Students from the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences are treating patients where they live—in this case, the streets and shelters for the homeless. Twice each week, students and faculty arrive at Buffalo’s downtown bus station equipped with basic medical supplies, hats, and gloves. The team members are part of UB HEALS (Homeless health, Education, Awareness, and Leadership in Street medicine), a service learning program that provides medical care and clothing to homeless people.
The effort gives students “an opportunity to realize that very close to the urban areas they’re used to is a whole different life,” said David A. Milling, MD, senior associate dean for student and academic affairs, and faculty advisor to the program. In mild weather, the students and physicians conduct rounds on the streets; during Buffalo’s bitter winters, they see patients in three homeless shelters. Although the scope of care is limited, UB HEALS connects interested people to other medical help.
Students receive training in understanding the varied needs of the homeless population, Milling said. In reflection sessions, they talk and write about what they’ve learned. Since March 2016, about 150 students have participated in the program, which was first suggested by a student.
Getting a clearer picture of patients’ lives
Students from Boston University School of Medicine (BUSM) interview and listen to homeless patients in a clinic and respite unit run by Boston Health Care for the Homeless Program (BHCHP). At the group’s facility located at Boston Medical Center (BMC), the students practice physical exam skills, work with a supervising physician, and learn about issues and conditions seen more in homeless people, such as hepatitis C.
“In medical school, we are taught to focus on treatment of the medical problems patients present with. But as a provider, you have to find out what is driving disease instability to break the cycle,” said Thea James, MD, vice president of mission and associate chief medical officer at BMC. “When a person doesn’t have secure housing ... [that] becomes a driver of health instability.”
As part of her BUSM curriculum, third-year student Stephanie Lie recalls watching a man have his history taken in the hospital. One month later, she interviewed the same man in the BHCHP clinic, where greater privacy, more time, and use of supportive language helped him open up more. “The clearer picture about his current medical problems was really awesome,” she said.
Through the project, Nicholas Chiu, also a BUSM third-year student, became interested in the movement to establish safe injection facilities for anyone with opioid addictions. “When you learn about the systemic problems, you get a perspective and want to do something about it,” said Chiu. The student-authored a resolution to the Massachusetts Medical Society (MMS) to study the feasibility of a pilot facility for safe injections in the state and to develop a society stance. The study was completed in 2016 and MMS now supports the concept. Although his effort to help people with opioid addictions went beyond the homeless population, “The whole process stemmed from going to the homeless health clinic, seeing the problems patients face, and having them tell you about it,” he said.
Residents at Boston area hospitals often rotate through BHCHP’s shelter clinics, too. For trainees, “it can be life altering,” said Joan Quinlan, MPA, vice president for community health at Massachusetts General Hospital. “For academic medical centers, it’s a fabulous training opportunity” to offer “community-based, real-world experiences.”
Read the first article in the series on how several teaching hospitals in Boston have collaborated to establish a clinical program to treat homeless people.