HEALTH
UofC Medicine Takes to the Streets Medical students work with The Night Ministry to bolster the South Side’s street medicine presence BY SUSY LIU
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orty-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 pointin-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 6 SOUTH SIDE WEEKLY
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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
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.
“UChicago CSM relies heavily on community partners who know the South Side well and have already built mutual trust and respect.” 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
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
