Meeting the homeless on the streets of Boston

by maritzac

The mission statement of BHCHP embodies day-to-day work and constant efforts of clinicians, researchers, and providers: to provide the best-quality of care to homeless men, women, and children in the greater Boston area. I saw that health care could be performed effectively and with dignity. Patients were treated holistically, as persons with mental, behavioral, and physical health problems as well as needs extending beyond just the medical—people with housing and social needs. I was constantly told of how critical the relationship between a provider and a patient is, and I saw some of the success in connecting patients to primary care. Social and community-driven change were at the very heartbeat of the program, and I was part of the drive to constantly provide better quality of care and services to patients. Through active interactions with patients, patient satisfaction evaluations, and internal quality measures, the clinical and research staff were always thinking about how to better care for patients. In a way, perhaps, such an organization has to be self-selecting. Only people who can really care about and work for homeless patients will be part of such a program, and I am happy to report that this is the best kind of “systemic social change”—where providers are incredibly happy and fulfilled to come to work, with enough energy and care for the patients that they can persevere over the challenges of working with a vulnerable population and within a broader health-care system that is constantly changing and also very focused on cost-effectiveness—and where patients can respond to providers and truly begin to be healed and housed.

I learned about public health, policy, and science in a fusion of experiences that I would have never expected to be so valuable. For the science research, I was truly part of a rigorous environment, where critical and thoughtful thinking were valued; my supervisors really taught me how to think about data, how to interpret it (with all of its myriad other factors and interpretations), and to understand both the limitations and nuances of what I was reading. For the policy and public health aspects, I learned about how to shape program-wide policies and how broader Affordable Care Act-changes were affecting the program as well. I learned about the importance of preventive care and education (for both providers and patients)—and these are key elements of public health as well.

I was incredibly fulfilled and challenged with the work I was doing. I was doing such a medley of activities as I grew to know the providers, patients, and the program: I visited sites, saw many different shelters, shadowed doctors and nurse practitioners, went on street and outreach visits, and did patient activities weekly. I was also doing my own research project concerning the science (understanding TB infection) and public health aspects of tuberculosis (how to improve screening guidelines of tuberculosis and to understand BHCHP-specific epidemiology of patients who had previously had a history of tuberculosis), which took a long organic process of slowly coming to understand the program and its aims. This was both daunting and also exciting—I was constantly asking questions and finding out if I could visit and go to other sites! 

Some of my other favorite parts included visiting the many different shelters and getting to know different providers. Among the clinical sites I visited were within bigger shelters/sites such as the Pine Street Inn (the biggest homeless shelter in Boston), Long Island Transitions, Woods Mullen, the Suffolks Down Racetrack, Rosie’s Place, St. Francis House, and Massachusetts General Hospital. I also had a wonderful time doing Street Outreach with the Street Team and both education and outreach with the HIV Team; this entailed briskly strolling around Boston and actively seeking opportunities to foster relationships or conversations with patients. Having life-changing and incredibly honest conversations with patients outside in the pouring rain, offering someone a hot sandwich or a coffee, and simply kneeling down to talk with someone that everyone else is passing by were some of my most enjoyable but also most challenging experiences.