20191127 贫民的医疗保险

ARI SHAPIRO, HOST:

When you're homeless, it's not easy to see a doctor. That's where street medicine comes in. It's an emerging practice, and it can be found in dozens of cities, including Atlanta. That's where Sam Whitehead of member station WABE followed a medical team that visits patients living on the streets.

SAM WHITEHEAD, BYLINE: It's late afternoon, and a van filled with medical supplies idles near an interstate overpass in Atlanta. Herman Ware is getting a flu shot.

HERMAN WARE: Oh, it might sting. Yup, I figured that (laughter).

WHITEHEAD: Ware filled out some paperwork, and a nurse wishes him well as he heads back to the nearby homeless encampment.

UNIDENTIFIED NURSE: Take care.

WARE: I will.

UNIDENTIFIED NURSE: Got that flu shot out the way.

WARE: Yeah, all right.

UNIDENTIFIED NURSE: (Laughter).

WHITEHEAD: This is street medicine. Four days a week, Mercy Care, a local health clinic, sends teams to spots in the city where homeless people gather. Nurse practitioner Joy Fernandez de Narayan runs the program.

JOY FERNANDEZ DE NARAYAN: When we're coming out here to talk to people, we're on their turf.

WHITEHEAD: That means she can never assume anyone wants her help, whether that's a vaccination or something simpler like a bottle of water.

FERNANDEZ DE NARAYAN: We'll sit down next to someone like, hey, how's the weather treating you? - and then kind of work our way into, like, oh, you mentioned you had a history of high blood pressure. Do you mind if we check your blood pressure?

WHITEHEAD: She says it can take several encounters to gain someone's trust and get them to accept medical care. That persistence is how the team helped Sopain Lawson recover from a foot fungus she caught while living out here.

SOPAIN LAWSON: So I couldn't walk, had to stay off my feet. And the crew - they took good care of my foot. They got me back.

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WHITEHEAD: Matthew Reed has been doing social work with the team for the last two years out here among the sounds of trains and rapid transit lines.

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MATTHEW REED: This is what street medicine is about is, like, going out into these areas where people are not going to seek attention until it's an emergency, so we're trying to avoid emergencies. But we're also trying to build relationships.

WHITEHEAD: Those relationships can also connect people to other services such as counselling or housing. Dr. Jim Withers is medical director of the Street Medicine Institute, which works to spread the practice. Withers started making house calls to the homeless with a clinic in Pittsburgh in 1992.

JIM WITHERS: Health care likes people to come to it on its terms. And the philosophical central point of street medicine is go to the people.

WHITEHEAD: Doing that work in Atlanta costs Mercy Care about $900,000 a year. The street medicine team gave direct treatment to some 300 people in 2018. Many of them got help multiple times. That helps traditional hospitals, which Withers says aren't great at treating the homeless.

WITHERS: They're still sick. They're still coming to the emergency rooms, and we're not dealing with them well. And we're - they stay in the hospital longer. They have more complications.

WHITEHEAD: And that isn't cheap. One recent estimate says Atlanta's homeless population racked up more than $60 million in medical costs that were passed on to taxpayers. Mercy Care says their program makes homeless people less likely to show up in local emergency rooms and healthier when they do. That's good for them and for taxpayers.

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WHITEHEAD: It's twilight. The final stop for Mercy Care's team is a church in Atlanta. A handful of people settle down for the night on the sidewalk. Among them is Johnny Dunson, a frequent street medicine patient. He says the team helps everyone who needs it.

JOHNNY DUNSON: You got to let someone know how you’re feeling, you understand me? Sometimes, it can be like behavior, mental health. It's just not me, you understand me? It’s a lot of people that just need some kind of assistance to do what you’re supposed to be doing, and they do a wonderful job.

WHITEHEAD: Dunson says the street medicine team gives him help and respect. He says living out here, it can be hard to find either.

For NPR News, I'm Sam Whitehead in Atlanta.

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SHAPIRO: This story comes to us from NPR's reporting partnership with WABE and Kaiser Health News.

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