On a Mission

A group of University of Rochester medical students combs the streets of Rochester, looking for homeless people who need medical care. And gladly give it.

It’s 6 p.m. on a Friday night in February. Ten University of Rochester medical students and two Medical Center physicians pile into the U of R Street Medicine van and a few cars. Driving down Alexander Street, they pass fellow Rochesterians in East End bars enjoying happy hour. But on this chilly winter night, the students have other plans.

The vehicles drive a few blocks down to REACH shelter, the Rochester Emergency Action Committee for the Homeless. It’s busy inside. The cold nights bring in more folks looking for a place to sleep and feel warm and safe. The students, equipped with stethoscopes, blood pressure cuffs, diabetes screening kits and other supplies, spread out and begin talking to people.

Sonia Nicholson approaches medical students Nathan Holterman, Steve Morgan, and Keaton Piper. She’d like them to check on her health. She eyes a blanket that Morgan has brought into the shelter.

“Is that blanket for me?” she asks, with a bit of playful sass. Without hesitation, Morgan hands her the blanket, which she wraps around her shoulders as she sits down to talk. This is something that he and the other students do to gain the trust of the people they treat. A blanket, a pair of socks, or some food sets a person at ease and can help her to open up to questions about her health.

Holterman and Piper ask her how she’s feeling, and Nicholson begins a long story. She tells them how she became homeless, how she was jilted by a man and how that drove her to alcoholism. She tells them she was sleeping in abandoned buildings before coming to REACH shelter that day.

“Mentally and physically, I just can’t take it,” Nicholson says as she laments her situation. She has children and grandchildren, but she doesn’t want to be a burden. “I just want a place I can call my own.”

Holterman, Morgan and Piper all listen attentively, gently asking her questions about how often she drinks, if she smokes, and if she’s been to the doctor lately. She’s recently spent time in the hospital, having a surgical procedure on her chest. They check and redress her wound, but it’s clear that more than anything, she just wanted to be heard.

Piper says this is a big part of what the Street Medicine program does for the homeless population. They listen. “Most of the time, people just want to tell their story. They’re calmer after talking. It’s really therapeutic,” Piper says.

UR Street Medicine
UR Street Medicine
UR Street Medicine

Shelter residents look forward to seeing Street Medicine students. The students go beyond the diagnosis, showing an interest in their patients’ stories.

It’s the element of human interaction that gets lost when doctors and patients are in clinical environments, he explains. The doctors are simply too busy to listen to a person’s story in depth. But those precious moments of truly being seen and heard are what this largely ignored population craves.

Orezont Ragans wasn’t staying at REACH, but when she heard that Street Medicine was coming out, she stopped in. Students checked out some problems she was having with her vision, and referred her to a doctor for more thorough diagnosis and treatment.

“They’re very passionate, and offer listening time,” she says. “Just meeting them feels like you’ve known them all your life. Street Medicine is a positive resource. When you can’t get somewhere, they can come to you.”

As Morgan walks through the building, people recognize him. And they should. He’s been in the program since 2011, and without him, Street Medicine probably would have burned out a few years ago due to lack of funding.

Back when Morgan worked Street Medicine with program founder Emma Lo, students and assisting physicians roamed the streets equipped with backpacks, headlamps and stethoscopes. They’d do blood pressure checks, diabetes screenings, check on other chronic health issues, and give out supplies like hand warmers, socks and gloves. But after seeing three or four patients, they’d run out of supplies. Morgan approached his mentors at the U of R to see how they could obtain more supplies and serve more patients.

“When the request came across my desk, I literally eye-rolled, like this is never going to happen,” recalls Flavia Nobay M.D., emergency medicine physician at Strong Memorial Hospital. “Just imagine the resources involved.”

Nobay’s assumption was a fair one; Rochester’s homeless population is a challenge. According to ACT Rochester, an initiative of the Rochester Area Community Foundation, Monroe County funded nearly 8,500 placements in emergency shelter facilities in 2014—a tall order for a small, student-run program. It’s also a migrating population. Without a permanent address, Rochester’s homeless don’t often stay in one place for too long, moving from the street to the shelter and back throughout the night. But she gave her support, seeing a unique combination of determination and naiveté in Morgan.

“Had he really known what he was getting into, he may have never done this,” Nobay says. The difference between what Steve did and brought to the forefront versus every other project that’s failed was pure passion.”

Erik Rueckmann M.D., another emergency medicine physician at Strong and mentor to Morgan, also saw how Morgan could make such an improbable program work. “A lot of times we forget that it takes that first step to make a change,” he says.

Armed with the support of his mentors and experience from his MBA, Morgan and a few other students worked to gain funding through private donations and grants. These donations provided medical equipment, supplies, food, and perhaps the biggest game-changer for the Street Medicine program: a van.

Morgan retrofitted the van with a friend, taking out the extra seats in the back and filling it with medical equipment, installing a mount and laptop with wireless Internet, and a rollout tent off the back, for easier onsite treatment.

With the addition of the van, extra supplies and equipment, Street Medicine went from a capacity of three to four patients per night to more than 20. More than 60 medical and nursing students have signed up to participate this year. First-year med student Erin Schikowski says that her entire class signed up. Piper, a third-year student, says it’s one of the reasons he came to the U of R to study medicine in the first place.

“It’s helped me interact with people more,” Piper says. “Everyone has a unique story. You have to think beyond medicine, and take a more holistic approach. We try to get them involved in long-term care. Medicine is more than diagnostics.”

UR Street Medicine

Students of all levels sign up for Street Medicine, and receive training before heading out in the streets. They receive medical training specific to the needs of the homeless population, such as wound care and foot care—that’s a big one, Morgan says, dealing with issues such as athlete’s foot to neuropathy in diabetics. They learn how to set up and use the van and its equipment, and how to drive it safely. Police of cers come in and train the students on how to be aware of their surroundings while out on the streets and assess the safety of situations.

And although Street Medicine is a student-run program, physicians go out each night to assist when needed, providing advice when requested, and even writing prescriptions for diagnosed conditions.

Given the crowds in the shelters this evening, the impact of the program’s expansion and fundraising efforts is seen. After leaving REACH Shelter, the team heads over to the House of Mercy. It’s more of an open space than REACH, and has multiple rooms and spaces where people can stay and sleep. In the House of Mercy, rows of couches and recliners line the main room, where most people in the shelter sit and watch TV or sleep. The students and two physicians disperse again, greeting individuals and asking if they need any medical help.

A young man who was nearly hidden in the corner spots Morgan, stands up and smiles. Morgan shakes his hand, remembering him from a previous visit. They catch up and Morgan asks if there is anything he needs tonight.

Like the other students involved in Street Medicine, Morgan has a genuine love of helping others. His small-town upbringing outside of New Orleans and his military background provided a basis for his giving nature. That, paired with a love of science, drew him to medicine in college and a focus in emergency medicine. But on the streets and in the shelters, his appearance can carry more weight than his manner in establishing trust.

“Because of the socioeconomic issues in Rochester, the homeless population really doesn’t see a re ection of themselves in the hospital,” Morgan says. Giving an example, “I had an individual on the street tell me that he didn’t know African Americans could be doctors.”

This identification is crucial in getting homeless people to gain a sense of health literacy— understanding their conditions and learning how to manage them, taking their medications properly, and reducing their risk for other health problems.

“When I’m out on the street, I feel like they’re a little bit more receptive to what I say, simply because of the color of my skin ... I’m just a southern boy from Louisiana.”

Morgan and his fellow students have worked hard to build trust with the homeless community in Rochester. That’s not an easy thing to do. Many homeless people feel mistrust towards local hospitals, because they feel that doctors don’t believe them when they go to the hospital for help, Morgan says.

It’s exactly why the Street Medicine program operates the way it does. “By us going out in the community, by us coming to you, somewhere you know, in your environment ... that begins to break down the barriers,” Morgan says.

UR Street Medicine

Establishing trust enabled Morgan and the Street Medicine team to distribute 50 influenza vaccines for individuals at the House of Mercy last year. With the help of critical care pulmonologist Matt Kottmann M.D., Morgan obtained the vaccines through a donation from the Monroe County Immunization Program. After distributing yers to promote the vaccinations, they put together winter care packages (hat, socks, gloves and hand warmers) to give to people in exchange for being vaccinated. The plan worked; all 50 vaccines were administered, and they’re hoping to vaccinate even more people this year.

It’s after 10 p.m. when the team packs up and leaves the House of Mercy, deciding to make a last-minute stop at the old Sanctuary Village. It’s well below freezing, but some folks are still sleeping outside.

Due to conditions such as bedbugs and abuse, some would rather brave the harsh winter conditions than spend the night in shelters.

UR Street Medicine

Through his work in Street Medicine, Morgan has learned that everyone’s journey into homelessness is unique. While the public may often ignore or shy away from the homeless population, Morgan wants us all to see what he sees.

“They’re human. They’re not robbers; they’re not murderers. They’re just individuals that live on the street. They need help, and they’re receptive to help if they feel that it is genuine,” he says.

As the students walk past snow-covered tents, they call out and identify themselves, asking if anyone is outside tonight and looking for assistance. A couple responds, and accepts hand warmers, gloves and a hat from Piper. The students then say goodnight and split up, headed home. Another night’s work is in the books.