Street Medicine Brings Health Care to the Homeless

NOVEMBER 28, 2017

Frustrated with the lack of health care in homeless populations, Jim Withers, MD, decided to bring healing directly to the needy on the street.

In 1992, Dr. Withers started dressing as a homeless man to walk alleyways, search under bridges, and make undercover “house calls” wherever he could help the people of Pittsburgh, Pennsylvania.

“By showing them that you’re actually willing to go under a bridge to visit them, you’re reinventing how health care can be done,” Dr. Withers said.

On a single night in 2016, more than 549,900 people were experiencing homelessness in the United States, according to U.S. Department of Housing and Urban Development reports. A majority stayed in transitional housing, but about 32 percent were in unsheltered areas.

“Around the time that I got started I sensed that it was uniquely important to look at the unsheltered homes population, not just the homeless population,” Dr. Withers said.

Street Medicine: Reinventing Health Care

With a mission to bring health care to the homeless, he coined the term “street medicine” in the early 90s to formalize the grassroots movement.

“My contribution has been an unusual obsession with pulling it together and giving it a name,” Dr. Withers said.

His contributions actually expand much farther. Dr. Withers has helped pioneer street medicine and was even honored as a “2015 CNN Top 10 Hero.”

“I think everyone sleeping on the street in the world should have direct access to medical help.”
— Dr. Jim Withers

As the medical director of Operation Safety Net, Dr. Withers has created a structure for outreach and education. Operation Safety Net, which is part of Pittsburgh Mercy Health System, is a community-based system that focuses on improving mental, physical and emotional well-being through street outreach. Their services now include a mobile medical unit, drop-in center, winter shelter, housing management services, physical health services, legal assistance, and other community resources. Operation Safety Net has also helped more than 1,500 people who were once homeless to find homes since 1992.

Although Dr. Withers was making a huge impact on the homeless community in Pittsburgh, he wanted to do more. He knew there was a gap between the medical professionals who wanted to help the homeless and the people who needed health services.

“It’s a radical commitment to the most excluded of the homeless. For me, it was what they can teach us,” he said.

Dr. Withers has been a leader in the street medicine movement, but there are many others who were already practicing street medicine. He knew the most effective way to improve the health of the homeless and reinvent the health care model was to create a network of people with a common passion, so he brought them all together.

In 2005, people from 85 cities and 14 countries gathered for the first annual International Street Medicine Symposium.

“I think what people had in common was an awareness of how our health system, despite its strengths, left a lot of people out and maybe one of the most left out groups was people who were sleeping under bridges,” Dr. Withers said.

Shortly after the symposium, Dr. Withers and other street medicine practitioners launched the Street Medicine Institute. Since 2008, the Street Medicine Institute has served communities seeking to establish their own street medicine programs, improved the practice of street medicine and provided educational resources for street medicine practitioners.

Dr. Withers said the main focus of street medicine as a whole is caring to an individual’s basic needs. Whether it is in a doctor’s office or in an alley, primary care is a very deep thing, he said.

“Almost always, nurses understand these things first. Much of the work that’s done on the streets is done by nurses. They’re really the soul of the movement,” Dr. Withers said.

Health, Healing and Homelessness

Before doctors, nurses and other medical professionals can care for any health issues, they first have to gain trust from their new patients.

Dr. Withers says the first three things he asks himself are:

Do they feel respected?
Do they feel respected?
Do they feel respected?

Showing respect is the key, especially with men, before he can even begin treatment.

“That’s the last thing they’ll probably get from society,” Dr. Withers said.

Many of the women he encountered are living on the streets because they fled from violence. He said it is common for them to be concerned for their safety when interacting with strangers.

Dr. Jim Withers Street Medicine Institute “They really need a sense of safety with you and trust,” Dr. Withers said.

He focuses on showing he cares for them as a person and weaving himself into the community before he starts medical treatment. This step lays the foundation for healing.

“The secret agenda is love, your total well being,” Dr. Withers said. “Sometimes the immediate need is can I address that wound? Can I give you a blanket, socks?”

When he initially set out to give medical assistance to people living on the streets, he had no idea the amount of care that people needed.

“It was kind of like going to a third world country but it was right under your own bridges,” Dr. Withers said.

He was shocked to see the amount of people suffering in Pittsburgh. Trauma history, mental health issues, traumatic brain injuries, diabetes, cancer, liver disease, addiction — that’s just the start of the overwhelming amount of health issues he has seen.

“Everything you see out there is undertreated or not treated at all,” Dr. Withers said.

There is also a lot of violence on the streets so people get injured often. Their wounds are typically neglected, until street medicine practitioners came along.

“Almost everyone I know on the streets has been assaulted,” Dr. Withers said.

Living without a home and being isolated from society is a tough life. Dr. Withers and his team help the homeless transition into homes and rebuild their lives.

He remembers a time he was at a bank and there was a “distinguished man” working there. The man approached Dr. Withers and thanked him.

“I was under a bridge in the 90s and you helped me. Thank you very much,” the man told him.

It is interactions just like that one that remind him why he got involved with street medicine in the first place.

He also has many stories of homeless being shocked that people are even trying to care for them at all. Dr. Withers remembers a time when he was taking a man’s blood pressure by a riverbank and the man suddenly starting crying.

“I can’t believe someone cares we’re still alive,” the man told him.

Jim Withers Street Medicine