Medical students, residents volunteer for ‘street medicine’ | MUSC


Under a beautiful blue November sky in a city routinely ranked among the best in the country for its architecture and cuisine, two medical students were about to get their first glimpse of something not listed in any Charleston guidebook. They made their way through a swampy stretch under Highway 17, less than a 2 1/2 mile walk from the iconic Rainbow Row, but a world apart in most other respects. Their destination: some of the city’s hidden homeless camps.

Anna Beth Eitel and Cora Bisbee, freshmen at the Medical University of South Carolina, had volunteered to help with what their guide called “homeless home visits.” “It’s kind of fun doing this because all we’re doing now is studying and going to class. It reminds you what you’re here for,’ Eitel said.

dr. Thomas Ricks talks to a homeless man sitting in a van. The man, a drug user, is concerned about getting HIV.

Their guide, Allan Woods, is an emergency medical technician who founded the nonprofit Charleston Street Wellness Patrol. His group monitors homeless camps and provides basic necessities and sandwiches. And when someone is in a medical crisis, they do what they can to help.

Earlier this year, Woods asked MUSC if some of his students and medical residents would like to join his team on their visits to homeless camps. The students would be there to learn and help. The residents, doctors who received additional training, were able to treat health problems for anyone who needed it. Woods got a quick response.

“This was an easy yes for me,” said Patrick Cawley, MD, MUSC Health CEO and vice president of health affairs at MUSC. “During my training in Georgetown and later in Durham, North Carolina, I regularly worked in homeless clinics. So I know this is a population that needs care.”

Allan Woods and Dr.  Thomas Ricks check out a homeless camp to see if anyone is there.
Allan Woods, founder of the Charleston Street Wellness Patrol, and Dr. Thomas Ricks checking to see if anyone is in a homeless camp.

Providing that care is a valuable learning experience, Cawley said. “There are the socio-economic issues that need to be appreciated and very specific medical issues that need to be understood. It’s easy for me to think back to things I learned to care for the homeless and that I still use today. So it’s absolutely important .”

Back at the swampy spot below Highway 17, Eitel, Bisbee and Woods were joined by a neighboring county mental health expert and medical resident Thomas Ricks. at a site where homeless people can get everything from clothing to healthcare to legal advice. Ricks was there as part of his residency program at MUSC. His visits to homeless camps were a voluntary extension of that.

The first camp Ricks and the rest of the group reached was home to two young men. It contained a small tent, a bench, and a stack of bicycles. Three flags—one bright pink, one blue, and one American—were hanging from trees. Also, there were enough empty food and drink troughs to fill a recycling truck.

One of the camp residents wanted to talk to Ricks privately. The conversation lasted about 15 minutes. Later, Ricks questioned the medical students. It was clear that this had been no ordinary appointment. His patient didn’t just live in a homeless camp – he was also a drug user with a lot of worries.

Medical students Anna Beth Eitel, left, and Cora Bisbee listen as Dr.  Thomas Ricks having a homeless talk.  Allan Woods follows after them.
dr. Thomas Ricks talks to a homeless man, usually out of sight on the right, while Anna Beth Eitel and Cora Bisbee look on. The man is concerned about a skin problem, a common problem among homeless people. Allan Woods follows after them and gets ready to visit homeless camps that he regularly checks to see if anyone needs help.

“He asked about HIV. He is super scared of getting HIV. What can we do for him or someone else who is at risk of getting HIV?” he asked Eitel and Bisbee.

“A prophylactic agent?” said one of the students, referring to a drug that prevents disease.

“Yes, you take it once a day and it pretty much eliminates your risk of getting HIV,” Ricks replied.

Ricks said the man was also feeling ill months after suffering a bout with pneumonia. “What specifically is something else that causes chills, sweats, and cough symptoms — sputum production, shortness of breath? Something you don’t always see in America.”

“Tuberculosis?” a student guessed.

“Precisely.”

Ricks would later return to try to give the man a drug that could prevent HIV and have him tested for TB, a condition that is more common in the homeless than in the general population. Being homeless is associated with many health problems. It can also shorten a person’s life by about 20 years.

Cristin Adams, DO
dr. Cristin Adams

Cristin Adams, DO, MPH, knows that well. Like Ricks, she’s from the MUSC Department of Family Medicine. She is also an assistant professor at the College of Medicine, directs the program that connects medical residents with homeless services, and serves as the medical director of both the Navigation Center and Woods’ street medicine team. Street medicine involves bringing social services and health care to homeless people where they live.

“There’s a lot of chronic illness, checking medications and checking things that patients had been seen in the hospital for. They check blood sugar, they check wounds. And there have been emerging situations,” Adams said.

“In one case, a young girl who was addicted to heroin was dangerously ill. She had very low blood pressure and a very high heart rate, and they had to call an ambulance right away. It’s intense. If such people do not receive care, which often happens, they simply end up back in the emergency room or the hospital because they have no other choice.”

Woods has run into people who didn’t get to the hospital on time. ‘I’ve found people dead. That’s why I always look to the side of mattresses. And these are people I really knew,” Woods said. He has created a memorial to some of the homeless he knew who died, with their names on a pole near a downtown skateboard park.

Ricks said it’s important not to judge, but to do what Woods does: try to help people and treat them with respect. “I think sometimes we approach things from a very paternalistic point of view. Such as: ‘You mustn’t drink; you shouldn’t be taking IV drugs.’ But do they know that? Alcohol use disorder, IV drug use, those are diseases in their own right. They also expose themselves to a variety of other things due to their circumstances.

And so, whether you can ease their feelings about certain risks — for HIV, the risk of tuberculosis, that sort of thing — or whether you can really encourage them to get tested or let them know that there are medical therapies available that can help. To mitigate or reduce those risks, it’s important to tell them about those things. It’s a public health problem,” Ricks said.

Some homeless people don’t want medical attention for what can be obvious problems. The next camp the group visited was home to a woman Woods has known for years. “Of. a lot of meth. You can see it in her mouth,’ he said.

Whiteboard at The Navigation Center lists times when people can see MUSC caregivers.
A whiteboard in the Navigation Center tells visitors when MUSC will offer personal care and telecare.

Methamphetamine can cause serious tooth damage, a phenomenon known as meth mouth. But the woman did not ask for help for that. She just wanted a sweatshirt for the cool weather and some other basics the group helped her with.

Then the team went to another camp. It was wedged into a small space near where a bridge landed, creating a cave. “There’s someone there again. Let me go upstairs first. I think I know that man,” Woods said.

It was another glimpse into a world that exists beneath the world most people see in Charleston — and another chance for the medical students to see how challenging the lives of some prospective patients could be.

“I enjoy getting into the community and volunteering, getting my experience for multiple types of communities,” Eitel said.

Allan Woods of the Charleston Street Wellness Patrol carries bags of supplies in the navigation center.
Allan Woods carries bags of supplies for the homeless at The Navigation Center.

She and Bisbee would take that experience to the MUSC campus. Adams, the assistant professor, would also be there, urging to expand the program so that more students and residents could take advantage of the kind of living conditions many had never interacted with before.

“I think this has been an even more positive experience than we expected, and the need is so great,” Adams said.

The program is the latest in MUSC’s efforts to help those who are under-resourced. MUSC runs the free CARES clinic in Mount Pleasant, along with a program that collects and distributes supplies for the elderly homeless and another program that provides telecare to the homeless.

Cawley, the CEO of MUSC Health, said Woods’ street medicine initiative is a welcome addition. “It broadens the mind of anyone who goes out.”



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