By Jeanelle Posch, DWW Operations Director

The 15th annual International Street Medicine Symposium was recently held October 20-23, 2019 in Pittsburgh Pennsylvania.  Nearly 500 clinician, services providers, educators, researchers and students from 70 cities in 15 countries were in attendance.  I had the honor of attending as a representative for Doctors Without Walls to learn and listen as speakers from around the world described their work, explained how to address a variety of clinical conditions in rough-sleeping settings, shared data and research findings, discussed how to build and fund a street medicine program and spoke about advocacy issues.  Also in attendance were two of DWW’s Medical Directors, Jason Prystowsky, MD and Jori Nilson, NP, two of DWW’s Coordinators, Chris Stathis and Sean Scheiner and two other very dedicated long term DWW volunteers, Cathy Mollkoy, RN and Lynn Mathis, MFT.

The topics covered by the various presenters over the course of the conference provided a wide-ranging and pertinent overview of the many challenges faced by organizations committed to street medicine.  Here were the highlights that I took away from the presentations and workshop discussions that I attended:

  • To effectively work with the population we seek to serve, it is paramount to build trust and relationships with both them and partner organizations in our community.  Outreach workers are needed to help bridge and mediate.
  • Having a stakeholder involved in your organization (someone who has experienced or is currently experiencing homelessness, a substance use disorder, etc.) is important for success.
  • Helping clients with addiction should include harm reduction measures (such as helping dispense clean needles and connecting them to Medication Assisted Treatment (MAT)), reducing shame and be non-judgmental.
  • The challenges we see in our rough-sleepers (those unsheltered and sleeping on the streets) is much more complicated than just a lack of housing and the current ‘Housing First’ model of the Federal HUD department may be short-sighted.  If/when rough-sleeping homeless are housed, wrap-around care / supportive housing is critical. This approach has been especially proven by Dr. Jim O’Connell’s Boston Health Care for the Homeless Program. At the symposium, Dr. O’Connell’s team presented on ten-year data regarding long-term outcomes for rough-sleepers, which demonstrated supportive services for this population are necessary.
  • Values-Based Engagement in Healthcare – a new trend to practice values-based healthcare within this population was shared.  Dr David Buck, with the Patient Care Innovation Center at the University of Houston College of Medicine presented on his team’s success with a re-designed electronic medical record geared towards treating patients in this manner.  Values-based health care enables patients to express their values / goals (e.g. what they may want out of life), teases out what behaviors may be getting in the way of that person achieving those goals and then involves the patient in helping decide how their healthcare provider can support them in pursuit of living those values.  The EMR being used by this group links the social and medical records, allowing for a stable continuum of this values-based approach as their patients navigate through their system. This allows their patients to get connected to the right resources at the right time. Dr. Buck shared that initial results from this new approach was thus far promising, in that positive patient outcomes had increased, and healthcare worker fatigue was declining.

The International Street Medicine Symposium was a dynamic and engaging meeting.  It was energizing to gather with colleagues from all over the world who share DWW’s goal of providing quality healthcare to the most marginalized in our communities.  It was also clear that as long as the current status of our healthcare system continues, the continuation of our humanitarian work is needed more than ever. Our team will be looking for opportunities to incorporate what we learned at the symposium to continue to improve our own DWW street medicine program.  More information on the Street Medicine Institute, can be found by visiting