34
COM Outlook . Spring 2014
individuals who experience chronic home-
lessness suffer a disproportionate burden
of poor health, suffering, disabling condi-
tions, and ultimately, premature death.
They are disenfranchised from systems
that may be well-intentioned but are not
perceived as inviting.
NSU-COM’s Project HOPE enhances
the college’s mission with an emphasis on
preparing effective and sensitive primary
care physicians through an innovative
educational model that has the potential
to lessen health inequities and expand
upon the economic and social opportuni-
ties available to all citizens. Accordingly,
all third- and fourth-year medical students
are required to track the housing status
of all patients—irrespective of service set-
ting—through a semi-structured interview
as well as to track symptomology within
these patients, as these factors are integral
to the patient care plan.
Initial results have surprised medical
students, faculty members, and project
staff in recognizing that individuals with-
out stable housing present at all of our
medical settings and constitute the under-
served in both urban and rural settings.
Detecting housing status and providing
care to homeless individuals during stu-
dents’ rotations may assist in building trust
Dedication to Health Care for
Unsheltered Homeless Populations
T
FACULTY PERSPECTIVE
...UNDERSTANDING STREET MEDICINE
By
Kristi Messer, M.S.W., M.P.H.
, Assistant Professor of Public Health and Disaster and Emergency Preparedness,
Elliot Sklar, Ph.D., M.S
.
, Assistant Professor of Public Health, Family Medicine, and Disaster and Emergency
Preparedness, and
Devra Cohen, M.P.H.
, Coordinator of Interprofessional Research and Outcomes Assessment
he process of reorienting pa-
tients to the center of health care
delivery is nowhere more poi-
gnant than in working with the home-
less, outside of traditional emergency
rooms, hospitals, and outpatient clinics.
Street medicine
reaches people where
they are
—in alleyways, under bridges,
on the streets—an essential first step to
establishing a foundation of trust. This
foundation is vital when providing care to
individuals who have undoubtedly experi-
enced trauma in their past and who are
likely to be leery of traditional medicine.
NSU-COM’s Project HOPE (Homeless-
ness in Osteopathic Predoctoral Educa-
tion), a HRSA-funded initiative, presented
“Project HOPE: An Innovative Approach
to Homeless Health Care Education” at
the Ninth Annual International Street
Medicine Symposium in Boston, Mas-
sachusetts, in November. Symposium
attendees accompanied outreach workers
from Boston’s Health Care for the Home-
less program to provide primary care to
individuals on the streets of Boston who
call this
home
.
The opportunity to spend time with
the homeless in Boston was a salient re-
minder that caring for people is not solely
defined by the provision of medical aid,
but also by the powerful healing prospects
that come with listening to their personal
narratives. They are people, and they mat-
ter. It is the delivery of medical care in the
broadest sense in terms of a commitment
to health and to caring.
Fundamental to street medicine is the
building of trust with the unsheltered in
their own environments and on their own
terms. Providing care in this manner exem-
plifies respect and serves to reduce critical
barriers to care and ultimately promotes
continuity of care. These resource-poor
and engage those experiencing homeless-
ness to consider actively participating in
the health care system.
Providers of street medicine recognize
that they often are not able to meet all
of the health care needs on the street,
but there is always merit and benefit to
extending an invitation to the unsheltered
individual to be open to receive care.
While accompanying the other confer-
ence participants in Boston, Project HOPE
staff members discovered the importance
of personalizing the type of care deliv-
ered, according to the preferences of the
individual. In the absence of any gaping
wounds or urgent needs, staffers tailored
their brief visit to a particular concern,
including brushing someone’s hair, dis-
pensing toothbrushes and toothpaste, and
distributing clean, warm socks.
Focusing on a single aspect of helping
one feel cared for sums up the encounters
of those who specialize in street medicine
and seek to aid individuals experienc-
ing homelessness. This work challenges
providers to do more and to look beyond
what others may see as just another home-
less individual. NSU-COM has developed
a partnership with the TaskForce For
Ending Homelessness, Inc. in Broward
County, Florida, to provide NSU’s medical
and psychology students with an oppor-
tunity to provide outreach services to the
homeless via two mobile units that ven-
ture out into the local community twice
per day, 365 days a year.
It is a privilege to meet individuals
where they are located and to connect
with them as a person with the goal of
permanent housing and quality health
care. This is simply one of many examples
where NSU-COM is paving the way in
medical education as it relates to caring
for underserved populations.
