Guest column: Doctor's work on homelessness shows what medicine can be

I was excited to read Tracy Kidder’s new book, "Rough Sleepers: Dr Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People."

Kidder wrote my favorite work of nonfiction, "Mountains Beyond Mountains,"which profiled Paul Farmer, founder of Partners in Health, a doctor who did pioneering public health work in Haiti and other places, with spirit, humor and tenacity. This latest book is not dissimilar in that it portrays a physician, this time working with the chronically homeless in Boston.

Kidder is adept at immersing the reader into the worlds of his subjects. He writes how, as a young medical resident, O’Connell was asked to defer a coveted fellowship and spend a year bringing health care to Boston’s homeless. One year turned into two, two into his life’s work.

O’Connell started out soaking homeless people’s feet, a humbling experience. Traveling the streets in a van equipped with hot soup, warm socks, and medical professionals, he learned that winning the trust of people living on the streets was difficult, but essential.

Kidder introduces us to a number of "rough sleepers," their struggles, their strengths. There’s Tony, a huge man who spent years in prison, survived a childhood of abuse, and now lives on the streets, using his strength and essentially benevolent outlook to protect others, while struggling with his own drug addiction.

The hope is to find housing for many of these men and women. But the undertaking is fraught both with regulatory challenges, and personal ones. Many people don’t want to live alone in an isolated, unfamiliar apartment building. Some invite their rowdy friends over to spend time with them and end up getting kicked out.

“Because they had routinely avoided doctors and hospitals, many homeless patients had problems that required complex, time-consuming interventions,” Kidder writes. “This was true of every homeless person who had TB or AIDS, and of those with maladies grown dire from years of neglect, such as the old man with the hernia that hung below his knees. Jim spent hours in conferences with surgeons planning the successful repair. And virtually every patient had social problems: Women arriving at the shelter clinics with bruised faces, broken bones, whispering in tears about abusive boyfriends; men and women telling him they were sick of the drinking life and asking him to find a detox for them.”

O’Connell and his team treat high blood pressure, diabetes, broken bones, frostbite, and cirrhosis. The team offers a clinic, and a "respite," where people can spend a few days getting their lives together, resting, eating well, and being listened to and cared for. Life on the street, of course, is frightening. There’s violence, abuse, the constant temptation of addictions, the threat of freezing to death in Boston’s harsh winters. There’s also joy, camaraderie, sacrifice, and all of the life challenges any human being faces.

Nineteen cities received grants to build Health Care for the Homeless Programs in the early 2010s. The assumption was that the homeless problem would be taken care of after four years. Those like O’Connell who took on the challenge sought continuity of care, not fragmented medicine, for their patients. Their mandate was to seek out homeless people wherever they were and follow up consistently, integrating their program with the city’s medical system.

Kidder describes how community plans to help the homeless in Boston were often eclipsed by development and sprawl. He looks back at the origins of the current era, a severe recession in 1980 inaugurating this period of rising homelessness. Returning Vietnam vets, the closure of psychiatric hospitals, a decline in jobs for unskilled workers, redlining, evictions and epidemics all complicated the picture.

Noting the Reagan administration’s attacks on Black welfare mothers, Kidder writes such attitudes had deep roots in Western attitudes toward poor people generally and especially Black poor people. Reagan even claimed homeless people preferred the streets to living in shelters. It’s true that living in shelters poses challenges for many. But what if they had their own homes?

From a handful of clinicians seeing 1,200 patients, the program grew in 10 years to 43 clinicians and 10 times as many patients. There were always objections to providing this care, such as from those who claimed that people who worked, paid taxes, and struggled to pay for their own health insurance shouldn’t have to pay for care for people who lived at public expense. In fact, O’Connell claimed the program lightened the burden the homeless placed on other medical organizations. As he said, “‘We’re making up for what wasn’t done for our patients. What you didn’t provide — schools, jobs, safety.’”

According to Kidder, O’Connell exhibited a fondness for all of his patients. “He had a knack for ‘pre-admiration.’ His presumption was, ‘Oh, I’m eventually going to like this person. I will find some reason, I just happen not to know it yet.’”

This reflected his opinion that the person, not the system, must come first. In this age of managed care and Medicaid privatization, O’Connell’s view that “medicine is not supposed to be efficient” may sound unfamiliar, but it sure hits home.

Andy Douglas is the author of "Redemption Songs: A Year in the Life of a Community Prison Choir" and "The Curve of the World: Into the Spiritual Heart of Yoga."

This article originally appeared on Iowa City Press-Citizen: Opinion: Doctor's work on homelessness shows what medicine can be