So, what is street medicine, or “street med” to those who are closely acquainted with the field? In a few words, it is a rapidly expanding sector of medicine that addresses the unique health and social service needs surrounding the unsheltered homeless population. As street medders, we embrace a philosophy of harm reduction and kinship while also providing medical care and essential hospitality items to our clients. As we like to say, we “meet people where they are,” in both a literal and figurative sense.
Through occupying a role as a member on the board of leadership for the street med program in the impoverished city of Camden, NJ, I have grown to see and view Camden as a landscape substantially disparate from most members of the medical school community. For any newcomers, the shifting perception of the city can be viscerally experienced the moment you step out of your car at 7th and Atlantic, where you are instantaneously immersed in what feels like a tumultuous period in a developing nation, or a war-torn ghost town from the past, where nothing remains but dilapidated ruins of what once was. As you look around, you gather that this is not just a regular intersection, but a piece of land where a homeless community has been struggling to maintain their right to exist for years, all in the face of constantly shifting laws and regulations, as well as cultural and social norms developed by and intrinsic to the community itself.
Dusting off my old anthropologist hat, I realize that there is more to this community than meets the eye. For instance, there are well-entrenched social conventions that have become engrained to the point where they form a set of unwritten governing laws. Moreover, there are rules regarding who can panhandle at certain locations and for how long; there are social divisions and rivalries that deem who can talk to who and for what reasons. The list goes on. And while these may just seem like interesting observations by an academic, in reality, this is what drives our behavior and interactions with our clients; for, we street medders must always remember we are guests in our clients’ space and must always take caution to remain guests and avoid devolving into intruders.
From my neophyte medical perspective, these friends of mine on the street go through hell. They are exposed to the elements 24/7 and often lack the necessary supplies to maintain their health. When one gets sick, they do not go to the doctor. Not because they think there is nothing amiss, but because the healthcare system treats those experiencing homelessness in a way that all-to-often leads to the misdiagnosis containing the stigmatizing ICD-10 code of “malingering,” when all the person wanted was an antibiotic for their abscess and perhaps one decent warm meal while being treated. Despite this common perception, I truly believe the time street med has invested over the years to construct real, deep relationships is finally coming to fruition. The countless hours of exhausting, yet terrifically rewarding, work has enabled us to earn the trust of the community we serve. Furthermore, by leveraging this trust, we can guide clients to seek the care they need and so much deserve to optimize their well-being and quality of life. And thus, accomplishing the ultimate goal of street medicine.
Of course, spending all this time with people and sharing deep aspects of our lives inevitably leads to intimate connection. I was brought to deal with this epiphany head on the other day when one of my closest clients asked if I wanted to grab a beer and watch a football game. My heart automatically bellowed, “Heck, yes. I know the perfect place on Kingston Ave.” However, before I could get it out, my ethical mind kicked in and said, “Bubu’s a great guy, but in this life, you have stay professional and keep the lines from blurring as best you can.” This was an interesting moment for me, as my wise mentor’s voice, Dr. McGeehan, rang loudly in my head, reminding me of my convictions and reigning me back into making the right decision by declining and maintaining the sanctity of the physician-patient relationship.
Looking back, all I can say is, it’s been a crazy but truly eye-opening roller-coaster ride over these past three years. Yet, I would not trade my experiences with street med and the lessons learned about human life and human nature for anything.
Nicholas Bascou is a medical student.
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