Blog

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

ON THE STREET RUN: EXPANDING ACCESS WITH STREET MEDICINE DETROIT

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: http://critical-moment.org/2014/06/19/on-the-street-run-expanding-access-with-street-medicine-detroit/

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 http://brooksjyoung.com/. 

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
President

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

Dr. Withers - The Father of Street Medicine

In medical school, it can be easy to lose sight of the big picture; many of us bury ourselves in studying and concern ourselves only with our impending exams rather than what they will eventually allow us to do. But then there are those moments that reaffirm our dedication and show us that the opportunities we’ve been afforded will allow us to truly make a difference. Dr. Withers’ visit did just that.

Dr. Withers, a pioneer of the street medicine movement, generously donated his time to speak to us about his personal journey into the field as well as future directions we might take as an organization and more individually as future physicians. His talk ranged from touching to upsetting to motivational. He showed images and shared stories about his childhood mission trips with his medically inclined parents to his humble beginnings as a medical student searching for a residency program that would allow him to serve a chronically forgotten and ignored population: the homeless.

From there, he described how he established his connection to the community in order to help them. He learned to dress “like a homeless person,” sometimes rubbing dirt into his hair and wearing tattered clothing to remain inconspicuous and appear as more of an equal in order to gain trust. He pointed out how he tailors his posture to show patients their due respect, often crouching at their feet or sitting beside them as he listens to their stories, appreciates their humanity, and provides the necessary care. His concern for the homeless is extremely apparent, and his dedication is inspiring.

Dr. Withers’ presentation reminded me that, regardless of skill level, we are all capable of helping in some way. Whether we listen to stories, take blood pressures, form differential diagnoses, prescribe medications, or simply choose to keep an open mind about the homeless community, we are all involved in creating an environment that helps to rehabilitate and strengthen individuals who have found themselves without homes. As my classmates and I continue to learn new skills and become the next generation of physicians, I hope we all keep Dr. Withers’ lessons in mind.

"To love is not to give of your riches but to reveal to others their riches; their gifts; their value; and to trust them and their capacity to grow. So it is important to approach people in their brokenness and littleness gently, so gently, not forcing yourself on them, but accepting them as they are, with humility and respect." – Jean Vanier

Sarah Bommarito, MSI
Communications Director

SMD - A Fourth-Year Student's Perspective

This morning, I had the good fortune of practicing medicine in a homeless shelter with Street Medicine Detroit. SMD is a student run organization at Wayne State University School of Medicine that ventures out into the community and provides compassionate medical care to the underserved and homeless of Detroit. Because of the cold weather in Michigan, our "street run" took place inside a church just off of Trumbull street on the west side of Detroit. This church serves as a place of respite for homeless men and women, a space where they can see the news of the day on TV for the first few hours of the morning and have a quiet time of reflection for the remainder of the morning. 

On this day, our street team of six medical students and one attending clinician offered our services to the group of roughly twenty people. Four people requested a full visit and a few more asked to have a few of their medically-related questions answered. As one of the team leaders, I was able to care for two patients - a middle aged man recovering from an attack of acute gouty arthritis and a young man with chest pain. The older man's knee pain and gouty flare was complicated by an inability to take colchicine because of renal impairment discovered when he was last hospitalized. His case was also challenging because of his high blood pressure that could have been related to his self-reported state of stress or his on-going knee pain. Whatever the cause, we were able to schedule a follow-up appointment at a local free clinic. The younger man's chest pain was found to be caused by a case of community acquired pneumonia, which was discovered after a thorough physical exam lead us to listen and compare his lung fields that revealed coarse crackling sounds on one side, or unilateral rales. Unfortunately, this case was also complicated, this time by GERD or gastric reflux, asthma, depression, and crack cocaine use.

Substance abuse is prevalent among the homeless population and has been described as a way to palliate the stress of homelessness itself - an interesting but vicious cycle. So our group offers only what the patients are ready/willing to take on. We offer medications if they are able to take them regularly, we counsel about risk reduction, and we attempt to set up follow-up appointments to see if our treatments are effective. We also build rapport - to practice street med, you have to have a certain amount of street cred - and the time we spend with these men and women and the compassion that we show does not go unnoticed. Word spreads quickly through the complex networks of support that holds the homeless community together, and we were told that we have earned a degree of trust and respect among those that we serve. It's been an honor to be there and I'm looking forward to the next opportunity.

Paul Thomas, MSIV

http://paulcthomas.weebly.com/1/post/2012/12/street-medicine-detroit.html

My First Street Run

As the street run group and I pulled into the NSO parking lot, I couldn’t quite piece together how I felt before my first street run. There was some degree of uncertainty as to what I might encounter and what my role would be as a first-year medical student, but I also felt an undeniable sense of excitement. Being able to care for people who truly need help is what initially drew me to Street Medicine, and I knew the experience would not disappoint.

We assembled the rest of the crew and, since it was raining and we were unlikely to find anyone outside, headed to an indoor shelter. Men huddled in coats on the steps greeted us warmly as we entered and walked downstairs to set up our makeshift clinic in the basement consisting of a few chairs and our boxes of supplies.

One by one, patients approached us to receive a variety of services. Some nervously asked for their blood pressure to be taken, knowing that they were hypertensive and hadn’t been able to afford their medications in a while; others were mainly interested in having a conversation while we listened to their lungs and placed our fingers on their wrists to feel their pulses. Each of them had a story, and, as we took patient histories and listened intently to their words, we learned the circumstances that had led them to their current state of being and current state of health.

Our patient interview forms became filled with details of these histories and plans for care—medications to be dispensed, hygiene packs to be given on later dates—and our patients seemed relieved as they turned to leave, smiling, shaking our hands, and thanking us by name.

As we left the shelter, I realized that the few hours of time I had offered to the patients that morning could mean months of better health for them. At the very least, I had listened to their stories and planned for some part of their futures, knowing that our group will pick up where we left off during the next street run. More than anything, I left with the understanding that the people we helped that day can now live with the hope and knowledge that somebody truly cares and will help to provide for their well-being for the months and years to come.

Sarah Bommarito, MSI
Communications Director