PERSPECTIVE

Street Medicine Provides Safety Net for Unsheltered People

Omar Guzman , MD

Published September 14, 2021

Healthcare worker standing outside and holding a mask and stethoscope

Omar Guzman, MD, built a street medicine program to serve vulnerable neighbors in his community in rural California. His vision is supported by colleagues who are equally passionate about addressing healthcare disparities and giving back to their communities. Across Vituity, street medicine programs have forged stronger bonds between clinicians and medically underserved communities while reinvigorating a passion for medicine.

The St. John’s River Trail in Visalia, California, is a pretty spot to cycle or hike. It’s also the place that some of Tulare County’s most vulnerable residents call home. Dozens of unhoused people shelter from the searing summer heat and winter chill in tent encampments along the dry riverbed. Their living conditions starkly contrast with the expensive road bikes and jogging strollers zipping past.

People experiencing homelessness rarely receive appropriate medical care. They may be unable to schedule appointments, travel to doctors’ offices, pay for care, or leave their belongings unattended. Many have also experienced negative treatment within the healthcare system. As a result of these access issues, unsheltered populations have a high disease burden and decreased life expectancy.

To help combat these disparities, my emergency medicine residents, medical students, and I began making regular “house calls” to the Visalia encampments to care for patients and deliver sanitary supplies. When we launched this initiative three years ago, we simply wanted to give back and build bridges between unsheltered people and our safety net hospital. We didn’t realize we were part of a growing movement.

Today, health systems around the country are using street medicine programs to reach underserved populations and combat health disparities. And they’re learning—as we have—that caring for the most vulnerable in our communities benefits us all.

How Street Medicine Works

Street medicine providers deliver primary and urgent care services directly to patients experiencing homelessness. To this end, they travel to shelters, encampments, parks, and anywhere unsheltered people need care. Many street medicine providers forge trusting relationships with patients that allow them to address social as well as medical needs.

Street medicine benefits include:

Effective follow-up for recently discharged patients.
Improved population health that reduces strain on local EDs.
Containment of COVID-19, HIV, shigellosis, and other infectious diseases.
Deeper trust between unsheltered people and healthcare providers.

A multidisciplinary street medicine team may include physicians, medical residents and students, advanced providers, and nurses. Social workers and case managers may also join the visits. Some teams even include people who have personally experienced homelessness to help break the ice with unsheltered patients and provide peer support.

Street medicine is just one way clinicians and health systems are meeting cultural demands for better access, equity, and experience in healthcare.

Omar Guzman, MD

Building Healthcare Equality in My Community

Kaweah Delta is a public healthcare district serving Tulare County, which is one of California’s poorest and home to a large unsheltered population. As a Visalia native, I chose to practice here in order to give back to my community. Many of my emergency medicine colleagues, students, and residents at Kaweah Delta Medical Center likewise share a special connection to this place and a motivation to serve the underserved.

I was inspired to launch Care Without Boundaries (as our street medicine program is now known) after volunteering at a local homeless shelter where many residents were suffering from unaddressed health problems. From the start, my colleagues and students were keen to accompany me to the encampments and were always moved by the experience.

Care Without Boundaries is funded by community organizations that donate resources and supplies. In addition, we recently won a Vituity Innovation Grant, which enabled us to purchase several virtual care tablets. This has greatly expanded our outreach by allowing our ED clinicians to provide telehealth coverage for our student- and resident-driven street teams.

Care Without Boundaries helps to build trust and goodwill between unsheltered patients and Kaweah Delta providers. When street medicine patients see our familiar faces in the ED, they’re noticeably relieved. The program has also been enormously satisfying for clinicians and students, who say it brings meaning and satisfaction to their practices. On a few occasions, team members literally saved lives by recognizing heart attack or stroke symptoms and rushing the patient to the ED.

Keeping the Joy in Medicine

Adventist Health and Rideout (formerly Rideout Memorial Hospital) serves the small city of Marysville in Greater Sacramento. The area is home to about 1,000 unhoused residents, many of whom live in encampments along the Feather River. A 2019 survey conducted by the Yuba City Council found high rates of chronic illness and mental health and substance use disorders in the unsheltered population.

Adventist Health and Rideout responded by creating a street nursing program. Nurses visit the encampments to provide direct care and deliver sanitary supplies. In addition, clinicians at the hospital take turns providing telehealth coverage to the program, consulting as needed with the nurse and patient via a virtual care tablet.

Originally, the emergency department clinicians provided about 2.5 hours of coverage each weekday to street nursing. Thanks to a Vituity Innovation Grant, this was extended to seven hours per weekday in May 2021. The program is currently funded through spring of 2022.

“Street nursing has helped us to embed care in the homeless camps, which previously were very hesitant and resistant to outsiders,” says Adventist Health and Rideout’s ED Medical Director Kamara Graham, MD. “We’ve combined forces with our street nurses, our substance use navigator, and our county mental health worker and have had some wonderful success stories. This is really the type of initiative that helps us keep the joy in medicine.”

The Power of Meeting Patients Where They Need Us

At Vituity, these programs are not unique. The germ of an idea from a clinician like me becomes a reality through the support of passionate colleagues who give their time and resources to serve our communities.

Most recently, the Vituity Cares Foundation has launched its own street medicine programs. Partnering with local organizations, volunteer teams are holding pop-up clinics that provide food, clothing, and essential medical services to unsheltered communities in Skid Row in Los Angeles and in Oakland.

I’m proud that our programs are part of a national trend. Street medicine is just one way clinicians and health systems are meeting cultural demands for better access, equity, and experience in healthcare. At Vituity, we call this patient-centric paradigm Health in Place.

For me, the street medicine experience has brought great joy and satisfaction to my practice. I chose to return to my hometown in order to give back to the community I consider family. As the pandemic illuminated, we are each only as healthy as the most vulnerable among us. So by helping our unhoused neighbors, I know I’m creating a healthier future for all of us here in Visalia.

Learn more about Vituity’s commitment to healthcare justice.

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