People who are homeless may delay seeking care at hospitals due to fear and lack of transportation and information, among other obstacles.
“You are treated like trash in the ER. They say, ‘oh, they’re homeless’… and that’s all you would hear in the hospital,” said Dez Martinez, executive director of We Are Not Invisible, during the “What the streets are saying: Lessons in street medicine” panel at AHCJ’s 2023 fall summit, Homelessness and Health, in Oakland, Calif.
Martinez, who experienced a period of homelessness, said that for three years, she didn’t seek care from doctors. She said she was sexually harassed and suffered two heart attacks while in their care. “I was traumatized by the doctor. Why go?”
Even if she had wanted to go to the hospital, Martinez faced other barriers. There was the anxiety of not knowing how to find a doctor, or where the doctor was located or how to get there.
Street medicine aims to tear down those hurdles, said panelist Joseph Becerra, a certified clinical supervisor with USC Street Medicine. Street care is “100% patient-centered,” he said.
Becerra was joined by fellow health care providers during the 1.5-day event to discuss the benefits of street medicine, clarify misconceptions about the practice and offer insights from care providers’ day-to-day interactions
Street medicine is often confused with mobile medicine, where a team will park a large vehicle somewhere in a community and work to treat people on-site instead of having patients come to a medical building. But there are philosophical and practical differences between the two, said Brett Feldman, director of street medicine at USC’s Keck School of Medicine.
Street medicine works to meet unhoused, unsheltered people in their reality, Feldman said, “where they are most comfortable.” The aim is to intentionally flip the pervasive power dynamic between people living on the street and their medical providers.
Not only do street medicine teams meet people in their encampments or on the street, Feldman said, but in establishments like McDonald’s, as well as in hospitals and jails.
“The goal is the same quality of care on the street that you’d expect in a brick and mortar clinic,” Feldman explained. “We know that health care is more than an office visit, even if that office is under the bridge. So we dispense medications, draw labs, we do ultrasound on the street, EKGs. I do a lot of joint injections on the street.”
Street medicine teams’ ability to provide care to people wherever they are was codified nationwide this year when the Centers for Medicare & Medicaid stipulated that health care provided “on the street” is now reimbursable under federal health care.
Street medicine is getting results. Such interventions in Atlanta were shown to reduce symptoms of post-traumatic stress disorder by 60%, according to panelist Liz Frye, vice chair of the Street Medicine Institute.
“Our goals for ourselves are to be in solidarity with our sisters and brothers who are sleeping outside. Period. And sometimes all we do is sit with them and be with them in the suffering that they have,” Frye said. “Building trust with people works, and it helps people heal.”
