Newsmaker Q&A: Brett Feldman, director of LVHN’s Street Medicine program – Allentown Morning Call

Physician assistant Brett Feldman is the director of Lehigh Valley Health Network’s Street Medicine Program, which brings free health care and medication to homeless people at Lehigh Valley soup kitchens, shelters and homeless encampments. He is the subject of this week’s Q&A.
Q: What is street medicine?
A: Street Medicine is a program born from the idea that everybody matters. When you start with that foundation you see that segments of the population aren’t served by traditional health care delivery. Our neighbors in the homeless community don’t access care the way the housed population does due to lack of health insurance, transportation, and trust in the health care system. Because everybody matters, it becomes our duty to bring health care to them, on their terms and in a way that fits with their lifestyle – all things that should be considered with all patients. We open clinics located inside homeless shelters and soup kitchens. Some people are hesitant to even come into these locations and, because those people matter too, we go to them. We deliver basic primary health care in shelters, the woods, under the bridges, or anywhere else people stay. All care is provided free of charge including medications, laboratory work and diagnostic studies. We can even draw labs in the woods if needed. The goal is to provide quality primary care on site.
Q: How did you become interested in working with homeless people?

A: My first exposure to homeless health care was while my wife, Corinne, was in physician assistant school in Chicago. Even though I didn’t have any medical training, they invited me to come along. I will never forget my first patient. I don’t remember why he came, but I remember him stopping in the middle of the story to say, “You know, I wasn’t always like this. I used to be somebody. I used to have steak every night for dinner.” My first thought was that no matter how much money people have, no one has steak every night for dinner. But my second thought revealed the real reason for his comment. He wanted me to know the he USED to be somebody, which meant he felt like a nobody. Being homeless is extremely dehumanizing; having to sleep on the street, beg for food and safety. I’ve had patients who I visited in the hospital after being assaulted who told be they didn’t fight back because they didn’t feel their life was worth fighting for. I want all people to see their intrinsic worth.
Q: Describe a typical day in LVHN’s Street Medicine program.
A: We really let the streets guide our day. We have a clinic every day, usually over lunch. The mornings and afternoons are dictated by phone calls from the community or the hospital for people who could use our help. We have clinics in Allentown, Bethlehem and Easton, and also cover all Lehigh Valley Health Network Hospitals so it can get crazy at times. No matter how crazy it gets, we always have fun.
Q: Is it hard to convince some homeless people to accept medical care? How do you break the ice in these situations?
A: At times it is hard to convince them to accept help for a variety of reasons. Many have become homeless because of violations of trust from people who they should be able to rely on, like parents or family members. Others have been promised help along the way and when it was repeatedly not delivered, it became easier to believe it will never be delivered. When you are constantly turned away from jobs, asked to leave park benches when you are just sitting for a moment, and told “no” when you ask for help, it hard to trust the next time help is offered. Some people see this a learned helplessness, but it’s really learned hopelessness, which is what we are up against. I try to maintain a consistent presence in their lives to rebuild that trust. I’m there for everything they don’t want others to see like the horrible conditions they live in, or the horrible food they are forced to eat. Despite it all, we continue to offer help. We work so hard to build that trust and it becomes the most valuable thing we can offer, much more valuable than the free medications we provide.
Q: What are some of the most common health concerns facing the homeless population, and what are some of the more unusual illnesses you’ve seen?
A: The most common health concerns are things that the rest of society thought were solved a century ago, like sanitary living conditions, clean water and food hunger. We often miss that because of how the definition of health care has evolved away from those basics and now focuses on things like blood pressure or diabetes, which is a good thing for society as a whole. In terms of chronic health conditions, the homeless are ill in general. The average life expectancy is about 49 years, with 38 percent having two or more major medical illnesses. Mostly those illnesses are the same as the housed population just more prevalent and usually untreated. Perhaps unique to the homeless population would be frostbite. Every year we have 3 or 4 patients with a limb amputation from frost bite. They also get unusual bacterial infections from bathing in streams or sleeping in the dirt, which wouldn’t be typical in a housed population.
Q: What can members of the Lehigh Valley community do to help our homeless neighbors?
A: That’s a great question. I think the number one thing would be to treat them like neighbors. Don’t try to reincorporate them in to society and realize they are already part of our society. As such, get to know each person like you would anyone else. Help to restore their dignity. Once you get to know the people out there, you will know more specifically what needs to be done. Our mission is to provide care for everyone, not judge who is worthy to receive that care. This can be extended to anyone who has a talent or a good that might be helpful in their lives.
—Laurie Mason Schroeder