Street Medicine Reaches People Where They Live

81

ISLAMABAD: One summer evening, on his regular rounds through the streets of Syracuse, NY, David Lehmann, MD, PharmD, came across an unsheltered man in dirty clothes who seemed to be making his bed each night on the pavement where he stood. An exam in the privacy of the medical van revealed a painful, infected boil on the man’s backside.

After some coaxing, Lehmann lanced the infected sore, gave medicine and instructions for care, and handed the man some clean underwear. Pretty standard stuff, he thought.But then, just as they were parting ways, something unexpected happened: The man broke down. “He just melted into my arms and started crying and hugging me.”

Lehmann was taken aback. Just weeks earlier, he had left conventional medical practice to treat people in the streets. He made the jump because he had tired of seeing unsheltered people arrive at the hospital with emergencies that could easily have been avoided with earlier medical treatment.

On this summer night in 2018, far from the safe, clean, well-stocked, air-conditioned medical offices where he had practiced for most of his career, he learned the need was more than purely medical.
“It’s about providing dignity,” says Lehmann, who does his work through an organization called HouseCalls for the Homeless, which he helped start.

“You have to connect with them as human beings. You never know where it’s going to lead. You can be an influence to get people treated and regain their own humanity,” he says.The man with the boil is a case in point. That first encounter was the beginning of a relationship that deepened over time. Today, he has found permanent housing and regular employment and his physical and mental health are much improved.

A Great Unmet Need
More than half a million people are homeless in any given year in the United States. And an estimated 192,875 of them are sleeping unsheltered on any given night. In Los Angeles County alone, more than 63,000 are homeless, the vast majority unsheltered, with little to no access to health care.

Many don’t get medical care when they need it because of mental health issues, or a lack of resources, or substance misuse, or something as simple as a lack of ID. And the result can be deadly.Death rates for the unsheltered are hard to track, but one JAMA study showed that a group of 445 adults (average age 44) who lived unsheltered in Massachusetts between 2000 and 2009 were 10 times more likely to die during that period compared with similarly aged adults in the general population. The National Health Care for the Homeless Council says that amounts to between 17,500 and 46,500 people without shelter who died just in the year 2018.

It’s an immense problem that often flies under the radar, Lehmann says.
The ‘Father of Street Medicine’
The traditional health care model just doesn’t work for this population, says Jim Withers, MD, who founded the Street Medicine Institute (SMI), which helps expand street medicine globally.
Withers, known as the father of street medicine, began his journey into the field 30 years ago after a patient he had just treated at a Pittsburgh hospital walked out into the streets and, just hours later, froze to death.