At first glance, the seven people picking their way through the shadows of a southwest Detroit underpass at the end of March could have been mistaken for a trash pickup crew. Looking closer, the stethoscopes around their necks and heavy bags of supplies told a different story. The team of students from Wayne State University School of Medicine, a physician and clinical supervisor were out on the chilly spring morning scouting for individuals who had sought refuge in the concrete shelter — and might be in need of their help.

Street Medicine Detroit volunteers spend their time on “street runs,” or group visits to the streets, where students offer impromptu check-ups to homeless people as they encounter them, for all different reasons. The most urgent is that bringing health care to the city’s homeless population can be the difference between life and death.

Founded in 2012, Street Medicine Detroit is modeled after an acclaimed Pittsburgh program and works to bring medical care to Detroit’s homeless population, estimated at more than 14,000 in 2016. Last year, more than 160 students volunteered with SMD to serve about 400 of those individuals. With the majority of their patients concentrated in the city’s downtown, Corktown and Midtown districts, the students reach anywhere from five to ten shelters and street corners per month.

Most patients suffer from chronic issues like diabetes, hypertension, edema and high blood pressure, easily controlled by the over-the-counter and prescription medication they struggle to access on their own. But students also encounter more serious conditions, and spent last school year trying to staunch the spread of hepatitis A.

KEEPING AN OUTBREAK AT BAY

Michigan’s hepatitis A outbreak reached its peak late last year but continues to spread, and 865 people statewide have contracted the illness. Since August 2016, the highly contagious liver infection has caused 27 deaths. The disease is transmitted person-to-person, and there is a particular risk for certain groups, including people who are homeless and individuals who use illegal drugs.

“It’s spread from a fecal-oral route,” Jay Fiedler, manager of the Surveillance and Infectious Disease Epidemiology section of the Michigan Department of Health and Human Services, told Detour. “If you’re not cleaning your surfaces or hands good, then you’re able to pass this very readily through either close personal contact or contaminated surfaces.”

In Detroit alone, there have been a total of 172 cases — 27 of whom were homeless individuals — and eight deaths, the most cases behind Macomb County.

Alexa Thibodeau served as Street Med’s president before graduating this spring — she’s now a resident at Beaumont Hospital. She said that many Street Med patients already have hep B or C; contracting hep A in addition can lead to “even worse outcomes.”

“Administration of the hep A vaccine can be especially important for the patients we come across that are unlikely to also be receiving any sort of treatment for these chronic conditions,” she said.

Detroit Street Medicine student volunteers seek out and treat patients experiencing homelessness for health issues like infection, diabetes and high blood pressure. Seen on June 6, 2018 bicycle run. Credit: Shiraz Ahmed.

County health agencies have been working to vaccinate other at-risk residents, and the number of new cases has plateaued in response. But Street Medicine Detroit’s unique ability to reach a vulnerable population outside the system put them on the front lines of the hep A outbreak, coordinating with MDHHS and other agencies. While on routine street runs, SMD has administered more than 200 vaccines to consenting individuals.

MDHHS spokeswoman Lynn Sutfin explained why the agency was willing to collaborate with a university group to treat the outbreak.

“They involve community advocates who were formerly homeless or have good rapport with people who are homeless to help address barriers to care,” Sutfin said. “[The organization was] already out in the community accessing vulnerable community members who may not stay in shelters or be accessible by local health departments.”

“We know that Street Medicine Detroit’s vaccination efforts are what is needed in this outbreak to end the spread, as pre-vaccination exposure is the key to prevention,” she added.

Wayne State University medical student Tiffani Strickland takes the blood pressure of patient Bernard Arnold in the Greektown neighborhood of Detroit on June 8, 2018, during one of the group’s bicycle runs. Credit: Shiraz Ahmed.

BRINGING THE DOCTOR’S OFFICE TO THE PATIENTS

Many of Street Med’s patients are wary of traditional healthcare facilities, and some have experienced mistreatment when they engage with the system. Public programs, focused on urgent care, fail to address the non-medical needs of their homeless patients. That’s why the students provide more than basic medical care, said William Mason, a medical student who served as Street Med’s communications coordinator in the spring.

“A big thing with Street Medicine is looking at the different hardships your patients have to go through and looking beyond the medical problem,” says Mason. “People get buried in, ‘what’s your cholesterol and blood pressure,’ but they don’t focus on why your blood pressure is so high.”

WSU medical school alum and former Detroit Street Medicine board member Alex Pezeshki, then a student, treats patient Eddie Johnson for respiratory and other health issues at the Spirit of Hope church in Detroit, April 21, 2018. Credit: Shiraz Ahmed.

The effort to look at their patients’ holistic needs is possible due to a partnership with the Neighborhood Service Organization nonprofit. On most street runs, the group is accompanied by a NSO caseworker who educates patients on housing options and other resources. The students also help interested patients make same-day appointments with primary care providers. With these small steps, SMD hopes to bridge the disconnect between the medical profession and the people on the streets.

During the March street run, students came across a patient in a covered enclosure at Hart Plaza. Beaumont physician Asha Shajahan signaled a cluster of students to approach so they could examine a patient with signs of a stye, a bacterial eyelid infection that could be treated with baby shampoo. It’s standard practice for students to hang back while the accompanying health professionals make the initial approach, to not overwhelm patients.

While some students dispersed to look for others seeking shelter underground, a few others assessed a patient suffering from an abscess, or a buildup of pus that causes infections underneath the skin and can occur with intravenous drug use. The man had recently been turned away from a church shelter due to misbehavior and ongoing drug use, and said he usually slept on a heat vent on the outskirts of downtown.

The rain had driven him to seek a space with a roof, but he refused the offer to return to NSO for a warm meal. So the student volunteers gave him an inhaler for his bronchial-like cough and a bottle of antibiotics to treat his infection, then let him be and went looking for their next patient.

“People know us in the city and the areas we go in,” says Kendra Colbert, a medical student and the group’s patient education director.

“You can’t fake like you care for homeless people. We go to them. We bridge that gap.”

Damon A. Mitchell is a writer living in Detroit. Follow him here. Detroit photographer Shiraz Ahmed is making a documentary about medical care in the city. Follow him here.