In December of 2020, a group of residents and students of the WMU Homer Stryker M.D. School of Medicine established a Street Medicine Team. Recently, Drs. Sravani Alluri, Nic Helmstetter, and Rebecca Reardon-Lochbaum, a fourth-year medical student at W.Med, discussed the team.
Please give a brief history of the team. When did
it start? Who initiated the team? And why?
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| Dr. Sravani Alluri |
Dr. Alluri – We started the Street Medicine Kalamazoo team in January, 2020. At the time we were seeing a lot of unhoused patients in the hospital and in our clinics, and we always had trouble with following up with them consistently in the office. In general, unhoused patients have trouble accessing the traditional medical system. We learned about street medicine initiatives to improve access to care for unhoused individuals through the Street Medicine Institute and started working in conjunction with the Street Medicine Institute and the Kalamazoo Harm Reduction initiative to reach out to the unhoused community.
Reardon-Lochbaum –
Basically, we had two separate groups coexisting before December of 2020, but
then we got together and joined forces. In a way, Covid forced medical students
to do local service projects [instead of out-the-area options] because travel
had been shut down.
Does the team practice in established locations
with scheduled times?
Dr. Helmstetter – We practice anywhere.
That includes unhoused patients being discharged from hospitals, encampments
and under bridges, by the People’s Food Co-op, and Ministry with Community.
Because of the people we’re interacting with, the times and locations for
service are fluid, depending upon the need.
We’ve also seen unhoused patients at the Salvation Army during
warming center operation. Local hospitals also triage patients and then
refer them to our team.
Could you describe some of the surprises you’ve
experienced while engaging with unhoused patients?
Reardon-Lochbaum – We were
surprised by how easy it was to gain the trust of the unhoused patients.
Because we show up as human beings [not as doctors], the trust level is much
deeper than with a traditional patient.
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| Dr. Nic Helmstetter |
Dr. Helmstetter – The patients we see mostly haven’t been able to access [health] care because of the stigma [attached to being unhoused]. But they are open and honest. This causes a bigger impact and so we get more [accomplished] from these contacts.
Reardon-Lochbaum – It’s
how we approach [unhoused] patients, versus traditional medicine. We approach
the patients as human beings and the patients tell us what their needs are.
They lead the experience.
What have been some of the challenges you’ve
encountered?
Dr. Helmstetter – The City [of Kalamazoo]
clearing out the [unhoused] encampments, with no plan for follow-up has been a
challenge. It was done in a sort of ‘out of sight, out of mind’ way.
Dr. Alluri – We have to be flexible and
adjust to the patients’ environments. With the closure of the encampments,
we’ve had to adjust the logistics [of serving them]. We try to make it easier
for the patients to get primary care, but there are still challenges with
medical referrals to specialists. It’s often surprising, sad and frustrating to
see the lack of follow-up.
In what ways does street medicine differ from
traditional medical practice?
Reardon-Lochbaum – I think
it’s more similar than different. It’s not rogue medicine and it looks
incredibly similar. The difference is in the flexibility we have with our
patients. We take our lead from them.
Dr. Helmstetter – The medicine we practice
is with the same standards and goals as that of traditional medicine. But there
tend to be more layers to [street medicine] health care because of the stigma
and racism that make up the social determinants to health.
What advice would you give to any medical school
considering establishing a street medicine team?
Dr. Alluri – Understand the population that
you’re working with. Before we started treating unhoused patients, we went out
to the encampments and talked to people living there. You can’t plan street
medicine in a board room, you have to directly engage the population you want
to work with and understand their specific needs.
Each community has its own challenges to access health care,
so you have to understand the anatomy of the community you’re serving. [Street
medicine] is different than practicing within the four walls of a clinic. You
need to be flexible.
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| Rebecca Reardon-Lochbaum |
Reardon-Lochbaum – It’s all about knowing the people and the population you’re serving and what their needs are. And finding the right community partners so you can build on what the partners have established and then piggy-back on that foundation. Like with the Kalamazoo Harm Reduction initiative, Ministry with Community, and the Kalamazoo Gospel Mission.
Dr. Helmstetter – And you can find
traction within these parent organizations for funding and support.
How has the Street Medicine team evolved since its
start?
Dr. Alluri – We first engaged the [unhoused]
population by providing things like hygiene products and socks. We evolved to
providing a broad range of primary care services using a mobile model of care,
similar to a mobile clinic. We can now provide almost any [medical] service
you’d provide in a traditional clinic. And we have more students and more
residents involved.
Reardon-Lochbaum – We’ve
solified our brand. Our patients know us and refer friends to us. Our patients
now recognize the [WMed] Street Medicine team.
Dr. Helmstetter – We’re continuing to grow
with more students and residents and with a few more grants.
Do you have any plans for the future of the WMU
Homer Stryker M.D. School of Medicine’s Street Medicine team?
Dr. Alluri – Our hope is to become more
integrated into the clinical architecture of WMed. This will provide a
structured opportunity for students. And we’re working on developing a curriculum,
with dedicated time [for practicing street medicine], instead of only using
volunteers. We’re also trying to get a small mobile unit, with more of a
private area for exams, tests, or to talk [with patients privately].
Reardon-Lochbaum – We need
to build Street Medicine into the curriculum because students need to be taught
how to care for the unhoused. Learning to treat patients where they are will
shift the arc of educating medical students.
For more information on the WMU Homer Stryker M.D. School of Medicine’s
Street Medicine team, click here, or call 269.220.0372.
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