Dr. Bret Feldman, MSPAS, PA-C, doing an examination on the street. Photo provided by Brett Feldman,Â Director of Street Medicine at the Keck School of Medicine
Medical teams bring old-fashioned house calls to unsheltered homeless communities.
Back in the day, when patients couldnâ€™t get to the doctorâ€™s office, the family physician packed up a little black bag and brought the medicine to the home. Today, street medical teams follow that model, taking primary care services to the unsheltered, no matter where they call home. Examining and treating people on the streets of Skid Row, on freeway embankments and under highways, can be tricky during the best of times, and these arenâ€™t the best of times.
The pandemic has forced street teams to adjust their practices to keep their patients and themselves safe. This has come at a great cost according to Brett Feldman, Director of Street Medicine at the Keck School of Medicine. â€śMedical care comes after love. Now we have to try and keep our physical distance. Wearing masks and gloves, itâ€™s really hard to make that intimate connection we strive for,â€ť he says.
Feldmanâ€™s crew is trying to overcome this problem by learning to make their eyes as expressive as possible. Sadly, they havenâ€™t found a way to offer the hugs they usually dole out freely. â€śMost of the people on the streets havenâ€™t been touched in many years other than out of anger,â€ť says Feldman. His whole team will be happy when they can hug again.
The street medicine team from Keck School of Medicine of USC getting ready to go out. Photo provided by Brett Feldman
Dr. Susan Partovi, known as the Skid Row Doctor, has a similar philosophy. â€śI try to build trust. Thatâ€™s where it all starts,â€ť she says. Partovi describes seeing a man slumped on a filthy mattress on a sidewalk in Koreatown. Dirt, necrotic skin, and oozing sores covered his legs. From several feet away, she smelled human waste. â€śIt was nasty,â€ť says Partovi, Medical Director of Homeless Healthcare Los Angeles. â€śI look for the sickest, most isolated person, and then I see what I can do,â€ť she says. â€śThe visit on the street can open doors to getting them additional help. Itâ€™s the start of a relationship.â€ť
Clearly, house calls have changed in many ways since their heyday in the 1930s. Even the reasons for patients needing to be seen where they live are different.
â€śOur patients canâ€™t come to us because of physical disability, mental disability, transportation issues, and the need to protect their lifelong belongings that will be stolen if left unattended,â€ť explains Dr. Coley King, Director of Homeless Health Care at Venice Family Clinic. It isnâ€™t only these practical hardships that keep unhoused people out of more traditional medical settings. Many simply donâ€™t trust the system. â€śEspecially IV drug users who often get treated like crap when they go in to be seen,â€ť says Partovi.
Dr. Coley King treating patient on the street. Photo provided by Venice Family Clinic
Since the onset of COVID-19, ensuring care for people living on the streets, in the alleys, and on freeway embankments has become even more urgent. Though â€śin a cruel way, the vast majority were already physically distanced, living in small encampments and having little contact with the outside world,â€ť says Feldman. It isnâ€™t possible for the unhoused to stay indoors completely. The harsh reality of their lives forces them out to take care of basic necessities, and this brings them in contact with other people and with the virus.
â€śOur mission since COVID-19 is much more urgent and defined, and that is finding people with symptoms, contacting public health, and getting them transferred to quarantine,â€ť says King. The second priority is identifying people in high-risk groups, people over 65 and those with serious health conditions, and getting them into Project Roomkey, a collaboration between the State, County, and Los Angeles Homeless Services Authority to place those at risk in motel or hotel rooms.
As Los Angelenos do their best to maintain social distance and follow other safety precautions, street medicine carries on. With little thought to their own well-being, these medical specialists continue to make house calls throughout the county, bringing treatment, resources, and compassion to the most vulnerable citizens.
Dr. Susan Partovi, Medical Director of Homeless Healthcare Los Angeles, and nurse treating a patient on the street. Photo provided by Dr. Partovi
What happens next? Project Roomkey has taken thousands of people off the streets and placed them in temporary shelters. What will happen as the city returns to something more like normal? â€śPeople are indoors,â€ť says King. â€śLetâ€™s keep them in there.â€ť He worries that these men and women, still among the most vulnerable in the unhoused population, will be returned to the streets when the current crisis passes. Right now, this question remains unanswered.
One thing we know for sure, some people will continue to live unsheltered for the foreseeable future. And because of this, teams of dedicated medical professionals will continue to make house calls to the unhoused, providing prescriptions, treatments, and hopefully soon, those much-needed hugs.