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WHEN THE NURSE PRACTITIONERS APPROACH:
At first, refuse care // See the same familiar faces each week // Finally consent to being examined // Grow to trust the caregivers who are coming to you

Homeless Health: Care on the Street

By Rachael Moeller Gorman // Photographs by Matt Eich // Spring 2012
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Matt Eich

Living on the streets or in a homeless shelter brings with it a range of medical problems most physicians rarely encounter. “It’s an exotic tapestry of health issues,” says James O’Connell, a primary care physician at Massachusetts General Hospital and president of the Boston Health Care for the Homeless Program (BHCHP). “You certainly see all of the usual chronic and acute illnesses, but I also had to learn how to take care of frostbite, hyperthermia, infestations of lice and scabies. You even see scurvy and pellagra, things I had rarely seen until I came to the shelters.”

The stresses of the streets also undercut resistance to illness, so homeless people get sick or injured at three to six times the rate of those in the general population; on average they’re battling eight or nine illnesses at once. Many who are homeless are mentally ill and addicted to drugs or alcohol, and whatever treatment they get is usually delivered in hospital emergency rooms. In 2000, BHCHP began a study of 119 “rough sleepers”—people living chronically on the streets—and in the first five years, they made 18,384 ER visits. Despite an average age of 46 at the time of enrollment, 50% have died in the past 12 years. The most common cause of death: cancer, followed by liver and heart diseases.

Every night, as many as 700,000 people in the United States may be living on the streets or in shelters, and a kind of medical subspecialty has evolved to tailor a range of largely low-tech, high-impact solutions to their special circumstances.

Click here to watch the leaders of the Boston Health Care for the Homeless Program on the challenges of treating this special population.

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Video: Care on the Street

Leaders of the Boston Health Care for the Homeless Program discuss the challenges of treating this special population.

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