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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