Forty-four years ago, the Rev. Tom Behrens drove through the streets of Chicago with a trunk full of food and medical supplies, seeking to help people experiencing homelessness in need and engage with them on a personal level. Since then, his work has expanded into a nationally recognized organization, The Night Ministry, which has served thousands of people by providing them with food and medical care and connecting them to housing resources. Now, the organization is helping University of Chicago medical students serve people on the South Side, where, according to the city’s 2019 point-in-time count survey, close to one-quarter of Chicago’s unsheltered people reside.
Street medicine, a concept The Night Ministry borrowed from Dr. Jim Withers’s street medicine program in Pittsburgh, brings the medical care typically provided in a doctor’s office to those who live on the streets and cannot easily access medical resources. In 2016, the University of Illinois at Chicago became interested in joining the effort and began its own program, Chicago Street Medicine (CSM), in partnership with The Night Ministry. CSM later expanded to include other Chicago medical schools. Last year, the University of Chicago Pritzker School of Medicine established its own chapter of CSM, bolstering the South Side’s street medicine presence by providing healthcare, food, and other resources to people experiencing homelessness on the South Side.
Street medicine takes a very different approach than traditional medical institutions, which often fall short in providing the care people experiencing homelessness need. Stephan Koruba, a senior nurse practitioner on The Night Ministry’s street medicine team, worked as an emergency room nurse in the Loyola University Health System for a couple of years. Koruba said he felt that the ER was ill-equipped to help people experiencing homelessness who came in for help. “If all we do is throw [people experiencing homelessness] back out on the street with no support, they get sicker and weaker, they come back, a lot of money is spent on them, they go back out, they get sicker and weaker, and they eventually die,” he said. “The average life expectancy for [a person experiencing homelessness] is twenty years less than the average American.”
Koruba says that his street medicine patients typically have bad experiences with the healthcare system and tend to avoid it for a variety of reasons. Sometimes, people experiencing homelessness are worried about leaving their belongings unattended. ER wait times or hospital stays often cause those struggling with opioid use disorder to experience withdrawal to the point where they decide to leave before receiving care for another health issue; withdrawal symptoms are severe, and many patients fear inconsistent treatment of opioid dependency at Chicago hospitals. Stigma toward those experiencing homelessness, and embarrassment about the way others may perceive them, can also discourage people from going to clinics and hospitals. In general, if people experiencing homelessness encounter a lack of proper medical and personal treatment in a healthcare interaction, it can encourage mistrust toward the healthcare system.
The health problems people experiencing homelessness face are often due to structural socioeconomic inequalities and need to be addressed more holistically, with housing, employment, and rehab resources. Koruba said that as an ER nurse, he would have felt more secure in the effectiveness of the care he provided if there were a social worker present. Just as homelessness is often a structural issue, there seems to be an institutional lack of knowledge and competency in terms of caring for people experiencing homelessness as well. “I feel that police and EMS are in the same boat. We tell them to give [people experiencing homelessness] our number, and a lot of them were just like, ‘Thank you so much for giving us something we can do.’ ”
In the street medicine world, empathy and honesty take precedence. Health professionals with their medical supplies typically traverse parts of the city in vans or set up pop-up clinics at specific locations. Koruba said the important things for street medicine are being emotionally present with patients, being real and honest about what street medics can offer, “and being really, really okay when they say, ‘I’m not going to do that, even though you’re telling me it’s the best thing for me right now,’ and replying with, ‘Okay, when you’re ready, we’re here for you.’ ”
David Wywialowski, director of the Outreach and Health Ministry at The Night Ministry, also emphasized the importance of building a human connection, establishing trust, and listening to the patient’s needs. “We have seen other groups pull up to an encampment, literally just set the food on the sidewalk, get back in their vehicle, and pull away,” Wywialowski said. “Sometimes the encampments get overwhelmed with food,” which can attract rats. “We always go out with food, but we’ll ask, ‘Do you need food?’ and allow them to say yes or no.”
The Night Ministry has between four and six people on each street medicine run, including a nurse practitioner, a case manager, and an outreach professional. Other members may include a social worker, a substance abuse professional, a peer advocate, or additional outreach workers who drive the van and answer calls from patients. The street medicine van, which operates seven days a week, is a fifteen-passenger van equipped to have a medical professional see a patient inside. The van visits the harder-to-reach homeless encampments and is more flexible in its coverage; a Night Ministry bus staffed by medical professionals, social workers, and community partners who provide hot meals also makes regular stops in specific communities six days a week. Between the two services, The Night Ministry goes out sixty hours a week and hits about forty locations. As the organization has gotten to know the people it serves well, word of mouth has established it as a regular fixture in Chicago’s homeless community. The Night Ministry is always on the lookout for new encampments, and patients often inform its workers of areas where there are people in need.
When medical schools in Chicago became interested in street medicine, The Night Ministry provided guidance by bringing medical students on runs and participating in a monthly collaboration phone call between medical schools involved in street medicine, such as UofC, UIC, Northwestern, and Rush. The Night Ministry coordinates with the other street medicine efforts to ensure efficient and broad healthcare coverage on the streets.
The Chicago Street Medicine chapter at UofC, known as UChicago CSM, was founded by medical students who believed street medicine was a meaningful and effective way to practice medicine and help hard-to-reach communities. The organization is still very new, but it sets up a pop-up clinic once a week, alternating between two different locations. In addition to medical students, who triage patients to determine whom to prioritize, a licensed faculty member and an attending doctor treat patients and ensure they receive proper care. A South Side community partner, the Nation of Islam, distributes hot meals. When no attending doctor is available, UofC’s street medicine team goes on resource runs, where medical students assess patient conditions, refer patients to health resources, and provide health education. Sometimes, a social worker or lawyer also helps people obtain up-to-date identification like driver’s licenses in order to connect them to various resources and public assistance programs. On a warm day, UofC’s street medicine program serves fifty to one hundred people. In colder weather, the program has also tried to hold public indoor clinics, which are typically smaller.
Reaching and serving people experiencing homelessness on the South Side poses unique challenges. Compared to the Loop and some areas on the North Side, where there are many large, visible encampments, the South Side sees more transient homelessness, where people experiencing homelessness are taken in by friends and family for the winter. As such, UChicago CSM relies heavily on community partners who know the South Side well and have already built mutual trust and respect. UChicago CSM visits the same spots the Nation of Islam has been visiting for a long time, refers patients to Iman Community Health Center—which provides primary care at a low cost—and learns from organizations such as the Heartland Alliance and the Chicago Recovery Alliance. Working with community partners is especially important because the relationship between the University of Chicago Medical Center and the South Side has long been strained, as evidenced by the years of protests calling for an adult trauma center before the university announced at the end of 2015 that it would reopen one. Additionally, UofC’s street medicine team, like The Night Ministry, is mindful of how it approaches patients. Philip Sossenheimer, one of the founders of UChicago CSM, said, “Even if people are ‘homeless,’ the space where they’re living is kind of their home. You still need to respect their privacy.”
Another challenge is that many of the biggest health issues UChicago CSM sees are chronic disorders resulting from poverty. In Sossenheimer’s experience, diabetes and heart disease are the most common health problems among UChicago CSM’s South Side patients, whereas Koruba’s patients, who are concentrated more toward the center of Chicago, suffer mostly from health issues related to physical trauma and substance abuse. Further, the South Side has well-documented resource deserts, which can make it difficult to refer patients to an accessible community health clinic. Although UChicago CSM does its best to treat patients with chronic disorders, Sossenheimer says the root of the problem is ultimately social.
Sossenheimer has great ambition for the future of UChicago CSM. The organization is working on expanding its volunteer pool, especially of attending doctors, and increasing the frequency of its street medicine runs. In terms of medical care, Sossenheimer hopes to expand the group’s services to include harm reduction, which is a healthcare approach designed to reduce negative consequences of behaviors such as drug use. He added that they are also exploring opportunities to give prescriptions to patients, but that it’s “very tenuous” because finding a way to follow up with patients is challenging. Follow-up is a challenge that The Night Ministry faces as well. Additionally, CSM at UChicago is pushing for an automatic referral system—which has no precedent at hospitals in Chicago—at the University of Chicago Medical Center for any homeless people admitted, which would connect them to social workers and inform the street medicine team for any necessary follow-ups. The group is also working with The Night Ministry to extend its services through runs on “L” trains to reach more people.
Sossenheimer is optimistic about the visibility universities can bring to street medicine, as they wield large amounts of political and financial power in the medical world. Furthermore, he says medical students, who may have more time and energy than medical professionals, can contribute a lot to the street medicine effort, and that students will become better healthcare professionals through the practice. “I think street medicine will go a long way in changing the culture of medicine,” he said. “I think if every doctor does street medicine, they’ll all be better doctors and more empathetic people who are better adjusted to live in society—a just society.”
Koruba shares Sossenheimer’s optimism. “I think it’s a really neat time in Chicago for street medicine,” he said. “There’s a lot of interest—a lot of resources, people and energy coming into street medicine now. And I think in the next couple years, it’s going to be a completely different scene. I think it’s just going to really grow and develop as a service in Chicago.”
Since the novel coronavirus that causes COVID-19 began spreading in the U.S., The Night Ministry and UChicago CSM have faced new challenges. The Night Ministry is still doing its best to support those on the street, working with a reduced staff of two to three people on each run. Patients are no longer allowed inside the street medicine van, and if they need to be transported to healthcare resources—which are becoming increasingly limited—The Night Ministry calls an Uber for them instead. Staff members are fully equipped with masks, gloves, and gowns, and are giving out tents and sleeping bags to help people self-quarantine if needed.
UChicago CSM has suspended its street medicine runs, but the group has multiple initiatives in place to continue to serve the South Side’s health needs. The group’s members have created a fundraiser drive at the Pritzker School of Medicine for survival equipment, hygiene supplies, food, and personal protective equipment such as gloves and masks, and have committed to donating sixty sandwiches a week to The Night Ministry to continue supporting the homeless community. They are also working to disseminate educational material related to COVID-19, and are working with local government and healthcare centers to advocate for better health services during the pandemic. One specific program is emergency isolation hotels for people experiencing homelessness during the pandemic, which they say must include those with mental health or substance use disorders.
Koruba said The Night Ministry is dealing with the pandemic one day at a time. “But our protocols are ready, our people have been trained,” he said. “We’re just trying to stay healthy, because we’re really the last people doing a lot of services out there. So many teams have had to call it back and [put] a hiatus on their plans.” Where some of the work has fallen off, other efforts have ramped up, he added. “We’re just trying to keep doing what we can.”
Susy Liu grew up in Boston and is currently an undergraduate student at the University of Chicago studying economics and sociology. This is her first contribution to the Weekly.