Street medicine experts gather at symposium

Tuesday, October 29, 2019 - Updated: 3:29 pm

By JOHN FRANKO Staff Writer

In 1998, Dr. James Withers, in collaboration with Mercy Hospital of Pittsburgh, founded Operation Safety Net, which has received international acclaim as a model street medicine program.

Withers was instrumental in founding the annual International Street Medicine Symposium, first held in Pittsburgh in 2005. Four years later, he joined street medicine leaders in founding the Street Medicine Institute.

In recognition of the collaboration between Pittsburgh Mercy’s Operation Safety Net and Allegheny Health Network’s Center for Inclusion Health, the 15th annual International Street Medicine Symposium was held Oct. 20-23 at the August Wilson African American Cultural Center in Downtown Pittsburgh.

More than 400 clinicians, service providers, educators, researchers and students from 70 cities in 15 countries were in attendance. The ISMS is under the direction of the Street Medicine Institute and is the only international forum in the world designed exclusively for health care workers who serve the rough-sleeper homeless population.

The term “rough-sleeper” refers to those who are unsheltered and sleeping on the streets. Since the first ISMS, street medicine programs have been initiated in more than 100 communities in 25 countries and six continents. The fundamental approach to street medicine is to reach out to the homeless in their environment and engage them on their terms to reduce barriers to care access. It is seen as a form of intermediate “home care.”

“This whole thing is a work in progress,” Withers said, relating the story of street medicine in Pittsburgh through Operation Safety Net. “We’re making it up as we go.” While the problems of every person can’t be solved, he noted, it is important to keep up the fight for those on the streets.

Withers was teaching medical students when he began to see the disconnect between the reality of the health care system and many of the people it was meant to serve. He sought to recapture the spirit of humanity, he said, by making the streets his classroom. Withers added that he found “no competition” for his patients, and he considered it to be a “privilege” to be with people who were struggling.

He noted the words of Lao Tzu in stating, “Go to the people. Live among them. Love them. Learn from them. Start from where they are. Work with them. Build on what they have.”

Withers added, however, that an effective relationship hinges on first getting the trust of the people. 

Dr. Liz Frye, chair of this year’s ISMS and a member of the Street Medicine Institute’s board of directors, echoed the need for health care providers to be transparent and authentic, adding, “You can’t -------- (‘fool’) a street person.”

Brett Feldman, director of street medicine and assistant professor of family medicine at the University of Southern California’s Keck School of Medicine, said health care providers must prove to the people on the streets that they are worthy of quality care.

He pointed out that, when he was contemplating a move from Allentown, Pennsylvania, to Los Angeles, he was driven to the County Hospital in Los Angeles, where he found a dozen people sleeping on the lawn of the facility. He also encountered a man in a wheelchair who had been there for three days. 

Feldman noted that the man had suffered a nonoperable pelvic fracture in a car accident. He was placed in the wheelchair and sent outside to a bus stop. The experiences convinced Feldman to make the move.

“You have to decide what job you need to do when you leave here today,” he said.

With long waits for housing, Palka said, people are kept in situations that are unsafe. In addition to providing medical care, Operation Safety Net mitigates relationships with law enforcement, emergency medical services and the judicial system, he said. Palka said that civic officials in Pittsburgh have been open to addressing thorny issues.

But in the end, Palka pointed to the importance of forging one-on-one relationships with people on the streets. “It informs on the way you advocate with someone who is living outside,” he said. “If we’ve done anything well, we’ve listened.”

Brian Matous, homeless services manager, noted how far Operation Safety Net has come, from Withers and a couple of others, to the comprehensive program that continues to evolve today. He likened its growth to the story of the original seven Sisters of Mercy, who came to Pittsburgh in 1853 to start their ministry.

“Their passion and what they wanted to do was to help people who are struggling,” he said.

Dr. Patrick Perri, medical director and co-founder of AHN’s Center for Inclusion Health, said “it is obscene that we need to be here to learn about street medicine.”

Founded in 2014, the center is its own division with the Department of Medicine, and it develops clinical approaches to improving quality care to socially-excluded patient populations such as the homeless, HIV positive and substance abusers. It also offers outreach to immigrant and refugee communities, as well as healthy food centers.

Dr. Jimmy Miller, street medicine team leader for the Center for Inclusion Health, spoke of meeting an amputee patient who hadn’t had the dressing on his wound changed for two weeks. The man was fortunate that he was treated before further surgery was necessary.

“Meet people where they are, but don’t leave them where they are,” he said, quoting an anonymous source.

Dave Lettrich, executive director and founder of Bridge to the Mountains, spoke of the “traveler” population in Pittsburgh. The sub-culture includes many young people, some as young as 12. He spoke of one 14-year-old girl whose father was in jail with her mother battling a methadone addiction. She dumped her school books out of her bookbag and turned it into a backpack to hit the streets.

As Lettrich spoke, images of young people crossed the video screen behind him. They were photos of the 16 young people who have died on Pittsburgh’s streets in the past year.

“Sixteen beautiful, magnificent, wonderful human beings,” he said. He spoke of the need to get past labels and meet people where they are.

Pittsburgh Mayor William Peduto addressed the gathering Oct. 21 and surprised Withers by presenting him with a key to the city. He also designated that day as “Dr. Jim Withers Day.” 

“We are blessed to have Jim as part of our city,” he said. “Just as your cities are blessed to have you as part of it.” He described Withers as being a “hero” of his.

Withers praised the mayor for being a staunch advocate for the homeless, and the mayor responded by stating that he won’t let the homeless be neglected in Pittsburgh.

“It’s a town that has a big heart,” Peduto said. “It’s a compassionate town.”

In addition to visiting the usual tourist attractions in the city, Withers urged those gathered to visit the memorial wall that commemorates those in Allegheny County who have died while homeless since 1989. It is located beneath an overpass at Fort Pitt Boulevard and Grant Street in Downtown Pittsburgh.

More information can be found at www.streetmedicine.org; on Operation Safety Net at www.pittsburghmercy.org; and on Facebook at Street Medicine Institute and Pittsburgh Mercy.

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