When Alisa Vickrey, PA-C, first learned about street medicine, she wasn’t sure what to think. As a physician’s assistant, she is trained to make people better, to be secure in knowing she has done the right thing for her patients. But with street medicine, the outcomes are elusive, offering no guarantees for success.
Still, she was drawn to this type of medicine because it serves the most vulnerable of populations, who are so often overlooked.
“The hardest thing with street medicine is learning not to have high expectations,” Vickrey said. “The whole point of this type of medicine is you are just out there planting seeds. You don’t know what is going to happen; all you can do is go out there and try to educate and hope that you connect.”
Providence Health & Services Alaska’s Alaska Family Residency Program, of which Vickrey is a part, is a community benefit program because it prepares residents to be physicians, specifically doctors that will serve marginalized populations. Medical residents from this program are involved in many community-welfare projects, including the Brother Francis Medical Shelter Caring Clinic, where residents help care for homeless patients who come in off the streets. The street medicine program, while fully voluntary, is an expanded version of the clinic, wherein residents seek out those in medical need rather than wait on them to come in on their own.
Last summer a handful of volunteer residents partnered with the Municipality of Anchorage to visit camps and offer medical treatment to homeless residents throughout the city. In just a few months, according to associate program director Teresa Bormann, MD, more than 200 patients have been served.
“Providence has provided critical support for the program as an extension of the Brother Francis Clinic,” Bormann said. “Their support also is in line with Mayor (Ethan) Berkowitz’s focus on reducing homelessness in Anchorage.”
The street medicine program is based on a simple premise: Since most homeless people won’t go to a doctor, the doctors come to them. Throughout the summer, residents and municipal social workers visited homeless camps they had identified through a citywide mapping database. Once there, they offered medical treatment or advice and began charting who they saw. The slow, methodical process required patience and trust, Bormann said.
“We would be in a three-to four-person team, and we would walk around until we found a homeless camp,” Bormann said. “We treat this as this person’s home. We call out, ‘Hello? Anybody home? We are here.’ And usually a head will pop out of the tent, and we start a dialogue.”
Bormann said the discussions range from finding housing to checking for medical problems – or just hearing peoples’ stories. Once, when visiting a gentleman sitting behind a gas station, her group found he had been to the emergency room just a week before after suffering a head injury. He was still having difficulties and overdue to get staples removed from the head wound, so they were able to provide what limited treatment he would allow on the spot.
Vickrey once discovered a patient with serious heart issues.
“We were able to get him to come back to Brother Francis Shelter to do a full examination, and he was actually in heart failure,” she said. “We were able to get him to Providence and get him cared for. He was shocked; he didn’t know his symptoms correlated to a clinical picture of heart failure.”
Bormann credits Vickrey with solidifying the street medicine program in Anchorage. It is based on established programs she researched in such cities as Pittsburgh and Santa Barbara, Calif., with modifications to serve the unique needs of Anchorage’s colder climate and cultural diversity. About five residents and three doctors now volunteer, working alongside municipal social workers to offer care.
“Our whole model is based on the idea that we will create trust, and with repeated visits and hopefully a recognizable person, the homeless person would be able to come to us if they need us,” Bormann said.
Vickrey agrees: “You can’t take it personally if they don’t want our help, and that is the hardest part to learn.”