Medical care for Detroit's homeless gets a half a million dollar boost

They sleep along a main road in Detroit or near the whooshing sound of cars whizzing by on the freeway. They stay outside of a downtown church or at a local park. 

They are unhoused Detroiters, living out on the streets of the city, struggling to find an open shelter spot in one woman's case or, for another man, finding a place to live, despite working. Through it all, medical care can be hard to come by. Transportation can be unreliable and keeping a health care provider can be daunting while moving from place to place.

A man with a foot wound had walked to a hospital — about eight blocks — to get it checked out. He was referred to a wound clinic, he said, but didn't have a way to get there. Another person hadn't been seen by a doctor in about eight years, she said, or a dentist in well over a decade.

These are the individuals Dr. Shaina Shetty, a family physician with the Community Health and Social Services (CHASS) Center, and a team, including a housing specialist, visit. They were out early Monday morning bringing medical care straight to people experiencing homelessness in Detroit.

The practice is known as street medicine and involves delivering primary medical care to people facing unsheltered homelessness who have trouble getting to a physical location or struggle to get the prescriptions they need. The program, a partnership between the Neighborhood Service Organization (NSO) and CHASS, recently received $562,868 in American Rescue Plan Act dollars to expand services through June, allowing the nonprofits to help more people, pay team members and offset costs for lab tests and supplies. The outreach marries medical care, while helping people access housing and other wraparound services.

"You bring care to where people are at," Shetty said.

It's also the first time the city of Detroit has funded a street medicine outreach program, according to the housing and revitalization department. The city already funds five street outreach teams, but that generally connects people to emergency shelter.

Homelessness, according to housing experts, has multiple causes, from mental health challenges and substance abuse to evictions and affordability hurdles. In 2022, there were about 200 people counted as homeless on the streets of Detroit, Hamtramck and Highland Park, according to a one-night tally conducted by the Homeless Action Network of Detroit (HAND) in January. Last year, those experiencing unsheltered homelessness were not counted but there were 1,280 people living in shelters or other housing programs. These numbers are likely an undercount. 

"Street medicine has been shown to be a promising model for improving physical and behavioral health outcomes for individuals experiencing homelessness. Street medicine teams provided critical, non-emergent, services to this population," said Terra Linzner, homelessness solutions director within the city's housing and revitalization department, in a statement.

'It's hard to get to the doctor'

On Monday's street medicine run, Shetty — joined by a family nurse practitioner, a medical student and an NSO peer support specialist who helps connect people to housing — hopped into a van and visited what they call "hotspots" to meet regular patients.

Throughout the morning, they drove through an alley near Eastern Market and then checked in on a client at a nearby inn. They made stops at the Pope Francis Center downtown, then went on to a meal program outside St. Peter's Episcopal Church. They checked with patients at two parks in Corktown and behind an auto repair shop above a freeway. They set up a makeshift pop-up clinic at a soup kitchen. Along the way, the doctor spoke to her patients and dropped off medication.

Crouching down at the steps of the Pope Francis Center downtown, Shetty, with her orange medical duffle bag in tow, talked to Debbie Cieslak.

Cieslak said she has been homeless for four months. Cieslak and her husband are sleeping outside on the sidewalk, but don't have a tent, she said. She had her clothing, phone, purse and medications stolen from her. Cieslak, who said she requires an oxygen machine but didn't have one on her, said she keeps getting sick.

"It's hard to get to the doctor," she said because, without a phone, she can't make an appointment or get a ride. Cieslak, 50, said she has missed appointments. Shetty has been "a great help" and without her care, Cieslak said she doesn't know where she'd be.

Cieslak said she visits the Pope Francis Center — which provides meals, laundry and showers to people experiencing homelessness — often.

"It gives me time to like just sit and relax," she said, about the respite when she's having trouble breathing and her body aches.

The team dropped by the Manna Community Meal program outside of St. Peter’s Episcopal Church, where they met Daniel Lewis and tended to a wound on his foot. He hopes he doesn't have an infection and is a bit sore, he said. Lewis, 60, had walked to the hospital over the weekend, but hasn't had a way to get follow-up care. He has been staying outside of a downtown church for the past few months, he said.

"I do need some transportation," he said.

Krystal Arzadon is among the patients seen by Shetty at the Capuchin Soup Kitchen. Arzadon is currently at a shelter with her wife and has been there since April. Arzadon has been homeless on and off for about a decade, living with friends and family. She hasn't seen a family doctor or dentist in years because Arzadon, who grew up in Taylor, hopped around from city to city — from Detroit and Roseville to Mount Clemens and Rochester Hills.

"I haven't been to a doctor in a while, so I might have diabetes and not know it, I might have whatever and not even know," Arzadon, 29, said.

On Monday, she scheduled an appointment to see Dr. Shetty at a clinic.

Federal dollars will grow program's reach

The federal pandemic funding for the street medicine outreach will allow the nonprofits to serve an additional 80 individuals and families, in about 1,000 encounters, said Dr. Felix Valbuena Jr., CEO of CHASS. These are repeat face-to-face visits with the same people who may have chronic illnesses, but who struggle to get to a doctor.

"Our ultimate goal is to try and have these individuals be as healthy as they can," he said.

The team goes out twice a week, but their goal is to add another day. That's an increase from once a week, before the funding. A lot of street medicine teams in Detroit are volunteer run, Shetty said, but it's hard to continue care out on the streets on a volunteer basis. Medical students from Wayne State University, University of Michigan and Michigan State University take part in street medicine teams. Student teams are expected to partner up on outreach efforts, Shetty said. The team is also slated to get a van that can help increase access to medical care.

The program allows CHASS and the Neighborhood Service Organization to combine street outreach — connecting unhoused people with case workers, housing navigators and therapists — and street medicine, said Linda Little, president and CEO of NSO. The federal dollars allow the program to have enough staff and support. Before, she said, NSO had to pull together "threads and strings," in the form of grants and donated medical supplies, to offer street medicine.

"It's pulling them out of the shadows and into the mainstream system of care," Little said of the patients the street medicine team serves.

Street medicine has been around since the early 1990s and has grown across the country. People who are homeless typically have a lifespan that is decades shorter than the general population, according to a 2017 study, and they face roadblocks retaining primary care because of previous negative encounters, a distrust of medical professionals, challenges navigating health care systems, mental illness and substance abuse, a 2022 study found. Other barriers, according to the city of Detroit's Linzner, include language, literacy and being underinsured.

"Connecting these individuals with physical and behavioral health care can significantly improve health outcomes but requires building trust with the population and providing services where they are," she said.

The city of Detroit will be monitoring the implementation of the street medicine program, including success and challenges, which will determine ongoing funding. Over the past year, the city of Detroit has ramped up its safety net, including 24/7 street outreach, more shelter beds and a housing resource hotline. The increased homeless services and outreach is supported with funding from the American Rescue Plan Act, as part of the city's broader $203 million housing plan.

Contact Nushrat Rahman: nrahman@freepress.com. Follow her on X: @NushratR.