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Street Medicine: An Innovative Approach to Patient Care

Created July 10, 2013 by Tejas Chhaya and Andrew Nguyen
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There is a growing effort involving health care professionals, health care students and undergraduate pre-health majors. It includes community service, clinical work and primary care medicine. It allows students to gain experience in the medical field which may far exceed traditional avenues of volunteer and community service work. This movement is fun, exciting, and is already gaining momentum with students in southern California as well as with physicians and students at prestigious schools of medicine, such as The University of Pennsylvania, Loma Linda University, and University of Rochester. Pioneered by Dr. Jim Withers of the Operation Safety Net, this movement is known as “Street Medicine.”

Street medicine involves health care professionals, students, and community leaders working in interprofessional groups and proactively meeting underprivileged patients on the streets. Even in cities where there exist good networks of public health clinics, the response can still be overwhelming. According to Sarah, a graduate of Loma Linda University School of Medicine, having public health facilities sometimes just aren’t enough. “People who are homeless or impoverished often feel alienated from these public places or they may not be able to transport themselves. When we go to them, their reactions are often very heartfelt.” Armed with basic diagnostic equipment and donated medications, street medicine teams work to promote disease prevention, connect patients to community resources, and treat a wide variety of illnesses. Providers and volunteers in these projects have treated diabetes, colds, and even tooth infections that could have led to more serious, even life threatening complications. As more people join and the efforts garner more public and private support, it is hoped that street medicine can grow and develop further.

Street medicine, in its current form, is still severely limited in scope and reach. The deficiency in the number of physicians nationwide is a frequently discussed topic in the US. However, the extent of the deficiency is best seen in urban and rural areas, where street medicine grew out of necessity. Aside from shortage of providers, street medicine has had relatively little success catching the attention of students and community members. From just casual conversations regarding the topic, most students seem to not know of street medicine or have only heard of it in passing. Currently, there are street medicine organizations in over 30 major cities around the country; however their resources are limited and they rely heavily on medical student and non-physician labor. As a result, it is difficult for street medicine teams to make waves even in their own local communities. Since the project is still in its infant stages, many exciting changes are likely to occur. For instance, efforts are being made to involve specialists who are able to bring their skills to the street. Cardiologists, Infectious Disease experts, and Podiatrists are physicians whose skills would largely be inaccessible to impoverished patients. As the operation grows, it is hoped that more participation will also encourage more financial support and resource pooling from different humanitarian groups and government agencies of all levels. Despite the current lack of resources, the outcomes on the community are remarkable and students often give highly positive reviews of their encounters with patients, doctors, and community members.

Our current health care system is set to go through drastic changes effective in 2014 and is likely to change even further in the future. However, despite the proposed expansion of coverage (financially) to many more people, many aspects of “access to medical care” still go unanswered. As mentioned before, the shortage of physicians is still an issue of access. Many care providers work for institutions and if those institutions choose to not accept the new coverage for patients, many would be left without physician access. Further impediments to access include transportation. Issues which may be mundane to most people such as lack of bus routes near clinics can be a major hindrance to a good number of patients. Christina, a practicing Family Doctor and Osteopathic Manipulative Medicine practitioner, offers home visits for a handful of patients. “Some of my patients live alone and have difficulty driving. Unfortunately for them, other methods of transportation are not feasible time-wise or are just too costly, such as a cab. Finally, patients may not decide to proactively seek out health care for any number of personal reasons (e.g.: distrust in institutionalized medicine). Bringing the care to patients has proven to be an effective supplementary approach to the growing health care need of society and have given students unparalleled opportunities to work with providers and witness the delivery of health care first hand in their very own communities.

Providing health care to the underserved/homeless is an experience unlike any other. As Stacy, a pre-med from southern California recounts, “I’ve never felt more empowered. Even as an undergraduate student, I felt I was making a tremendous difference in peoples’ lives and that’s very cool to say.” However, it is not as simple as approaching street patients directly with medication. Trust is a strong factor in the work that is done on the streets. There may still be a hint of distrust of authority figures in white coats, even if they’re outside of an institution. Therefore, most teams rely on community partners and trusted sites to reach out to the underserved. Among the first to provide access to underserved populations are houses of worship (churches, mosques, etc.), soup kitchens, and shelters. Most teams collaborate with pastors and priests to reach the community. Many were happy to introduce street medicine teams to people who they know were at risk, allowing teams to build rapport quickly. Afterwards, consistently visiting the community is necessary to maintain the progress that is made with patients from the area.

Street medicine is not necessarily a new project, but one which has recently gained much more momentum. This is likely due to the changing health care environment. Frustration and concern regarding the barriers underprivileged patients must face in obtaining health care have found their outlet in street medicine. Even with the Affordable Care Act (ACA), there are still many opportunities for students to become involved with street medicine. For instance, many communities still lack a street medicine group so there may be opportunities to establish and lead your very own group. Besides contributing to the community, you’re also gaining valuable shadowing and leadership experience that will strengthen your application for graduate study, regardless of which health profession you choose to pursue. Additionally, students can help refer the medically underserved to areas in their community where they can register for ancillary services, such as WIC, food stamps, and Medicaid. Many physicians who take part of street medicine services are also faculty members at their respective schools and you’d have opportunities to share conversations with them about school and student life. Whichever way you look at it, street medicine benefits everyone.

References

The Street Medicine Institute’s website
http://streetmedicine.org/wordpress/.

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