by: Andrew Giang, DWW-SBSM communications intern

John Geddes once wrote, “You don’t need a calling to minister love.” Yet in a conversation about the street medicine movement with Dr. Jim Withers and Dr. Jason Prystowsky, it becomes abundantly clear that nothing compares to the instance when profession coexists with passion. On this particularly warm February afternoon, sitting beachside at Goleta’s own Beachside cafe, Dr. Withers and Dr. Prystowsky explore various aspects of their own callings to serve the marginalized from Pittsburgh to Santa Barbara. They discuss the beginnings of their respective organizations, Operation Safety Net and Doctors Without

 Walls- Santa Barbara Street Medicine, exemplifying the zeal that has become emblematic of their fellow volunteers. Along the way, Dr. Withers shares invaluable anecdotes about his own experiences working with underserved populations as well as his hopes for the student volunteers and the future of street medicine.

Andrew: What first stoked your interest in medicine, Dr. Withers?

Dr. Withers: I came by it pretty naturally. My parents were in the medical field, they worked overseas, but I think it really first took hold on a trip to Nicaragua. There’s something about working in that kind of environment that solidified the whole idea of being a physician.

I do look back though, and sometimes I think you don’t know what you want to do. I think you need to have faith that you’re going in the right direction. It is really remarkable to look back and see the whole picture. Even without the answers, I think you need to trust your heart and pursue it. For instance, one part of getting to where I am now was a significant period of mountaineering. I was totally into mountain climbing, I did Wilderness Medicine Conferences every year, I went on expeditions.  I felt like it was really a detour, it had nothing to do with the values I grew up with, the values I held dear. It was about as selfish a thing as you could do, to use up all your vacation time, risk your life, basically could throw it away in a minute. Either way, once it’s over, and you’re back in the states, who have you really helped? There might be some local people in that country, but you just barely help them with some bandages and things. But that was what I was doing, and now I realize it was good training for working under bridges, for the backpacking experiences, feeling like I could work outside of the hospital. I’m sorry, I don’t want to go all Yoda on you.

Andrew: That’s actually how Dr. Jason described you before you came.

Dr. Withers: Well let me de-Yoda-fy myself if I can. I think I really saw myself, my potential self, when I was outside of my own world. I watched my parents working, and I saw how much satisfaction they got from connecting, from connecting service, adventure, connecting with people. That’s something that’s really important to me, connecting things that might not necessarily belong together. To get slightly metaphysical, the underlying healing urge that has to do not just with fixing people’s boo-boos, but working towards a place where people are united, where there’s really love, where the barriers that we put up between people are overcome, I think there is a bit of that deep down inside all of us. The healing urge that has to do with peacemaking and unity. We’re just really in health care to have a practical means to channel that urge. We can do it with our hands, we can do it with our knowledge, and we’re given permission to do so.

Dr. Prystowsky: A lot of students are interested in global health and international medicine. You got your start in international medicine, in Nicaragua, that kind of got you started in street medicine. Would you care to comment on how the two are connected in your mind?

Dr. Withers: Like the unified field theory?

Dr. Prystowsky: If you’d like to take a crack at it. Einstein couldn’t do it, but you might.

Dr. Withers: Let’s call it the unified field theory of street medicine. I love it. I think there is some overlap there. When you’re doing homeless health care, you run into a lot of people who turn out to be your soulmates who are doing international healthcare. That’s why your austere medical conferences really spoke to me, because I would to these wilderness medicine meetings, and I’d find people who had worked with the homeless, or worked with Mother Teresa. To some degree, those people are sort of high stimulus people that want to look over the next mountain, look around the next corner. They’re curious people. We did a study back in the nineties on our volunteers, and the most consistent trait among them was curiosity. They’re really intellectually curious people.

Dr. Prystowsky: It’s interesting that there are so many students willing to go off to Africa, to Haiti, or Latin America to do service work. But those fundamental principles are irrespective of geography. It’s about those human connections.

Dr. Withers: Right. Something I’ve really enjoyed, and I know Jason has to, is the sense that you’re part of a legacy, a profound thing like health care. On the other hand, no matter what you do, I think there is a lot of satisfaction in being able to make your part of it your own. It’s like going to Paris. I didn’t want to go to Paris because everyone said it was so great, so beautiful, and I wasn’t excited to go anymore. But when I got there, it became my own. I couldn’t help it, I fell in love with the place. I think healthcare is the same way. You have to make it your own in some way, otherwise you’re kind of just drafted into it. It is so much more satisfying when you can find your own niche, engage your own value system. It so much more fulfilling that just resting on your laurels and coasting. I guess out here it’d be resting back on your surfboard.

Andrew: So would you say that street medicine and Operation Safety Net have been your way of making healthcare your own?

Dr. Withers: I think so. I do think that service, and street work for that matter, is done to help people, but at the same time the benefits to you, your growth as a human, your growth as a professional, is invaluable, incalculable. And I guess sometimes that’s the secret? A lot of people don’t know that, but those that do, it just becomes a part of you. It’s a lifestyle, a wonderful one.

Dr. Prystowsky: And it’s not like it’s beneficial to keep it a secret. The more people you tell about it, the more it helps everyone.

Dr. Withers: Absolutely. I’d say street medicine wasn’t my urge early on. But I was in a place where I felt trapped in a paradigm, and because of my childhood, because of my personality, I put up with it until I just couldn’t anymore. I couldn’t practice medicine in a way that was so choreographed, where people had to come to us on our terms, and it dehumanized them, and it dehumanized us because we were the faces they saw when they came. I couldn’t accept that structure. I wanted to get back to first principles, somewhat like making house calls with my dad where I could just be a person instead of a great, all knowing doctor figure. It just got to the point where I could not put up with it anymore.

Dr. Prystowsky: In this day and age, we’re able to do so much more pragmatically. But when it comes to the human condition, it seems like we’re deteriorating, like we’re going further away from what medicine is about. You talked about house calls with your father. That at its core is what medicine is about and we’ve gotten away from that.

Dr. Withers: I think you just have to get out of that structure. Understand its power, but at the same time find a way around it, humanize it again, and really work to see what it can do for people. We had student volunteers come out with us for Operation Safety Net, and a large part of what we’d do is just explore literature and some of the thinking behind street medicine. I like to talk about and explore what happens when you cross over to the Other, and you experience an unknown territory. There’ll be people behind you telling you you’re crazy, telling you these dirty people deserve their fates. But then you learn the reality that people are living in, you find how you fit in that reality, and ultimately it comes back around and you see how interconnected we are. The whole us versus them, worthy and unworthy thing, is all a construction of frightened, lazy people that judge people you don’t even know. And then you become less tolerant to that kind of judgment as you get more proof that its a big lie. Sure there are some people that are difficult, but as you get closer, you start asking questions. Why? Why is this person so angry? Why is this person so uncooperative? Instead of judgment, you make it into an intellectual puzzle, and you flip around so that you take into account the role of trauma and violence in the person’s life. Soon you find the human condition immensely interesting.

Andrew: You’ve been there from the beginning with Dr. Jason, with Doctors Without Walls. Could you talk about our origins from the perspective of a person who has seen street medicine grow? Perhaps you could give us some insight on how we’re doing from a person with an insider view.

Dr. Prystowsky: Well I love uncovering layers, uncovering something that was already there, and that’s how I felt after just a few weeks on the streets in Pittsburgh. I saw a three dimensional image of what Operation Safety Net would be, what it could represent on so many levels. It wasn’t just an educational breakthrough for me. It would strategically address the health needs of people everywhere because there was now an entity that was part of their world that could coordinate it. And then I saw the effects on the community that could layer onto that. So I was extremely excited, but I was feeling pretty alone in this. I went to India, and I met Jack Preger, and he really validated everything that I was trying to do through his actions, and I finally saw it as a field of medicine. So I went on the road, I went wherever I needed to go, wherever people needed me. I learned about Jim O’Connell in Boston and what he was doing. And every time people got together, there was this beautiful surge of energy, of recognition. It was like, “Oh my gosh! You’re doing what I’m doing. I thought I was alone.” And I really got the sense that this was something no one person could own. It was something we all needed to share in to develop. So anyway, I ended up at an American Medical Student Association meeting many years ago, and Dr. Mimi Doohan, a medical student then, came up and talked to me after and she was on fire. She said that this was what she wanted to do. And sometimes you see people and you say, “Wow. This person is really serious.” So I asked her why, and she told me it was because she herself had been homeless as a child. So I encouraged her, and she came to Pittsburgh to do some street work with us. I think she and I gave a haircut to man on the street one night, and she thought that was way cool. So she stayed in touch, and she finished medical school, stayed in touch, did her residency. People often disappear, but she did not. She came out again to do some more work with us. And then she met the people here in Santa Barbara, got them all together, and it ultimately culminated in street rounds and what is now Doctors Without Walls. And I watched it, marveled at Doctors Without Walls, because every city has its own stakeholders, its own unique situation, its own energy source. I believe in the power of volunteerism, I believe in just not waiting until you get the right brand. But just walking rather than talking. And I think you guys have really exemplified what can be done with the validation of that energy. You support each other, you’re very deep philosophically. This isn’t just a mechanical business to you guys. You reflect on it, you tap into the power of volunteering as much as any organization I’ve ever seen. So I’ve been very gratified to see you guys grow. I’m very impressed and honored to be part of it.

Andrew: What do you see for the future of street medicine? Would it be possible to create more connections, especially between such diverse groups?

Dr. Withers: I’ve been so blessed to be a part of these organizations, and sometimes I feel like I may not be the one to bear the reins. Sometimes i feel like I haven’t been the best steward because I haven’t been able to make the Street Medicine Institute as financially solid. But I think, like you guys, it’s made us stronger because we’ve had to be a grassroots effort. we’re going on our tenth international meeting, we had a record attendance this last year. So the global energy to do this, we’re in a watershed moment. I do envision all of us finding ways to interconnect, to share our experiences, to reaffirm our underlying philosophies. I think that’s one of the most powerful things we can do, is to articulate and stand for the rights of people in all cities, those who are excluded. We have the fortune of being able to provide that in a medical context, so it’s very practical. So I just see more networking. I see street medicine becoming a more recognized concept. I think everyone in the world should have access to direct medical care that meets them where they are, and I think every classroom that teaches anything about medicine will have a class about street rounds.

Andrew: What advice would you have for younger volunteers?

Dr. Withers: I’d say, relax, and absorb what you see as a person rather than a future doctor. There’ll be plenty of time to cram down methodologies, but you learn more directly than you’ll ever know. Just be mindful to what’s not being done and what your hearts tugs at you to do.