People experiencing homelessness often rely on the hospital emergency room for medical care. In Porterville, Vera Miles has done it multiple times. She’s lived under the trees along the Tule River in Porterville for five years. The 60-year old shares the space with her partner. She says she isn’t worried about getting the coronavirus.
“I think we're safer down here than anywhere actually,” says Miles. “With this going on, I'd rather be here.”
But Miles has chronic obstructive pulmonary disease, or COPD, and asthma, which she’s gone to the emergency room multiple times to treat. In a pandemic, it may feel safer, but living outside is dangerous, says Dr. Omar Guzman.
“There's no access to water, no one's wearing masks,” says Guzman, who is out here today to offer health care to people like Miles. “Even if you wore a mask, if you don't change it, it just becomes a nexus for infection anyway. They can't wipe down their encampments.”
Guzman is the Director of Undergraduate Medical Education and runs Kaweah Delta Medical Center’s Street Medicine team. He along with volunteer physicians and medical students go out every other week to homeless encampments throughout Tulare County.
On this day, he reminds the team that this work is like making house calls.
“No one's waiting to be seen, there's no line,” says Guzman. “So, spend time and talk to the patient, figure out a little bit about them, really make that patient-doctor connection that you guys are supposed to be doing.”
With that advice, 15 people grab intake forms and start walking along the river.
Street Medicine’s mission is to meet people where they are, providing preventative care. Similar programs exist in Los Angeles and San Francisco, and some studies show it works to reduce the time and money spent treating people in the emergency room.
Throughout the coronavirus pandemic, the state of California has also tried to reduce the risk for people experiencing homelessness by providing funding for hotel rooms.
While walking along the river looking for encampments, doctors and students call out: “Hello? We're with Street medicine. Is anyone around? Anybody here need to see a doctor?”
Diana Trumble says Street Medicine was one reason she chose Kaweah Delta for her residency.
“I'm one of the second-year emergency residents at Kaweah,” says Trumble. “One of the medical students is gonna be following me, but this is new for me, so it’ll be interesting.”
After 40 minutes of looking for tents hidden along the riverbank, Trumble meets Holly Bella who tells her she needs some antibiotics.
“I got a channellock stuck in my leg,” says Bella. The incident happened back in February.
The 55-year old Porterville native points to a scarred spot just above her ankle. She says she went to the hospital when she was injured, but lost the antibiotics after getting treatment.
“I tried to keep it clean, and I did have one of those cast-boot things on, but that thing was so damn big, it was like, just gigantic,” says Bella.
Trumble pulls an antibiotic from a backpack stocked with medications. An attending physician from Kaweah Delta signs off on the prescription. It takes ten minutes.
“You’re gonna do one pill, twice a day, for just seven days,” instructs Trumble. She tells Bella that Kaweah Delta is also testing for COVID-19 further up the river.
“Thank you very much. God bless you guys,” says Bella.
By the end of the morning, the group reconvenes near the canopies where nurses were conducting COVID-19 tests. Only a few people have accepted medical treatment throughout the morning. In larger towns like Visalia or Tulare, sometimes the team talks to 30 or 40 people.
Veronica White is a housing navigator with the Kings Tulare Homeless Alliance and she’s been out along the river too. She says many of the people here are reluctant to accept help.
“The client that has COPD, she’s always been very closed to services, she never really wanted to come out to talk to any of us,” says White, referring to Vera Miles, the woman who’s lived on the river for five years. “I think it was her husband who convinced her to meet with the doctor and that opened up the door to be able to talk to her about our Project Roomkey and our housing programs.”
It helps to have the medical team, says White. They can offer immediate care, whereas housing involves paperwork. But sometimes, it becomes clear to patients that housing improves their health.
“We were able to house two of our patients that were in a big need of housing, because they're getting to the point where they're going to be hospitalized,” says Dr. Omar Guzman. “I think they probably, if they were to remain out here, would have been hospitalized within the next 48 hours.”
Guzman says the team will be back in a month or so. Soon, Street Medicine will have a weekly outreach to get more people preventative care, and if they’re open to it, connect them to housing.