In a world where healthcare often operates on rigid schedules and within traditional settings, there exists a growing need to adapt to the realities of those who cannot easily access or adhere to such structures. This is where organizations like Street Med STL step in, redefining healthcare delivery by taking it to the streets, quite literally.
Origins of Street Medicine
Street Med STL, short for Street Medicine St. Louis, draws its inspiration from the concept of Street Medicine, a term coined by Dr. Jim Withers, a physician based in Pittsburgh. The essence of Street Medicine lies in its approach to reach individuals where they are, rather than expecting them to conform to the norms of traditional healthcare settings. It acknowledges the challenges faced by marginalized populations in accessing care and seeks to bridge this gap by bringing medical services directly to them.
The inception of Street Med STL can be traced back to the experience Dr. Nathan Nolan, from the Infectious Diseases Division at WashU, had during his fellowship training working with Dr. Laura Marks, who was running the Bridge to Health Program. This program aimed to provide support services for hospitalized patients grappling with complications arising from substance use disorders, many of whom also struggled with housing. During this time Dr. Nolan realized that hospitalization was a critical time for reaching patients but missed opportunities to intervene before patients experienced catastrophic health consequences. He started to wonder how he might move this care upstream of the hospitalization.
One of the most amazing things about Street Med STL is the team’s passion for meeting people where they are. Their organization not only provides outstanding clinical care to a traditionally “hard-to-reach” population but has also been critical in providing our research teams with an opportunity to incorporate unhoused people in basic science research.
Laura Marks, MD, PhD
A Vision Takes Shape
During his fellowship in infectious diseases, Dr. Nolan began contemplating how principles of care from the Bridge to Health program could be extended to serve the unhoused population. He recognized the need for proactive measures to address health issues before they escalated into emergencies requiring hospitalization. However, the onset of the COVID-19 pandemic disrupted many plans, redirecting resources towards pandemic response efforts.
I wondered how I could take some of these principles of care and apply them to a different population, specifically those who are unhoused. Many people who are unhoused also struggle with substance use or injection drug use.
Nathanial Nolan, MD, MPH, MPHE
Amidst the chaos of the pandemic, Dr. Nolan found himself assisting shelters in optimizing space while adhering to public health guidelines. This experience provided him with firsthand insight into the challenges faced by the unhoused population and further fueled his determination to address their healthcare needs.
Addressing Complex Healthcare Needs
With healthcare at the forefront of Dr. Nolan’s mind, he set out every Saturday to aid the unhoused, providing care, someone to talk to, and recognizing the importance of addressing basic human needs. For several years he was hitting the streets solo, but by the end of 2022, it became an increasingly expensive and time-consuming endeavor. This was the first time friends and colleagues suggested making it into an actual non-profit.
And so that’s how Street Med STL got its start. Nolan shares “A year ago, we started to have more people start volunteering with me, including some students. Then we went from that to now being a formal 501c3 and having regular outreach every Saturday.”
Nolan shares, he has more people interested in volunteering than he has time to train. And he’s trying to figure out how to balance that and make sure that they continue to provide services to folks. Street Med STL’s outreach efforts encompass a blend of humanitarian aid and medical services. Volunteers distribute essential supplies such as food, clothing, and cold weather gear while engaging individuals in conversations to assess their medical needs. From treating minor injuries to facilitating access to long-term care programs, the organization endeavors to address both immediate health concerns and underlying issues contributing to homelessness.
Beyond the confines of traditional healthcare settings, street medicine seeks to restore dignity to those often marginalized by society. Building trust within unhoused communities, establishing privacy during consultations, and navigating logistical hurdles are among the myriad obstacles encountered. However, these challenges only serve to underscore the urgency of the mission.
“These are individuals who don’t really have any semblance of privacy or stability. And so, we try to be attentive to that. We have thrown around the idea of a mobile health van to offer a place to provide privacy while offering care.“
Joshua Fernelius, MD – Street Med Stl Volunteer
Every encounter with the unhoused population brings forth a diverse array of healthcare needs, often ranging from routine wound care to more complex medical issues. Dr. Nolan recounts a recent case involving a gentleman with abscesses resulting from injection drug use. Utilizing ultrasound technology, the volunteer team assessed the situation, provided antibiotics and initiated discussions on harm reduction and substance abuse treatment. This holistic approach underscores the organization’s commitment to mitigating the health risks associated with substance use.
Community Partnerships and Support
One might wonder how seemingly mundane items like cookies find their way into Street Med STL’s outreach efforts. The answer lies in the power of community connections and grassroots support. Farrin Manian, MD, who is the Chief of Medicine at Mercy Hospital, is one of Street Med STL’s many volunteers. He and his wife have connected with local businesses, like Crumbl Cookie, which play a pivotal role in enhancing the organization’s outreach. Beyond mere sustenance, these donations serve as catalysts for meaningful interactions, breaking down barriers and fostering trust between volunteers and those they serve.
“When we come up, people are a little bit shy. They’re not necessarily interested in coming out of their tent, However, if we say hey, I have some cookies from Crumbl Cookies, I can’t tell you how many times that’s been an enticement to open the door to a more meaningful conversation.”
Nolan
The impact of Street Med STL extends beyond mere medical interventions. By meeting individuals where they are, the organization not only delivers healthcare but also restores dignity and hope to those often marginalized by society. However, sustaining these efforts comes with its own set of challenges, from financial constraints to resource limitations.
Expanding Reach and Impact
As Street Med STL continues its journey, the focus remains on expanding outreach efforts, enhancing volunteer training, and forging partnerships to maximize impact. Through a combination of compassion, innovation, and perseverance, the organization strives to make a meaningful difference in the lives of St. Louis’s unhoused population. Dr. Nolan envisions a future where multiple outreach initiatives operate concurrently across various neighborhoods, ensuring that assistance reaches those in need wherever they may be.
“I want to be able to help support Dr. Nolan to build this up in a way where there’s other people and physicians that can step up and develop some sort of capacity. I think it would be ideal if we’re able to set up a rotation so that others can help participate and expand the efforts“
Fernelius
Street Med STL exemplifies the transformative power of grassroots initiatives in reshaping healthcare delivery and addressing the needs of vulnerable communities. By embracing the principles of Street Medicine, it serves as a beacon of hope, advocating for healthcare equity for all.