THE POWER OF COMMUNITY & COLLABORATION TO MAKE AN IDEA COME ALIVE
This article originally appeared in the winter 2023 edition of Minnesota Family Physician magazine.
by Jeffrey Woods
Nothing spoke to me my first year of medical school like a talk street medicine pioneer and Street Medicine Institute founder James Withers, MD, gave to the Rochester, Minnesota, community in April 2021. As my classmates and I were in the midst of long days and nights studying biochemistry, histology, anatomy and pathology, Withers was talking about a different side of medicine. He spoke of “the soul of our profession,” about what constitutes a “platform for healing” and of the vital importance of “deep affirmation, unconditional regard, harm reduction, love [and] consistency” in delivering medical care for anyone, but especially for communities that have been subject to stigmatization and have experienced and internalized a lot of shame imposed by society.
With my background as a non-traditional medical student who studied philosophy and religion in undergrad and grad school and who previously worked as a hospital chaplain and meditation teacher, Withers was clearly speaking my language. Over the course of that 45-minute talk, I became determined to do whatever I could to create a street medicine program in Rochester.
ESTABLISHING THE STREET MEDICINE SELECTIVE AT MAYO CLINIC (ROCHESTER)
Street medicine is an emerging field of medicine that addresses health inequities and the lack of medical care for those experiencing homelessness by delivering care to individuals where they are and on their own terms. Withers pioneered the field of street medicine in 1992 when he began making medical visits to people living on the streets of Pittsburgh, Pennsylvania. Since then, dozens of street medicine programs have sprouted up in cities across the country and across the world.
I left Withers’ talk hoping that Rochester could be next. As a first step, two classmates and I teamed up to create a street medicine “selective,” an optional elective for preclinical Mayo Clinic medical students. The selective consisted of service learning experiences and trainings covering a range of topics from chemical dependency and mental health to community resources and skills for triaging and treating common medical conditions.
We (perhaps overly ambitiously) built into that inaugural Street Medicine Selective curriculum plans for students to go out and do essentially what Withers had done over 30 years ago in Pittsburgh: work with yet-to-be-identified physicians to start to bring needed medical care under bridges, in encampments and on street corners in our community. In that sense, the selective was a sort of leap of faith that student interest and enthusiasm could be a primary driver in creating a street medicine program and that, by the end of the academic year, selective participants could be helping with “street runs” as part of a brand-new program in Rochester.
While we didn’t quite reach that goal, by the end of the 2021-2022 academic year, we had at least created the beginning of a street medicine program. The Zumbro Valley Medical Society and its executive director, Beth Kangas, PhD, took the lead in coordinating all street medicine efforts and became the institutional “home” for street medicine in Rochester. Several Mayo Clinic consultants and fellows from internal medicine and emergency medicine became very engaged in devising how to deliver medical care on the streets of Rochester. We also received institutional support from both Mayo Clinic and Mayo Clinic Alix School of Medicine.
At the same time, to get more medical students engaged, we developed two hours of street medicine content that was integrated into the first-year medical student community engagement curriculum, including a session in which medical students visited a local homeless shelter where a panel of individuals with lived experience of homelessness discussed their own experiences and gave advice about ways to provide care. The hope is that it will be recurring, yearly content experienced by all incoming medical students.
GROWING THE STREET MEDICINE SELECTIVE—NOW IN ITS SECOND ACADEMIC YEAR
With the start of the new academic year in summer 2022, four students from the inaugural Street Medicine Selective took over as leaders of the selective’s second iteration. This time around, under their leadership, the selective has been further developed to include the “street medicine runs” that we originally envisioned.
On those runs, teams consisting of medical students, a physician and a community service partner provide basic medical care to unhoused individuals on street corners, in encampments and under bridges. In December 2022, selective participants also ran a foot care clinic, where medical students, Mayo Clinic physicians and community partners collaborated to provide foot and nail hygiene, free socks and shoes, clinical care and social service support.
For first- and second-year medical students at Mayo Clinic in Rochester, street medicine has been invaluable to experientially learn how, as Withers put it, “deep affirmation, unconditional regard, harm reduction, love [and] consistency” are the “platform for healing” in all health care encounters, but especially on the street, where relationships of trust are an essential precondition for delivering medical care.
This academic year, 25 first-year students—nearly half the class—are participating in the selective. Students chose to participate to experience meaningful clinical encounters early in medical school, work with vulnerable and underserved populations, contribute to health equity and get to know realities within our local community that may not be encountered otherwise.
COLLABORATING WITH COMMUNITY MEMBERS EXPERIENCING HOMELESSNESS
As impactful as street medicine has been on many of my classmates and me, it goes without saying that the program exists for and is driven by the needs of the individuals we are serving. As we explore how to best deliver medical care on the streets in Rochester, our focus is on becoming known in the community and building rapport and trust with individuals who are experiencing homelessness. Our primary aim is to meet the people where they are, to listen, to learn and to continually adapt. For that, collaboration is essential, and it is our guiding principle. Essentially every session of our selective and every step we’ve taken in establishing a street medicine program in Rochester has been in close collaboration with leaders of Rochester’s homelessness service agencies, Mayo Clinic physicians, leaders of the Zumbro Valley Medical Society and, most importantly, individuals with lived experience of homelessness.
COMING TOGETHER AS A BROADER COMMUNITY TO SUPPORT STREET MEDICINE
Support from the broader community has been an additional and unexpected difference maker, as well. Vastly more individuals and organizations within the Rochester community have taken an interest in supporting street medicine than I ever dared hope for.
Rochester Mayor Kim Norton proclaimed a week in April 2021 Street Medicine Awareness Week. Meetings of the Street Medicine Selective were covered by the Post Bulletin newspaper, which helped create visibility and momentum. The Minnesota Medical Association Foundation provided a grant that funded our early outreach efforts, which was instrumental in helping us get to know the medical needs of individuals in Rochester experiencing unstable housing. After our efforts were publicized in a Mayo Clinic intranet news article, we received inquiries from Mayo Clinic staff members asking how they could donate or contribute to street medicine efforts. Students from the University of Minnesota Medical School reached out to discuss how to create street medicine programs across the state. There are countless other ways community members have contributed.
When I started helping with street medicine efforts, I imagined that it would be a program collaboratively created primarily by medical providers, leaders from Rochester’s homelessness service agencies and individuals with lived experience of homelessness. The outpouring of support and interest street medicine has received has taught me that I was blind to not realize that there is, indeed, a role for every single one of us as we collectively tend to the health and well-being of those in our community. I am so thankful I experienced the power a community has to lift up a project and make it come alive.
Jeffrey Woods is a third-year medical student at the Mayo Clinic Alix School of Medicine. He helped launch the Street Medicine Selective in Rochester, Minnesota. If you’re interested in street medicine and want to get involved, go to zvms.org/street-medicine-longitudinal-selective or email email@example.com.