House calls to the homeless

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Dr. Jim Withers used to dress like a homeless person. On purpose.

Two to three nights a week, he rubbed dirt in his hair and muddied up his jeans and shirt before walking the dark streets of Pittsburgh, searching for the very people he was trying to emulate.

Withers wanted to connect with those who had been excluded from his care.

“I was actually really shocked how ill people were on the street. It was like going to a third-world country,” he said. “Young, old, people with mental illness, runaway kids, women (who) fled domestic violence, veterans. And they all have their own story.”

Homelessness costs the medical system a lot of money. Individuals often end up in emergency rooms, and stay there longer, because their illnesses go untreated and can lead to complications.

For 23 years, Withers has been treating the homeless — under bridges, in alleys and along riverbanks.

“We realized that this was something that could be addressed. We could make ‘house calls,’ ” he said. It’s something that Withers’ father, a rural doctor, often did.

Withers’ one-man mission became a citywide program called Operation Safety Net. Since 1992, the group has reached more than 10,000 individuals and helped more than 1,200 of them transition into housing.

In addition to street rounds, the program has a mobile van, drop-in centers and a primary health clinic, all where the homeless can access medical care.

Today, Withers is also fostering a global “street medicine” movement. His nonprofit, the Street Medicine Institute, supports communities in starting programs of their own. Its network includes dozens of teams in the United States and around the world.

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Below is an edited version of conversation with Dr. Jim Whiters:

CNN: How does it work, doing rounds in homeless camps?

Dr. Jim Withers: It can be a challenge to keep up with where the camps are. The homeless are often evicted. Their belongings are taken. And so they have to keep moving. And therefore we have to keep moving to keep up to date on their camps.

Doing walking rounds, we try to keep our team down to four people. We don’t want to invade (their space) with a lot of people. It’s their home. So there’s an outreach expert who knows the field and knows the people. There’s myself or a medical person, and then we always have a student or two. And we bring a social worker with us.

We’ll go into the camp, and we make sure they’re OK with us coming in. Almost all the homeless are cordial, if not downright really friendly. And we just join them, and they can express what’s going on. We always try then to check in with how they’re doing medically. If they have insurance, if they have medicines that they should be on that they ran out of. Do they have a doctor? “Did you get that looked at?” What’s important to the patient, the person, is our priority.

The care that we deliver out there is dependent on what’s in our backpacks. We try to emphasize that this is not good enough. Getting (them) into primary care is our goal.

CNN: What ailments do you see out there?

Withers: People on the street, they’re exposed to the elements obviously. So you see a lot of things that have to do with the weather and the difficulties of sleeping out there: frostbite, dehydration, hypothermia. But they also have everyday things, like high blood pressure, diabetes, coughs and colds, pneumonia, injuries.

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In His own words

Below is extracts from an that Dr Jim Whiters wrote:

Iniitially, I didn’t tell the hospital (or my malpractice carrier) what I was doing. My guide was a formerly homeless expert, Mike Sallows. Together, we made house calls under the bridges, along the riverbanks and in the abandoned buildings of Pittsburgh.

A whole new world opened to me. The depth of medical need I saw was exceeded only by the hopelessness of the people I came to know. Each person became inconveniently real to me, and going home to my warm bed became increasingly difficult. But what I also discovered was the profound satisfaction of bringing care directly to those who would otherwise have none. I was becoming part of the street world.

Another reality

In the homeless camps and in the alleys, I found people who had suffered extremes of weather, violence and prejudice. Many were older, confused people; some were war veterans holding on to the last shreds of their dignity; others were simply people who had fallen on hard times and lost hope. I saw hideous leg ulcers and cancers that were untreated. But mostly I saw human beings who had minimal access to loving, effective services.

The street homeless live in another reality. It is often brutal and short. Health issues are secondary to immediate survival, but according to the National Coalition for the Homeless, theaverage life expectancy among that population is estimated between 42 and 52 years, compared with 78 years in the general population. This essentially makes street homelessness one of the most fatal conditions in the United States.

As I watched more and more people die out there, these numbers became a very real experience. Looking in from the streets, I saw my community as a largely hostile, unforgiving place.

The reaction of the non-homeless to those sleeping on the streets is often negative. I know this is born from frustration, but I believe that as long as ignorance and fear dictate how we perceive others, we have little hope of building effective, inclusive solutions. We must get close enough to know each other.

I am also convinced that by “going to the people,” health care can learn to engage people on their terms, holistically building health solutions grounded in their reality. This will potentially make health care delivery more cost effective and efficient as the principles of “street medicine” are applied to other populations. How much we can learn from those who are left out!

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