The 13th annual International Street Medicine Symposium on October 19-21, 2017 in Allentown, Pennsylvania provided an opportunity for healthcare experts from around the globe to present clinical topics, innovations, research outcomes, and best practices relevant to medical care of "rough sleepers," or people living in unsheltered conditions. 

A team of attendees and presenters from Madison, Wisconsin included Ann Catlett, MD (pictured at top right and above), clinical instructor, and Christine "Bootsy" Harden, OD, MS (pictured at lower right), associate outreach specialist and project coordinator for the Madison Street Medicine Initiative, both of Hematology, Medical Oncology and Pallative Care, as well as colleagues from partnering organization Madison Area Care of the Homeless (MACH OneHealth), several School of Medicine and Public Health students, and Department of Family Medicine and Community Health faculty members Bethany Howlett, MD, clinical assistant professor and David Deci, MD, associate professor (CHS).  

Dr. Catlett led a workshop entitled, "'I'm Dying' Here:' Palliative and End-of-Life Care on the Streets." The workshop was attended by about 80 people. 

"Most participants were providing health services on the streets but hadn’t considered addressing end-of-life care, and I sensed that people were very engaged and anxious to learn how to approach the needs of the dying. I emphasized the need for a comprehensive rather than band-aid approach, the need for ongoing research into this area, and collaboration with local palliative care and hospice services," said Dr. Catlett.

With street medicine practitioners from all across the United States as well as India, the Republic of the Congo, Greece, France, Denmark, the United Kingdom, and the Netherlands, the symposium was truly international in scope. 

"What was amazing to me was that it was also a tremendous opportunity to energize connections and strengthen bonds between fellow Madisonians involved in the movement," said Harden. 

Dr. Catlett remarked on advances that other street medicine programs in the United States and beyond have made to interconnect their efforts with regional healthcare systems. "I was inspired by how thoroughly integrated some of the other street medicine programs were with their health care systems, such as using their EHR and outcomes tracking systems, providing in-hospital consultations for homeless persons, and so forth," she said. 

Several presentations by representatives of street medicine programs across the world provided an intriguing glimpse into their impact on population health. "While there is little longitudinal data regarding the impact of street medicine programs, the data that do exist demonstrate significant reduction in readmission rates and ED utilization," said Dr. Catlett. "One program that uses the same outcomes measures their entire system does (glycemic and blood pressure control for example) showed surprisingly good outcomes with their patient panel of homeless persons!"

As Dr. Catlett, MACH OneHealth co-founder Garrett Lee, and Harden (pictured together at right) begin gearing up a Madison Street Medicine Initiative that was recently funded by a Baldwin Wisconsin Idea Endowment grant, the team is immersing itself in discussions with others who have undertaken similar projects in other locations. "There was general encouragement for the MACH Street Medicine Initiative and abundant offers to mentor and guide us as we develop. Most people attending this symposium were a few steps ahead of us in program development and service delivery," said Dr. Catlett.

The symposium was also a sobering reminder of contributing factors to homelessness such as trauma and sexual abuse, as well as the ongoing health toll of these experiences. "While I was already well-versed in the shocking mortality rate and average age of death (47-53) of those who are un-housed, I became more aware of the prevalence of prior trauma as well as sex trafficking in this population," said Dr. Catlett.

"I learned that street medicine initiatives are strongest when they integrate the voices and wisdom of people have experienced the traumas associated with housing insecurity," said Harden.

Interspersed with quantitative and pragmatic talks about outcomes, data, and implementation was an unflinching focus on empathy. "I hadn’t expected so much frank talk about love and kindness from the physician leaders in this movement," said Dr. Catlett. "I was struck by the guiding principles of one of the prominent and well-established homeless health care teams: “Everybody Matters. Go to the People. Share in Suffering with Joy.”

In this way, the conference provided both tools and fuel for the nascent street medicine community in Madison, remarked Dr. Catlett. 

"A big take-home message was to 'do the right thing' and keep on doing it despite the obstacles street medicine practitioners may encounter." 

Additional attendees and presenters from the Madison, Wisconsin area included:

• Kali Kramolis (pictured at right), fourth-year UW School of Medicine and Public Health medical student and Bethany Howlett MD, clinical assistant professor, Department of Family Medicine and Community Health, who presented a poster entitled "Assessing Barriers to Healthcare for Patients Experiencing Homelessness in Madison, WI." The poster summarized a 2016 project they conducted in conjunction with MACH OneHealth.
• Matt Julian, MSW, Meriter Foundation Helping Educate and Link the Homeless (HEALTH) program.
• Mike Aughey, MD and Barb Aughey, RN, SSM Health Dean Medical Group.
• David Deci, MD, associate professor (CHS), Department of Family Medicine and Community Health. Dr. Deci serves as a mentor to MACH OneHealth. Prior to his arrival in Madison, he was a street medicine practitioner in West Virginia.
• MACH OneHealth volunteer James Ircink, MD, who completed his medical degree at UW School of Medicine and Public Health in 2017.

Resources:

• "Dr. Ann Catlett leads street medicine project for people experiencing homelessness," Department of Medicine, July 19, 2017
• International Street Medicine Institute
• "From the hospital to the streets: Madison's homeless need health care, respite, hospice," Wisconsin State Journal, August 28, 2016