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. 

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