Reprinted from AtBuffalo
Published December 21, 2016
“Tonight I’m going to sleep right out there,” Anthony said, waving vaguely in the direction of an office building. “I use this as a blanket. You can’t miss me.” Just when the street medicine crew persuaded Anthony to take off one of his shoes wasn’t clear. That’s understandable — UB HEALS makes a concerted effort to be as seamless and nonthreatening as possible. Christian R. DeFazio, clinical assistant professor of emergency medicine at the Jacobs School of Medicine and Biomedical Sciences, sat on one side of Anthony, while second-year medical student Amanda Gotsch sat on his other side, holding a stethoscope. The scaling on both of the man’s shins was not hard to spot.
All the easy banter came to a stop as soon as that first shoe came off. What remained of an old sock clung to Anthony’s right foot, and a nauseating odor spread through the cool night air. As DeFazio carefully peeled away the wasted sock, the extreme condition of Anthony’s foot became clear. It was covered in blisters, deeply discolored and still wet from whatever had soaked through his threadbare sneaker weeks ago.
Sean Sticek, a social worker for the Matt Urban Hope Center, walked away from the group and sat down on a curb, clearly shaken. “I’m having a hard time with this one,” he said. “I never saw anything like that.”
Anthony, silent now, winced as DeFazio and others in the crew cleaned up his right foot, then the left, dressed them in ointment and put on new socks they had brought with them. A case of trench foot, DeFazio told the students. No infection yet, but serious damage could ensue if his feet got wet and dirty again.
DeFazio turned to Anthony: “I think it would be important for you to see a foot doctor,” he said.
Anthony thanked the group, bowed his head and asked them to join him in prayer. Then, after giving him the name of a local shelter, the team members said their goodbyes and piled into their vans. Back at UB, they would enter Anthony in their record system, noting where they had found him and alerting future crews to ask about his feet.
But they never saw Anthony again, despite returning to the spot in Lafayette Square multiple times. That’s not unusual, says Moudi Hubeishy, UB HEALS’ program manager. “A lot of the patients we try to follow get lost,” he says.
While the rest of the world marvels at Buffalo’s economic resurgence, UB HEALS focuses on a different side of the city — the one known to men like Anthony. An innovative street medicine and outreach program, UB HEALS (for Homeless health, Education, Awareness and Leadership in Street medicine) was established earlier this year to provide access to health care to the city’s homeless while simultaneously giving UB medical students real-life experience in community medicine, in arguably the most challenging population in which to practice it.
Since early March, small groups of UB physicians and first- and second-year medical students, accompanied by social workers from the community, have set out two nights a week visiting “hot spots” in search of the homeless. When they find someone, their first order of business is to make sure the person is receptive to their help. If so, they try to find out what the individual needs, whether that is medical attention, basic supplies (the team carries snacks, blankets and other necessities with them) or just someone to listen. Throughout the interaction, they look for an opening to persuade the person to take advantage of available social services. The main goal, always, is to help get people off the street.
There are fewer than 10 medical school programs like UB HEALS in the country. According to David Milling, senior associate dean of student and academic affairs in the medical school and the faculty adviser for the program, UB has one of them because UB has Hubeishy. A second-year student from Rochester, Hubeishy conceived of the program, got it up and running, and is its driving force.
Two years ago, Hubeishy was working for the central office of the Rochester City School District, which included running a volunteer program that provided extended learning to elementary school students. Before taking the position, he recalls, “I thought I understood poverty and the struggles that city residents faced because I researched the demographics of the schools prior to the start of the school year.” But after his first three months on the job, he realized how little he knew.
“I worked with students who faced and feared the reality of having their family go broke due to a parking ticket, who felt desperate to do whatever was necessary to support their mother who worked three minimum-wage jobs, who faced numerous difficult circumstances that typically don’t exist in affluent communities,” he says. “I began to question, ‘What makes me so special? Why was I so fortunate to grow up in a community that gave me so much while the kids I worked with had so little?’”
Hubeishy was still wrestling with these ideas when he got accepted to medical school. “As medical students,” he recalls thinking, “we spend two years learning the intricate details of every disease state and how to care for the various pathologies. Then we spend two years learning how to apply that care in a clinical setting. But when do we learn how to understand the various types of people we will care for and how to connect with them, especially when the patients we are seeing come from a background different than our own?”
Hubeishy’s concerns led him to the website of Jim Withers, a physician who founded the Street Medicine Institute in Pittsburgh and is widely recognized as the father of street medicine. Hubeishy dropped a note in the comments box of the site and was surprised to hear back from Withers himself, who convinced him to start a program at UB and gave him all the starting materials he would need.
Hubeishy’s next move was to write a long email to Milling explaining what he wanted to do. Turns out, Hubeishy’s street medicine proposal dovetailed perfectly with the medical school’s recent focus on service learning. “Our students have always been volunteers,” Milling explains. “But over the past two years, we have tried to develop service learning programs, which are different. If you’re volunteering, you get on your bike and go on a 5K ride. The idea behind service learning is that there is an identifiable community need. Students committed to service learning undergo training, go through the activity and then reflect on it.”
Milling says that for this particular program, “The students have to understand what homelessness means, the backgrounds of the types of individuals who end up in this predicament and how it relates to health care.” As future doctors, they also need to learn to cope with what they encounter. “When I go out with them, some of what I see is pretty raw, even after 20 years of practicing,” he says. “It’s a lifelong skill to be able to process what you have seen and not become cynical about it.”
With Milling’s blessing, Hubeishy spent the winter break during his first year of medical school writing the program configuration. He convened the first UB HEALS e-board meeting this past January and launched the program, and its first street medicine round, on March 4. Since then, about 150 medical students have participated, helping to fulfill a requirement to complete 10 hours per year of service learning but, more importantly, gaining an experience and education they would never have if they were restricted to the classroom.
About an hour before the UB HEALS group met Anthony, the group drove by a small common area the team called Broadway Park. Hubeishy spotted a young woman sitting on a bench with an overstuffed purse and a suitcase. As the van pulled up, he got out and walked over to greet her. The woman, Tatiana, said she was 18 and had spent the previous night sleeping outside in the park. She was waiting for her boyfriend, she said, but she didn’t know where he was or when he would show up.
Gradually, the others approached. “Do you have family here?” Gotsch asked.
“Yes,” she answered.
“What are they like?” Gotsch asked.
In accordance with its protocol, the UB HEALS team told Tatiana about last-minute housing available to her. Tatiana said she had a mental illness but because her boyfriend does not, she would have to go there without him, something she was not willing to do. Gotsch told the young woman to call her on her cellphone when the boyfriend arrived and she would come back with more supplies.
Tatiana didn’t call and, as with Anthony, UB HEALS never saw her again, despite multiple return visits to the park.
Gotsch, who worked as an AmeriCorps volunteer in a community health center before entering medical school, says she will never forget her encounter with Tatiana that night. The single suitcase with all her possessions, the fact that she had slept the previous night in the park waiting for her boyfriend, who may or may not have been on his way.
“I was the only female medical student on the team,” Gotsch says. “I felt a bond between us. I asked her about her family, her relationship, her safety. Although she told me she felt safe, she really left a lasting impression on me because I remember what I was like when I was 18. I imagined myself at that age sleeping in a park without shelter.”
As heartrending as the rounds can be, Gotsch is nothing but grateful for the opportunity. “These experiences have given me firsthand insight into the social aspect of medicine that you don’t get to appreciate fully in a hospital setting,” she says, adding that she thinks all health care students should participate in at least one street medicine round. “Just one round can open your eyes to a world beyond medicine.”
And sometimes, in addition to getting their worldview widened, the students get to tell a story with a happy ending. Hubeishy likes to tell of a man in his 50s whom the team first met in March, sleeping on a park bench in Lafayette Square. He had partially amputated feet from frostbite, both infected and in need of new bandages, but he refused help.
He slept on that same bench every night, so the UB HEALS team continued to visit him once a week. After several weeks, he allowed them to change the dressings on his feet and provide some basic medical care. Eventually he allowed them to be the point of contact with the health care staff at the hospital when things would get so bad he’d go to the emergency room.
But he was still homeless and still sleeping in the park, in the cold, every night.
“We were really afraid he was going to die,” Hubeishy says. “Every time we saw him we would wrap his whole body with blankets and tarps to keep the rain off him.”
He made it through the winter and by May he was accepted into housing. Now he has an apartment with the accessibilities he needs and is being seen by a primary care physician who is handling his infections.
“It was hard to leave him outdoors, knowing that we could only do so much,” Hubeishy says, looking back on those late-winter rounds. “A lot of us connected with him and we really felt the limitations of the health care system. But to know we kept him alive during this very vulnerable time, when he was so susceptible to the dangers of homelessness … we felt like UB HEALS had a reason to exist.”