Dr. Jim Withers is the Founder of the Street Medicine Institute.  The Institute evolved as an off-shoot of his groundbreaking work with Pittsburgh Mercy's Operation Safety Net, the street medicine program he established and continues to work with in Pittsburgh, PA.  Dr. Withers describes his experience with street medicine in his Ted Talk here.

March 26, 2020

Even more than usual, I have been thinking of all of you and the people you serve.  The arrival of COVID19 reminds us that we are all connected and that we must respond in ways acknowledging that reality.  I’m sure most of you have been exceptionally busy these past few weeks.  We have all been forced to create new protocols that balance the epidemiological imperative to isolate with the moral imperative to not neglect our brothers and sisters on the streets.  For many of the challenges, we have found ways to adapt our practices in the streets while maintaining CDC standards of care.  In our local communities we have worked in unprecedented coordination with government and non-profit agencies.  The Street Medicine Institute has coordinated closely with the CDC and the National Healthcare for the Homeless leadership to develop guidelines for the care of the unsheltered homeless.  I was very proud of the Street Medicine Institute board for creating a document for the delivery of care within four days at the beginning of the US epidemic.  But as we know, there are other challenges that are much more difficult such as finding adequate protective equipment, testing materials and options for isolation and quarantine of our infected patients.  These will be difficult times.  But I have faith that we can do this.

We have often said that rough sleeping homelessness is a chronic disaster.  I believe that insight has prepared those in the street medicine movement for this moment.  On a daily basis we have had to work with limited resources and difficult access to mainstream medical services.  We know how to find water and distribute it to our people in killing heat waves.  We know how to create a winter shelter when the temperatures reach -20F.  We know how to work with people who are mobile and focused on daily survival.  If any group of healthcare professionals can adapt to this crisis, it is the incredible women and men who practice street medicine.

These are the times that reveal the sacred calling of healthcare.  I recall as an intern when HIV was reaching epidemic proportions, but testing was not available.  Many of the hospital personnel refused to draw blood or place IVs.  Much of that work was left to we interns who were just learning those skills!  I recall being both terrified and proud at the same time.  What a sacred privilege to be there for those whom others were rejecting.  Yes, there was risk, but this is what I had prepared myself for all my life.  To be able to help others in times of crisis – especially those whom others forget – is the soul of healthcare.  As with the early days of HIV, we must work to fight the stigmatization of our patients.  Information and love are the treatment to combat the ignorance and fear that can kill as well as any virus.

We must not forget that our greatest asset in our work is the trust, wisdom and love of the people living on the streets.  Let them know they are not forgotten.  Teach them the public health precautions they need and work with others to provide them with portable sinks, toilets and water.  Get the phone numbers of reliable camp leaders and call to check-in on a regular basis about the well-being of others.  Work with community partners to make sure the gaps in service are addressed as well as possible.  Find extra tents for isolation and ways that the people can protect themselves if there are no other options.  Ask them how they are feeling and for their ideas on how to solve the problems they see on the streets.  I believe these times, as difficult as they are, are also an opportunity to deepen the love and solidarity with the people.  God Bless you all.  Wash your hands.

December 2019

With the coming of winter, our work with the people living on the streets always takes on a different character.  Not only do the dark and the cold take their toll on those experiencing homelessness, but we begin to tally up all those who have died on the streets.  This year was especially difficult for the Pittsburgh community.  It wasn’t just the fact that we lost more people than in previous years, but also that it seemed the people we lost just broke our hearts.  Many of you remember Roberto, who gave the keynote address in Allentown.  His presentation spoke to the struggles he overcame and the profound love he had for those still on the streets.  We gave him a well-deserved standing ovation.  Sadly, he succumbed to alcohol and lost his battle this past year.  We lost a gifted artist who always advocated for the younger people on the streets.  We lost a dear man who had paranoid thoughts but was a loyal friend to those in his camp.  And we lost too many others.

Being medical people, we ask ourselves about the causes of death and the first culprit in most of our cities has become fentanyl.  Never have I seen one drug kill so many people.  But there is also violence, untreated medical conditions and suicide.  What we know, however, is that these are all diseases of despair and exclusion.  The streets are a death zone and the longer you are there, the more likely you are to die.  The rough sleeping people are the ones who suffer the most, but all those who practice street medicine and outreach are also deeply affected.  And so, every December 21st in the United States, we recognize our National Homeless Memorial Day.  It is a time to declare that real, precious human beings are dying on our streets.  It is a time to grieve, to remember, sometimes to laugh and to dedicate ourselves to preventing more tragedies in the future.

In Pittsburgh, we hold our memorial service at the homeless memorial wall.  Back in 1996, I had reached a point where I could not walk the alleys and riverbanks without sensing the presence of those who had died in almost every part of our city.  And as my sadness grew, it was obvious that very few people were aware of the horrendous reality of all those deaths.  As far as I could see, Pittsburgh didn’t care if “those people” died.  But every person was someone I had loved.  It made me angry.  As Harsh Mander would say, I felt outrage.

Following some media coverage, I received a letter and a check from the author, Sidney Sheldon.  Immediately, I knew what I should do.  My street partner Mike and I bought plaques for the people we had recently lost.  At the top of each plaque, it said “We Remember”, the name of the person, and the year they died.  Our plan was to drill them into the place where each person had died as a testament – and as a cry of outrage to the greater community.  If it was next to city hall, so be it.   If it was under an obscure bridge, so be it.  (As it turned out, it is illegal to just put up plaques like that).  So I went to the mayor’s office and he gave us permission to put them on a wall under a bridge at the end of Grant Street – the same street where city hall is located.  It has become sacred ground for all of us on the streets.  Above the now long rows of names is a larger plaque on which a nurse, Susan O’Toole, and I inscribed these words,

In Memory of those who lived and died on our streets

We believe you are no longer cold, hungry, lonely or frightened

May you watch over us from a warm, caring home above

It was to this wall we returned on December 21, 2019 with heavy hearts for the many losses of dear friends in the past year.  I was secretly grateful that others had taken the initiative to organize the event and they did so beautifully.  Before long, well over a hundred people picked up their candles and formed a semi-circle facing the wall.  Behind them, a line of police officers respectfully joined us.  A few came up to me and expressed their feelings of loss for the new names on the wall.  I stepped off to the side and decided to just take in the feelings.  I was tired and I was sad and I could feel the pain amongst the homeless people, the families and the outreach workers in the crowd.  I didn’t feel like I had anything left to give.  I wanted to cry not just for those who had died in Pittsburgh, but for all those dying on the streets throughout the world.  Those moments are the ones I dread.  When all the pain of all the years is suddenly just-right-there.

But in the crowd, I could see more than just faces of grief.  I saw old volunteers like our nurse, Jan Boyd.  I saw many of those still on the streets and many who had found housing.  I saw selfless volunteers and staff from other agencies, and I saw people who just cared.   There was a spirit of humble solidarity that was stronger than the darkness of that night.  When a group of young girls from an elementary choir began to sing, it was like some angels had joined us.  Dr Wahrenberger from Pittsburgh Mercy gave a moving speech honoring Roberto and the others and then some of those experiencing homelessness spoke about the friends they had lost.  Nothing could have been more respectful and powerful.  And healing.

From my position at the edge of the crowd, I could see all those faces illuminated by their candles.  A sob left my chest and was replaced by a feeling of hope I at first did not understand.  But it was there as plain as could be.  These people loved the people we had lost.  And they loved each other.  And most importantly, they loved the people who were still struggling to find their way out of the darkness.  It was at that moment I got a glimpse of the power of love.  It cannot be conquered.  It believes all things are possible.  It hopes all things.  It endures all things.  Love will never end.   

What we and those with whom we are privileged to work are building is a fabric of love.  We have to work together to see that it is strong and inclusive.  Even with all the loss and discouragement, that love will prevail and overcome the fear and the darkness.  I am grateful to know this deeper truth.  Keep loving each other.

September 9, 2019

I thought this would be a good time to give an update on some of my recent travels.  At the kind invitation of the Princess Alexandra Hospital in Brisbane, I flew to Australia last month to speak at their annual symposium. The theme was about connecting hospitals to communities, so I was delighted to talk about how street medicine was a possible template (and philosophical foundation) for such a connection.  They could not have been kinder to me and I was (once again) deeply impressed with how our colleagues within the healthcare system are genuinely searching for better ways to meet the needs of their communities.  As always, I emphasized that we have much to learn from those who have been excluded.   

While in Brisbane, I was thrilled to be able to catch up with Karen Walsh and the folks from the Micah Projects.  They have built an incredible array of services based on their work with the rough sleeping population and other groups who have been marginalized.  I had the fantastic opportunity to see many of their programs and make street rounds with two outstanding teams.  I want to particularly thank Joe, Gillian and Kim for letting me meet the people and witness their skillful street work.  I loved the individuals I met while making rounds, especially one man who shared accounts of his struggles on the streets with such kindness and humor.  I also enjoyed my time with Jim who has been with Karen from the early days and was an incredible source of wisdom.  By a typically bizarre street medicine coincidence, I had dinner with Jim O’Connell (who happened to be visiting Australia) at the home of Karen Walsh. 

Brisbane was not my only stop in Australia.  Fortunately, I was able to visit Melbourne and see the work of Dr. Ed Poliness.  I met Ed at the last International Street Medicine Symposium in Rotterdam and we immediately hit it off.  Ed is kind of the Nigel Hewitt of Melbourne.  Through him I was able to see some of the many things happening in that town, particularly the work at the Living Room. Harm reduction is very advanced in Australia and they do it very well.  I really enjoyed street rounds with Chito and Mark.  Also – since I first arrived in Melbourne without my luggage, I want to thank the Living Room for supplying me with clothes! 

My final visit was Sydney; what a lovely city and harbor!  Much of my time there was spent with Rev. Bill Crews, who created the Exodus Foundation.  I had the chance to attend his church and see the wide array of services they have created for those in need.  I came early (anonymously) and participated in breakfast service along with the homeless and poor.  They were so welcoming and I truly enjoyed the company of the people.  Bill shared his amazing life story with me over Chinese food the night before I left.   

My street medicine impression of the cities I saw was that the needs are significant. The indigenous people (as always) have suffered greatly and are over-represented in the homeless population.  Addiction issues are profound.  There seems to be a strong sense of compassion and a desire for social justice. There are great leaders and dedicated workers, but they need to come together more.  There was talk of an Australian street medicine symposium, which I would love to see.  

One of the things I love about traveling to see other street medicine programs around the world is how people make you feel like you are family.  I know many of you do travel to see your colleagues in other communities.  I would encourage everyone to do the same.  It is fascinating to see the same love and commitment to the people in an entirely new place.  And as I was reminded, such travel not only informs and inspires us, but it also affirms that we are not alone in our love for our sisters and brothers on the streets. 

The good news is that this October 21-23 we can all experience our global street medicine community at the 15thInternational Street Medicine Symposium in Pittsburgh!  I would encourage you all to register now on our web site.  I have a feeling it is going to be really popular this year… See you then!

March 18, 2019

After allowing too much time elapse I would like to share some experiences and thoughts with you.  For those who were not able to make it to the last symposium in Rotterdam, it was a fantastic event.  Great thanks to Igor, Marcel and all the team from the Netherlands!  One of the take away lessons for all of us was how a city can make enormous progress in reducing homelessness when organizations and government work together.  Despite being away from our traditional base in the United States, there were over 300 participants.  The presentations just seem to get better each year and our keynote, Jeff Olivet, truly inspired us to reflect on how to partner with advocates to address the deeper issues of social justice that lead to homelessness.  But by far my favorite moment was the official launching of the Street Medicine Institute Student Coalition.  Brianne Feldpausch, a medical student from Michigan State University, organized a group of student leaders to promote the global student street medicine movement.  I am pleased to report that this momentum has grown and they have subsequently identified and connected 30 health science schools that either have street medicine programs or are working towards that goal.   

I left immediately from Rotterdam to fly to Delhi in order to visit my dear friend Harsh Mander.  Many of you will remember Harsh from his powerful keynote address at the 13thInternational Street Medicine Symposium in Allentown in 2017.  He is the founder of the Centre for Equities Studies, and from that platform he and his team are helping to revolutionize social justice in India.  I suggest you all look him up and read his books.  In recent years, Harsh has created four new street medicine programs in Delhi, Patna, Jaipur and Hyderabad.  I was blessed to join them on street rounds in Delhi and visit the work in Patna.  The poverty is shocking, but the spirit of solidarity is strong.  I loved the teams who visit the streets, and I was thrilled to visit the new recovery centers they have established for the unsheltered homeless with a variety of serious illnesses.  At my talk in Patna, the medical students were particularly enthusiastic which made me quite happy.  My deepest impression from the time I spent in India was that Harsh has truly built upon a profound respect for the humanity of those living on the streets and is creating a future in which social justice will be central.  I hope we can make one of our future symposiums in Delhi!

From Delhi I flew home, and then the following day I was off to Sao Paulo Brazil.  Dr. Mario Campos is another incredible leader who has created his own street medicine movement within Brazil where there are now four new street medicine programs.  Again I was privileged to lecture at the local medical school and enjoyed witnessing their work on the streets of Sao Paulo.  The needs of Sao Paulo are enormous, but so is the volunteer spirit!  There are literally hundreds of volunteers all working together in their Sunday street clinics.  There are social workers, physicians, nurses, physical therapists and even street clowns. You can feel the love and joy coming from those who serve, and those who are being served.  In a very different setting, I felt the same fierce sense of community I had just witnessed on the other side of the world in India.  It’s hard to describe how inspiring it all was, and to see how street medicine is able to catalyze so much goodness. 

 We had hoped to join our wonderful partners in Miami for the upcoming 15th International Street Medicine Symposium this year, but were unable to find a suitable venue.  I am hoping we can partner in the future as they have been doing fantastic work in Miami for many years.  The SMI board elected to return the 2019 symposium to Pittsburgh – the first time ever to repeat a city location.  I am so excited to invite you all back!  I could not be more proud of my home organization, Pittsburgh Mercy’s Operation Safety Net, which will be co-hosting along with Dr. Pat Perri’s Center for Inclusion Health.  Things are falling nicely into place so make sure to join us.  With any luck we will be able to show the Street Medicine Documentary film that has been 3 ½ years in the making!   

Well, that’s just a small part of all that is happening in the world of street medicine. Colleagues all over the world continue to pioneer new initiatives to bring care to those most in need, while others work to design research tools to document the effectiveness of that care. Health systems are becoming aware of the street medicine movement and are beginning to embrace the logic of going to the people who have fallen through the cracks.  Students who are changing healthcare are emerging in greater numbers. But beyond all this, I can assure you that something more profound is happening.  Hope and love are growing under bridges, in dark alleys, in slums, in the woods and abandoned buildings where too many of our brothers and sisters still dwell.  We are affirming our deep connection and commitment to each other.  This is the foundation we need to reimagine ourselves. I urge you all to continue and pray for your success.

Prior Blogs:

July 27, 2018