PHOENIX — Alfred Handley leaned back in his wheelchair on the side of a major Phoenix highway as a street medicine team helped him rehydrate with an intravenous saline drip dripping from a bag hanging from a pole.
Cars passed under the scorching 96 degree morning sun while the 59-year-old homeless man with a nearly toothless smile got the help he needed through a new program run by the nonprofit Circle the City.
“It’s a lot better than going to the hospital,” Handley said of the team providing health care to homeless people. He has been mistreated in traditional clinics and hospitals, he said, more than six years after he was hit by a car while sitting on a wall, leaving him in a wheelchair.
Circle the City introduced its intravenous rehydration program as a way to protect homeless people from life-threatening heat illnesses as temperatures regularly reach triple digits on the hottest subway in America. Homeless people counted nearly half of last year’s record 645 heat-related deaths in Maricopa County, which encompasses the Phoenix metro area.
Dr. Liz Frye, Vice President of Institute of Street Medicine which provides training to hundreds of health care teams around the world, said he knew of no other groups besides Circle the City administering IVs on the streets.
“But if that’s what needs to happen to prevent someone from dying, I’m willing to do it,” Frye said.
Like summers get hotterhealthcare providers from San Diego to New York are being challenged to better protect homeless patients.
Even the Boston Homeless Health Care Programfeatured in last year’s book, “Rough Sleepers,” now sees patients with mild heat exhaustion in the summer after decades of treating people with frostbite and hypothermia during the winter, said Dr. Dave Munson, medical director of the rough sleeper team. .
“It’s certainly something to be concerned about,” Munson said, noting that temperatures in Boston reached 100 degrees with 70 percent humidity during the June heat wave. Homeless people, he said, are vulnerable to very hot and very cold climates not only because they live outdoors, but they often cannot regulate their body temperature because of medications for mental illness or high blood pressure, or because of substance use on the streets.
The Phoenix team searches for patients in homeless encampments in dry riverbeds, choking alleys and along the canals that bring water to the Phoenix area. About 15% are dehydrated enough to receive saline.
“We go out every day and find them,” said nurse Perla Puebla. “We take care of wounds, refill medications for diabetes, antibiotics, hypertension.”
The Puebla street team found Handley and 36-year-old Phoenix native Phillip Enriquez near an overpass in an area frequented by homeless people because it is near an establishment offering free meals. Across the road was a camp of tents and outhouses along a chain-link fence.
Enriquez sat on a patch of dirt as Puebla began to drip at him. She also gave him a prescription for antibiotics and a referral to a dentist for his tooth infection.
Living outdoors under the scorching Arizona sun is difficult, especially for people who may have mental illness or use sedating drugs like fentanyl that make them less aware of their surroundings. Stimulants like methamphetamine contribute to dehydration, which can be fatal.
Temperatures this year reached 115 degrees (45 Celsius) in metro Phoenix, where six heat-related deaths were reported. confirmed until June 22nd. Another 111 are under investigation.
“The number of patients with heat illness increases every year,” said Dr. Aneesh Narang, assistant medical director of emergency medicine at Banner Medical Center-Phoenix, which treats many homeless people with heatstroke.
Narang’s team frequently works with Circle the City, whose primary mission is to provide respite care, with 100 beds for homeless people who are unable to return to the streets after a hospital stay.
Extreme heat around the world requires a dramatic response, said physician assistant Lindsay Fox, who cares for homeless people in Albuquerque, New Mexico, through an initiative led by from the University of New Mexico School of Medicine.
Three times a week, Fox treats infections, cleans wounds and manages chronic illnesses in consultation with hospital colleagues. She said the prospect of more heat illnesses worries her.
Highs in Albuquerque could reach the 90s and not drop low enough for people living outdoors to stay cool at night, she said.
“If you’re in an urban area that’s mostly concrete, you’re trapping heat,” she said. “We are seeing heat exposure that can very quickly develop into heatstroke.”
Severe heatstroke it’s much more common in metro Phoenix, where Circle the City is now among several homeless health programs in cities like New York, San Diego and Spokane, Washington.
Circle the City, founded in 2012 by Sister Adele O’Sullivan, doctor and member of the Sisters of Saint Joseph Carondelet, currently has 260 employees, including 15 doctors, 13 physician assistants and 11 nurses. It serves 9,000 patients annually.
Grants, donations and other gifts represent about 20% of funding. Most of the remainder comes from insurance payments for services provided through Medicaid and Medicare.
Circle the City works with medical teams at seven Phoenix hospitals to help homeless patients receive further care when they no longer require hospitalization. It also has two outpatient clinics for monitoring.
“This partnership allows us to provide the best outcomes for our patients,” said Craig Orsini, social services manager at St. Joseph’s Hospital and Medical Center in Phoenix.
Often it’s a few weeks of respite care or, for less urgent needs, a stay in one of the few medical beds at the downtown shelter for things like changing wound dressings. Someone who needs months to heal may go to a skilled nursing facility.
While patients recover, Circle the City works to find long-term transitional shelters, such as those for people 55 and older, or permanent housing. About 77% of respite patients are sent somewhere other than the street or an emergency shelter.
“We try to find the best option for people,” said Wendy Adams, community outreach supervisor for Circle the City.
Circle the City’s medical staff distributes tens of thousands of bottles of water every summer and tries to educate people about the dangers of hot weather, said Dr. Matt Essary, who works at one of five mobile clinics that park outside cafeterias. social and other services for homeless people.
Essary said Circle the City is also considering a blood analysis tool to detect electrolyte imbalances caused by dehydration.
“You can immediately see how dehydrated they were because it’s very difficult to draw blood,” he said. Other possible symptoms include headache, extreme thirst, dizziness and dry mouth.
“We also see a lot of people with superficial burns,” Essary said of the common injuries in scorching Phoenix, where a medical emergency or poisoning can cause someone to fall onto a scorching sidewalk.
Rachel Belgrade waited outside Circle the City’s converted truck with her little black-and-white dog, Bo, for Essary to write a prescription for the blood pressure medicine she lost when a man stole her bike. She accepted two bottles of water to cool off as the morning heat increased.
“They make this whole thing easier,” said Belgrade, a Native American from the Gila River Tribe. “They don’t bother you.”
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