Illinois Medicine

ore than 1,200 Chicagoans will be unsheltered tonight, according to a survey report from the Nathalie P. Voorhees Center for Neighborhood and Community Improvement at the University of Illinois at Chicago. Chicago Coalition for the Homeless statistics show that 44 percent to 60 percent of the city's homeless suffer from mental illness and 25 percent to 38 percent grapple with substance-use disorders. Many have undiagnosed traumatic brain injuries or cognitive impairments. Homelessness is also the single greatest risk factor for a signifi- cantly reduced lifespan. The average life expectancy of a chronically unsheltered individual is 53 years, according to the report, "Healthcare and Homelessness," published by the University of Illinois Hospital & Health Sciences System. Given these statistics, it's easy to see why homelessness is a health hazard—or a social determinant of health. While homelessness is a much bigger problem than any single hospital or health system can solve, the College of Medicine and UI Health are playing leadership roles in the citywide effort to meet the immediate health care needs of this vulnerable population. Meeting the Homeless on Their Terms and on Their Turf IN MARCH 2016, COM student Joshua Smith happened across a newspaper article about Jim Withers, MD, who has treated the home- less on the streets of Pittsburgh for 25 years. Inspired by the article, Smith reached out to The Night Ministry, an organization that provides medical care and supportive services for Chicago's homeless. In May, he began to accompany The Night Ministry's Health Outreach Team to a South Loop field, where more than 70 city residents were living in a state of chronic, unsheltered homelessness. The human cost of homelessness was immediately apparent to the first-year medical student as he walked through the field, introduc- ing himself to the inhabitants of the makeshift tent city, listening to their stories and administering to minor medical needs. But it was not long before Smith—a dual degree candidate in medicine and public health—also recognized the staggering societal cost of providing health care for the city's homeless. "Some of these people had been living on the streets for 10 to 20 years, and they had become so marginalized by society that they no longer felt welcome in our world," he says today. "This fear of institu- tions made them less likely to seek out primary or preventive care. Whenever a health care need arose, they chose the most accessible and most expensive option: the emergency departments of the city's safety- net hospitals." Smith began to wonder if a Chicago street medicine program staffed by medical students could deliver more consistent care for less money, while building relationships with the unsheltered homeless and restoring their trust in the health care system. When he broached the topic during a steering committee meeting at UIC's Student Run Free Clinic, his thoughts about street medicine captured the imagination of fellow COM student Brandon Collofello. "Josh and I bonded over a common passion for serving the under- served and helping this vulnerable population," says Collofello. "We saw that there was an enormous, unmet need—and we wanted to do something about it." Soon, Smith and Collofello were teaming up for street rounds with The Night Ministry and brainstorming ideas for a student-run street medicine program that would bring compassionate, cost-effective pri- mary and preventive care to Chicago's homeless "on their terms and on their turf," as Smith has called it. As their dream began to take shape, Smith—who was enrolled in the Patient-centered Medicine (PCM) Scholars Program at the College of Medicine—turned to PCM program director and associate head of family medicine Memoona Hasnain, MD, MHPE, PhD, for advice, as- sistance and oversight. The idea resonated with Hasnain, who agreed to serve as a faculty mentor for the students as they roughed out the program and applied for grant funding. "I am happy to help Josh and Brandon shape the street medicine program, and we will be working closely to operationalize it and design and gather impact data after the program's launch," she reports. "We have also discussed the possibility of integrating the program into our PCM Scholars curriculum." From Hasnain's perspective, the street medicine program is a natu- ral fit for a PCM Scholar. "The PCM Scholars Program has been training students in the M COM students Joshua Smith (above, left, attending to a homeless man) and Brandon Collofello (pictured with flashlight on opposite page) were inspired to connect with The Night Ministry to address health the issues of Chicago's homeless population. I L L I N O I S M E D I C I N E | 31

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