House calls for homeless: Street docs find no quick fix

• Today%2C there are Street Medicine programs in 85 communities around the world
• About half of those are in the United States
• The trend also teaches participating medical students how to relate to non-traditional patients

DETROIT — Jonathan Wong, a 29-year-old Wayne State University medical student, moved the blood pressure cuff from one of Thomas Wise's arms to the other aiming to get a better reading.

Then another medical student tested the 45-year-old's cranial nerve response — could he puff his cheeks? Could he move his tongue?

The students were at St. John Congregational Church in Detroit earlier this month, treating some of the men in the church's shelter as part of a new venture between about 100 Wayne State medical students and the Neighborhood Service Organization.

Called Street Medicine Detroit, the program takes doctors-to-be such as Wong and Paul Thomas, 25, out of the clinic and into the city, treating homeless people in the shelters, parks and underpasses where they often live.

The Wayne State program is part of a growing international movement known as street medicine, where doctors take medical care to homeless people who need it but who aren't likely to turn up in a clinic.

"That's the fastest-growing groups, the ones that are connected to medical schools," said Jim Withers, a physician with Mercy Health System in Pittsburgh, a pioneer in the field of street medicine.

Withers began visiting homeless people living in abandoned buildings and under bridges in Pittsburgh in 1992 and quickly gathered a following among his new patients and his medical colleagues.

"It was a snowball that grew pretty fast," Withers said.

Mental illness and substance abuse are common among those treated by street doctors, as are frostbite and wounds from living on the street, Withers said. But so are more typical illnesses such as diabetes, high blood pressure and lung disease. Immediate needs are handled on the street, but patients with more chronic problems are referred to participating medical facilities for follow-up care.

"When you go out on the street rounds, you're building that trust," said J. Todd Wahrenberger, Medical Director of the Pittsburgh Mercy Family Health Center, which provides more advanced treatment to homeless patients. "They come over here and they are able to get higher-level care."

Wahrenberger said he often asks patients how they learned about the clinic and, invariably, they say Withers referred them.

Today, there are Street Medicine programs in 85 communities around the world, about half of them in the United States, said Withers, who visited Anchorage last week to speak to a group working on a program there.

In 2005, doctors and others involved in treating the homeless formed the Street Medicine Institute, a non-profit group that promotes street medicine.

In addition to helping the homeless, the work benefits students, teaching them to relate to non-traditional patients, said Jason Prystowsky, of doctor with Street Medicine Santa Barbara, which formed in 2005.

Many homeless people won't leave their camps to visit a clinic, Prystowsky said.

"They don't have anyone to watch their possessions, they don't have anyone to watch their dog," he said. "Students get a firsthand education on what true barriers to access are. Part of good medical care is adapting to the needs of the individual."

Students learn not only medical techniques, but also the nature of the calling to work in medicine, said Trevor Mells, a student who works with the Santa Barbara program.

"What's kept me around is the dedication everyone has to educating the next generation," Mells said. "I definitely feel a strong commitment that I'll keep throughout my career."

Paul Thomas, a fourth-year med student at Wayne State in Detroit, agrees.

"It's a value no one else can give," Thomas said

He said that in 10 years of volunteering and working at clinics from high school through medical school, he has learned that social workers and other professionals who work with homeless people can't always deal with the health issues associated with life on the streets. He said this is where he and the other student volunteers can help.

"It's social justice," he said.

Wisely also reports for the Detroit Free Press