Medicine Without Walls

Kelsey, Third Year Medical StudentI was unavoidably aware of how incongruous my business professional clothes were as we wandered across Secombe Park, looking for Dr. Carla Toms. Earlier in the day, I’d worn the same clothes in clinic and hadn’t given them a second thought. Here, in the heart of San Bernardino, 6:00 pm, they feel a bit pompous and I’m borderline embarrassed we pass a group of elementary kids playing soccer, sidelines scattered with parents and toddlers. Cody, my husband, and our friend David and I are the only white people in sight. I’d never met Dr. Toms, never participated in a street clinic, and dusk was settling in around us. The coming night had all the possibilities of a great adventure.

Fortunately, Dr. Toms did not disappoint. A tall, slender woman equipped with a backpack of medical supplies, we found her examining a woman in the backseat of a truck. Apparently, the woman had been having episodes of vertigo for quite some time. Dr. Toms finished up with the woman, and we began walking to another corner of the park, listening to Dr. Toms’ “Street Medicine History 101” lesson, interspersed with her calls of “Hello! Anyone need a doctor?” to anyone we passed.

We came upon a Caucasian man and an African American woman sitting on a bench, both appearing to be in their fifties, both appearing to be homeless.  Dr. Toms explained that we were from Loma Linda, that we were doctors and medical students, and that we come bearing socks, underwear, and free medical care if anyone needed it. I stood toward the back of the group (only about six of us were there), unsure of my place in our “street clinic” and highly curious to see how Dr. Toms interacted with these patients. And here, in this small interaction, I saw how different our clinic without walls was, how powerful it was. Within two minutes of us meeting these patients, they were equipped with socks, underwear, they were being examined by medical students, while Dr. Toms was furiously scribbling down names and numbers of resources for them to contact for dental and other services. She was asking them their stories (How long they had been homeless? Did they have other friends on the street? Where could we find them? If we came back to the same spot next week, would they be here at the bench?). The man admitted that he’d been stabbed about a week earlier and had been to the ER. We looked at his wound, which was healing well.

The power-structure reversal was unmistakable. Instead of asking our patients to find their way to our clinic, where they might wait an hour or more to see us in a small room where we swoop in for a mere 10-15 minutes and then hasta luego, here was Dr. Toms, giving her own time, seeking these patients out on her own, and then trying to stuff as many resources into the hands of the patients as possible. But these are not just any patients. Street medicine patients are the patients that show up in the ER because they have no other place to go, often for simple measures such as asthma inhaler refills, forcing ER physicians to act as primary care physicians to these patients, further driving up the cost of health care. It was all clicking in to place for me. Since coming to medical school, I’d been looking for a way to find these marginalized people and make a real difference in their lives. Enter Carla Toms and Street Medicine. I was buying in.

From the park, we walked to an empty lot next to a cemetery one of our patients had pointed out as housing several homeless. We walked around mimicking Dr. Toms’ call, “Hello! Does anyone need a doctor?”. Sometimes we realized we were calling out to piles of rubbish, sometimes the piles would move and a human would emerge.

After we had canvassed the field, we drove to an overpass where Dr. Toms had been told we might find some people. We all scrambled our way down the dirt slope under the bridge to find a single man there, a fairly young man who had been riding the trains for 10 years, and who only needed some socks. He seemed extremely kind and was grateful for the new socks. He told us the next overpass south of where we were might have some more people, so we tromped the half-mile to the next overpass. Cody, David, and I were simultaneously in awe of Dr. Toms and her passion for street medicine and completely invigorated by the adventure unfolding in front of us. Up to that point in our medical school career, no one had challenged us to take the skill set we’d built (albeit small), and go climbing around under bridges and other forlorn places at 8:00 in the evening, in San Bernardino no less.

After finding one more patient under the next overpass, we started heading back for the cars. Dr. Toms shared her dreams for the street medicine program as we walked. I’ll include some information below about the clinic if you’d like to know more about street medicine or participate in one of the “clinics” on Tuesday nights.

Careful though, it’s contagious.

Stigma plays a big role in poverty. This stigma forms a barrier. This is perhaps the biggest barrier the outreach will face. Talking to a homeless person require you to face despair and suffering.  You will be changed by this experience.  You will lose your ability to look away, to see homeless people as somehow less than people.  You will have to face the profound failure of our societal institutions. You will have to confront your own comfort in the face of another person’s desperation. You will have to come to grips with your own sense of duty and our responsibility to one another.
During street outreach, you will talk to vulnerable, mistrustful, disillusioned, and alienated people and, more importantly, listen to them. You will be asked to approach strangers and initiate conversations with them. You will be asked to listen to them as they talk about their problems, their needs, their strengths, and their hopes. You will be asked to be gentle and kind and patient. You will come to know them and to care about them. You will touch them, hug them, and worry about them. They will become part of your world.
                                               — Dr. Carla Toms, regarding Street Medicine
Resources for Street Medicine
If you’d like to join the email list for the Loma Linda Street Medicine Outreach, please email: CToms@llu.edu