Cheryl Martin (Host): One of the most vulnerable populations is those experiencing homelessness. But now, a new initiative at Mercy Medical Center Merced will take healthcare to the streets, meeting people where they live, under bridges, in camps, on benches. And here to tell us about street medicine are Dr. Aisha Khader, a family medicine resident; and Juan Velarde, Director of Rural Health Clinics for Dignity Health.

This is Hello Healthy, a Dignity Health podcast. I'm Cheryl Martin. Dr. Khader and Juan, I'm delighted you're on to discuss this new program. So, Dr. Khader, let me begin with you. What is street medicine and how will it affect Merced?

Dr Aisha Khader: Hi. Thank you for having me. It's a pleasure to be here. I'd like to start off by saying that street medicine is a very specialized healthcare approach that is able to provide medical care and support individuals experiencing homelessness or who are living in marginalized or vulnerable populations. This can include a multidisciplinary team including doctors, nurses, nurse practitioners and other social workers. By using street medicine, we are going to be able to bring medical services directly to streets, shelters and other places where these underserved individuals are found, rather than requiring these individuals to seek care in traditional healthcare settings. By doing this, our goal of street medicine will be to improve the health and well-being of these marginalized populations by making healthcare more accessible and by addressing these unique challenges faced by these individuals.

Host: Now, Juan, what services will be provided?

Juan Velarde: So for our street medicine clinic, we will be providing services from a wide range of items, which include point-of-care testing, which might be hemoglobin A1c. It would also include lead testing, strep testing, some STD testing as well. It is a full range scope of practice. Within our street medicine program, we are looking to see what we can do to best accommodate the population that we are serving. We are looking at social services, we're looking at our food pantry to see what we can give the patients. A lot of times, in the ED when they are there, a lot of times they're looking for those specific things. They're looking for shelter. They're looking for food. They're looking for clothing. Those are some of the items and services that we will be able to provide them with.

Host: Now, Dr. Khader, what is reality-based healthcare?

Dr Aisha Khader: Reality-based healthcare, I'd like to say it's a very pragmatic approach to our healthcare delivery. It involves addressing our practical real world challenges a little bit like what Juan said about food, basic necessities, things that we may take for granted. These are constraints that we face every day by our healthcare systems.

In this context of patient-centered care through street medicine, we are able to focus on our patients' real life experiences, preferences and needs. We can hope to understand these everyday realities and tailor our healthcare plans to fit these realities, rather than expecting our patients to conform to idealized healthcare models.

Host: And so, how large is the homeless population in Merced County? Any idea?

Juan Velarde: Currently, the statistics that I looked at, it is quite a bit of individuals. We roughly have about 700 individuals that would fall under the homeless category. Now, that's kind of broken into two different categories, whether they're sheltered and unsheltered. Roughly about 300 being unsheltered and around 400 being sheltered. But as we know, the homeless category falls into different aspects, whether they are, for lack of a better term, sleeping on other people's couches, multiple families living in a unit. That's kind of where the shelter, although they have a shelter, they are still considered homeless in that aspect of it.

And I'd also like to just chime in a little bit about what our doctor said was, as our services are expanding, we're looking at our social determinants of health. We will be providing those medical services, but also looking at what we can do to help them as a whole person, helping them in the different aspects of their journey of living better lives.

Host: So, is your goal to have enough services to reach this entire population or just a segment?

Juan Velarde: So, our goal is really expanding our services as much as we can in collaboration with a lot of different organizations within Merced that are also doing similar work. We'll be more of the healthcare aspect of the work that's being done in Merced and also being that bridge, because we're well aware that housing is needed, but there also needs to be a bridge to healthcare as well. And we're hoping that with having our medical services out in the community, we'd be able to be that bridge. And if we can do some type of coordination with our human health services agency, with our food banks, with the shelters that are within the organization, it'll just be that much more better for our community.

Dr Aisha Khader: I'd also like to add to what Juan was saying as well regarding our population, it is definitely a migrating population and it is also fluctuating every day. Some people can find placement or homes and then, the next day, things might not be as available for them. And our goal with this is transportable healthcare where we can reach out to them wherever they are.

Host: Dr. Khader, how great do you see the need for trust-building first with the homeless community?

Dr Aisha Khader: Definitely, a community trust is very, very important in this aspect. In traditional healthcare settings, we may not be able to build that kind of rapport that we would like to with these underserved individuals. They may experience shorter, less personal interactions. So if we were able to go out into their settings and establish trust and strong relationships with them over time, I really think that we could really help this community.

Host: Juan, what will the street mobile care team look like?

Juan Velarde: Currently right now, we will have a mid-level nurse practitioner as the provider on the mobile unit and within our encampments. We do have about three community health navigators, which will play different roles. One of the roles being out in the encampments with the provider. Making sure that we're capturing their needs. We will have a few in office just to make sure coordination of appointments, medication pickups will be filtered and facilitated. We'll have a medical assistant, we'll have an LCSW to help with more of those, social behavioral and mental behavioral aspects of their healthcare. We will also have a medical assistant who will be able to help facilitate some of our basic vitals and intaking of the patients.

We are really trying to capture a full range of information to make sure that we are really meeting them where they're at and what they need and eliminating the barriers to what they need to be successful in their healthcare journey. We mentioned earlier that we're trying to meet them where they're at. So, trying to create less barriers is ultimately what we're trying to do. And by doing that, we're hoping to get the trust of our patients.

Host: So, are there certain times of day that these mobile care teams will be out on the streets?

Juan Velarde: Yes. So currently right now, it is going to be a five-day full clinic. It will be three days mobile care. As we know mobile care and street medicine, little different. Our mobile care unit will be out at different sites labor camps, school base, healthcare. Some of the different navigation organizations are within Merced. And then also, it'll be two days of actual street medicine, and this is us building the continuity of the patients that are in the encampments and making sure that we're following up with them, making sure that we are somewhat being a continuity provider for them.

Host: You've touched on this a little bit. Any other differences between street medicine and mobile care?

Juan Velarde: Correct. We're thinking of street medicine, going and meeting the patients and the population where they're at, that's exactly what street medicine is. It's us trying to eliminate those barriers to healthcare. Our mobile care clinic is we do have an RV that will be going to the labor camps at specific locations, specific dates, which there will be a calendar created and published for the community. And it's going with our mobile unit and providing them with, as we mentioned, a lot of the point-of-care testings, our EKG machine, our ultrasounds, providing those services to those specific patients, that can kind of meet us where we're at, but still have a lack of continuity of medical care.

Dr Aisha Khader: I think that's a great thing about that, that you said, Juan, because a lot of our patients, unfortunately, don't have access to transportation. And us being able to reach out to them is probably their biggest barrier.

Host: Well, that leads into a question that I had specifically for you, and that is why is street medicine so critical to our advancement as a medical community?

Dr Aisha Khader: I think, first and foremost, street medicine will help us address these health disparities. These patients have very limited access to care. They have higher rates of chronic illness, shorter life expectancy. Being able to bridge this gap and sort of, as Juan also mentioned, provide a continuity of care, we would be able to reduce that as best as possible while also being able to provide our street medicine practitioners to work in real world conditions, you know, that are very different from the controlled environments of hospitals or clinics. I think this can really enhance our skills and adaptability as healthcare providers.

Host: Now, Juan, when will this program be fully functional?

Juan Velarde: We're in the process right now of launching our street medicine portion of our street medicine program, mobile care clinic. So, we will be doing some of exactly what you just mentioned as a trust building. We'll be going out to some of the encampments. We're working with partners in Merced to make sure we're not duplicating work and make sure that we're really capturing the most patients that we can. So, we're starting that within the next couple of weeks and our initial outings will be more, as we mentioned, more of building that trust, providing services, really figuring out what they need. We have an idea of what they need, but really hearing it from them, surveying the population to figure out what's needed is kind of our first steps we'll be starting in the next couple of weeks. Our mobile care clinic is expected to be up and running, no later than the end of February. Right now, we're working on just some logistical things and licensing and things like that. But in the meantime, as I mentioned, we are actively working with some of the other organizations within Merced to even provide some type of medical care for the patients.

Host: And here's a question for both of you, how would you define success for this initiative?

Dr Aisha Khader: Well, creating this program has been very challenging for accessibility purposes, continuity or migrating population. I think success would be if we were able to have continuity of care with a certain set of patients where we were able to work on their chronic conditions such as diabetes or hypertension and we see as a goal the community's healthcare improving, not just our physical healthcare, but all the other social determinants of health as well.

Host: What about you, Juan? How would you answer that?

Juan Velarde: Success to me would be being able to bridge some of the social needs and the medical needs of the patients of this vulnerable community. I've been very blessed and very privileged to see it firsthand. We recently had a patient who was not coming to the clinic and who was homeless and I was able to build a trust with her and that rapport with her, that now she's actually coming to the clinic and receiving those cares. And I can just see a 360 change in her health, in her well-being, her spirit, because as we mentioned, medical is a big part of it, but it's a whole person aspect. So for me, the success would be seeing the lives change, even if it's one person. Obviously, we want to target as many people as we can, but it's seeing these lives change and seeing the growth in helping the community.

Host: Dr. Aisha Khader and Juan Velarde, thanks for talking about this new initiative that is sure to bridge that gap between healthcare and the homeless population in your community. Thank you so much for coming on.

Dr Aisha Khader: Thank you.

Juan Velarde: Thank you.

Host: You can learn more about Mercy Medical Center's Family Care Clinics at dignityhealth.org/merced-clinics. Once again, that's dignityhealth.org/merced-clinics. And if you found this podcast helpful, please share it on your social media and check out the entire podcast library for other topics of interest to you. Thanks for listening to Hello Healthy, a Dignity Health podcast.