Meeting People Where They Are:
An Interview with Trailblazer Jim Withers, MD
Bringing medical care to people who are experiencing homelessness takes a radical commitment: not only to the person, but also to understanding their perspective and everyday reality. At Pittsburgh Mercy’s Operation Safety Net®, a member of Trinity Health, and part of the global Street Medicine network, we meet people where they are – bringing medical care to people directly, going under bridges and into camp sites. Our “house call” ethos forges deep trust that lets us break down barriers and create real, life-long, interdisciplinary relationships – allowing us to fully support those we serve, in spite of their sometimes extreme aversion to working with conventional care systems.
At its most basic, a street medicine program delivers direct medical care to those whom we call the “unsheltered homeless,” but as that program matures, the work expands to intersecting social domains, integrating with local community resources, like legal aid and housing assistance. They go beyond providing direct care by serving as advocates to find organic solutions to systemic barriers. Dedicated staff works directly with people on the street to address social service needs and coordinate efforts within the larger community.
As with other “excluded” populations, data are limited; however, street medicine inpatient consult services have been shown to reduce hospital length of stay and readmission rates. When partnered with “housing first” models, street medicine programs succeed in housing the most vulnerable of the street homeless. At Pittsburgh Mercy’s Operation Safety Net, we have helped house more than 1,500 people in just the last 15 years. Our model is rapidly spreading; there are now more than 100 street medicine programs on six continents, including more than 50 in the United States.
After 25 years of street practice, I’ve been privileged to share in the lives of many people who have lived on the streets. One of our long-term clients lived in a tent. He accepted basic services but was unwilling to consider housing or other higher medical care. He was always dignified but reserved. Tragically, he suffered burns that disfigured his handsome face and caused him to lose his lower leg. When I visited him in the Burn Unit, I asked him if he had any family I should call. I will never forget how he looked in my eyes with tears and said, “Operation Safety Net is my family!” Fortunately, he was able to accept housing in one of our programs, and these days, I often see him bicycling with his artificial leg.
Beyond the cost savings, street medicine is a type of complex care that starts deep within the reality of people who are used to being excluded and treats them with compassion, dignity, and perhaps most importantly, humanity. It represents a radical new way to structure health care services – starting with the individual, standing alongside them; empowering them to cross traditional barriers; and creating new working relationships that serve the people rather than the systems that treat them. Ultimately, it’s the people who teach us what needs to be done. The question is: Are we listening?
Dr. Jim Withers, Nic Wilder, and Christopher Roach on street rounds in Pittsburgh.
Photo © 2017 Pittsburgh Mercy’s Operation Safety Net®. Used with permission.
Dr. Jim Withers, headshot
Photo © 2017 Archie W. Carpenter and Pittsburgh Mercy. Used with permission.