Taking Health Care to the Streets

At first glance, Big Dave is a scary guy. Barrel-chested, with a long gray beard, the East Boston native wears a black hooded jacket decorated with skulls and looks a lot like a Hell’s Angel. In fact, he’s the local guardian angel.

“I had him straight for eight days,” says Dave, referring to a homeless alcoholic he personally led through the abyss of detox. Although the man’s relapse was a letdown, Big Dave doesn’t give up on his “guys,” most of whom are homeless and suffering from substance abuse.

“They’re a nice bunch of guys, just down on their luck a little bit,” he says, standing on the sidewalk bordering East Boston’s Central Park, where Boston University medical students park their outreach van every Thursday night.

“I watch over all of ’em like my own kids.”

Dave shares that job with the Outreach Van Project, founded in 1997 by students from the Schools of Medicine and Public Health. A rotating group of volunteers and a doctor provide basic health assessments — like blood pressure and heart rate checks — distribute food, clothing, and toiletries, and make referrals to other community services, such as detoxification programs and homeless shelters.

At one time, the project made stops in Cambridge and at Suffolk Downs racetrack. These days, the volunteers focus solely on East Boston, where they are the only street health-care provider serving the homeless, elderly, and immigrant populations — at least 40 clients each week. These people know that if they cancount on nothing else, the outreach van will appear rain or shine, every Thursday night

“They trust we’re going to be there,” says project cocoordinator Matthew Gonzalez (MED’12).

Brian Penti, a Boston Medical Center family medicine doctor, was one of the first project members. He acknowledges that the van can provide only limited care. The goal, he says, is to learn about clients’ lives, earn their trust, and persuade them to try other medical and social services.

“The project also teaches medical students that if a patient’s got a medical problem and is homeless, you’re dealing with a different animal,” says Penti, who volunteers regularly with the students.

Gonzalez sees the benefits: “If you’re going to be able to talk to these people about medical issues,” he says, “you can talk to anyone.”

On a chilly night in early April, the red Ford Windstar pulls up alongside Central Park. At least a dozen people move toward the van. The doors open and six students — dressed in jeans and sweatshirts, some sporting stethoscopes — set up shop.

They take out a folding table and plop down three, five-gallon buckets of soup, a bread tray, and bottled water. Some prep the back of the van, packed with plastic tubs of donated toiletries, canned and dry goods, and clothing (underwear and socks are big hits).

Within minutes, a group of people is huddled beside the van, holding to-go baggies or Styrofoam bowls of steaming soup. Others clutch shopping bags full of cereal, Ivory soap, and gently used sweatshirts. Students use broken Spanish and gestures to communicate with some clients.

Marie Hruska lost her job as a nurse’s assistant eight months ago, but counts herself lucky to have a home, savings, and a caring family.

“I saw them before I needed them,” Hruska says of the students, who prepare a bag of pantry goods for her. Although she’s never been unemployed before, she doesn’t pity herself. Being jobless here is better than it would be in her native Czechoslovakia. “Here,” she says, “people know how to help each other.”

Most people grab their meals or goods and leave. But half a dozen men hang around to chat with students, some of whom they know by name, and razz each other. Some are drunk or high; all are regulars.

Rooster has been on the streets for four years. Tonight he wears a Patriots cap and has a partial beard. He has broken blood vessels across his nose and a disturbing knack of crowing like a barnyard animal.

A student asks Rooster about his blood pressure. A tad tipsy, Rooster can’t remember. “Ask the doc,” he says, referring to Kelli Jarrett (MED’13). She pauses, blood pressure sleeve in hand, and says, “135 over 85.” Rooster seems pleased.

Freddy, another homeless client, saunters up. Big Dave slings a beefy arm around him and jabs at him for falling off the wagon. Freddy takes it in stride: “He’s like a father, a brother,” he says of Dave. “He drank with me years ago.”

A common clutch of medical problems afflicts street clients. Many suffer from high blood pressure, diabetes, substance abuse, mental illness, depression, sexually transmitted diseases, and for some, mostly immigrants, the after-effects of torture.

“What we’re doing out here is like a Band-Aid,” says Rachel Mott, a family medicine doctor and MED clinical instructor. “It’s an entry point into a more stable system.”

Considering the terrain, outreach volunteers have learned to count small steps as major accomplishments. Rooster, for example, is one tiny victory. He calls Penti his primary care physician, recently started taking blood pressure medication, and got up the nerve to make his first appointment with the doctor, for later tonight.

Despite the X-rated banter and nonmusical serenades, the scene on the street is calm. Pam Emmanuel (MED’09), a project cocoordinator, says they’ve never had to call police for protection.

“They keep it under control for us,” Emmanuel says of the van’s clients. “It’s bad for everybody if something goes wrong.”

When foot traffic slows, the students start packing the van. Clients take the cue to disperse; Freddy walks across the park alone, and another regular sits on a nearby bench, finishing his soup.

The outreach group heads to a parking lot across the street to rehash the night’s events. Mott briefs students on the medical condition of each client she saw. They talk about irregular heartbeats, withdrawal symptoms, and how to convince clients to seek medical help. Someone mentions the progress Rooster has made, making his first medical appointment, even if he never did show up.

The Outreach Van Project is grant-funded and always welcomes donations of clothing, toiletries, and nonperishable food items. Contact volunteers at 617-872-7782 or outreach@bu.edu.

Leslie Friday can be reached at lfriday@bu.edu; follow her on twitter @lesliefriday.