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Homeless Health Care

Peter L. Slavin and David F. Torchiana explain how physicians have taken to the streets to help some of the most vulnerable among us.

Spring 2012
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Homelessness is as varied as the individuals who make up this disenfranchised and vulnerable population. Their stories are difficult to hear—raw, heartbreaking, often fraught with loss and tragedy. And there are so many stories. The number of people in the United States who experience homelessness in a given year is thought to be around 3.5 million, though identifying and counting the homeless is imprecise at best. Delivering care to this growing population represents one of medicine’s most difficult challenges.

Homeless people are nearly six times more likely to become ill than are people who have a place to live. Homelessness is often accompanied by poor nutrition, hygiene and dental care. Medical conditions common among the homeless include heart disease, cancer, liver disease, kidney disease, skin infections, HIV, pneumonia and tuberculosis. The homeless are also at high risk for frostbite and hypothermia; more than 30% suffer some sort of mental illness; substance abuse tends to be high; and many have injuries related to the violence of urban streets.

Fortunately, there are dedicated people such as Jim O’Connell, who has shaped the care of the homeless into a specialty of sorts. A physician at Massachusetts General Hospital and president of the Boston Health Care for the Homeless Program, O’Connell designed and implemented the nation’s first system of computerized medical records for homeless patients. He is editor of one of the most widely used texts about homeless health care, and for more than 25 years, O’Connell’s exam rooms have been on the street, under bridges, in doorways, in subway stations and in large cardboard boxes. His tools go far beyond pills and ointments, extending to socks, blankets, sandwiches, hot coffee, compassion and respect.

In this issue of Proto, we offer a glimpse of how O’Connell and other dedicated caregivers have pioneered innovative ways to help the homeless. An accompanying video introduces those who take to the streets and shelters to deliver care to those who so desperately need help but are often reluctant to seek it.

Humanitarians in Boston and in cities across the nation who deliver health care to the homeless have chosen to pursue a field of medicine in which the frustrations are often overwhelming and the rewards may be few and far between. We salute them.

Peter L. Slavin, M.D.
Massachusetts General Hospital
David F. Torchiana, M.D.
CEO and Chairman
Massachusetts General Physicians
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