When Julianna Smith moved from Kingman, Arizona, to Phoenix to attend Arizona State University, she immediately noticed the homeless population. She wasn't used to seeing encampments in her hometown of 30,000 people. Instead of looking away, Smith wondered how she could help.
"My family is service-oriented. My mom's a teacher and my dad's a lawyer," she says. "When I worked as a nursing assistant at a hospital, I had conversations with patients who were in pain or bad situations and became comfortable talking to strangers about their life experiences."
While at Arizona State University, Smith got involved with an organization called Street Medicine Phoenix. She wanted to continue that volunteer work at Mayo Clinic Alix School of Medicine.
She found a kindred soul in fellow medical student Christopher Poyorena. The pair facilitated the school offering student volunteer opportunities with Street Medicine Phoenix, whose mission is to ensure quality health care for the city's homeless population.
Street Medicine Phoenix organizes students and faculty from the University of Arizona, Arizona State University and Northern Arizona University to bring services to people who are homeless. Student volunteers walk side by side with a physician on street runs, doing blood pressure checks, blood glucose screenings, wound care and general health checks, and dispensing supplies, including hygiene kits.
Smith and Poyorena didn't start from scratch. They built on the contacts fellow medical student Terence Meyerhoefer made when he tried to start street medicine volunteerism at the medical school a few years earlier.
Since the volunteer opportunity was introduced to medical students on the Arizona campus in fall 2021, more than 25 students have participated in street runs, and twice as many have signed up to participate in training.
"Our medical school class started during the pandemic and has had largely virtual education, so being able to interact with and help people in the community has been especially fulfilling for many of us," says Smith. "The homeless population has been hurt badly by the pandemic and is too often overlooked. They can benefit from the knowledge and skills we're learning as medical students. This is why I went to medical school — to serve people."
"You can relate to almost anyone's story and see how we're all just a few steps away from ending up in a bad situation."Julianna Smith
Smith says many of the people experiencing homelessness that she serves appreciate being cared for — something they may not get in other areas of their life. She describes one individual who needed a bandage and asked her to put it on instead of putting it on themselves.
"Even though it was a small act of service, it felt like the most important medical thing I did that day," she says. "When volunteers debrief and share experiences, we don't talk about how many wounds we bandaged. Rather, we talk about the nice person we met from Pennsylvania who moved here, had a traumatic experience and their support system fell through. Or the person who served in a war. You can relate to almost anyone's story and see how we're all just a few steps away from ending up in a bad situation."
Poyorena, a native of Los Angeles, can relate. He was a college student one semester shy of graduating when his life took unexpected turns. When he heard a man speak about his similar experiences, turning his life around and becoming a trauma surgeon, Poyorena felt encouraged to find his passion, engage in service and turn his life around.
Poyorena returned to school, became an EMT and had a series of jobs in the emergency department at Keck Hospital at the University of Southern California. He got involved in a friend's nonprofit organization to distribute Narcan to homeless people, among others. And he volunteered to help University of Southern California physicians at outreach free clinics.
"It would be arrogant to think you know them or what they need. We ask them how we can best serve them."Julianna Smith
"About a third of the patients in the emergency department were homeless. Many people pretended not to see them, but I love them," says Poyorena. "You can't solve many of their problems, but you can listen to them. They just want to share their stories. I now have an opportunity to be a force to help them."
As a force behind the street medicine volunteer opportunity at Mayo Clinic Alix School of Medicine — Arizona campus, Poyorena says he would like the program to evolve into an official selective — something that will continue after he and Smith have completed medical school.
"We're at a privileged institution. It's good to get exposure to people who aren't the standard Mayo Clinic patients," he says. "We can show empathy and demonstrate to people who lack shelter that they have value and matter. Every student who has participated has said it's the best experience they've had in medical school so far."
Smith says the experience requires adaptability and constant learning.
"I've been involved in these efforts for six years and still don't know how best to serve the homeless population. It would be arrogant to think you know them or what they need. We ask them how we can best serve them. Sometimes they want flypaper or twine. Other times, they want backpacks or shoes. We deal with a lot of colds, flu and congestion, high blood sugar, and wounds from walking in bad shoes. We triage — referring some to a nearby free clinic and calling EMS when necessary," Smith says.
"My experiences have given me perspective and transformed me, no matter where or how I practice."Christopher Poyorena
"There's no continuity of care in street medicine," she says. "You do everything you can in that moment and hope it helps. There's no way to track them after that moment. We walk away from them knowing they need much more help than we can give."
Smith is considering a focus on critical care or cardiology for her career. Poyorena is set on emergency medicine and possibly an addiction medicine or critical care fellowship.
"My experiences have given me perspective and transformed me, no matter where or how I practice," says Poyorena. "I hope that by sharing these parts of myself and advocating for street medicine service, I'm helping my classmates and future medical students experience that same gift."
On the Rochester campus of Mayo Clinic Alix School of Medicine, street medicine is a new longitudinal selective, in conjunction with the Zumbro Valley Medical Society — a nonprofit professional membership organization serving 3,000 physicians and physicians-in-training in southern Minnesota.
In the first selective group, 28 first- and second-year medical students are getting firsthand supervised experience working with homeless people on their own turf over nine months. The students participate in classroom training at the Rochester Community Warming Center, which provides emergency shelter for adults who are experiencing homelessness.
"We went under bridges and into the woods, and I leaned into my discomfort."Yonghun Kim
Zumbro Valley Medical Society provides the training, which includes gaining trust, building rapport, hearing personal stories of people who have experienced homelessness, practicing how to work with people experiencing chemical dependency or mental illness, learning about housing policies and programs, discussing homelessness among youth and providing support.
Before students interact with homeless people in a medical capacity, they spend time volunteering in related nonmedical environments, including preparing and delivering meals to clients at The Landing MN, a nonprofit organization in Rochester that helps people who are experiencing homelessness with housing assistance, medical needs and other services.
The clinical service students provide includes working in the clinic at The Landing. Walter Franz III, M.D., Mayo Clinic Department of Family Medicine, along with a faculty mentor team, provided the students with hands-on practical training in first-responder critical skills.
The selective was student-initiated. Jeffrey Woods heard a Zumbro Valley Medical Society-sponsored talk by Jim Withers, M.D., founder of the Street Medicine Institute, and wanted to get involved on a local level. He joined forces with classmates, including Yonghun Kim and Tatsumi Yanaba, to start the movement to develop the selective.
Woods had volunteer experience with a needle exchange program in San Francisco. Kim volunteered in a free clinic in the Bay Area.
"I hope we'll all see the homelessness in our communities and feel inspired to be of service in whatever capacity we feel drawn to."Jeffrey Woods
In Rochester, they and other medical students participated with county and community representatives to collect data for a census — going to areas where unsheltered people live.
"We went under bridges and into the woods, and I leaned into my discomfort," says Kim. "I think it's important for us to experience the unconventional environments where people who don't have reliable shelter live. The advocates we accompanied already had relationships with many of these individuals, which made me realize the importance of relationship building with our community partners — our most valuable allies in this work."
Doing the census work, Woods noticed people living under a bridge by a drugstore he frequents. "They were always there — I just hadn't noticed them," he says. "Now I see them.
"I've always felt moved by helping people who need it or may be part of a vulnerable population. Through my experiences, including living in rural China for a year, I've built skills to feel comfortable with people in difficult circumstances," Woods says.
"I went into medicine because I want to treat people in a way that makes them feel safe, understood and whole when they experience illness, trauma or loss, or are socially marginalized. Nothing feels more purposeful than that. When I heard Dr. Withers speak about street medicine, it was the most inspired and moved I'd been since starting medical school. Building relationships with the community to help, heal and comfort those shunned by society is, for me, the pure spirit of medicine and a pure act of service," he says.
Getting Mayo Clinic medical students and leadership on board was one of the easiest things he's ever done, he says, and a testament to the kind of people who work and learn at Mayo Clinic.
"I hope we'll all see the homelessness in our communities and feel inspired to be of service in whatever capacity we feel drawn to," he says.
Tags: Christopher Poyorena, Dr. Walter Franz III, Jeffrey Woods, Julianna Smith, Mayo Clinic Alix School of Medicine, Medical Education Stories, Staff Stories, Tatsumi Yanaba, Terence Meyerhoefer, Yonghun Kim