News23ABC In-Depth


Street medicine teams expanding care for the unhoused

Posted: 7:24 AM, Feb 21, 2023
Updated: 2023-02-21 14:12:16-05

BAKERSFIELD, Calif. (KERO) — Homelessness is a complex condition. Being unhoused opens these individuals to a variety of dangers and medical conditions, but there’s a new movement pushing medical providers to meet these people in their environment.

It’s called street medicine.

At Clinica Sierra Vista, the street medicine team is up before the sun, getting ready to head out on rounds.

“Morning guys, how’re you?” Dr. Matthew Beare asks as a group of individuals appears from the riverbed. They’re patients Dr. Beare has been working with for several years now.

“It was hard to trust them because not many people want to come out and help the homeless people, and now we’ve built that special bond,” said Perry, one of Dr. Beare’s patients.

While Perry’s dogs run around the side of the riverbed and the sunrise begins to warm to cool morning air, Dr. Beare checks on Perry’s Sublocade injections.

“How’s it been cravings wise?” Dr. Beare asks. Perry responds that he hasn’t experienced any cravings for several weeks now. Dr. Beare is ecstatic to hear this.

Dr. Beare and his team set up near the riverbed in Oildale Thursday morning. At 7 a.m., Dr. Beare honks the horn on to the caravan of vehicles. The unsheltered individuals approach with their dogs, waiting for check-ups, coffee, and supplies.

“A lot of what we provide, a lot of what we do is actually non-medical and it’s harm reduction,” Dr. Beare said.

The street medicine team has supplies from clean syringes, dental supplies, sanitary wipes, snacks and water. They even have collars and leashed for pets. They’ve also partnered with other providers, like Kern Medical, Church Without Walls, and Marley’s Mutts to offer showers, haircuts, even vaccinations for pets.

Dr. Beare said the hardest part of street medicine isn’t treatment, but building trust among his patients.

“A large portion of the homeless population has a very jilted or jaded relationship with a variety of systems,” he said. “There’s such a distrust between the medical community and these patients that they just wont to seek out care, but we know like these patients deserve care, and they need care.”

As medical director of special populations for Clinica Sierra Vista, his passion for street medicine started in 2019. After attending a conference in Washington, D.C., Dr. Beare said he and his team packed a backpack with supplies and hit the streets of Bakersfield.

The team has come a long way from medical supplies in a backpack. Now it’s not just harm-reduction and hygiene.

“We do a lot of chronic illnesses we treat so much lung disease, COPD, diabetes, high-blood pressure,” he said. Dr. Beare brings a prescription pad during rounds and provides patients with prescriptions and directions to pharmacies. At times, his patients experience some kind of animal attack. He says these attacks can be serious enough to warrant a trip to the emergency rooms, but his patients will be wary of returning for follow-up care. So it’s up to his team to provide those services.

“I think again, the reason why so many patients will hold off, a lot of them feel anytime they go into the ER or even to clinics or any medical profession,” he said. “There’s a perceived idea that they are not welcome in these spaces.”

He said this feeling can come at a deadly cost.

“Something that would otherwise the mild and easily treatable in a primary care setting gets to a point where it gets so severe that now like it requires emergency attention so like a wound,” he said. “A simple wound that if it was treated early, you could provide antibiotics, maybe open that will clean it dress it if it’s left unattended, it will get worse and worse for wear. The patient become septic. It’s such an uncomfortable feeling for them to feel like they just won’t go to the ER even when it’s going to cost their life.”

When it comes to substance abuse, Dr. Beare calls it the bread and butter of his clinic. He said when it comes to street medicine, his patients’ circumstances aren’t so cut and dry.

“There’s this very tragic thing that happens in homelessness where the environment becomes a motivator for substance use disorder, for example we will often hear that patients won’t have meals for days and they don’t want to feel the hunger pains,” he said. “They will use methamphetamines to stay up through the night so they can sleep during the day where they’re more visible to avoid sexual assault.”

After checking in with all his patients at the campsite Dr. Beare and his team drive into the riverbed looking for any others they haven’t seen yet. Most of his patients are covered under Medi-Cal. Those who aren’t still receive treatment, with Clinica footing the bill.

“I could be in clinic right now seeing patients and making a lot of revenue for Clinica, but Clinica is like no this is important enough we want you out there even though this is costing us money.”

Dr. Beare believes this and the stigma surrounding homeless patients are the reasons more providers overlook street medicine.

“I just think they think it’s the wild west but anytime someone actually comes out and sees, they’re like, ‘Oh yea this is just medicine that’s not in in an office.”

He said while they’re able to provide care for many different conditions to their patients on the street, he believes the greatest for his patients to relieve suffering and reduce morbidity is to find more long-term housing solutions for our homeless.

For now, the street medicine team will continue to do what they can. For Perry, he said it’s a blessing.

“There’s a lot of us out here that need the help and can’t get to the hospitals, the doctors, and they need the help. We really appreciate it,” Said Perry.