekend in Allentown that is exactly what happened. Although not bound by grants or funding, Zion Church opened their doors to those most in need of sheltering from danger, just as they did in 1777 when they “housed” the Liberty Bell, keeping it safe from the British during the Revolutionary War (www.libertybellchurch.org).  Let it be a lessoned learned; that true responsibility comes from within.

Sitting on a tarmac outside of the Newark NJ airport, I am trying to wait patiently for my plane to take off. I hear mostly white noise as people are shuffling to their seats and stuffing oversized bags into small overhead compartments. I look to my right and see a recent DeSales PA Program graduate sitting a few seats away. In the midst of our boarding process, I hear words being shared about street medicine and homelessness to the unsuspecting middle seat passenger. In 6 hours, Seth could have her convinced to attend the 11th Annual International Street Medicine Conference with us.

 

While I don’t often spend much time reflecting back on progress over time, I find that preparing for conferences like these tends to send me back to a time when I knew less in both knowledge and people. Two years ago, Brett and I attended our first International Street Medicine Symposium in Boston. We had read so much about the world-renowned Boston Health Care for the Homeless Program (BHCHP) founded and flourished by Dr. Jim O’Connell. I had followed their website for years and had a visit to BHCHP on my bucket list for years. (Hey, some people sky dive, I visit homeless programs.) The opportunity presented itself for this visit with just a few weeks notice. Generous support from both of our sponsoring institutions (to let us go) and family (to keep our kids) allowed Brett and I to travel that Fall to Boston. It was the first time we were able to see a mature and robust healthcare for the homeless program and see first hand how something like that is grown and cultivated over time. Each member of BHCHP seemed to share the vision that had begun more than 20 years before. They were motivated, enthusiastic and committed. At a dinner reception after the first day, Brett and I met Dr. Jim O’Connell for the first time. He was genuinely interested in our small but eager programs. I mentioned that the DeSales Free Clinic has an operational budget of about $18,000. I’ll never forget his response. “You do all of that with $18,000? I have a multimillion dollar budget. It sounds like I have something to learn for you.” I was dumbfounded. You? Learn something from me? It sounded laughable ( and still does) but he was sincere. And a reflection of how all Street Medicine Programs are treated by their peers. This type of interaction has been repeated many times over as street medicine programs come from all over the world, once a year, to learn, share, eat, drink and be merry. Dr. Jim Withers of Operation Safety Net (Pittsburgh, PA) once told me that he thinks that people at this conference and his patients sometimes understand him better than his family. (True)

Now, we are heading to San Jose (CA) for this years conference. Our programs have grown exponentially since that first trip to Boston. So many ideas were illuminated, so many seeds planted. We are travelling with 8 other street medicine team members- 2 University of South Florida SELECT medical students, 2 DeSales University physician assistant students, 2 recent graduates of the DeSales PA Program, LVHN Street Medicine’s new case manager and new clinical coordinator. It is hard to imagine the life trajectories that can change when armed with the knowledge that comes from conferences like these. Brett and I sometimes joke that it feels like you are going away to camp. The time is short, the bond is strong.

In the Spring of 2013, Brett came across a conference being held in Washington, DC a few weeks later. We scrambled with our employees and our families to find coverage for the many hats we wear and off we went to the National HealthCare for the Homeless Council conference.  I have been to many, many educational conferences in my professional career and I can say that up until that point, none of them would be described as life changing.  Prior to our attendance, we had been running the DeSales Free Clinic since 2007 but had not really met other people who were doing the same things. Two things happened at that conference that changed the trajectory of our lives.

First, we were able to see that what we had created at the DeSales Free Clinic was as comprehensive and well thought out as many of the programs who were presenting their healthcare models at the conference. We always felt in our hearts that what we were offering was logical and right but we really had nothing to compare ourselves to. The second thing was that we were able to meet all of these people that were offering healthcare to their homeless population in ways we had never even thought of.

It was like a mental explosion.

I remember sitting at a restaurant with Brett after the conference was over.  We made a plan at lunch that day about what we wanted homelessness medicine to look like in our area. It was suddenly blinding that what we were doing was great but there was SO MUCH MORE that needed to be done. More people, more locations, more populations, more awareness. For both of us, a sudden and sharp vision (blessing)was born.

We wanted to start with developing a Street Medicine Program. We don’t really know how to do anything small and so considering starting something in a logical-one-step-at-a-time method is a nice theory but we know we’ll blow it right out of the gate. We knew that the biggest job was two fold- 1) convince important decision makers that the Lehigh Valley has a homelessness problem and 2) Get buy in for this never-heard-of-it-before type of medicine called Street Medicine.

A few months after the NHCHC conference, we attended the International Street Medicine Symposium in Boston, MA. Again- mind blown. The benchmark program- Boston Health Care for the Homeless Program- hosted the conference and I thought our heads were going to explode on the car ride home.

Today, Brett starts as a full time Street Medicine PA in the Lehigh Valley Health Network Street Medicine Program. He has worked tirelessly at the hospital and had more meetings in the last year than I think he ever thought possible. It’s funny but Brett is more of a do-er and less of a talk-er but he knew that he had to get people to see the vision as clearly as it lived in our heads. He met with grants people, finance people, security people, mechanics, community partners, HR, PR, IT, development, department chairs, managers…he learned about departments that we never knew even existed. And amazing people who were willing to help in any way that they could to give this idea legs.  Their eyes were opened and all of a sudden, they couldn’t imagine why we hadn’t thought of this sooner. He did lunch meetings, breakfast meetings, stand in the hall and chat meetings. The goal was to create an idea so big that once your ready to ‘go live’, it would be nearly impossible to stop. Their eyes were opened and all of a sudden, they couldn’t imagine why we hadn’t thought of this sooner.

Everyone has a different dream and I feel like very few get to wake up and do what is living in their heart all day. There is a pure joy that escapes unabashedly out of a person when they are doing what they love. Today is that day for Brett.  Dream big or don’t dream at all.

” It ain’t about the money you make, when a record gets sold, It’s about doin’ it for nothin’, ’cause it lives in your soul.”  – Eric Church