Teams of healers head outdoors to bring help to homeless
ALLENTOWN, Pa. — Nurse Laura LaCroix was meeting with one of her many homeless patients in a downtown Dunkin’ Donuts when he mentioned that a buddy was lying in agony in the nearby woods.
“You should check on him,” said Pappy, as the older man is known. “But don’t worry, I put him on a tarp, so if he dies, you can just roll him into a hole.”
LaCroix called her boss, Brett Feldman, a physician assistant who heads the “street medicine” program at Lehigh Valley Health Network. He rushed out of a meeting, and together the two hiked into the woods. They found Jeff Gibson in a fetal position, vomiting green bile and crying out in pain from being punched in the stomach by another man days earlier.
Feldman told him he had to go to the hospital.
“Maybe tomorrow,” Gibson replied.
“Tomorrow you’ll be dead,” Feldman responded.
Months later, the 43-year-old Gibson is still in the woods, but this time showing off the 6-inch scar from repair to his perforated intestine.
He greeted Feldman warmly. “You’re the only person who could have gotten me to the hospital,” he said. “You’re the only person I trust.”
Pappy and Gibson are “rough sleepers,” part of a small army of homeless people across the country who can’t or won’t stay in shelters and instead live outside. And LaCroix and Feldman are part of a burgeoning effort to locate and take care of them no matter where they are — whether
under bridges, in alleyways or on door stoops.
“We believe that everybody matters,” Feldman said, “and that it’s our duty to go out and find them.”
Facing new challenges
Most of the time, members of the street medicine team provide basic primary care to people who live in dozens of encampments throughout eastern Pennsylvania’s Lehigh Valley. During their street rounds, they apply antibiotic ointment to cuts, wrap up sprains and treat chronic conditions such as high blood pressure and diabetes.
But they also help people sign up for Medicaid, apply for Social Security disability benefits and find housing. Three or four times a month, they deal with individuals threatening to commit suicide. After heavy rains, they bail out “the Homeless Hilton,” a campsite under an old railroad tunnel that frequently floods — and where two rough sleepers once drowned. Many days, they simply listen to their patients, trying to relieve emotional as well as physical pain.
Street medicine was pioneered in this country in the 1980s and 1990s by homeless advocates Jim O’Connell in Boston and Jim Withers in Pittsburgh. Yet only in the past five years has it caught fire, with a few dozen programs becoming more than 60 nationwide. A recent conference on the topic in Allentown, Pennsylvania, drew 500 doctors, nurses, medical students and others from 85 cities, including London and Prague. Most programs are started by nonprofit organizations or medical students.
Even as it comes of age, street medicine faces new challenges. A younger set of leaders is less interested in cultivating a bleeding-heart image than in establishing the approach as a legitimate way to deliver health care not only to the homeless, whose average life expectancy is about 50, but also to other underserved people. Backers say street medicine should be considered a subspecialty, much like palliative care is, because of the unique circumstances of treating its target population.
Proponents also are pressing for more financial support from hospitals, which can benefit greatly when homeless individuals receive care that helps keep them out of emergency rooms. Feldman’s program Duckie checks her hair in a mirror that she keeps near her tent at a homeless encampment. The street medicine team helped her get hospital treatment last year for a severe skin infection. Making a connection
On one morning this fall, Feldman’s team made its way from downtown Allentown to a swath of mosquitoinfested woods between the railroad tracks and the Lehigh River. A few blocks
away, an extensive redevelopment project, complete with a luxury hotel and arena for the minor-league Phantoms hockey team, is revitalizing parts of the longdepressed area.
Bob Rapp Jr., who has worked extensively with homeless veterans and knows the location of many campsites, was the advance man. “Good morning! Street medicine!” he called out.
Feldman carried a backpack full of drugs. LaCroix used her “Mary Poppins bag” to try to coax people out of their tents: “We’ve got supplies — socks, toilet paper, tampons,” she called.
A thin woman with striking blue eyes popped out of a tiny tent, pulling at her wildly askew blond hair. The woman, 60 years old and known as Duckie, hugged LaCroix. She had bonded with the nurse after LaCroix previously had helped her get new clothes and emergency treatment for a virulent, highly contagious skin infestation.
Feldman kneeled in front of Duckie with his stethoscope to check her lungs; the last time he saw her, the longtime smoker had bronchitis. No breathing problems this time, but Feldman said he wanted her to have a psychiatric evaluation. If the doctor confirmed that she has bipolar disorder, depression or post-traumatic stress disorder — all diagnoses Duckie says she has heard over the years — she will be able to get the drugs she needs and perhaps transitional housing.
“I self-medicate,” she said with a shrug. But she liked the idea of moving inside with winter coming. She agreed to see a psychiatrist, a volunteer who comes out once a month, at her tent the following week.
Later in the day, the team went to see a favorite patient. When the group approached his plastic-covered hut in the woods, Mark Mathews frantically ordered them to stop. “I don’t want to be caught with my pants down!” he yelled from within.
Moments later, khakis on, the 57-year-old emerged. The son of a successful Allentown actor, the gray-bearded Mathews spent years playing Santa Claus in malls. He also worked for a high school theater department and in the 1980s was part of a localcable comedy show.
He became homeless after having a falling out with his sister four years ago. “The money ran out, and I couldn’t get another job,” he said.
LaCroix took his blood pressure and found it high; Mathews admitted he hadn’t taken his blood-pressure medicine. The team agreed to come back in two days to do a recheck, which Mathews said was fine with him. “I enjoy their company,” he said.
Like other homeless patients, Mathews has the team’s cellphone numbers. He frequently texts LaCroix to tell her jokes or alert her to someone’s possible health problem.
“I try to help other people,” he said. “I lend people phones if they don’t have them. I help them get to their appointments. I should be nominated for sainthood.”
Finding a calling
About 550,000 people in the United States were homeless in 2016 on any given night, according to the most recent estimate by the Department of Housing and Urban Development. About a third of them were sleeping outside, in abandoned houses or in other “unsheltered” places not meant for human habitation. In Santa Barbara, California, so many people live in their cars that the local street medicine team provides care in automobiles.
Estimates for the number of homeless people in this area of Pennsylvania — the Lehigh Valley includes the cities of Allentown, Bethlehem and Easton — range from more than 700 to almost twice that number. But that’s likely a big undercount.
A study of people who came to three area emergency rooms during the summer of 2015 and the following winter identified 7 percent as homeless. Feldman, who led the study, said the finding suggested that more than 9,200 of the health system’s emergency room patients were homeless sometime during the year — in communities with no permanent emergency beds for couples and fewer than two dozen for women.
The street medicine program that Feldman founded takes care of about 1,500 people a year. Since 2015, it has pressed relentlessly, taking laptops into the woods to get homeless patients insured, usually through Medicaid; today, 74 percent have coverage. Over the same period, emergency room visits by the program’s patients have fallen by about three-quarters and admissions by roughly two-thirds.
Feldman’s collaborator is his wife, Corinne Feldman, a physician assistant who is an assistant professor at DeSales University. When they first moved to the Lehigh Valley in 2005, the couple wanted to work with the homeless but couldn’t find them — until realizing they were in campsites in the woods.
The Feldmans started by setting up free clinics in shelters where they worked without pay. But a 2013 Boston conference on street medicine sharpened their focus. They would go to wherever the homeless were. “We thought, this is all we want to do with our lives,” he recounted.
By then a physician assistant at Lehigh Valley Hospital, Brett Feldman got a grant from a local philanthropy that allowed him to do street medicine one day a week. Over time, he received more grants, as well as backing from the health system to set up a full-time street medicine program. It launched in 2014.
There have been plenty of disappointments and heartbreaks: Two patients at an encampment in Bethlehem froze to death. A man with third-degree burns from sleeping on a heating vent fled rather than have his badly infected lower leg amputated. And before the psychiatrist could come out, Duckie disappeared.
At the same time, there have been poignant victories. When a 50-year-old man, living in a drainage pipe, was diagnosed with advanced colon cancer, he declined treatment but eventually was able to move into an apartment, where the streetmedicine team provided him palliative care. When his symptoms worsened and Feldman said it was time to go to hospice, the man replied, “First, I have to clean up the apartment because the landlord was so nice.”
The team helped him do the cleaning and then took him to hospice, where he died a peaceful death.
“Most of our folks think they will die alone, that their future is canceled,” Feldman said. “Bringing hope is more important than any medicine.”