On a cool autumn evening, a group of volunteers gathered at Gravier and South Derbigny streets in downtown New Orleans, organizing first aid and medical supplies: antibiotic lotions, bandages and bottled water.
Among the faces: Charles Zhang, 29, an LSU Health Sciences Center New Orleans emergency resident physician and founder of Street Medicine New Orleans, which visits underpasses and abandoned lots to find homeless people in need of medical attention.
A stethoscope wrapped around his LSU fleece vest, Zhang said he was inspired by Dr. Jim Withers, considered the father of street medicine, when Withers gave a talk at Tulane University years ago.
Soon after, Zhang founded SMNO for what he saw as the “huge unmet medical need” in New Orleans.
The group, which started two years ago, “hasn’t reached full potential, though we are receiving incredible help from our students," he said.
One student is Sana Shuja, 23, a second-year Tulane medical student who is part of Tulane Street Medicine, which formed earlier this year and has recently teamed up with SMNO.
It was her first walk, and she was excited to learn. Shuja, who said she plans a career in primary care or emergency medicine, believes the street work reinforces classroom learning.
She has a particular interest in the poor because the smallest help can mean a world of difference, she said.
Start the engines
The volunteers’ faces turn as a full-sized van pulls up.
The driver is B.B. St. Roman, 69, head of the New Orleans Police Department's Homeless Assistance Unit.
St. Roman has always been adventurous. As a documentary sound technician, she has filmed subjects from Mother Teresa in Beirut to the Dalai Lama in India.
St. Roman said that Mother Teresa showed her the meaning of “being compassionate and seeing everyone as a human being.” Through the special unit, she has built rapport with the city’s homeless community, which allows her to assume the critical role of guiding the team during street walks.
After a brief logistical discussion, the volunteers filled the van and the engines started. It was a short drive to the underside of the Claiborne Avenue overpass.
The students fanned out, weaving among the concrete freeway pillars, around which groups of men and women lie on mats besides brimming shopping carts and beat-up suitcases.
As the volunteers make their rounds, experienced members of the team recognize familiar faces. St. Roman gets a heartfelt hug from one man who whispers tearfully into her ear. Most patients greet the students enthusiastically, readily accepting water and supplies.
Other patients are new, including a man who said he recently left home after a serious marital argument. He clarified that his stay under the overpass will be a temporary one, and thanked the volunteers for a pair of socks and deodorant.
Skillful exam is crucial
While most patients showed no obvious injuries, a few required Band-Aids or an application of antibiotic ointment. Zhang explained that the most common ailments are superficial wounds such as bug bites, exacerbated by scratching or neglect. Often, a focused series of questions is sufficient to rule out serious medical problems.
Avoiding oncoming vehicles, the students cross the street to the Greyhound bus station. Zhang spots a man in a wheelchair.
The man says he feels ill and finds it hard to breathe. The team takes his vital statistics and inspects his eyes, looking for signs of trauma or infection.
Patient encounters such as this provide a unique learning opportunity for the medical students. Far from the predictability of the classroom or the support of hospital staff and equipment, a skillful physical exam is crucial.
“Sepsis can present as fever, increased heart rate, increased breathing, and altered mental status,” Zhang explained to Shuja.
In this case, the students provide an ER referral in the event that his condition worsens.
The goal of street medicine is not only to provide immediate care, but to connect the population to medical and social services, Zhang said.
These services include a referral to a hospital or linking patients to the dozens of other services in the Greater New Orleans area.
Zach Schnitzer, 26, is a social worker who works for one such organization called Health Guardians. His program fills in the gaps, he said, recognizing “frequent fliers” to the ER and offering intensive case management, including home visits, counseling and medication management, transitional housing, healthcare education and literacy.
“I was raised to help people. I can’t imagine doing anything else,” Shnitzer said.
Weeds and empty lots
The students spend the rest of the night exploring a series of less populated spots.
In Gentilly, where St. Roman had received word that some patients might be living on an abandoned plot of land, she and Zhang explored on foot, shining flashlights through a field of overgrown weeds.
Pieces of clothing and empty water bottles suggested at least a temporary presence, perhaps days before. But this night, no one was here.
Locating the patients is only one of the unique challenges that SMNO has to face. The students know that street visits are only a temporary solution in the face of larger issues such as family problems or negligent government policies.
As with all medicine, it is the responsibility of the patients to follow up, comply with doctor’s orders, or to make an emergency room appointment. Without money for transportation or social support, though, change isn't likely.
The students ended their journey where they started. Several of the volunteers shared contacts and inquired about the dates of future walks.
For the time being, the team will continue to make the walks. For Neil Nixdorff, it is about “concentrating on a solution”, because no matter the population, “they still have their humanity.”
St. Roman concurs.
“I’ll consider retiring," she said, "only when there is a fully organized system for homeless healthcare in New Orleans.”