Working the streets

BY AMBER SMITH

David Lehmann, MD, was focused on how best to provide medical care to the homeless. He was aware of 60 “street medicine” programs around the world, most based at academic medical centers. He was intent on launching the 61st at Upstate.

So, Lehmann attended community meetings to learn about Syracuse’s homeless population and how he could start helping the men and women living on the streets. Also at the meetings was John Tumino, the former chef/owner of Asti’s restaurant who operates In My Father’s Kitchen, an outreach service that distributes lunches and other necessities to homeless people.

As a meeting wrapped up last spring, Tumino leaned over to Lehmann. “Hey, Doc,” he offered, “I could just take you out.”

That’s how Lehmann found himself riding shotgun in Tumino’s van, the side of which bears the message: “You are not invisible. Building hope. Changing lives.”

Throughout the warmer months, Lehmann brought medical care to the homeless twice a week, alongside Tumino’s distribution of lunches. Lehmann is building the infrastructure of a street medicine program. Eventually he would like to involve medical students so that he can seed the next generation of street medicine providers. For the time being, as Tumino describes, “He’s out here doing it, learning the cracks in the system.”

On a recent weekday, Lehmann settles into the van with Tumino and his employee Kat Schofield. Before they head out, they update one another on the people they hope to see that day. Then, they bow their heads. Tumino speaks: “Thank you, Lord, for this opportunity to hit the streets today. Give us wisdom to give a soft word and a soft touch to someone who is in need.”

Since 2011, 21 homeless people have died in Syracuse. Some were murdered. Some overdosed. Some perished in a fire they started to keep warm. Some succumbed to disease. In its seven years of existence, In My Father’s Kitchen has helped 105 homeless people find housing.

Lehmann hopes he can help make a difference. Most of what he provides is routine medical care: blood pressure monitoring and medication, treatment of infections and such. Colleagues of his from Upstate’s department of psychiatry and behavioral sciences participate in similar fashion, offering addiction treatment and psychiatric interventions.

They are all familiar with statistics that show the longer a person lives on the street, the greater his or her risk of death.

Beyond the physical care he provides, Lehmann’s medical diagnoses can be used to help some people qualify for supportive housing and get off the streets, Tumino explains.

They stop to check on a man who lives in a tent off of Interstate 81, not far from the Destiny USA shopping mall. They park and follow a dirt trail to his campsite. (Days later, the man would be attacked by someone with a brick who would steal his bicycle. During his hospital stay recovering from the attack, the man’s campsite would go up in flames. And, an apartment complex owner reading news coverage of the man’s plight would contact Tumino to offer housing.)

Blocks away at another campsite, Tumino and Lehmann call out for the occupant. Over the summer, this man developed a painful cyst on his backside. He sobbed with gratitude when Lehmann drained the cyst and Tumino supplied clean underwear. But he’s nowhere to be found today.

Later, the van drives by a man holding a sign at the end of a highway off-ramp. Tumino pulls into a nearby parking lot and signals to the man. It’s someone who has been homeless off and on since age 16, and who grappled with alcoholism for many years. He’s 49 now and recently lost his spot at the Salvation Army shelter when he arrived a half-hour past curfew.

The man climbs into the back of the van. Tumino pours coffee and produces a container of pasta — his grandmother’s pasta sauce recipe with his meatballs — with steam still accumulated on the lid.

Using the In My Father's Kitchen van as a patient room, David Lehmann, MD, examines a homeless man's wounds.

Schofield gathers gloves and boots for the man, who is wearing wet sneakers — along with two hoodies, a flannel shirt, denim jacket and a Jets hat.

Lehmann prepares to check his blood pressure.

The man reports that he is staying clean but has nowhere to go. “There is no one that I know that I can go to that don’t do drugs.” He says he’s had trouble getting a job because he lacks a birth certificate.

Tumino tells him that he will pay to obtain a copy of his birth certificate.

The man is stunned. “You would do that?”

Tumino and Schofield assure him they will, and soon Schofield and the man are at the Onondaga County Office of Vital Statistics.

Blocks away from Dinosaur Bar-B-Que, another man holding a sign stops panhandling when he sees the van. He settles into the back, next to Lehmann, who checks his blood pressure and examines some bumps on his arms and neck. The man receives a pair of size 10 boots along with coffee and pasta from Tumino. Lehmann phones in two prescriptions for the man; Tumino makes plans to retrieve the medications and deliver them to him the next day.

Lehmann sees parallels between the needs of people who are homeless in Syracuse and the people he has helped during international relief trips to Nepal, Kenya, Ecuador, Puerto Rico and Haiti over the years. “Both are underserved, indigent populations that have no health care or spotty health care,” he says.

Teaming up with someone who already had the trust of the homeless community made sense, and Lehmann appreciates how Tumino invited him to tend to medical needs while he distributes lunches. In a community as small as Syracuse, Tumino says efforts like this can help in meaningful ways.

They haven’t solved homelessness — at least 35 people in Syracuse sleep on the streets, plus others stay in shelters run by Catholic Charities, the Rescue Mission and Salvation Army — but they make incremental improvements in the lives of individuals.

Instead of being discouraged at the end of the day, Lehmann says, “you look for the little wins”: The freshly obtained birth certificate. The medicine that keeps a man’s blood pressure from climbing too high. The boots that replace wet sneakers and will keep a man’s feet warm tonight. ●

A PORTION OF THOSE who are homeless grapple with mental illness and/or addiction. So psychiatrist Sunny Aslam, MD, is establishing a program to provide psychiatric care and addiction treatment to the homeless.

He collaborates with David Lehmann, MD. Both began volunteering their services through the street outreach organization In My Father’s Kitchen as a way to reach homeless people who refuse services at shelters.

Aslam, an assistant professor at Upstate who specializes in addiction medicine and pain management, distributes his business card at shelters and with advocates for the homeless. He and psychiatry colleagues offer to help people who want help getting off drugs or need treatment for various mental illnesses.