Helping the Homeless

A recent study by the Committee on Health Care for Underserved Women revealed that women and families are the fastest growing segment of the homeless population, with 34% of the total homeless population composed of families and 84% headed by women.

Over the course of a given year, nearly 15,000 people are homeless in Washington, D.C., a majority of them women.

A lack of access to health care has been a profound issue for the homeless population, with data showing that approximately 73% of homeless individuals saying they have had at least one unmet health need, including medical, surgical, mental health, vision, or dental care or unmet prescription needs.

Homeless women often lack important and necessary preventive care, including prenatal care, mammograms, and Pap tests and also exhibit higher rates of poor health status, mental illness, poor birth outcomes, and mortality.

Unity Health Care has made it a mission to help the homeless population. It’s Community Health Center’s outreach program for the homeless was originally founded back in 1985 as Healthcare for the Homeless, one of the nation’s first 19 Healthcare for the Homeless projects.

“Dr. Janelle Goetcheus, our founder and chief medical officer since the beginning, had the belief to meet our patients where they were, so rather than building a big clinic somewhere and hoping or accepting that our patients would come to us, we really wanted to go to where we knew our patients to be already,” says Catherine Crosland, Medical Director for Homeless Outreach Services at Unity Health Care. “As the medical and political landscape of DC has changed over the years and the public hospital DC General was closed, in conjunction with the Department of Health and a number of other partnerships, Unity Health started to focus on DC’s uninsured and underinsured population more generally.”

Each week, clinicians go to numerous areas in the District to provide primary care services to the most hard-to-reach individuals who are homeless. Individuals who are homeless receive free, confidential services including education, counseling, and testing for HIV/AIDS, sexually transmitted diseases, hepatitis B and C and tuberculosis, and medical and case management services.

One of the first clinics it set up was in the basement of the CCMB Shelter, which is the Center for Creative non-Violence, still the biggest shelter in DC down at the corner of 2nd and D Street NW.

“There are about 1,200 beds at that shelter, and we have a clinic right there in the basement, which is probably our largest site that serves folks experiencing homelessness,” Dr. Crosland says. “At the site, we have multiple medical providers on any given day as well as a number of specialists, including a dermatologist who comes once a week, an OB-GYN who comes once a month, case managers who are essential in helping meet the social needs of our patients, a dentist who sees folks five days a week, and a podiatrist who comes once a week.”

Additionally, Unity runs a number of outreach sites; clinics that are much more rudimentary where there’s no physical clinic space, but often a provider with a bag that has certain resources like a blood pressure cuff, a glucometer and some basic medications for women who don’t have medical insurance.

“We go to breakfast programs and dinner programs and we either do street medicine, where we approach folks on the sidewalk, in parks, under bridges, in various encampments throughout the city where we know folks to be, and just try to engage folks in their health and find out if they are attached to primary care and get a basic history,” Dr. Crosland says. “We recently were able to get some iPads so that in some cases we are able to access their electronic medical record from the street, which has been a huge help, because it used to be that I would see somebody and only find out after I got back to the clinic and was entering their notes into our electronic medical record that the person actually had HIV and had been out of care, and I hadn’t been able to make that connection with them because I didn’t know.”

One of the issues that affects homeless women is the threat of violence and many of the female patients have experienced physical, sexual violence—both random acts of violence as well as incidents from people that they know.

On any given day, Dr. Crosland could see a patient with breast cancer, one who is pregnant, one addicted to tobacco or alcohol, and many who are suffering from a mental illness.

Recently, she saw a young woman at Pat Handy, the newest women’s shelter in DC, who was so depressed that she tried to commit suicide. She was found in the shower unresponsive and was taken to a nearby hospital.

“When I saw her, all she wanted to do was get into a drug treatment program, but because of problems she was having with not having the right identification, she couldn’t get through the front door of the Addiction Prevention and Recovery Association,” Dr. Crosland says. “When I saw her, I actually FD12’d her, which means I sent her against her will back to the hospital because I was still concerned that she was in such a desperate place that she would do something to harm herself. And from there, she then got into the Psychiatric Institute of Washington to help with her depression.”

There was another woman from Bosnia who came to the U.S. on a tourist visa and decided to stay and is now living at Union Station. She had such bad swelling in her feet and blisters from having slept on a bench that she was having trouble walking. Dr. Crosland was able to provide help.

Weather-related issues are also a problem, and many women suffer from hypothermia, trench foot (which can lead to gangrene) and nosocomial infections such as scabies, lice and bed bugs. 

“We see a fair number of abnormal Pap smears, when we’re able to get them,” Dr. Crosland says. “Not everybody is accepting to screening tests for various reasons including past sexual abuse and trauma, as well as mental illness, but we do see a fair number of abnormal Pap tests, and that’s why it’s really wonderful that we have an OB-GYN who comes in once a month and she can do the colposcopies for those abnormal Paps.”

The program is vitally important and one that Unity continues to advance as it looks to improve the health of as many homeless women as possible, with the hope that one day, the problem will not be so severe.

For a list of shelters where Unity provides healthcare services, visit https://unityhealthcare.org/homeless-services/