by Annabella Li, Chanel Li, and Siegfred Yano
For many people, winter means holidays, gift-giving, and family gatherings. However, for those experiencing homelessness, as the leaves start to turn, seasonal changes present brutal challenges. Exposure to cold weather combined with a wet outdoor environment can cause a variety of conditions, including both hypothermia and frostbite, that lead to permanent-damage, like arthritis and sensory loss. In severe cases, these conditions can lead to amputation and even death. Furthermore, exposure-related conditions like these may be exacerbated if one struggles with substance abuse. Despite this, people experiencing homelessness may not be able to seek medical attention, especially in areas lacking affordable transportation and fully operating services. University District Street Medicine (UDSM) is a student-run, inter-professional organization uniting healthcare professionals, students, and volunteers to eliminate health disparities by providing free comprehensive care to the underserved and educating current and future healthcare providers. A core part of this mission are UDSM outreaches, where teams of students and medical professionals travel on a monthly or bi-monthly basis to sites within University District and the greater Seattle area to provide healthcare resource referrals and basic first to consenting houseless clients. The concept of “literally and figuratively meet us where we’re at” is the foundation of UDSM’s current model and efforts. To help the people facing these life-threatening situations daily, particularly in preparation for the trying times in winter, UDSM holds an annual, virtual Winter Fundraiser from November 29th to December 31st. Below is more information from the on-site outreach managers themselves on the importance of UDSM’s mission and how donations for the Winter Fundraiser can help save lives in the coming months. Firstly, we sat over Zoom with our Outreach Managers at different shelters: Jessi Kelly from OneHealth and Kendall Jones from Elizabeth Gregory House to discuss their experiences as outreach coordinators, the effect of winter weather on the homeless individuals, and the important work accomplished by UDSM. Here is our conversation with Jessi Kelley: UDSM: How long have you been involved with OneHealth and UDSM and what really got you into it? Kelley: I had initially joined UDSM as a volunteer just generally and this outreach position for OneHealth came up… OneHealth is an interface between human, animal, and environmental health… the engagement of the human within the animal and the environmental world … is unique in serving our under-resourced and houseless population. UDSM: Is there any emphasis on people that have pets or people that come in for treatment with pets? Kelly: The OneHealth clinic is a partnership between UDSM, NeighborCare, WSU Vet Medicine, and New Horizons. New Horizons is [a] homeless shelter. They do day services and then they also have transitional housing areas and are specifically for young adults 18-25. Neighbor Care is a human health organization. Part of the impetus for this was creating human care accessibility in addition to animal care accessibility, so a lot of the young adults who come into our clinic come with their pets to get the accessible health care services because having a pet and veterinary medicine can be very expensive. It’s not like they have very accessible insurance policies… It’s expensive to have health insurance for your pet, it’s expensive to access healthcare for your pet, so WSU has a program - they get a lot of donations and can provide free vet care - so a lot of times these young adults are bringing in their animals for vet care and then part of our [program] is also increasing accessibility of primary care access to our unhoused young adults. So when they bring in their pets, we also say, “and part of this OneHealth is you seeking care for yourself so everybody’s healthy”. (0:16-5:09) UDSM: Do you think you can speak a little bit to how winter might impact people’s health, health of their animals as well… things that you see that are specific to the cold or are exacerbated by the winter weather? Kelley: … [G]enerally, environmental factors for our area, the cold and wet - I know we have another UDSM clinic that does foot care - that’s a huge issue in this population specifically. ... if people can’t access shelters that might be because they have a pet, that might be because they, there might just be certain policies within the shelters that might make it hard for people to seek their services, they might not feel comfortable with the community there, etc … so people … will prefer to be in the elements. So in the elements, especially with the rainy weather, people might not have dry socks or shoes, so trench foot … is a big issue when people don’t have access to dry socks and foot care. They might not be taking off their socks and shoes to check that their feet have wounds or [are] getting bad, that’s a big one we see in the hospital. Sometimes that might lead to as far as amputation if people have just not been making sure that their tissues are healthy. Sometimes people might stay up at night and sleep during the day because the weather will get so cold that they don’t want to freeze to death. (8:19-10:22) UDSM: [on our focuses for the article] if there was an increased demand for … healthcare services, if that was a thing, and if so if that was something that caused a strain because there wasn’t enough infrastructure to support that demand? Kelley: We definitely see an increase in emergency room utilization, which has impacts for everybody. People might use substances to stay warm, which doesn’t actually have a good physiologically effect. It can exacerbate already existing chronic conditions, which brings people into the hospital. The snow [which] we only get once or twice a week, generally, in this area which is good, but that can have huge impacts just for people accessing basic things, like food, water, pharmaceuticals, and then also we’re not always prepared with our road systems, so ambulances actually being able to get people to where they need to go can be challenging when you have snow and ice (12:30-13:17) … unfortunately a large part of our poor access to primary health care and preventative health care, sometimes in this area, and generally in this country, can lead to people not getting care quickly or before things get really really bad. So there’s high utilization of tertiary care system, so like acute care systems, where if we did a better job with our preventative and primary care, we wouldn’t have as poor outcomes for especially our unhoused people (13:53-14:24) UDSM: More generally, [are there] certain situations that you see multiple patients finding themselves in? Kelley: Specifically for OneHealth since the population is 18-25, a lot of them are learning agency and how to navigate just being a young adult and then also navigating to services. For New Horizons... With Kendall Jones: UDSM: How did you get involved with UDSM? What do you feel is important about what you do? (What do you feel is the importance of street medicine?) Jones: I am currently a second-year medical student at the University of Washington. I got involved with UDSM because I believe the homeless population are among the most marginalized people. Before UDSM, I worked in a supportive housing program in Boise that was well staffed! However, the program faced some obstacles as well with regards to severe mental illness. Being a smaller town, we have a smaller homeless population, so people are known to police, but people in Seattle can be known by shelters too. Recently, we have had issues with signing preceptors and volunteers. Elizabeth Gregory House has a goal of having two outreaches a month with the goal to connect people to resources and be-listeners. UDSM provides a safe place for prescriptions and healthcare. Going to where they are [located] can repair some trust between them and the healthcare system after possibly being rejected by it. UDSM: What does a typical day as a UDSM outreach manager look like? Jones: [A typical day usually happens] on Sunday morning. We arrive with three volunteers and a preceptor at 9 A.M., [complete] a check-in and do a temperature screen. At EGH, [we have] a sort of back area where during the week they have a nurse or case manager (support staff). It has access to two different rooms and a hallway space. [Before starting], we orient the preceptor and volunteers if they are new. There is a fair amount of supplies there including vitamins and over the counter medications. At 9:30 A.M. we see anyone in the shelter that wants to talk; there is shelter staff [present all the time including a list of all the women present in the building with meetings lasting 2 to 3 hours]. Every visit is different: some people want vitamins because nutrition is hard when unhoused, some people want to stay on top of their health, some people are more scattered when it comes to [visiting us]. We get a detailed history, like a clinical visit, then follow-up with a detailed physical exam which we give to the preceptor who will give more specific recommendations or more exams. [From there], we help connect people to more care, like a primary provider, vaccine appointment, or act as a case provider. UDSM: What are some needs in the houseless community that UDSM (and more specifically outreach sites) help to address? What areas do UDSM need to improve on to provide unmet needs? Jones: EGH is well resourced [as] we’re able to provide vitamins, naproxen, and PT tape. We have the ability to buy supplies when needed. Lately, getting preceptors has been an issue. With street outreach, we usually hand out emergency blankets, snacks, and socks but they go pretty quickly, so having those resources is crucial. It helps to have good communication and rapport [with people on the street] because they might not want to talk. I’ll have to think more on this question. Not really [related to] UDSM, but a place for improvement right now is [having a look-up directory] to refer to clinics [such as] having a printout might be smoother and more useful and digitizing a resource library. But being a resource manager is challenging because you have to stay on top of it. It might be good to have a specific resource manager role at outreaches for this. UDSM: What are the common infections or medical complaints you encounter during outreach events (during winter?) Jones: There are no outreaches in the summer [though] weather changes come up in people’s concerns a lot. [People usually present] a runny nose, cough, or have difficulty breathing. Covid symptoms means they may not be able to [stay] in the shelter. But, it could just be allergies, a cold, or asthma. Shelters can isolate those with symptoms and still be treated. UDSM: We currently face a global pandemic, how has COVID-19 impacted medical outreach to homeless populations (the health of the houseless community as well)? What have people in healthcare learned about the unprecedented crisis? Jones: If [a person] has cough symptoms, they might not be allowed into the shelter, even if they have a common cold, allergy or just [any] other issue. Some [conditions] could totally be benign, but there is more worry now. As winter season approaches, and the temperatures continue to drop, the risks of exposure-related conditions increase. Basic necessities like warm socks, gloves, and hats that keep one dry can make a big difference in the health of those exposed to the elements. You can make an impact on someone’s life by making a donation to UDSM. If you would like to donate to our Winter Fundraiser, please do so by December 31st at give.uwmedicine.org/UDSM. Keep an eye out on the UDSM instagram, @udstreetmed, for more information on how to donate.
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