Miami-Dade County

Street medicine brings healthcare to Miami’s homeless

“Rose!” Shouts rang out and hands waved as nurse Rose Anderson piloted the Camillus House van alongside a couple of dozen people camping on a sidewalk by a vacant lot. Among them: Danny Dessassau, who has seizures; Danny Walkerow, recovering from eye trauma, and Lisa Flowers, who left her family for the third time because, she said, “Apparently, I’m schizophrenic.”

Each week, new arrivals show up at homeless encampments like this one in Miami-Dade County, displaced from homes by a breakup with a boyfriend, a lost job or a bipolar mood swing that prompted a spontaneous bus trip. And each week, Anderson goes in search of them with the Camillus health team.

“The sooner we get them into treatment, the better off they’ll be,” said the 56-year-old nurse practitioner, placing her stethoscope against the chest of a man who is missing most of his front teeth.

With facilities in one of Miami’s poorest ZIP codes, the nonprofits Camillus House and Camillus Health bring people in stages from the streets to permanent housing, a process that often takes years. Street medicine has been part of the program since 1985, reaching the homeless where they live and delivering treatment if needed until they’re ready for ongoing primary care. The staff members saw roughly 1,000 street patients last year.

“We enter the homeless culture, understand its words and patterns and try to be the bridge that helps them come in from the street,” Anderson said. Although the practice of street medicine is relatively uncommon — the Camillus team is among a handful doing it in Florida, according to the International Street Medicine Institute — it fills a critical gap for people who might otherwise get healthcare in an emergency room, shelter or jail cell.

The street rounds begin at the end of a clinic day, with Anderson pulling medications from the dispensary. In the tackle box that serves as a medical bag, staff members tuck vials of Ranitidine for chronic acid reflux caused by alcoholism, Metformin for diabetes, Amlodipine for hypertension, antifungal cream for foot infections and Dilantin, a drug used to control epileptic seizures.

Frequently caused by head injuries, epilepsy is a common problem for the homeless. A 2013 study published in Emergency Medicine Journal found homeless men had 170 times more severe head injuries than the general population and 300 times more head injuries causing bleeding in the brain. The resulting seizures can be a cause as well as a result of homelessness, Anderson said, triggering behavioral problems that launch people into a downward spiral that ends on the streets.

On this February evening, a spring breeze ruffled the trees near Northwest 17th Street, where the group had pitched camp. A man tidied the sidewalk with a broom. “Bless the sisters,” someone had scrawled on a utility pole, a reference to the nearby Mother Teresa Home for Women in Distress, where nuns distribute breakfast to the homeless.

Messiah Veda, 27, took a seat on the van’s tailgate, which served as an impromptu exam room. Veda had turned to the streets when his parents died and was receiving treatment for asthma and diabetes as well as seizures. “I feel dizzy,” he said as Anderson held an alcohol swab under his nose to clear his head while her five colleagues tended to other patients.

“Man, you can’t never get enough foot stuff,” said Anthony Ertha, 41, a k a Jazz, waiting in line for a tube of antifungal cream. The fungal infections come from exposure to dampness and too few opportunities to take a shower, Anderson explained.

Blondel Hines, in her 50s, sat on a nearby folding chair while a staff member helped brush her mane of black hair. Her legs hurt, she complained. Mentally disabled but not homeless, Hines had left her sister’s apartment in North Miami to stay with her homeless boyfriend on the street. “We’re the only ones who care for each other,” she said. Anderson offered her an appointment to be examined at the Camillus clinic on Northwest Fifth Street.

Twilight descended, but patients kept coming. Anderson worked methodically, watching for signs of an argument or fight that could disrupt rounds.

A woman calling herself Alisha waited at a distance, her face red from sunburn. She had contracted HIV after her release from prison in 2006 and was trying to get into a shelter. “How can I get healthy without a home?” she asked angrily.

Miami continues to grapple with ways to provide shelter for the homeless. Recently, the city offered to pay Camillus House to buy 100 mats for short-term stays as part of a downtown improvement plan to clean up the streets.

“It’s better than nothing, but they need wraparound mental and primary care, not a list of shelters printed on a piece of paper,” Anderson said before turning to the next crisis: a man whose best friend needed help.

“His family is taking his disability benefits and leaving him in the street,” the man said in Spanish, leading the team around the corner to a building where the friend slumped against a wall, sitting in his own excrement with a hoodie covering his face.

Anderson recognized the problem: “the picture of depression.” But the healthcare staff can’t administer psychiatric medications on the street. Anderson left him and returned a few days later with the staff psychologist, who got him hospitalized for treatment.

The vast majority of Anderson’s patients are mentally ill. She believes the homeless moniker diverts attention from their mental health issues. As she explained, the street problem is really a health problem dating to the 1963 Community Health Center Act, which determined mentally ill patients should be treated in community-centered day programs rather than psychiatric hospitals. The hospitals closed, but the community centers were never built.

Today, experts like Barbara DiPietro, policy director at the Nashville-based National Health Care for the Homeless Council, believe permanent housing coupled with support services is the best long-term solution for homelessness. Medicaid could help by funding the support services, she said, but Florida’s lawmakers have chosen not to expand the health insurance program for the poor.

“By not expanding Medicaid, Florida shot itself in the foot and left homeless people with nothing,” DiPietro said.

Back on the street, shadowy figures emerged from beneath the overpasses as Anderson steered the van back to Camillus House.

With less than a mile between the clinic and the sidewalks where some of her patients sleep, it’s hard for some people to understand why street medicine is necessary. But Anderson knows that most of the homeless population won’t seek treatment. It has to come to them.

“Sure, they have a medical home if they can walk over here,” Anderson said. “But for these patients, telling them to show up at a time and a place is too big of a step. They need a healthcare system that’s accessible to them.”

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.