- I'm 70 years old, I got terminal cancer.
They're trying to help make me feel better.
You know, had I got it taken care of earlier
it might have been able to catch it earlier.
I don't want nobody else to suffer this way.
(hopeful music)
- I'm Brett Feldman.
I'm the director of street medicine for USC and vice chair
of the international street medicine Institute
who provides technical assistance
about 140 programs around the world.
And in street medicine
we recognize that people experiencing homelessness
just can't access healthcare the way the rest of us do.
So we leave our offices and go
to the people with the goal of first providing
tender love
and then the same quality of healthcare on the street
that you would expect in a brick and mortar clinic.
Hey Steven
- Hey Brett how you doing? - Great to see you. Awesome
to see you. - Alright, alright.
- I first met Steven when he was admitted to the hospital.
He has congestive heart failure.
He actually had a pacemaker implanted lung disease
and more recently was diagnosed with lung cancer.
How have you been feeling?
- I'm still in pain.
I still have a lot of pain.
Today we're going to talk about some
of the goals that he wants for himself, for his care
and moving forward, how he wants us to care for him.
- You may get an appointment and days go by
and you don't recognize what day it is.
You'll miss your appointment.
So health team coming out really
helps a whole lot.
- Okay
They need more teams like this around
because there's a lot of people on the street.
They got health issues.
I've seen many people pass in the homeless community
because their medical issues weren't being properly
addressed.
They need more teams like this around.
- We're here to see my friend Takisha
for the past four years
her typical pattern is that
um
she will go into the hospital in a,
in a severe asthma attack.
She's been intubated multiple times
with the tube down her throat to help her breathe.
She'll stay in the hospital for a week or two
be discharged on steroids and be okay for about a week
or two out here on the back end to the hospital.
All right, Takisha.
Do you need help?
How's your breathing doing?
- (inaudible)
- You said you're starting to get short of breath again.
Let's take a listen.
- Before two years ago, I was in the hospital and you know
once every six, seven months now for the last two years
it's been like once a month.
- So how long does it take you from the time you leave here,
to the time you get back,
to go to an appointment? - Uh
They've helped me a lot.
They saved me trips to the doctors.
They've helped me get to the doctor.
Do you feel like in a few days
you'd have to go back to the hospital?
- You are, you are pretty wheezy.
- Yeah.
- So I'm going to give you the steroids here to try
and prevent you from having to go back to the hospital.
Yeah wrote it right here
four for three days
three for three days, two for three days
one for three days, then stop.
The Street Medicine act will help somebody
like Takisha because before we met her
she wasn't able to get any of her medications.
But essentially what it does is
that it legitimizes street medicine
as a real form of healthcare delivery.
And in doing so recognizes the people on the street
as human and somebody who's worthy of our care and our love.
Louis.
How's it going, Louis?
I saw you on a Friday
and we talked about going then.
What's changed today?
- Okay.
Do you mind if I take a look at it?
- (mumbles)
- When I push on the top and the bigger part,
it comes out the bottom.
So that means, I know
that they're communicating with each other.
There's a hole
but you see how much packing she's putting in that.
It's really deep.
A lot just happened here.
We came to visit our friend Louis
who we see a few times a week taking care
of a lot of the different abscesses that he gets.
And so it was severe
and he's going to go to the hospital later today.
But the other thing that happened was just
like other, you know, doctor's offices.
We get referrals, except our referrals are
from one bridge to the next.
Or what you saw today was one 10th to the next.
Hello.
I'm Brett.
Yeah. You know me, I guess.
So what do you think?
You want to go to the hospital?
Okay.
She had a very
very severe infection of some sort or a burn.
She couldn't stand and agreed to go to the hospital.
You'll see when you get it.
Her leg, is uh,
she, she can't
she can't walk and she can't get out.
I'm Brett I'm a PA with street medicine.
And I gave them my card so that when they get there
they know that somebody is going to look out for her
and they'll call us and we'll come see her in the hospital
help them understand what her reality looks
like, because the folks in the hospital can't be out here.
They can't see where she lives
in that if she's discharged with an open wound
how she going to take care of it and keep it clean
in this environment, they're not here with us.
And after almost 15 years of doing this
I've found that there is a big difference
between benefit eligibility and benefit access.
So about 85 to 90% of the people we serve
not only are eligible, but are signed
up for Medi-Cal or in other states it's Medicaid
yet they're not accessing those benefits.
So studies show that
about only 8% of people experiencing homelessness
identify as having a primary doctor and
in LA about 27% have ever seen that doctor.
So street medicine is an essential step of bridging that gap
between benefit, eligibility and benefit access.
So it's a much better use of taxpayer money
because the insurance companies are getting paid
by the state and the doctors who they're assigned
to through their managed care
through their insurance company are getting paid.
But the patients are not getting seen.
If the intent is to deliver the health care
to the patients of which they're entitled
to as beneficiaries for their health insurance
then it has to be done under bridges, behind dumpsters
and the river beds, and all the care is delivered on site.
So we'd dispense medications, draw labs.
We do point of care ultrasound with the goal of
of being in their reality, where they feel most comfortable
not where we feel most comfortable.
(slow music)
One of the things that we get asked a lot is how
do we solve homelessness, especially in LA
where the crisis is so huge.
And the truth is is
that all these programs and housing will help homelessness
but it's not going to solve homelessness.
It won't be solved by a program.
So what we have to do is start welcoming the folks back
into our community and take responsibility
and stand in solidarity with them.
But the people experiencing homelessness
they're our neighbors, and we want to take care of them.
So start separating the person
from their housing status and hate homelessness
but love the person experiencing homelessness.
And until we, as a society are willing to stop thinking
of them as others and take responsibility as one of us
then the problem won't be solved.
(slow ambient music fades out)