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It’s 6:15 p.m. on a Thursday, and the volunteers who staff a weekly street clinic in Santa Barbara, California, are ready to head over to a nearby park.There’s a lot of commotion as people grabbackpacks full of medical supplies and leave headquarters.
Doctors Without Walls–Santa Barbara Street Medicine, founded in 2005, runs several clinics in the area that reach Santa Barbara County’s one of the area’s most vulnerable populations – people dealing with homelessness.This one, designed to coincide with a weekly free meal offered in the park, provides basic medical care to anyone who needs it.
The team is made up of doctors, scribes, and volunteers who do everything from registering new patients to dispensing medications from the packs. Together, they care for abscesses, respiratory infections, skin conditions, hypertension, and anything else that can be treated on the spot. For more complex issues, they’ll offer to coordinate an in-office visit.
In many cases, patients just want their vitals checked. “Our homeless population wants to know that they are OK,” says Chris Stathis, a coordinator for Doctors Without Walls.
Treating these patients, who are often initially distrustful, isn’t always an easy task. “We try to build a rapport with them,” Stathis says. “We’re always going out to the parks, being where we’re needed.”
Maggie Sanchez, a founding member and volunteer of the organization, says it can take months to gain a patient’s trust. One woman regularly attended clinics but didn’t speak a word for an entire year. It’s important to become a familiar face and to show up as promised.
Also, to give out socks. “Socks are gold,” Sanchez jokes.
The park is just a couple of blocks away for the volunteers, and setup takes less than five minutes. Tables are placed in a square formation. Scribes open their computers. And volunteers prepare to use their Emergency Medical Packs, which Direct Relief supplies and Doctors Without Walls customizes with the prescriptions their patients need most often – including antibiotics, blood pressure medicine, and anti-parasitics.
“It’s basically a pharmacy on-the-go,” says Claire Sharp, a UC Santa Barbara student who’s manning a pack.
Patients begin to arrive. Volunteers check them in and take their vital signs before Dr. Jason Prystowsky, the organization’s Medical Director, sits down in the grass to take patient histories, perform exams, and provide treatment.
Prystowsky, an emergency-room physician at the local hospital, does this in his spare time. He joined the organization after a stint with the much-larger organization Doctors Without Borders, treating patients in South Sudan. Practicing street medicine is a way to get back to his humanitarian roots. “There’s something so rewarding about getting back to the basics, both clinically and philosophically, about what it means to be a doctor,” he says.
But it’s also the right thing to do from a publichealth perspective, he explains: “The better we are at getting [homeless patients] integrated into the healthcare system, the less of a burden there is on the emergency department, on ambulances, and on the 9-1-1 system.”
Dr. John Vallee, a retired physician who also provides medical care, heads out with three volunteers to do “street rounds” – essentially, walking through Santa Barbara’s downtown area and offering medical help where it’s needed.
Vallee spent his years as a physician “taking care of more affluent people.” Eventually, he retired after changes in medical protocol forced him to spend more and more time with a computer, and less and less time with his patients.
“I actually have better interpersonal encounters” with the patients who attend the street clinic, he says. There’s no invasive logging process, no frantic hours spent catching up on paperwork after the patients leave. It’s just Vallee, sitting on a folding chair on the sidewalk, talking face-to-face with someone who needs medical care.
The team doesn’t have to walk long. A man in a wheelchair tells Vallee that he needs antibiotics to clear up a worsening infection. Vallee unfolds his portable chair, and he and a scribe begin to take their new patient’s medical history. After 15 minutes of discussion – the man refuses a physical examination – a volunteer digs the right antibiotics out of an Emergency Medical Pack, Valley explains how to take them, and he and the patient shake hands.
He’s perplexed when he walks away. This particular patient, he explains, has a painful congenital disorder, and he’s entitled to more care than he’s currently receiving. The medical history Vallee received is convoluted, but he’s figured out whom he needs to call, and he’ll try to get the patient in a skilled nursing facility.
“This is a tough patient population to volunteer with,” Prystowsky says. Many patients are disillusioned with the healthcare system in general, and for many, mental health issues keep them from seeking treatment. “A lot of times, the people who really need our help the most don’t want our help.”
Despite the difficulties, volunteers are enthusiastic. “I’ve created good friendships with patients,” says Nicole Yang, who’s worked with Doctors Without Walls for almost two years. “It’s nice seeing the same people and their progress.” People who have benefited from the clinic, and who go on to find stable housing situations, frequently come back to lend a hand.
Fundamentally, “I don’t pretend to understand all the things that are responsible for homelessness,” Vallee says. He just knows he wants to help.