Posts Tagged ‘Healthcare for the homeless’

Brett and I had an opportunity to give some education about healthcare for the homeless/street medicine to third year University of South Florida medical students. It was a great chance to talk about the unique qualities our patients on the street possess and how they survive. We were incredibly fortunate to have Tyler Rogers, executive director of Safe Harbor (Easton,PA) speak as well. His passion for helping people end their hopelessness is palpable and contagious. The repeating theme in all of our discussion was the concept that everyone matters. Here is a story of a person Brett met today during street rounds with Tyler. It is a testament to why we do what we do and the courage our patients have that we often don’t appreciate.

” I’m incredibly blessed to have the opportunity for service that my job affords. Today was one of those days that reminds me even more than usual the importance of joyful work. I was doing street rounds today in Easton and one of the homeless people we met tipped us off to a young girl sleeping on the street who just arrived from New Jersey. I found her and it was quickly apparent she was pregnant– 28 weeks pregnant– and fleeing domestic violence from her mother who is a crack addict. Her mother has abused her and her brother since they were kids and she always stayed to try to protect her little brother who is now 17 and an addict himself. She felt the time was right to get out of the situation since she feared for the life of her baby because of the abuse. She came to Easton because someone told her she would find help there. I found her and her boyfriend in an alley and told her why we were there and about street medicine. I wish you could’ve seen the look on her face. She has been in Easton for 6 weeks and didn’t know who to call to try to get help or prenatal care. She didn’t have insurance or money to pay so the plan was to go to the ED when she went into labor so she wouldn’t be turned away.

While I was with her we scheduled an appointment for her in the Center for Women’s Medicine. I spoke with the team there myself and she was treated with respect and dignity every step of the way. Now she is very much looking forward to her first appointment next week. Jen, the Case Manager at Safe Harbor, has started the paperwork for her insurance and her boyfriend has enrolled in their job training program. She and her boyfriend were placed in a home affiliated with Safe Harbor today so they can stay together and won’t have to sleep in the streets.”

Sometimes people ask us how we stay encourage. How do we stop from burning out or getting discourage. The answer is simple – Everyone Matters.

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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

The weather has always baffeled me. In a strange way, weather has a way of forcing you into the next phase of the year, ready or not. Saturday had temps in the 90s with humidity so high that it made my normally very straight hair resemble the before shot of an antifrizz hair product commercial. Heavy rains came Saturday night and just like that, Fall arrived. Football, crisp morning air, windows open.  

Last Fall, Brett and I attended our first Street Medicine Symposium in Boston. The Boston Healthcare for the Homeless Program has been the program that all others compare themselves to. It is a huge, well established program that has the most comprehensive programs, resources and street teams. The tentacles of this program seem to reach into all the parks, shelters, hospitals etc. To say we learned a lot would be a stupid understatement.  I recall having a conversation with Dr. Jim O’Connell, president and founding physician of the Boston program.  We were talking about funding (of course) and I said I was amazed at the multi million dollar budget of his program.  He inquired as to the budget of the DeSales Free Clinic and the scope of services. After I told him our annual operating budget was $15,000 he response was ” jeez, we must be doing something wrong if we need so much money”. We then talked about how we operate on limited funds. This is the attitude in Street Medicine – no matter how big or small your program is, fledgling or benchmark status, we can all learn from each other.

A unique feature of these conferences is participating in street rounds with the hosting institution. We really got to see how the pros get it done. I was rounding with a case manager who was looking for one patient in particular- John. She had not been able to find him for the last two weeks and was worried about him. We checked all the usual places that he hung out. We met his street friends who had much to tell us – except for where John was. And so our search continued.

It was about 6pm and downtown Boston was bustling with people leaving work. The streets and the crosswalks were very crowded, horns blaring, quick feet. At a particularly busy intersection, we began to cross just as we see a large dip form in the sea of humanity. As we approached, we saw that our lost patient- John- was right at our feet.  Wheelchair bound, he had lost his balance and tipped right out of his wheelchair and onto the ground. I was impresssed at the number of busy Bostonians who stopped to help him and make sure traffic would not hit him when the light changed to green. We scooped John back into his chair and moved him to the sidewalk. 

John was a rather imposing figure, both in size and in scowl. When you close your eyes and picture a chronically homeless man on a wheelchair, you are likely picturing John. Standing, he was most likely over 6 feet tall. He was wearing many layers of well worn and tattered clothing. He had on an old navy blue winter hat that was a little lopsided so only one eyebrow was showing. He was missing most of his teeth and had a rosy hue to his deeply wrinkled skin. He was not particularly friendly toward me and answered the case managers questions in a short and gruff tone. Yes he had been drinking. No, he didn’t need anything. No, he wasn’t hurt. Then she asked if he was hungry- and for a second, the fiercly guarded wall came down. He was hungry, and thirsty too.  He hadn’t eaten in several days. 

While the case manager went into a Panera Bread, I had a chance to talk to John (or attempt). I started by trying to figure out if he needed anything else since it seemed the peace offering of food had opened the door just a smidge. He told me part of the reason he had a hard time eating despite the available soup kitchens and food vans was that he had a peanut allergy. A severe peanut allergy. Imagine the great lengths moms across America go to in order protect their childreen from inadvertant peanut ingestion. There is even a service through my children’s daycare to find them a playdate with a child whose allergies match your childs ( think match.com but for kids with allergies). Before John, I had never considered what it would be like to have a food allergy on the street. I asked him a few questions about his peanut allergy and then, apparently, crossed the threshold of number of questions allowed.  

I had squatted down to talk to him. Being at the same eyelevel of someone who is wheelchair bound (homeless or not) is extremely important for leveling the playing field. Suddenly, John looked angry. He was nose to nose with me and yelled with a slurred speech, ” Do you reaaaaaaallllllllyyyyy care?” Pause. ” Well, do ya?!” I told him that I really did care. He looked away and muttered, “Well, I don’t know why.” 

There was they key to this whole interaction. Imagine wanting to be helped but feeling inside that you are so worthless that no one in their right mind should want to help you. Therefore, you prophylactically refuse the help because somewhere inside of you, you believe that you are protecting yourself from the inevitable. The dissapointment you will feel when the person decides you aren’t worth it and that they don’t care. Self preservation is a vital survival tool when living on the streets.

We walked with John to a location across town that he liked to hang out ( we had actually been there earlier that day looking for him). He was greeted warmly by his street brothers. A fleeting smile crossed his eyes (but not his lips). As we walked away, I turned back to see John breaking his sandwhich into four pieces – one for him and one for each of his street friends while they passed the bottle of newly purchased lemonade around. A reminder that the parable of the fishes and the loaves is lived every day on the street.