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