More than 100 physicians and other health professionals gathered in Atlanta last month to refine strategies for treating the most vulnerable of homeless populations: those who live unsheltered in the nooks and crannies of the world's urban landscapes.
The fifth annual International Street Medicine Symposium drew 130 participants, including 20 medical students, from an array of U.S. cities as well as Calcutta and New Delhi, India; London; and Stockholm.
Highlights included an address by H. Westley Clark, M.D., director of the Center for Substance Abuse Treatment, a division of the Substance Abuse & Mental Health Services Administration, and a first-ever meeting of street medicine physicians and Centers for Disease Control and Prevention physicians in charge of high-risk populations.
James Withers, M.D., the internist widely known for pioneering the field of street medicine through his Operation Safety Net program in Pittsburgh, says the CDC meeting focused almost exclusively on the H1N1 virus. “We had probably an hour and a half discussion where we talked about the risk in terms of infectious disease for homeless people and how that impacts the general public.” Withers says the discussion was “groundbreaking.”
The CDC officer at the meeting, Scott Santibanez, M.D., says people with chronic medical conditions like asthma, diabetes and heart disease are more likely to experience flu complications that result in being hospitalized and occasionally result in death. “We know that a lot of homeless people have chronic, underlying medical conditions like these. It is vitally important that these individuals get vaccinated against H1N1, so that they don't become ill themselves and potentially spread H1N1 to others if they're in a crowded setting like a shelter,” he says.
The meeting included an opportunity for participants to engage in old-fashioned “street rounding” with Atlanta-based outreach workers and tours of clinics run by St. Joseph Mercy Care Services—a federally qualified health center dedicated to that city's estimated 7,000 homeless residents.
Jonathan Reisman was one of three medical student presenters. In his fourth year at the Robert Wood Johnson Medical School in New Jersey, Reisman recounted his experiences working with Calcutta Rescue, a 30-year-old medical practice providing care to the throngs of destitute pavement dwellers in Calcutta. Reisman says the combination of wanting to help the underserved and the intellectual challenge of providing care in nontraditional environments, where there is a lack of infrastructure, appealed to him.
As the crisis of homelessness increases across the globe, more physicians are finding professional satisfaction in this work, as evidenced by the fourfold increase in symposium registrations since 2005.
“I think it's an opportunity to deal with people directly and holistically,” Withers says. “It's so gratifying to be able to just do the right thing, as best you can, but to do it without too much in the way of structural restraint.”
Isabelle T. Walker is a freelance writer for Modern Physician based in Santa Barbara, Calif. She can be reached at [email protected].
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