SOS Mobile Health Diary – Entry 1: Building a Foundation of Trust with our Patients
The weather was sunny and mild on a recent Thursday morning as the Share Our Selves (SOS) Mobile Health Unit — a converted RV fitted out with all of the equipment of a brick and mortar medical clinic — pulled up to the Huntington Beach Navigation Center. SOS Chief Medical Officer Dr. Jay W. Lee and Eligibility Supervisor Lidia Campos set up tables, chairs, and a pop-up tent, preparing to provide primary medical care to the residents of the homeless shelter.
“We’re here to be the trusted source of medical care for the homeless living in this shelter,” Dr. Lee said. “In the beginning [with homeless patients] there are a lot of questions like, ‘what are you doing here, who are you?’ and so we’re trying to build that trust so that we can grow our presence here over time.” At mobile health clinics Dr. Lee provides a medical assessment to the patients, sets up any follow-up appointments, and helps with referrals if a specialist is needed. He is usually helped out with blood pressure readings, weight checks, and data recording by a Medical Assistant and Physician’s assistant, but on this day all the tasks fell to him.
The navigation center, which operates through a partnership between the city of Huntington Beach and the nonprofit organization Mercy House, opened in December with 176 beds, although due to COVID-19 many of those beds are going unused. Residents get three meals a day plus snacks, a locker for their belongings, clean bathroom and shower facilities, and weekly meetings with a counselor to help them work towards getting permanent housing. It is one of the few shelters offering RV parking for residents, and there is also room for couples and pets.
The first patient of the day was Chris Patapoff. Chris was one of the first residents of the shelter and is grateful to be off of the streets. He is trying to get housing but is having trouble because he doesn’t have an ID card. “I can’t get my ID from the DMV without my birth certificate, but to get my birth certificate I have to go to LA and pay $40. I don’t have a car and I don’t have $40.” Additionally, due to the pandemic residents are only allowed to leave one day a week to go to appointments, shop, go to job interviews, or take care of any other business.
“I think that highlights the structural challenges that patients have when they are poor and unsheltered or homeless: things that seem routine for us, like going up to LA from Orange County, can be barriers that are impossible to overcome without significant effort and time,” said Dr. Lee. He said that the pandemic has made the situation worse. “The bottom line is that Covid has made it more complicated. Things that were already complex are more complicated now.”
Despite the impediments, Chris is optimistic about getting back on his feet and glad to have organizations like SOS delivering the services people like him need to persevere. “It went really well,” he said after his appointment. “I got a lot of information that I needed. You have all the medication that I needed. I was really impressed that you got my blood pressure, my other readings, you got all this good stuff. And you’re here every two weeks and I like that. So I’ll be back in two weeks!”
As the morning progressed, more patients received medical assessments from Dr. Lee as Lidia Campos checked on their eligibility for health insurance, food stamps, and any other programs they might be able to enroll in. Most are eligible for health coverage through Medi-Cal, although they may not know how to sign up or may be hesitant for a variety of reasons. “Some of the population doesn’t know what programs they’re eligible for, especially people who don’t have legal status. But if they have a chronic condition or urgent medical need they can always apply for it. However, they need to request it, and they need to know their rights and responsibilities for it.” Lidia is there to make sure they know what programs are available and guide them through the enrollment process, which can be daunting. She can assure them that SOS cares for everyone, regardless of their legal status.
Midway through the morning, Dr. Lee felt good about the day’s progress. Despite some technical glitches he was able to access the medical records system through wi-fi and make appropriate changes to the patients’ charts.
“We’re seeing a mix of things today,” Dr. Lee said about the patients’ health. “A lot of musculo-skeletal complaints, a lot of chronic diseases. I will say I think people sometimes underestimate just how motivated homeless people are to do the right thing for their health.”
Dr. Lee said it is often not a lack of effort that leads to poor health among the homeless, but issues they have little or no control over. “They often feel stuck because their food options are limited,” Dr. Lee said, “and I had a really good conversation earlier today with a patient that wanted to have more choice and ability to purchase healthier options. And so everyone is motivated and part of it is having that conversation and tapping into that as the way to get to behavior change.”
“It’s not that people are lazy,” that leads to chronic homelessness, Dr. Lee said. “They’re trying mightily and they’re just finding that it’s a Sisyphean task to take care of themselves.”
As the clinic continued, more residents came out to see what was happening. Some asked for appointments and seemed eager to tell their stories, some stood quietly near the periphery. “Tom” asked that we not take his photo but was happy to share his story. He lived with his father in a mobile home park until his dad passed away in 2011. After that, Tom was asked to leave because the park was for senior citizens and Tom was middle-aged.
He bounced around friends’ and relatives’ couches for a while, then lived with a girlfriend in a motel, but left when it was raided for drugs. Then he lived on the streets. He said he was told years ago by a doctor that the best way to manage his schizophrenia and delusions was restful sleep and low stress. When he lived with his dad he would practice table tennis six hours a day to keep himself calm. On the streets, he rarely slept and had to be on the alert at all times, which made it hard to keep his mental health problems under control.
For Tom, being homeless was immensely difficult. He learned that a wall with high bushes or a restroom with a lock were the best places to sleep safely. He learned many other hard lessons he didn’t want to talk about, and was happy and relieved to be living in the shelter. He’s hoping to move to permanent housing after his medical assessment from Dr. Lee.
“I was very impressed with Dr. Lee, even though he’s not related to Bruce Lee,” Tom said with a laugh.
Another clinic visitor, Jane, spoke to Lidia as the clinic was packing up. She was not looking for a medical appointment, but help navigating the Medi-Cal application process. She showed Lidia a folder full of forms, letters, and other documents, and said she was frustrated that she could not get anyone from Medi-Cal on the phone.
Lidia asked for information so that she could look up her case, but Jane became suspicious and combative. She said that she is acting as her own advocate and survived on the streets because she is tough and smart and not quick to trust just anyone. Once Lidia explained that she worked for SOS, however, Jane’s mood changed. She smiled and said she had come to us for help before and had been treated very well.
“They blessed me with food. They blessed me with a Target card when I needed underwear, and I needed it. They blessed me with clothes. They got me plugged in to domestic violence recovery. There’s love there.” Jane asked that people who hear her story or see her on the street not judge her, but pray for her. “My name is Jane. I am homeless now but I am homeward bound. I’m not my circumstances. I didn’t make a foolish decision. What I need is to work a part-time job to function in this society. And I’m going to do that.”
As Dr. Lee retracted the canopy on the RV and prepared to leave the shelter, he reflected on the day and what he has learned through his time working with the homeless. “We were busy! This was the largest number of patients we’ve seen in a half day. I think our steady presence here is paying off.” He said many of the challenges facing the homeless such as access to medical care, dental care, behavioral health services, and more will be alleviated once SOS is able to link them to our clinics, where those services are available.
“I’m just glad we’re getting a nice rhythm and cadence with folks and they’re feeling comfortable to come and see us. I think a big piece of this is being present where people need us. Ultimately what that means is being consistent, being kind, and in a way you have to be vulnerable yourself. We try to bring that level of service and kindness to the work and we’ll continue to bring that wherever we go.”