A Graduating Medical Student's Reflection on Four Years with SMD

It’s widely accepted that medical school constitutes four of the toughest years in the training of a future physician. Hours studying, absorbing as much information as possible for future patients (and to pass the next exam). Ultimately, it’s worth it. After four years of hard work, students leave medical school ready to take care of patients. However, this intense process does more than teach medicine. Medical students also learn about themselves. Their weaknesses. Their strengths. Their passions. Their values. Street Medicine Detroit board member and graduating fourth year medical student, Jessica Lee, recently reflected on her time at the Wayne State University School of Medicine, and how SMD shaped her experience.

Street Medicine Detroit will always be remembered as one of the most defining parts of my medical school experience. I would not be the same person that I am today without SMD’s influence. It has affected every aspect of how I practice medicine and I am thankful I got to be a part of an organization that makes such a large impact on the homeless population in Detroit.

I was introduced to SMD during my time applying to medical school by a friend already attending the Wayne State University School of Medicine. When I shared that I had been accepted to her school, she congratulated me and sent me this message, “Join my student org, STREET MEDICINE DETROITTT.” She gushed about the organization, and when the opportunity arose, I volunteered with SMD to see if it was truly as great as she had described. It was. After my first street run, I was hooked. I loved the mission of the organization, the chance to do clinical work, but most importantly, I loved the patients and their stories.

As a first and second year, we are expected to hone our history taking skills. These patients were more than willing to share their medical histories and, as they did, they shared parts of their life stories, too. The conversations I shared with patients truly highlighted the person behind the label of “homeless.” It challenged many of my views of homelessness. Their stories gave me insight into why it’s difficult to get back on your feet when you experience homelessness. Some people don’t have the resources to get help. For others, mental illness is a barrier to ending their homelessness. Regardless, people experiencing homelessness face numerous challenges that are often overlooked at first glance.

An example of a challenge that really sticks with me is the importance of a government ID. Aside from the when I received my first ID, I never thought of it as particularly special. Yet, I’ve met numerous individuals who lost their government ID through theft or personal catastrophic events such as a house fire. Without an ID, they are precluded from many assistance programs. More upsetting, though, is that reobtaining an ID is nearly impossible for many people on the streets. Often, they have lost their birth certificates and numerous school closures hinder obtaining school records. They do not have any mail addressed to them because they have no home where they can receive it. Without a means to prove their identity, individuals experiencing homelessness find themselves out of options before they even get started.

I never would’ve known about the barriers people experiencing homelessness face if I had not spent time with them through SMD. During my third and fourth year of medical school, I learned how to take what I learned and advocate for individuals experiencing homelessness in the hospital. I stood up for them when lack of transportation forced them to consistently miss appointments. I supported their claims that medication non-compliance was because their medications were stolen with their belongings. I assured others that these were not merely excuses, but realities of those that live on the street. I testified to these things because working with SMD exposed me to patients who have been affected by identical obstacles time and time again.

All in all, if I could summarize what I have gained throughout my four years with Street Medicine Detroit in one word, it would be ‘understanding.’ I understand the barriers limiting people experiencing homelessness. I understand there are hundreds of reasons for homelessness. As a result, I believe I’m better prepared as a medical professional to empathize with patients experiencing homelessness and appropriately meet their needs. Through my work with SMD, I have learned that there is much more than meets the eye with every person I encounter and I intend to carry that lesson throughout the entirety of my career as a physician.

Jessica Lee, MS4, SMD Co-Director of Logistics & HR

Congratulations to Jessica and her classmates (listed below) who will be graduating from medical school and transitioning into residency over the next few months.

SMD Co-Director of Logistics & HR, Jessica Lee (center right), posing with SMD classmates after a board meeting

SMD Co-Director of Logistics & HR, Jessica Lee (center right), posing with SMD classmates after a board meeting

Andrew Wayne - Family Medicine
Anirudha Rathnam - Neurology
Ankita Chatterjee - Internal Medicine
Anthony McClafferty - Internal Medicine
Eleanor Kotov - Emergency Medicine
Esther Chae - Obstetrics/Gynecology
Jawan Gorgis - Family Medicine
Jessica Koehler - Emergency Medicine
Jessica Lee - Pediatrics
Mariam Diskina - Obstetrics/Gynecology
Rob Dikeman - Emergency Medicine
Samantha Terranella - Surgery

The International Street Medicine Symposium: Geneva, Switzerland

Street Medicine Detroit President, Esther Chae, attended the International Street Medicine Symposium in Geneva, Switzerland from October 20-22; while there she presented two posters created by our SMD Research Department. Our communications coordinator, Kristy Abraham, sat down with her to discuss how the symposium impacted her perception of homelessness and the Street Medicine movement as a whole:

Kristy:  So tell me about this conference. What was it about?

Esther: The conference was the International Street Med Symposium that The Street Medicine Institute puts on every year. The conference aim is to gather different street medicine organizations around the world in order to network and share ideas. Wayne State School of Medicine’s organization “Street Medicine Detroit” (SMD) presented two posters at the conference. One regarding the research we conducted with Detroit Receiving in order to determine the impact SMD has had in Emergency Department enrollments in Detroit. The other poster looking at patient demographics and growth trends from the last five years of the SMD program in order to reflect and improve or model.

Kristy:  How did attending this conference change your perspective on homelessness around you? What did you learn?

Esther: Hearing the stories of what people were going through there and seeing how much someone’s environment can impact their health was really eye opening. For people experiencing homelessness, their body perception isn’t the same as a healthy and sheltered individual. When you’re more concerned about where you’ll sleep on a given night, you’re less likely to recognize and attend to health concerns. After prolonged periods of homelessness, many individuals recognized basic needs of their own bodies. One of the speakers said that “when people become invisible to others, they also become invisible to themselves.” The psychology behind it is incredibly complex; even time becomes relative. When you don’t have a specific place to be during the day, you lose track of date and time- which is often one of the reasons homeless individuals are more likely to miss commitments such as medical appointments.

Kristy:  Detroit is a city of pockets. On one street, there’s a new stadium being built and new restaurants opening up every day, but just a few blocks down there’s incredible poverty. How has attending this conference changed the way you view your surroundings?

Esther:  My perception about community service changed a lot. I think about the work we do in Detroit and I realize that no matter where I am, the reason I do street medicine is to respond to a need in the community. The needs of the community changes all the time, and as physicians we can’t just be bystanders; we have to be actively engaged and respond to that. We have to attend to our community as it changes and make sure everyone in the community is still taken care of.

Esther Chae presenting research conducted at Wayne State SOM at the 2016 ISMS.

Kristy:  Now that you’ve learned more about the psychology of homelessness, what do you think we can we do to empathize more and develop a stronger connection with our patient population?

Esther: We have to keep it centered to our patients. Understanding their reality is the most important aspect of humanizing the process. Rather than thinking about ourselves as physicians in training and asking what can we gain out of this process, we need to think about what they need. Who are they? By getting to know our patient population, we can better see the world from their perspective. I know that’s really hard to do, but that’s the difference between sympathy and empathy: because instead of feeling sorry for them, you share that feeling with them and let them know that they are not alone.

Kristy:  Now that you’ve seen the reach of street medicine on a larger scale, how do you think Wayne State School of Medicine’s street medicine program compares to other organizations across the world? How do you think this program will impact the students as future physicians?

Esther:  What makes us different is that SMD is student-led. It’s a strength, and it’s also weakness. Since we don’t have a full time staff dedicated to this, we depend on volunteers, and sometimes that’s hard because medical students have other obligations and opportunities. But on the other hand, when a group young people get together there’s an energy that’s really unique and refreshing. We’re the next generation of medicine. Even though it’s a short duration in medical school, hopefully these four years can really have an impact on the kind of doctors we become. We’re so lucky to have such amazing community partners and preceptors like Dean and Dr. Bryce. They teach us a lot of social aspects of medical care that we don’t learn in school, like keeping people safe. We learn from our preceptors, but we learn from our patients the most.

A lot of people at the conference talked about how Street Medicine has changed their medical education and has changed how they would practice in the future. I know that it has definitely changed my perspective of medicine. You don’t really understand all the different social determinants of health until you have to see what the patients go through on a daily basis. I feel like I can see things outside of the box now. I hope that I’ll be more conscious of that as a physician: to make sure I get to know patients and their realities, and not just their symptoms. Cause it does matter; they do correlate.

Kristy:  It sounds like it was quite an impactful symposium, we’re glad Street Medicine Detroit could be represented. Thanks so much for your time, Esther. 

Six Health Concerns That Disproportionately Impact Individuals Experiencing Homelessness

Homelessness puts individuals at greater risk of certain health issues. Since individuals experiencing homelessness are not sheltered from the elements and may not have reliable access to nutritious food and fresh running water, some conditions are more likely to develop. The lack of safe and comfortable bedding, seating, and shelter also puts individuals at greater risk for injuries. On top of this, limited access to health insurance, makes caring for this population more difficult, as well.

While every individual experiencing homelessness is different, here at Street Medicine Detroit we know it’s important to understand important issues that disproportionately impact our population. This information helps us approach patients with compassion and screen for high risk conditions. Here we’ve listed six of the most common concerns we encounter when on a street run.

Mental Health and Substance Use Disorders

A large portion of the homeless population suffers from mental health conditions. In many cases, individuals become homeless after being released from hospitals or jails without any support or assistance for mental health conditions. Substance abuse among the homeless is a multi-faceted problem. Some individuals become homeless after battling with substance abuse issues, while others develop substance use disorders as a way to cope with chronic pain or the stress of homelessness.

During flu season, Street Medicine Detroit provides flu shots to protect our patients from viral infections

Infectious Diseases

Poor nutrition and compromised immune systems, as well as exposure to many people every day, put individuals experiencing homeless at risk of contracting infectious diseases. Activities more common among the homeless population, such as intravenous drug use and unprotected sex also put these individuals at greater risk for certain illnesses and conditions. Without access to antibiotics or a sterile environment for recovery, these diseases also worsen quicker than in a traditional patient.

Skin and Foot Conditions

Showering and moisturizing the skin regularly is difficult for those without homes; this makes individuals experiencing homeless more susceptible to develop skin conditions. In addition, walking many miles on a typical day, often in worn shoes, puts the homeless population at greater risk for developing foot problems. Furthermore, exposure to moisture in wet seasons intensifies these skin and foot complications.

Street Medicine Detroit wellness seminars teach kids the importance of proper dental hygiene

Dental Problems

Many individuals experiencing homelessness do not have access to running water and dental hygiene supplies, such as toothbrushes, toothpaste, and floss. This makes regular tooth care difficult, so tooth decay and gum disease are common among homeless. Inadequate access to proper nutrition also has a negative impact on dental health.

Assault and Violence

Individuals experiencing homelessness are often targets of violence. Without shelter to protect against crimes of violence, this population is vulnerable than an individual with housing. Men are much more likely to be attacked and women are often subjected to sexual assault. Lack of health insurance and financial resources also makes these attacks more likely to go untreated and develop into an infection or disability.

Unintentional Injuries

Individuals experiencing homelessness are more often struck by motor vehicles and suffer falls that go untreated more frequently than individuals with homes. Individuals may also suffer burns while trying to stay warm or become injured due to extreme conditions. Severe sunburn or frostbite is more likely to occur because homeless people have limited ways to shield themselves from the elements.

Street Medicine Detroit helps combat some of the health concerns disproportionately impacting the homeless population in the city. After receiving treatment and connecting with primary care physicians, patients have improved quality of life and are better prepared to focus on housing and employment.

Amanda Flowers draws on her studies in Psychology, English Literature, and Public Health to create online content that addresses human needs in a simple way. Flowers is currently a freelance health blogger and writer for Blue Cross Blue Shield of North Carolina.

Midtown Rx Pharmacy: Affordable Pharmaceuticals in Midtown

In the heart of Midtown at the corner of Woodward Avenue and Alexandrine Street lays Midtown Rx Pharmacy. Midtown Rx Pharmacy opened in January of 2016 as Midtown’s newest pharmaceuticals store. Though definitely not the first pharmacy in the area (the business is merely a few blocks from much larger competitors like CVS and Rite Aid), Midtown Rx Pharmacy chose its location in the center of Midtown with a very specific purpose: to provide more personal care. Mike Srour, Pharm.D., is the owner and operating pharmacist of the business; we sat down with Mike to learn more about his mission.

Mike Srour, Pharm.D., owner and operating pharmacist of Midtown Rx Pharmacy, prioritizes affordability

Srour had previously worked for a larger chain corporation with a familiar name and a steady customer influx. However, he felt one-on-one time with his patients often took a backseat to enhance speed of delivery and numbers of prescriptions filled. Srour decided to leave his pharmaceutical job at this larger company in an affluent neighborhood to instead set off on his own in the city of Detroit.

Almost immediately after beginning his business in Midtown, Srour noticed significant differences in his patient demographic. He found that many of his new customers in Detroit often didn’t know which prescriptions they were taking. Formerly, at the suburban pharmacy, most patients understood what each of their drugs were meant for and which drugs could or could not be taken together. In Midtown, Srour discovered that far more of his patients did not have a primary care physician or even insurance and could only describe their maintenance prescriptions as “the red pills.” He also encountered more patients experiencing homelessness than he had previously, many of whom were unsure of how to even administer their own medications.

Srour has recognized, however, that his new position as owner and operator of his own pharmacy affords him the opportunity to prioritize patient education and affordable care. Dedicated to these principles, he works six days a week and provides free home deliveries. On top of this, Srour finds time to sit down with his patients and explain to them what prescriptions they are taking. He employs medication therapy management to help his patients stay on track of all the medications they need. These business practices represent a change in approach from the larger corporate chain that formerly employed Mr. Srour.

Competing with larger corporate chains has not been without its share of difficulties.  As a private owner, reimbursements go down, and thus volume must go up. The location of the pharmacy has also proven challenging at times: individuals come in with fake scripts looking for narcotics, and Srour even experienced a break-in earlier this month. However, despite these obstacles, Mike Srour has found a distinct need for affordable pharmaceuticals, and he strives to provide the most personal care he can to his patients.

After recognizing the need for pharmaceuticals here in Detroit, Srour began working with Street Medicine Detroit to help provide our patients with appropriate medications. “Sometimes homeless people will stop taking their maintenance medication because it’s the last thing on their minds of stuff to worry about,” he noted. Srour will often personally deliver the pharmaceuticals to the shelter to make sure everyone is taken care of and fully educated on what their prescription entails.

Though it was difficult to build a patient base in the Midtown area (with several other competing pharmacies nearby, as well as pharmacies operating within the hospitals themselves), Srour has found a loyal following in the area, in part due to his philanthropic nature. Apart from assisting Street Medicine Detroit, Srour works with uninsured individuals on a case-by-case basis to see if he can provide the most cost-effective option for people to acquire their medications. Though he can’t provide a free pharmacy, he works hard to make medication affordable for those who are struggling and focuses heavily on educating all his patients regarding the details of their pharmaceutical regiment.

We asked Mike Srour what made him leave his comfortable suburban corporate pharmacy, open a pharmacy in Midtown Detroit, and take on the challenge of serving a much more impoverished community. “I wanted to do something different. I didn’t just do it for the money; I wanted to have a more direct contact with my patients. There’s a huge difference in the way that you can treat patients when you run things yourself. You can spend that extra time and explain things to them in a way that they will understand,” he said. This quote captures the selfless drive that motivates Srour to help Street Medicine Detroit serve our patients, and more importantly, empower the people of Detroit to improve their health.

Midtown Rx Pharmacy is open Sunday through Monday and is located at 4100 Woodward Avenue, Detroit, MI 48201

Kristy Abraham, MSI, SMD Communications Coordinator

Alana’s Foundation: Protecting SMD Patients from The Flu

Every year, the arrival of autumn brings with it familiar sights, smells, and sounds. We think about leaves changing color, cooler weather, football, Halloween, and seasonal foods flavored with apple or pumpkin. While it has also become commonplace, many people overlook the importance of getting their annual flu shot amid the excitement of fall festivity. However, without sufficient immunization your community is at high risk for flu transmission and the potential severe consequences. With the start of flu season in October, now is the perfect time to protect yourself and your community from the flu; head over to HealthMap today and find out where you can get your annual flu shot today!

    Influenza, the virus that flu shots protect against, is one of many medical conditions individuals facing homelessness are at higher risk of acquiring. Already at diminished health due to the environmental insults of homelessness, these individuals also experience specific risk factors that increase their likelihood of suffering from influenza. First and foremost, the arrival of colder and wetter weather generally pushes most homeless individuals to seek the warmth of shelters. Despite the best attempts of shelters to maintain cleanliness, this type of housing quickly becomes crowded and unsanitary. As with school-children, close quarters enhance transmission of influenza via aerosol droplets. When one individual in a shelter has an influenza infection, they can easily spread it to other people. Additionally, some homeless individuals tend to travel throughout the community increasing their exposure to influenza viruses. When they stay at a shelter, they share this exposure with everyone else. Finally, the challenges of homelessness (e.g., finding food and shelter, exposure to the environment, fear of assault/robbery, etc.) are extremely stressful. This impairs the immune system’s ability to respond to insults, such as influenza. In combination, these factors explain the elevated risk of acquiring the flu that homeless individuals experience.

    Despite this elevated risk, this medical need of homeless individuals often goes unattended. Shelters do their best to prevent transmission by promoting healthy behaviors (e.g., hand washing), disinfecting surfaces, and isolating infected individuals from other people. However, decreased access to and use of healthcare limits vaccination in this population. Here at Street Medicine Detroit we do our best to minimize the effects of flu season. This would not be possible without the generous funding provided by Alana’s Foundation. A Michigan-based non-profit organization run by volunteers and funded solely through donations, Alana’s Foundation was founded in the memory of Alana Yaksich who died of flu-related complications in February of 2003. Grieving for Alana and shocked at how few people knew the importance of flu vaccines, Alana’s family created her foundation to promote influenza vaccination. Alana’s Foundation promotes influenza education and provides financial and emotional support to people who have lost loved ones to influenza. Additionally, in partnership with the Michigan Department of Health and Human Services, they provide influenza grants for underserved populations to non-profits and colleges/universities.

    Street Medicine Detroit has been lucky enough to receive some of these grants. Last flu season, aside from treating symptomatic patients, SMD provided free flu shots to patients we encountered on street runs or at NSO. Without Alana’s Foundation, we could not have provided 100 flu shots to a group of people who otherwise might not have received this vaccination. Additionally, thanks to generous funding from Alana’s Foundation, we will be doing the same again this year!

To find out more about influenza and flu season visit the Center for Disease Control and Prevention website

Eric Walton, MSII, SMD Director of Communications

Street Runs: How do they enhance medical education?

It's often easy to understand how a Street Medicine Detroit street run impacts our patient population. Patients leave with newly-dressed wounds, medication for their chronic illness, relief their medical concern isn't so serious after all, or at least a look of momentary satisfaction that someone listened to their concerns. These are the things that inspire everyone at SMD to put in the time and effort to make our organization a reality. However, in all of the positive work SMD does, people often lose sight of how Street Medicine Detroit adds to the medical education of many students at Wayne State University. To help explore these additional benefits, here are a few reflections that demonstrate what medical students find on street runs that aren't part of the traditional curriculum:

Role Models: SMD introduces medical students to physicians who demonstrate how to engage a neglected population

"From the moment you meet him, it's clear Dr. Bryce genuinely cares about people, regardless of whether they are a patient or not. He exudes interest in you as a person and any concerns you may have. This ability to instantaneously connect with an individual makes Dr. Bryce an excellent physician; his demeanor relaxes patients and encourages them to reveal fears they wouldn't normally share. More importantly, though, this quality makes Dr. Bryce particularly well-suited to engage with individuals facing homelessness. Dr. Bryce's friendly face and demeanor help him bridge this trust gap between him and homeless patients much better than most physicians. Furthermore, Dr. Bryce completely invests himself in every interaction. If he's talking with you, you have his full attention, and he's going to enlist every tool at his disposal to help solve your problem. Perhaps more than any other population, homeless patients require this tenacity. Unlike a patient encountered in a traditional clinic, individuals facing homelessness have fewer resources and face more challenges. Only with resolve and creativity is it possible for physicians like Dr. Bryce to find solutions for the issues impacting the homeless population."

-Eric Walton, MS2

Early Patient Interaction: SMD offers medical students an opportunity to apply clinical knowledge in a dynamic, rather than structured, environment

"Going on a street run was the first time I got to do a complete patient interview with a real patient who didn’t follow a script or already know what questions I might ask. It was a great learning experience, and very rewarding to see the patient react positively to my interview. Additionally, our preceptor, Nurse Dean, was great at explaining diagnoses to a first year medical student. He was able to correlate classic disease presentations from patients with the basic science material I've learned in class. Combining clinical knowledge and skills together with a real patient made it easier to retain information and apply it again in the future, both on exams and with other patients."

-Yusra Oral, MS2

Perspective: SMD forces medical students to reconsider priorities and privilege

"For doctors in training, SMD is the perfect reminder of the answer to the question posed in our interviews: "why medicine?" As medical students, we pledged an oath to serve patients when they are at their worst, without judgment. This is the most important objective of medicine that is easily forgotten among the basic science lessons of the first two years; the overwhelming volume of work in residency; and the problematic system of running a practice, figuring out the insurance companies and dealing with administrative nonsense.  Serving the homeless population of Detroit has made me look at life differently. It is amazing to me how positive people can be in the face of despair and how simply one can ease some of that pain by providing basic medical care, conversation, encouragement and respect. Street Medicine has been an anchor that keeps me grounded and reminds me why I subject myself to hours upon hours of studying and sacrificing. It has also been a reminder of how fortunate we are as medical students. When I go to sleep at night, having had the invaluable experience of working with this organization, I am reminded of my obligation to serve rather than self-serve. This allows me to tackle everyday with enthusiasm and hope that I will be able to continue impacting patient’s lives, no matter who they are, where they come from or how challenging their situation may be."

-Andrew Failla, MS2

Community Support for Street Medicine Detroit!

It has been a busy but exciting few months here at Street Medicine Detroit! 

In January, SMD was selected as winner of the city-wide Detroit SOUP, a "micro granting" dinner that celebrates and supports community projects benefitting the residents of Detroit. Essentially, 4 different presenters (e.g. entrepreneurs, artists, organizations) come to share their idea, and attendees vote for the project they think has the best plan of execution and potential for community impact. At the end of the night, the presentation that receives the most votes gets the money raised at the door to carry out their project. 

John-Michael and myself presented on behalf of Street Medicine Detroit and raised almost $2,000 from the event. The money from Detroit SOUP has helped SMD purchase equipment and medication to serve our growing pediatric population, as well as replenishing our stores of winter weather materials (e.g. coats, hats, gloves, socks) to serve all patients. 

Andrew Darmahkasih and John-Michael Guest presenting on behalf of Street Medicine Detroit at the January Detroit SOUP.

Andrew Darmahkasih and John-Michael Guest presenting on behalf of Street Medicine Detroit at the January Detroit SOUP.

Street Medicine Detroit was also recently recognized by the Detroit Pistons as a Game Changer honoree. This award is given to individuals and organizations who are making a positive impact in the Detroit community. Four representatives from Street Medicine Detroit were recognized during the pre-game ceremonies before the Pistons game on Friday, March 18 for the work we do to benefit the homeless community of Detroit. We were also invited to sit courtside during the game, and Belle Tire, a Detroit Pistons sponsor, has committed $1,000 towards the ongoing work we do to benefit the homeless community in Detroit.

Finally, Street Medicine Detroit held our 2nd annual 5k Street Run fundraiser this past weekend with the Robert R. Frank Student Run Free Clinic. Despite the chilly weather, almost 150 people registered to participate in the event. Through the generous support of our sponsors and participants, SMD and SRFC raised almost $3,000 from the fundraiser, money which will directly support the day-to-day operations of these two organizations and ensure that we can continue the work that we do.

We feel a deep gratitude to the Detroit community and are overwhelmed by the honor and support we have received for our work. While Street Medicine Detroit never began its operation to draw attention to ourselves, we are grateful for community partners who believe in us and recognize that what we do as an organization is important. We are hoping that any award or recognition we receive for our work would serve to bring awareness to the large unmet medical needs of those experiencing homelessness in the city of Detroit and inspire others to take action (in large or small ways) to meet those needs.

Andrew Darmahkasih MSII, SMD Communications Director

Street Medicine News: Community Leadership Award and a New Elective!

The past couple of months have been very exciting for us here at Street Medicine Detroit. We have definitely been feeling support from the people of Detroit, and we’d like to thank all of you out there for your encouragement. It energizes our efforts to provide street medicine.

This past January we received the Dr. Arthur L. Johnson Community Leadership Award from Wayne State University’s Office of Government and Community Affairs. This community service award is given in remembrance of Dr. Arthur L. Johnson, a civil rights leader and Wayne State administrator. As part of the award, Wayne State sent out their film crew on one of our Street Runs to record a short video with SMD.  They presented the award and the video at the University’s annual Dr. Martin Luther King, Jr. Tribute. We’ve added the video, featuring SMD Vice President Esther Chae, to our homepage. Take a look here!

We felt a great deal of support from those in attendance at the MLK Tribute, and we are grateful to be have been recognized by the University at this important event.  In a way, it’s also an endorsement by our community to continue to work to improve access to healthcare for those experiencing homelessness in Detroit. It also brings our patients’ stories and struggles to a wider audience. We’re hopeful that this increased community awareness will result in more funding and resources for our patients’ day-to-day needs.

SMD students with the  Dr. Arthur L. Johnson Community Leadership Award

SMD students with the Dr. Arthur L. Johnson Community Leadership Award

In other SMD news, we are excited to announce that the School of Medicine has just approved a Street Medicine elective for 3rd and 4th year medical students! This new elective will give students an opportunity to spend a month-long rotation learning how to manage the primary and preventive healthcare needs of those experiencing homelessness. Students will take on the roles of clinician, teacher, and project leader as they are immersed in an experience of outreach-based medicine. The new elective will challenge our 3rd and 4th year students to put their clinical knowledge and problem solving skills together in order to improve the quality of the healthcare available to those experiencing homelessness in Detroit. This is a unique opportunity to learn how to provide healthcare outside of the usual settings of the hospital and the clinic.

Besides providing our students with a solid training program for this often-neglected side of healthcare, the Street Medicine elective will help keep SMD sustainable. If fact with more students joining our ranks, we will potentially be able to expand our operations, seeing more patients and keeping the community safer with better preventative care. It’s an exciting time to be working with SMD. As the organization grows in both numbers and reach, we get closer to filling in the gaps and disparities that weaken our health system. There is definitely a lot of work ahead of us, but these recent developments keep us optimistic for the future of Street Medicine Detroit. 

Anthony McClafferty MSII, SMD Communications

SMD prepares for winter with new volunteers, new board members, and new coats

Wow, it’s been a couple of months since our last blog post. I hope we haven’t left you hanging! This fall has brought some great additions to our organization, including some folks that have helped expand our impact during street runs. Arta Duda, a volunteer from Wayne State University, has been providing patients with care packages containing socks and other hygiene items. We have also had the pleasure of working with Mr. Ed Mischel from the Detroit Medical Center. Mr. Mischel is helping SMD provide better psychiatric care, and his assistance has improved our ability to offer services for patients with mental illness.

We just completed our fall recruitment for SMD’s Board of Directors, and I’m excited to say that we selected 8 new board members from the M1 class. No doubt they will be a great addition to the team. Check out our leadership page to see the new and improved Street Medicine Detroit Board!

As the fall comes to an end, SMD is on alert for injuries due to cold weather exposure. We are trying our best to help our patients stay warm and safe this winter. To that end, we are excited to announce that we recently received a generous donation of winter coats from a local Detroit nonprofit organization called The Empowerment Plan. The coat produced by the Empowerment Plan is special for two reasons. First off, it’s surprisingly resilient. The waterproof coat, which can also be unfolded to function as a sleeping bag, keeps its wearer warm in temperatures as low as 17 degrees. Secondly, The Empowerment Plan employs women who have had some experience with homelessness. The organization hires these women as seamstresses and also helps support their transition into stable housing. Presently, The Empowerment Plan has 18 previously homeless women on staff, and 16 of these women have found stable housing in a home or apartment. The remaining two employees are currently in the process of transitioning into housing. The idea to produce winter coats for those experiencing homelessness started as a class project for then College for Creative Studies student Veronika Scott. With a couple of successful prototypes and some local support, Ms. Scott went on to found The Empowerment Plan. The organization is set to produce and distribute 5,000 coats this year.

Empowerment Plan coat. Photo from

Empowerment Plan coat. Photo from

We at Street Medicine Detroit are very grateful to have Empowerment Plan coats to offer to our patients in danger of life-threatening cold exposure. Although we focus on trying to help our patients enter housing programs and shelters, the reality of the matter is that this process can take time and many are forced to brave the cold weather as they wait to be housed. These coats will make a great difference in the quality of life of our patients, and for that we’d like to give a big thank you to The Empowerment Plan!

Anthony McClafferty MSII, SMD Communications

Beat the Heat: Street Medicine Detroit Explains Heat-Related Illness and How to Cool Off

As Michigan’s weather wheel turns from the bitter cold of winter to the summer’s blistering heat, Street Medicine Detroit (SMD) and our partners at Neighborhood Service Organization (NSO) see a new array of health conditions among the community. Cases of frostbite and hypothermia are replaced with heat stroke, dehydration, and heat exhaustion.

Several factors affect the body’s cooling system during the hot summers. When the humidity is high, sweat does not evaporate as quickly and will not allow the body to release heat quickly. Age, obesity, dehydration, heart disease, mental illness, poor circulation, and use of prescription drugs or alcohol are factors that affect the risk of heat-related illness. Groups such as the elderly, infants, children, people with chronic medical conditions, and people who are experiencing homelessness are also at increased risk. For those who are experiencing homelessness, extreme heat affects other aspects of life. Intolerable sleeping conditions may lead to insomnia while the inability to keep food cool may increase risk of foodborne illness.

The August 2003 heat wave that occurred in France is a famous case studied by scientists to identify risk factors for heat-related illness. It also shows how serious extreme heat can be; during this time, there were nearly 15,000 heat-related deaths, particularly among the elderly. Social factors involved in these deaths include living in an urban area, low socioeconomic status, and social isolation. Many of these individuals were living alone and had no one to check on them.

While heat-related illness is serious, it is also highly preventable. Here are some identifying signs of the three most common heat-related emergencies from the Centers for Disease Control (CDC):

Heat cramps are painful spasms of the leg or stomach muscles and may be accompanied by heavy sweating. They do not require medical attention, but the person should stop all activity and sit quietly in a cool place and drink water, juice, or a sports drink.

Heat exhaustion includes extreme fatigue, heavy sweating, thirst, headache, dizziness, fast and shallow breathing, nausea and vomiting, pale and moist skin, and a fast, weak pulse. If untreated, it may progress to heat stroke. Ways to cool off include rest in an air-conditioned environment, lightweight clothing, cool, non-alcoholic beverages, and a cold shower/bath.

Heat stroke is a life-threatening condition caused by breakdown of the body’s thermoregulation. The skin no longer sweats but becomes red, dry, and very hot. Other symptoms may include chest pain, shallowness or shortness of breath, abdominal pain, confusion, anxiety, rapid pulse, and throbbing headache. Body temperature rises to 103˚F or above. Until emergency medical care arrives, cool the person rapidly with whatever methods are available: remove extra layers of clothing, fan, and apply cool water using a wet sheet, sponge, or garden hose.

Above all else, remember that heat-related illnesses can affect anyone. Please drink plenty of fluids this summer, not just whenever you feel thirsty. Avoid alcoholic and caffeinated drinks, as they can contribute to water loss. If you or someone you know has a risk factor mentioned above, adapt a buddy system with a friend to check on each other periodically this summer. Stay cool!

Anirudha Rathnam MSII, SMD Publishing Coordinator

Originally published in Thrive:D Street Newspaper August 25, 2014


Street Medicine Detroit welcomes the Class of 2018

SMD President Johnny Wong welcomes the new recruits 

SMD President Johnny Wong welcomes the new recruits 

Earlier this month, over 150 Wayne State medical students joined Street Medicine Detroit for our fall training session. Wait a second, you say. Fall? It’s still August. I mean yesterday was 90 degrees. What’s this fall business about? Well, I hate to break it to you, but here at the School of Medicine we’ve been back in school for almost a month now. Believe me when I say that I hate to break it to you. Ha. It’s only a joke! Despite the unseasonal end to summer break, it’s nice to be back at Scott Hall, and it’s great to continue working with the Street Medicine Detroit crew. Presented with an incoming class of first year students itching to volunteer, we hosted our fall training session to teach students about street medicine. I know, I know, we probably should have prescribed some anti-itch cream, but we love volunteers here at SMD. The support of Wayne medical students keeps our work in the community going. They’ll just have to scratch that itch.

Nurse Practitioner Dean Carpenter

Nurse Practitioner Dean Carpenter

Before our new volunteers could hit the streets with us, we needed to educate them about our patient population and teach them some useful medical interviewing skills. I really need to give a shout out to our Director of Education and Training, Jawan Gorgis, who took care of all the planning and logistics for the training. Her leadership was crucial to the success of the event. In order to help our new recruits understand the unique challenges, both medical and societal, that street medicine is trying to help solve, we invited some of our partners from the community to speak. Nurse Practitioner Dean Carpenter, our lead clinical preceptor from the Tumani Center, took the podium to dispel some of the myths surrounding homelessness. He spoke about how we as clinicians need to approach our patients with compassion and openness. Something he said really stuck with me: “We are not here to judge. We’re out here to help others realize their full potential.” Good stuff, Dean. Another speaker from the Tumani Center, Ms. Lydia Adkins, talked about the importance of hope for people experiencing homelessness. She spoke about how isolating homelessness is, and how simple kindness goes a long way in helping someone cope. A former client of the Tumani Center, Robert McClinic, also joined us. Mr. McClinic had spent many years of his life homeless, but an intervention by the Tumani Center helped him find stable housing and employment. Mr. McClinic’s advice for students: Never count anyone out. There is always the chance for people to overcome their difficulties.  

Guest Speaker Robert McClinic, "Never count anyone out."

Guest Speaker Robert McClinic, "Never count anyone out."

After our guest speakers, the Operations Department explained what goes on during street runs. Operations Coordinator David Friedlander also stressed the importance of confidentiality with patient medical information. It’s true we dropped a lot of new information on our incoming volunteers, but it’s extremely important that our students are knowledgeable and comfortable while working on a street run. Plus, we gave them free pizza. So I don’t expect any complaints. To that end of preparing the newly minted Street Medicine volunteers, we broke off into small groups in order to give the students a chance to try their hand at medical interviewing. In my group, I role-played as a 32 year-old male patient with diabetes, which was surprisingly easy. I think I might be getting old. The students in my group were a bit shy, but beneath that shyness they seemed to know the right questions to ask. Regardless that shyness won’t last long because pretty soon they will be out on the streets and in the shelters. They’ll be face to face with a patient, and they’ll have to ask the questions. Sure, they might make mistakes (that’s why we have licensed professionals with us – to catch those mistakes!) But overtime these students will improve and learn to be great doctors. That’s the beauty of street medicine. At the same time as we are helping some of our most underserved community members, we are training our future physicians to provide competent and compassionate care right from the start.

Anthony McClafferty MSII, SMD Communications

My First Street Run: How Trust and Respect Go a Long Way in Patient Interviewing

In late April of this year, I went on my first “street run” with Street Medicine Detroit (SMD). As a medical student, it’s nice to get away from the books and learn outside the classroom. Volunteering is a great way to complement my studies and help out in the community. Aside from gaining medical knowledge, volunteering with SMD provides insight on the dynamic of the doctor-patient relationship. On my first street run, I experienced firsthand how trust and respect inform this important relationship.

The street run took place at Manna Meal, a soup kitchen in Detroit’s Corktown neighborhood. As the SMD team walked through the kitchen and sitting area to the backroom, where we were to set up the clinic for the day, I was excited yet somewhat anxious. I recall two immediate concerns entering my mind: did I know enough medicine to assist these patients and even if I did know how to help, could I gain their trust and respect? I had spoken with individuals experiencing homelessness in the past, and some of them shared with me feelings of alienation from healthcare professionals. Would I be able to work past this divide? I quickly learned that my first concern was not was not an issue; I would be duly supported by Nurse Practitioner Dean Carpenter of the Neighborhood Service Organization (NSO) who assists students in diagnosis and treatment. Still, my second concern loomed.

We set up the clinic in a room at the back of the shelter and divided into teams of students. After setting up equipment, we met our first patient. He was a young man experiencing homelessness who presented with a rash above his right wrist. During the medical interview, he told us that he had been diagnosed with paranoid schizophrenia. He went on to inform us of his general distaste for medical care, including his aversion to sharp items like needles. He explained that he would have gone to the emergency department (ED), but he had prior bad experiences there. He preferred to be in a familiar environment, such as Manna Meal soup kitchen. This initial interaction bolstered my concern that I might not be able to connect with this patient. I knew we would have to work to earn his trust.

We worked slowly through the patient interview, asking about his past medical history and his social history in an effort to understand our patient and find out how we could help him. As the patient interview continued he seemed to slowly become more comfortable with us and began discussing very personal issues. We listened attentively and did our best to respond with respect and kindness. Thankfully, the patient load for the day was not over-burdensome, which gave us the opportunity to listen to the patient without interruption. He had lived a difficult life and the least we could do was lend an ear.  After completing the interview we consulted with Nurse Practitioner Dean Carpenter. A diagnosis of Methicillin-resistant Staphylococcus aureus (MRSA) was reached. We offered the patient potential drugs for the bacterial infection, but he informed us that he was allergic to one of the drugs (initially the patient had said that he had no known allergies to any medications). We began to discuss potential treatment options when, to my surprise, the patient stated that he wished to go to the ED for further care. Because of his prior statements and because I wanted to ensure he would actually seek further treatment, I asked him whether he felt comfortable going to the emergency department. He responded by stating that it was the proper thing to do in this scenario and that his time with us made him feel more comfortable interacting with healthcare providers. He thanked us and left for the ED.

I was initially disappointed that we weren’t able to provide direct care to this patient. However, after some reflection, I realized that we did many positive things for this gentleman. I’d like to think that the respect we gave him provided him with a positive medical experience and helped to motivate him to seek further care from the ED. This was a stark reminder that providing valuable healthcare does not always necessitate prescribing drugs and preforming procedures. Ensuring that patients are well respected and realize that healthcare providers are looking out for their best interests goes a long way towards helping patients, especially when it comes to patients in vulnerable situations.

Andrew Wayne, MS2, Communications Director for SMD


At Manna Meals in the basement of St. Peter’s Episcopal Church in Corktown, medical students from Street Medicine Detroit (SMD) carry backpacks and boxes of medical supplies as they pass through the cafeteria. A man in the hallway receives his meal and asks if there’s a psychiatric nurse among the group, a clue as to how one might end up at Manna Meals.

Chairs are pulled from the eating area and set up in a dusty backroom that houses a tuneless piano, some donated clothes, and at the moment a clinic. The students are dressed in street clothes, the stethoscopes around their necks the only outward sign of their medical role here. Over the next hour and a half, students get to work interviewing patients, checking vital signs, and presenting patients to Nurse Practitioner Dean Carpenter for diagnosis and treatment.

Dean provides primary health care services at the Neighborhood Service Organization’s (NSO) Tumaini Center. The center, located off of MLK Boulevard on 3rd Street in Detroit’s Cass Corridor, provides respite care for individuals experiencing homelessness.

“There’s a certain population who won’t or can’t seek our services,” Dean said. “Maybe they are mentally ill or the medical community has disenfranchised them in the past.”

In December 2011, Street Medicine Detroit founder and then first-year medical student Jonathan Wong approached Carpenter with an idea to make medical services available to Detroit’s nearly 20,000-person homeless population. Jonathan was inspired by the growing practice of street medicine. His initiative found a natural home at NSO as Dean saw a chance to increase his reach. Street Medicine Detroit officially organized in May 2012.

Many of SMD’s patients have had negative experiences with doctors in the past, and medical encounters are often vulnerable situations. Visiting a doctor can be an uncomfortable experience for the average person, but for someone on the margins of society, it’s prohibitive. Additionally, homeless individuals face structural challenges to accessing healthcare.

Medicaid requires a permanent address to verify state residency. Without insurance, emergency departments are overused in order to receive primary care. Lack of reliable public transportation in Detroit also makes it difficult to attend clinic appointments, especially during the winter months. By bringing health services directly to patients, SMD aims to remove most of these barriers with the ultimate goal of connecting patients to consistent primary care.

“If we did our jobs perfectly, we wouldn’t have any patients left to see. They would all have primary care providers,” Street Leader, Samantha Terranella said.

SMD’s mission is ambitious, but Street Medicine Detroit is not without its partners, many of which have a long track record of homeless outreach. Working alongside students, are NSO employees Philip Ramsey and Lydia Atkins, familiar faces around the homeless community. The two often triage patients for SMD, establishing the initial contact and trust necessary for a successful intervention. Carpenter stresses that SMD is also a teaching environment. He’s looking to instill confidence in his students’ interviewing abilities, so that they are comfortable treating any type of patient.

Along with the medical students, Carpenter brings nursing students on street runs. Joseph Kalejaye, a nurse practitioner student from Michigan State University has accompanied SMD on 15 runs, and his experience shows.

He counsels a patient on the best way to control her asthma, recommending that she returns to see him if she ever finds herself without her inhaler. SMD will provide her with one free of charge.

After speaking with the patient, Joseph admits to having been apprehensive about his placement with NSO and working on street runs. He now counts the experience as a unique and useful component of his education.

“This was my first experience around the homeless, and this work, for me, helped remove the stereotype surrounding homelessness,” he said. “I realized that many people are here due to situations beyond themselves. Sometimes there is a tendency to blame people for ending up here, but that’s not the reality of homelessness.”

With his last nursing rotation wrapping up and looking toward his future career in primary care, Kalejaye says that his experience with Street Medicine will inform his future decisions as a nurse practitioner.

“With the homeless community, you have to prescribe cost-effective treatments that patients will follow. It doesn’t do the patient any good to prescribe something that the he or she can’t afford or doesn’t want to take. This applies to all patients. We should be practicing cost-effective medicine everywhere.”

Wayne State University’s Department of Psychiatry and Behavioral Neurosciences has studied the frequent use of emergency departments by the homeless, finding that 66% of those surveyed had made 3 or more emergency department visits each year.

It’s not hard to understand why. Life on the street and in shelters is not conducive to managing a chronic disease, and health problems can quickly escalate, often resulting in visits to the emergency department. The study puts the number around $1,600 per day for frequent users from the homeless population at Detroit Receiving Hospital. Proper primary care management can help us avoid these expenditures. As the students pack their equipment and supplies in a van, a man stumbles up asking for his pills. He’s late and has missed the clinic. He admits, halfway between an apology and a weather report, that he’s been drinking. From the back of the van, Carpenter stretches forward for a better look, trying to place the man.

“He’s actually one of our success stories,” he tells the doubtful students, “well, partial success story.” As he digs through his backpack of medicine, he describes the patient’s story: how an NSO employee found him living in Savage Park and how the man would often experience intense seizures requiring him to go to the emergency room.

“In the ER, they would give him his Dilantin, but once he left he’d go back to drinking heavily,” says Dean “Once the pills ran out and the seizures came back, he was back in the ER.” With Mr. Ramsey’s help, Street Medicine Detroit intervened. “Now he comes to us to get his anti-seizure medication, like clockwork. He seeks us out. No more ER visits.”

Anthony McClafferty, MSI, Communications Coordinator
*this article was also published on June 19, 2014 in Critical Moment- see:

Dr. O’Connell, Advocate for People Experiencing Homelessness

Two weeks ago, Street Medicine Detroit and the Neighborhood Service Organization had the honor of hosting Dr. Jim O’Connell for a special seminar on medical respite. Dr. O’Connell helped to found the Boston Health Care for the Homeless Program almost 30 years ago and still serves as its president. His training in internal medicine allows him to recognize and treat the many afflictions he sees in his patients, and, perhaps just as importantly, his incredibly kind and unassuming demeanor elicits trust from his patients and encourages others to follow in his expertly paved path. After the seminar, Jane Philip, Director of External Fundraising, accurately remarked that Dr. O’Connell is “a man with a gentle spirit, and the genuine care and concern that he has for his work was very evident. He harbors a quiet strength, one that can be seen in the integrity of his work and principles by which he serves. There is no doubt that each one of us aspires to be a physician of his capacity.”

Ankita Chatterjee, Communications Coordinator, added, “I found him extremely approachable…I noticed him going out of his way to make each person he talked to feel comfortable. He always had a smile on his face.” Through his speech and his more personal interactions with our group, it became clear that he truly values the work he does and is interested in helping other organizations improve their operations. Through his talk he was able to “[tell] a story alongside making a complex issue like medical respite easier to understand. It was also a wonderful look into how an organization can grow to best serve a population.”

According to Jane, some of the most heavily emphasized lessons from the seminar included holding on to hope and optimism in one’s mission and values; being flexible with skills and training in order to adapt to patients’ needs, including learning directly from patients; and the notion that, in caring for the under-served, one must make sacrifices—time, money, or resources may not be readily available in this type of work, but the work itself is incredibly worthwhile and fulfilling, and it helps people who have often been made to feel ignored and marginalized by the mainstream health care system.

Dr. O’Connell stressed that he is still figuring out how best to accomplish this work over time. While he was certain not to idealize his role in Boston, he did inspire others to consider careers focused on helping those who may not otherwise receive adequate medical and social care. He helped us to understand why this type of work is so vital, and he left us with many important questions to reflect on.

Justin Petrusak, LMSW, QMHP, Clinical Supervisor at NSO, also helped us to reflect on our view of homelessness and encouraged us to consider many of the social aspects of caring for people experiencing homelessness. He made us more mindful of the connotation of labeling someone as a “homeless person,” explaining that homelessness is a housing status rather than a personal attribute. The term “homeless person” holds negative implications for people’s hopes, dreams, strengths, and weaknesses. Experiencing homelessness simply means that someone lacks a permanent place to live and is likely going through one of the hardest, most stressful times of his or her life—which is precisely where we meet our patients.

Amrit Basi, Co-Director of Patient Care, summarized the event by stating that “Dr. O’Connell’s message is one of kindness and acknowledgment that our patients, above all else, are people and deserve to be treated with dignity and the utmost respect. He said he could see himself in many of his patients. Once you realize that the patient you are treating could have been you, you develop an overwhelming sense of compassion and empathy.” Over time, we are all learning that we share a great deal in common with our patients, and we are humbled and inspired to learn more each time we recognize these similarities.

We are so grateful to have shared such insightful moments with Dr. O’Connell, and we are certain to carry the lessons we’ve learned from him into our future careers.

Sarah Bommarito, MSII, Communications Director
with Allison Pianosi, MSII, President

Maintaining Contact with Patients

While working with the homeless poses many challenges, one of the most difficult to navigate is the transient nature of the population. This creates difficulty in providing continuity of care, including scheduling follow-up visits, coordinating care through the complex social safety net, and charting our patients’ outcomes. With these challenges in mind, being able to follow a patient and witness the positive changes in his life is extremely rewarding.

Mr. Mason* was a homeless veteran with a past medical history of type II diabetes, post-traumatic stress disorder, bipolar affective disorder, and generalized anxiety disorder. Upon meeting Mr. Mason and running the available lab tests to determine his blood glucose values and HbA1c, we learned that he had gone without his prescription medications for quite some time. After a few visits with him, we were able to provide medications that stabilized his conditions and then to direct him to further medical services. While the scope of our practice is limited, Mr. Mason qualified for comprehensive care from Veteran Affairs (VA). After working through some of his initial hesitations about reentering the more formal healthcare realm, the Neighborhood Service Organization helped to redirect him to the care of the VA.

After Mr. Mason began services at the VA, we lost contact with him for some time. A year or so later, a colleague of mine described an emotionally labile homeless veteran under her care—a veteran who turned out to be Mr. Mason. I learned that he had been living at a VA facility, had joined a local church, and was beginning to find community and a support system at the VA. By his own account, he was progressing quite well until recently when he was assaulted, leading to his admission at a health care institution under my colleague’s care.

Mr. Mason noted to my colleague that he remembers our visits with him and that, in many respects, we had served as the necessary bridge for him to take back control of his life. Hearing these words is humbling, especially as our program is still in its infancy. The positive impact we have had in Mr. Mason’s life, however slight, exemplifies the beauty of street medicine and the influence that care and compassion toward others can achieve.

Johnny Wong, MSIII, Founder
with Sarah Bommarito, MSII, Communications Director

*Name changed to protect patient confidentiality.

World Homeless Day

With cold weather approaching, many turn their thoughts to evenings by the fireplace, sipping hot cocoa, or being surrounded by family during the holidays. For others, cold weather signals something entirely different--with few prospects for warm places to stay, this is a very frightening and uncertain time of year for the thousands of individuals who find themselves without homes in the Metro Detroit area. World Homeless Day, which takes place every year on October 10, asks us to consider these individuals and try to make an impact in any way we can.

Each year on World Homeless Day, Brooks Young* organizes an event in Mount Clemens to bring awareness of the issues surrounding homelessness as well as ensuring that homeless people in the area have at least one good meal that day. This year, she invited Street Medicine Detroit to join her. A group of us had the pleasure of meeting Ms. Young and talking with several people who stopped by for a meal and medical attention.

Our group in Mount Clemens on World Homeless Day 2013. From left: Dean Carpenter, RN, FNP-BC; Sarah Bommarito, Communications Director, MSII; Brooks Young; Gabriella Rubino, Director of Education and Training, MSII; and Allison Pianosi, President, MSII.   

Our group in Mount Clemens on World Homeless Day 2013. From left: Dean Carpenter, RN, FNP-BC; Sarah Bommarito, Communications Director, MSII; Brooks Young; Gabriella Rubino, Director of Education and Training, MSII; and Allison Pianosi, President, MSII.


Although homelessness presents on a larger scale in Detroit than in many other cities, this event reminded us that being homeless is a very real concern for individuals everywhere. While Street Medicine Detroit unfortunately cannot reach out to everyone in need, talking to Ms. Young about her efforts left us with a sense of hope. Ms. Young organizes multiple events per year and truly cares about the people she serves. For those who may go days without talking to another person, being shown this type of consideration and thoughtfulness can be a major force for positive change.

We were not able to see many patients on World Homeless Day, but we appreciate the opportunity to have helped those we did encounter. We are extremely grateful for Ms. Young and the many others who notice a need within their communities and take steps to fill that need. Engaging in these efforts--however small your role may seem--can, at the very least, allow someone to regain his sense of dignity and humanity, if even for a day.

Sarah Bommarito, MS II
Communications Director

*For more information about Brooks Young’s events, please visit her website at 

Cleaning Up the Streets

Friday marked Street Medicine Detroit's first venture beyond our comfort zone of health care provision. In what will soon become a regular occurrence, we hit the streets with garbage bags in hand to pick up trash around the NSO Tumaini Center. While we fully expected to pick up anything and everything cluttering the area, what we didn't quite expect was the help of two homeless clients who voluntarily chose to clean the area with us!

Our group and extra volunteers hard at work.

Social stigmas against the homeless do very much exist; we see it all the time and join in the fight against it as much as possible. Friday’s experience served to reinforce the views we at Street Medicine Detroit have developed of the homeless—that is, that “they” are just like any one of “us.” Both homeless clients shared their visions and dreams for the future and what they were doing to get there. They spoke at length about their families and upbringing, and one of the gentlemen glowingly told us about his recent engagement. The sparkle in his eye and the excitement in his voice were apparent as he spoke about his bride-to-be.

Our experience demonstrated so much to us in such a short amount of time. We have often heard misguided claims that the homeless are in their current position because they are “lazy” and do not want to work or that homelessness would be eradicated if homeless individuals were more hardworking; however, the two men who decided to help during our clean-up did so without prompting or reward. In other words, they went out of their way to do something positive in their community simply because they wanted to help.

The area after our clean-up. Great work, everyone!

With the success of our first clean-up event, we now hope that our future events will attract the attention of more clients. Seeing us out there may prompt them to join in our efforts and help one another in creating a better atmosphere, including continuing the discussions of and plans for their own brighter futures. Who knows—we may even arrive for a clean-up session one day soon only to find that a group of homeless clients have already taken it upon themselves to work together and maintain cleaner streets around the center. While working to keep the streets clean will not solve all of their problems, it is surely the sign of a great first step.

Jonathan Wong, MSII

Sarah Bommarito, MSI
Communications Director

A Nurse's Perspective on Street Medicine

After college I moved from Massachusetts to Detroit and began an AmeriCorps position at Neighborhood Service Organization (NSO). I wanted to leave my comfort zone, see more of the world, and make an impact in area that needed help. I wasn’t sure how I should do that, but the move felt right, and so I went.

My AmeriCorps position taught me a lot about the real world. I learned quickly that in the field of human services what matters most is the skill that you can offer to your clients. Yes, it is critical to be passionate and caring. But empathy alone is not enough. I learned that people do not need me to feel bad for them. Rather, they need resources, counsel, and compassion - in addition to food, a house, good health, and some general peace of mind. That means they need social workers, doctors, teachers, and nurses.

Growing up, I’d seen nurses as doctors’ helpers. I had considered it as a profession, but wasn’t sure I could handle not calling the shots. I wanted to be self-sufficient and capable of helping individuals in need, without always deferring to someone else’s judgment. When I met the nurse practitioner at NSO I began to understand the scope of a nurse’s practice. In watching him, I saw a person with autonomy, compassion, patience, resourcefulness, and perspective. He got down on the level of his patients, met them where they were at, and encouraged them to take small steps forward.

Motivated that I’d found a concrete way to make an impact in people’s lives, I got started on nursing school. Toward the end of my accelerated BSN program, with a little more free time, I found myself back at NSO.

Street Medicine gives me purpose and autonomy. I have the opportunity to use skills I learned in the classroom and clinical setting to help people who aren’t getting medical care or health education from anywhere else. When I volunteer, I consistently feel that I am making a difference.

Most of the patients we treat don’t have access to computers or a primary care doctor to call. The first patient I talked to didn’t know the basics of diabetes. He looked at me with rapt attention as I explained how to tell if [his blood glucose] was high or low, what to do if it felt low, and how to take care of his feet. I explained that because he couldn’t feel his feet as well, he was more likely to step on something and not realize it. We talked about using a mirror to look at his feet and drying them off completely before putting his socks back on. When he left he looked at me and said, ‘Thank you. This means a lot.’

I don’t always feel as purposeful as I did in that moment. Some patients are not as receptive as he was. Often, it’s because they have other things on their mind. I have to remind myself that my priorities are not always the same as my patients’ priorities. Street Medicine works because it allows health practitioners and students to meet patients on their turf. Many homeless individuals do not seek out care immediately because they have more pressing concerns: Where will I sleep tonight? How can I find food? What paperwork do I need to get so I can apply for housing and get my life together?

Street Medicine forces me to have a perspective about these things and consider the road blocks that homeless individuals experience on a daily basis. It also gives me a sense of autonomy and self-worth that I have yet to experience as a floor nurse. On a street run, I ask patients what their primary concern is, take a more thorough history, and then use these findings to guide my physical assessment. After reporting back to the nurse practitioner and documenting my work, I develop a nursing plan of care and recommend specific interventions. The clinical preceptor is the one distributing the medications, but I am able to educate patients on their use and answer any questions they may have.

I have just been admitted to the University of Michigan’s Family Nurse Practitioner program. While I am not sure where I will end up, I know that I want to use my skills out in the community, helping those in need. Street Medicine has helped shape my path forward from here.

Anna Kern

Partnerships - The Caritas Welcome Center

“Go to the people” – this seemingly simple and yet powerful statement is a guiding principle for Street Medicine Detroit. Why practice Street Medicine? Why “go to the people” when in theory there are plenty of free clinics and Federally Qualified Health Centers where the homeless can access care?

Homeless people in Detroit continue to be unreached, unsheltered, and service-resistant. Since the launch of our program, we’ve been blessed to listen to the patients’ stories. We learned that we need to meet them where they are and ultimately build relationships through consistency and respect.

When we met with the Caritas Welcome Center (CWC), we were impressed by their genuine passion for serving the community. Often, it is difficult to find the right partnerships; yet, this one evolved naturally due to our common values and vision.  CWC does a great job at ensuring that their facilities are a safe and judgment-free zone for the guests. Thus, Street Medicine Detroit can visit the same patients several times and better manage their health through continuity of care.

We’ve already seen cases of uninsured patients with uncontrolled diabetes and hypertension, both of which are chronic diseases that can have devastating outcomes if not managed on an ongoing basis. We bring the medications to treat these conditions. We aim to continue to provide follow-up care. Our work does not end there as we strive to build enough of a rapport that we can connect patients to housing and social services.  

To do all of this for even one patient is an enormous challenge. Moving forward, we know that we can’t do it alone. This is why functional partnerships are important, and why we value the one we have with the Caritas Welcome Center. Standing together in solidarity, we aim to reintegrate our friends living on the street back into the system from which they have been excluded.

Jonathan Wong, MSII
President and Founder

Expanding Our Reach

Practicing medicine on the street, as one might imagine, poses a unique set of challenges for health professionals. In our particular case, with each street team being composed of approximately six individuals and our potential patient base in the tens of thousands, we have recognized the need to implement new methods in order to improve our efficiency, expand our reach, and provide the best possible care to each patient we encounter.

One major roadblock during street runs is our inability to access patient records during encounters. We often lack information regarding our patients’ past medical history, recent hospitalizations or physician visits, and insurance status. Further complicating matters is that some patients are unable to provide accurate or complete information. Unfortunately, learning only fragments of our patients’ health histories can hinder our attempts to form feasible plans for their health.

With this in mind, Vice President Sal Calo and Fundraising Co-Director Carolyn Chen have developed a grant proposal to obtain mobile devices and wireless Internet access for use on the street. With the fulfillment of this grant, we will be able to track details of each encounter at the point of care rather than waiting until after a street run to document information. Perhaps more importantly, we will be able to view complete medical records during patient interviews to determine the correct treatment plan for each patient and direct the patient to appropriate types of care depending on his or her insurance status. This will improve our ability to provide accurate diagnoses and continue treatments in a way that makes sense for each patient. With this improved efficiency we may also be able to help more patients over time, bringing us closer to reaching our goal of connecting as many homeless individuals as possible to viable primary care options.

In addition to this grant, we are incredibly fortunate to have partnered with Alana’s Foundation. They have offered to provide our patients with flu shots on a yearly basis, which will further reduce our patients’ discomfort and improve their health.

As we continue to grow as an organization, we hope to form strong partnerships in many areas of the community. Our continued success will depend heavily on the support of others, both logistically and emotionally. We are very excited about the opportunities we have encountered thus far, and we look forward to a day when we can all come together to serve those who are most in need.

Sarah Bommarito, MSI
Communications Director