Fig Tree - Spokane Street Medicine program opened durding COVID

COVID jump-started Street Medicine program for homeless people

One silver lining arising because of COVID-19 is that Spokane's Street Medicine program for homeless people sped up to open earlier than planned.

Started to care for people experiencing homelessness, it reaches that population where they are and serves as a point of contact for homeless service organizations and health care.

"The program was in formation before the first wave of COVID-19, but the outbreak kicked it into gear," said Luis Manriquez, a family medicine physician in practice in Spokane, who is the program director.

It is a joint effort of Washington State University's Elson S. Floyd College of Medicine, Spokane Regional Health District (SRHD), CHAS Health (Community Health Association of Spokane), SNAP (Spokane Neighborhood Action Partners), Jewels Helping Hands, Volunteers of America and Catholic Charities.

Luis, assistant clinical professor at WSU Elson S. Floyd College of Medicine, leads Health Equity development efforts.

A graduate of the University of Washington College of Medicine in 2011, he completed a family medicine residency at Oregon Health Sciences University.

Previously, Luis, whose roots are in Arizona and Texas, earned a bachelor's degree in film and television at the New York University Tisch School of the Arts.

In March, he started doing rounds with Street Medicine from 9 a.m. to noon, Mondays, Wednesdays and Fridays, and 2 to 5 p.m., Saturdays. He hopes to expand services to all week.

"The team is a pool of volunteers. Some are clinicians and others are students doing rotations. We meet at the CHAS Dennis Murphy Clinic downtown to pack backpacks with supplies, and ride in the van until we find people," Luis explained. "Each team has a homeless outreach worker, clinician and a SRHD staff/volunteer."

The team provides screening and testing for COVID-19, acute medical care, the hepatitis A vaccination, HIV and syphilis rapid testing, and follow up appointments with CHAS, SRHD or House of Charity (HOC) clinic.

Commonly they treat sunburns, frostbite, lacerations, infections and traumatic injuries. The team acts as a mobile urgent care unit. They also call in prescriptions and treat wounds.

While Street Medicine was implemented in response to the COVID-19 outbreak and to provide health care to an already vulnerable population, it was in the works before then.

"It's easy for people to fall through the cracks," Luis explained. "People who don't have a phone can't make appointments, call in a prescription or call about health insurance issues.

"Small, mundane issues for us are huge on the street. People who are homeless are disconnected from the system," he said. "There are many ways our system is not acceptable, one is how hard it is for people who are homeless to access it. It's no one's fault, but the system doesn't work."

As it is, most health issues are not addressed until they become critical and require a trip to an emergency room. This can cause health care problems that could be prevented, Luis said. Often health problems were reported to a shelter social worker who determined if the situation required a call to emergency services.

Now, Street Medicine acts as a connection point to address health problems before they become critical.

"Our goal is to act as an adapter between people experiencing homelessness and the health care system, police, volunteers and shelters. We want to create a network of people and organizations," said Luis.

With social distancing and quarantine taking effect in COVID-19, Luis said the task of providing medical care for people experiencing homelessness became even more difficult.

"There has always been a disconnect between health care providers and people who are homeless. COVID-19 made the situation worse," he said.

For instance, many health care providers moved to Telecare. This is a safe alternative to in-person doctor visits, but only for those who have a phone or computer, he said. Most of the homeless population lacks cell phones or reliable ways to charge them.

"When COVID-19 hit, the city shut down, with a ripple effect stranding many who are homeless," Luis said.

The virus did not spread in the homeless population as fast as predicted, he said. There was a string of sickness in shelters in January and February, but lack of testing made it hard to gather data. Street Medicine started before quarantine, social distancing and COVID-19 testing began, so "we don't know if there was an outbreak," he said.

"People experiencing homelessness are generally socially distanced in the summer. However, there's concern for when winter hits and shelters are reopened. People will be in close quarters and the risk of transference is higher," said Luis.

Street Medicine is not the first program Luis started to connect medical practitioners with social work. Since starting his career, he has asked, "how do I connect being a doctor with social justice?"

Luis saw a lack of action to address needs of vulnerable people. He saw it as his duty as a health practitioner to address these needs and find solutions through social work.

In 2009, he helped found the Health Equity Circle. He is regional manager of the program that has hundreds of students in several states. In Spokane, it affiliates with EWU, WSU, Gonzaga University and the University of Washington.

Based in Spokane, the Health Equity Circle connects volunteer students from different practices and studies to the community and each other.

"We take their passion and give them skills to partner to address issues that affect us all," Luis said.

Chapters include undergraduate and graduate students in the social sciences, public health, health care and law. They tackle child health, correctional medicine, environmental health, healthcare and homelessness.

"Working with community partners, Health Equity Circle students have increased funding for affordable housing by $67 million dollars, supported a $327 million bond for early childhood education, protected medical interpretive services from budget cuts and supported legislation for workers to have access to sick and safe leave," he said.

Luis continues to apply his passion for social justice and medical expertise to help the community and inspire others to do so, too.

For information, call 360-395-5825 or email luis.manriquez@wsu.edu.