He sprinkles his conversation with references to inspirational movies. He talks about faith and family, mutuality and grace. He quotes the Chinese philosopher Lao Tzu, who said, “Go to the people. Live with them. Learn from them. Love them.”
There is nothing conventional about Jim Withers, M.D., an internal medicine physician and the founder of Operation Safety Net in Pittsburgh, Pennsylvania, one of the country’s first fulltime “street medicine” practices. So it should probably come as no surprise that when Dr. Withers checks on a patient living under a bridge, he’s not only treating a wounded body—he’s hoping to heal the soul of the medical profession itself.
“The people most at risk are my fellow doctors and me,” says Dr. Withers. “Our soul is dying. There is a sacred moment when you step outside of business as usual into the reality of people in need.”
Taking to the Streets
Dr. Withers believes that both patients and physicians need to be liberated from the confines of an impersonal medical system designed largely for the comfort of practitioners. “We need to get close to and respect the people we serve,” Dr. Withers says.
In 1992, Dr. Withers took to the streets, carrying his backpack of medical supplies to serve those who call Pittsburgh’s alleyways, riverbanks, and highway overpasses home. “I dressed like a homeless person because I wanted this to be a visual call to action to my peers,” Dr. Withers says. When others joined the work, Operation Safety Net was formed as part of the Pittsburgh Mercy Health System and Catholic Health East.
To reform a profession, you need to start from the ground up—with its future practitioners. Dr. Withers set out to create a “classroom of the streets.” When students participate, “they get it” he says. “Their eyes catch fire.” He describes the early days of their work together—washing the feet of people who were homeless, sometimes giving away their own shoes—as something out of the Frank Capra classic, It’s a Wonderful Life.
Connecting With Fellow Advocates
Still, Dr. Withers admits that he often felt as lonely and excluded as the people he served. Then, in 1993, he met Jack Preger, M.D., an English physician who founded a “pavement clinic” in Calcutta. Dr. Withers knew he had found a kindred spirit.
Over the next dozen years, Dr. Withers met many of his brothers and sisters in arms, including those working for the federal Health Care for the Homeless program. He decided he needed to get his “family” together. In 2005, the 1st Street Medicine Symposium was held in Pittsburgh, with support from Glaxo-Smith Kline and the Robert Wood Johnson Foundation.
“For me, this was an earthshattering moment,” Dr. Withers says. “It was like my Field of Dreams. I was meeting my heroes from Puerto Rico and Boston and Calcutta. I was worried the roof might collapse!”
At this first gathering, the group made three decisions. First, they wanted to remain loosely affiliated but not formally organized. Second, they wanted to meet again (in September 2012, the 8th International Street Medicine Symposium was held in Salt Lake City, Utah). And third, and perhaps most important to Dr. Withers, they wanted to provide inspiration and practical support for students.
The father of four grown children, Dr. Withers speaks with affection about the students with whom he has worked over the years. Despite the fact that there is no specialty and no certification for street medicine, many are eager to make this their life’s work.
Growing the Practice
To help both the pioneers of street medicine and its future practitioners, Dr. Withers founded the Street Medicine Institute in 2009. The Institute’s goals are to:
- Help communities establish their own street medicine programs
- Define and improve the practice of street medicine
- Host the annual Street Medicine Symposium
- Provide educational opportunities for students in health care and allied professions
This is an ambitious agenda for a group that recently lost its funding and is operating without any staff. Still, Dr. Withers is not discouraged. Speaking the language of health reform, Dr. Withers notes that street medicine “embodies the medical home model in a virtual sense, wrapping continuous care around a person.” Some street medicine practitioners have also implemented mobile medical records that follow a person from homelessness to housing. “Our ideas are scalable, and a small investment could have global impact,” Dr. Withers says.
Providing Quality Health Care
Ultimately, Dr. Withers acknowledges that providing health care to people living on the streets is not ideal, which is why he is committed to helping his patients find housing. Still, he is adamant about the need to maintain a mobile component to health care. He likens this “strike force” to fire and ambulance services. But unlike health care that focuses on emergency treatment, street medicine can help prevent more serious and costly complications, Dr. Withers notes.
How long can he keep up this demanding work? “I want to do it until I can’t,” Dr. Withers says with conviction. With luck, that will be a long time from now.
Learn more about Dr. Withers and the Street Medicine Institute on Facebook.
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