Street Medicine with The Night Ministry

by Suzanne Hanney / photos by Kathleen Hinkel

It’s 9:48 p.m. on a Monday night in February and the downstairs lobby of the CTA Blue Line terminal at Forest Park is set up for The Night Ministry’s street medicine program. On one side is a table manned by peer support advocate Keith Belton (a former StreetWise vendor), who is distributing “survival supplies”: socks, underwear, water, sandwiches, hygiene kits, harm reduction equipment and, when available, donated shoes, tents, backpacks or sleeping bags. On the other side behind the privacy screen is senior nurse practitioner Stephan Koruba. In the middle of it all is volunteer Kenneth Burnell, serving soup.

Many people may be familiar with the large bus that The Night Ministry takes to various neighborhoods on set nights. Since 2015, the street medicine program has used a smaller van to literally meet people where they are at encampments and stops around the city. The CTA program is an offshoot that began in winter 2020 and grew in response to reduced shelter capacity during the pandemic, which led to more people sleeping on the L.

From April 1, 2020 to March 31, the combined street medicine/CTA outreach program provided 1,109 free health assessments, treated 308 conditions that would have otherwise gone without care and prevented 75 emergency room visits. The programs also handed out 11,053 meals and 6,529 hygiene kits.

Mondays and Wednesdays from 9 p.m. to 1 a.m., the street medicine program will see an average of 120 people at the Forest Park terminal and 80 to 100 people at the 95th Street end of the Red Line. Forest Park draws more people because the Blue Line route from O’Hare to downtown and out to the near western suburb allows more time for uninterrupted sleeping. As soon as a train pulls into Forest Park, two security guards walk its length and invite sleepers to come downstairs for food and services. They don’t even have to come through the turnstile, which would mean another fare.

A social worker who is also a notary can help people get identification cards and birth certificates and sign them up for stimulus checks. Case manager Sylvia Hibbard describes the street medicine staff as a team, “a little family that forms a circle around each client.”

The nurse can help with wound care, blood pressure checks, as well as HIV, Hepatitis C, syphilis and COVID-19 testing — and now the vaccine. Long term, the hope is to connect the patient with a medical home: a primary care physician or health clinic that is accessible to them and can provide ongoing care. Mile Square, a federally qualified health center at 1220 S. Wood St. on the University of Illinois medical center campus, is one option.

Harm reduction materials start with Narcan nasal spray, an emergency medicine to reverse heroin overdoses, which Noam Greene, lead street medicine outreach worker, likens to an “EpiPen.” Short plastic straws are used for snorting; alcohol prep pads prevent skin infections; cotton takes the dust out of the drug; sterile water can be mixed with the drug in a metal cooker similar to a tealight, which is also included.

HIV and Hepatitis C are two of the main diseases that can be transmitted through blood via shared needles. Dirty needles can also lead to skin infections at the injection site or in blood sepsis that can lead to heart problems. That’s why clients at both at the CTA and the regular street medicine program receive clean needles – “rigs” – and sharps containers for used needles. Later on, the team will accept the filled containers, which are bagged up and taken back to the office as medical waste.

“Mental health issues and addiction go hand-in-hand,” Koruba said. “Many, many homeless people have it. It’s hard to say which comes first. A lot of folks get out here and start using to dampen the cold, the miserableness, the loneliness.”

Treatment to break opioid dependency with the drug Suboxone is a new facet of the street medicine program. Access to Suboxone improved with the U.S. Food and Drug Administration’s approval of a generic in 2018.

“As addiction is increasingly viewed as a medical condition, Suboxone is viewed as a medication for a chronic condition, such as a person with diabetes needing to take insulin,” Peter Grinspoon, M.D., wrote in a Harvard Health blog in 2018.

Since the COVID pandemic, insurance programs no longer require in-person visits and will pay for telehealth, which means that the street medicine clients can do their required psychiatric visits by cell phone and pick up the supplies from the street medicine crew.

The street medicine team generally visits a scheduled list of encampments, Greene said, but it can also respond to an emergency call. “The most important thing is we respect the client’s autonomy and don’t force them to make decisions we think are right. That helps build trust long-term.”

“Most of all, we build relationships with them so they know they can come to us, so we can do the next step, whether it’s housing or medical, or anything,” Koruba said.

The wonderful thing about the CTA program, Koruba said, is that it was suggested by Belton, who has experienced homelessness.

Belton was taking the L at 5:30 or 6 in the morning to his 7 a.m. spirituality class, switching from the Red Line to the Evanston-bound Purple Line. “I kept seeing these people on the L so I went to my boss. I knew they needed resources.”

The CTA coordinates the logistics and the Chicago Department of Public Health supports the Monday and Wednesday Red/Blue line program as part of a two-year, information-gathering pilot on people who are not connected to formal or informal supports in Chicago. The combined average of 200 people nightly makes the twice-weekly visits at the two stations the city’s second largest shelter, Koruba said.

Mental illness is still a cause of street homelessness, along with poverty, not enough housing, not enough work, Belton said. “Sitting on top of it is the pandemic, making it even worse.

“If we could just save one person out of 1,000 it would be great. We have to remember not everyone is ready for this. They don’t trust people. They got walls up; they’ve been hurt so bad, they won’t let the walls down.”

Belton was a StreetWise vendor in 2012 at the Walgreens on Clark street and Wilson avenue. Simultaneously, he was volunteering with Heartland Alliance, passing out flyers. He had gotten sober in prison, before coming to StreetWise. Eventually, Heartland was flying him to different states because he was on its community advisory board and board

of directors. He had also spoken to the National Health Care for the Homeless Council. He was teaching a class that included personnel from The Night Ministry and in the process was offered a job.

He started as a volunteer to make sure he felt comfortable with its corporate culture, “because I’ve been in the streets all my life. My mom was an addict and alcoholic. We went from apartments to abandoned buildings because of the drug use my mom was doing.”

Belton’s walls started coming down with Heartland Alliance.

“I was able to talk to them, let them know my feelings. They just welcomed me into their waiting room after I spent all my money. Their hearts were still open to letting me in. I could see that kindness and people who care. I got me a case manager and started dealing with the situation. Even though I went to prison, this time I didn’t even ask for treatment. The door just opened, and I said instead of being a destroyer of my community, I could be a builder. As soon as I came out, I started volunteering, staying away from friends, not visiting my family. My whole lifestyle had to change.”

Phil Baron, 54, has been coming to Forest Park since its inception. “I sleep on the train and just happened to show up at the right time the first night. They had soup. I was speaking with Stephan and he directed me to getting a LINK [food stamp] card.” Phil also relies on the program for hats, gloves, clothes and food.

Phil ordinarily sleeps in a tent in the woods, but in the worst weather he buries his suitcase and takes a blanket onto the Blue Line. He’s a carpenter but when winter comes around, the work drops off and the rent stops getting paid. “With the pandemic, no one wants you in their house.” He panhandled to support his heroin habit, which takes a minimum of $20 a day.

Having been homeless in 10 different states, Phil likes Chicago. “Even in the bad neighborhoods, there’s good people. If you’re not a racist and open-minded, they can see that. If you’re scared and got a problem with race, they’re going to see that too.”

Burnell is a professional chef at Columbus Manor, a residential mental health facility. He was feeding the encampment at the Chicago and Albany avenues Metra underpass when he met Koruba and the street medicine crew as they were distributing Narcan. Burnell promised soup for Mondays and Wednesdays in Forest Park when it got cold. He makes a thick, old-fashioned, homemade mixture of chicken thigh meat, noodles, organic celery and carrots.

Burnell says he’s tried other soups, but people complained they can’t eat tomatoes, can’t eat beef, can’t eat pork and never heard of minestrone. Chicken soup is simple.

“They can be particular, which I get. They’ve had a rough life. People think they can treat them any way. You’ve gotta love them until they love themselves.”

“It’s always good; it’s wholesome,” said one street medicine client.

“It’s not that salty, you won’t catch blood pressure and diabetes and it will fill you up,” said another.

A full-time student at DePaul University and a full-time chef, Burnell plans to graduate in 2022 and go to the University of Chicago Law School. He said he wants to give attorneys a better reputation in light of everything that has been happening to minorities in the past year. He’s also starting his own nonprofit, Souper Heroes, to feed people at the Clark/Lake station on the CTA Blue Line.

Meanwhile, Hibbard, the case manager, was listening to people’s stories to see what they need. Someone who wanted to get into a shelter had called three times. It was a long shot, Hibbard said, because with COVID the shelters had to take in fewer people in order to social distance. “It’s always been hard, but COVID made it 10 times harder.”

Outside on a Wednesday afternoon in March with the regular street medicine crew at the Chicago/Albany underpass, for example, there are 18 tents on the south side of the street, 10 on the north.

In 2018, Jill, 49, and her husband Rick were the first people at this encampment, after staying at Lower Wacker Drive, which Jill termed scary. Before that, they had rented for six months and then stayed at a friend’s house for a month. Rick picked the Chicago/Albany underpass because it was an empty, newer bridge with lots of foot traffic.

“The more people come through, the safer you are,” he said.

Jill said they lost their house in 2017 due to foreclosure. She had been on long-term disability from 2010 to 2016 for a herniated disc in her back and neck; Rick was in real estate. Before that, Jill had been a claims adjuster for litigation, fraud and injury. Right before coming to the underpass, Jill got MRSA pneumonia, ultimately cured by antibiotics. But she was hospitalized for two months and had three lung surgeries.

The Night Ministry street medicine program helps them with clean rigs and food; they also use the program as a mailing address. The program helped put them on the list for housing a year ago. Because of her lung surgery and the pandemic, she said she is on an emergency list.

A street medicine caseworker also helped Jill get her Social Security card and birth certificate, both lost between the foreclosure and City crews coming for monthly street cleaning. Their tent and meds were lost four times.

“We received our stimulus check,” Jill said. “They signed us up for it, did everything. I love them, they don’t judge.”

The program also saved her husband’s arm, she said, after he had surgery and the stitches popped. He had developed an infection, where you could see down to his bones.

Another stop that Wednesday night was at the Ewing Annex Hotel, 426 S. Clark St. Although not an encampment, the men are considered unstably housed, Hibbard said, because their names are not on a lease. And while encampment residents get drop-off donations of food and blankets, the hotel residents don’t.

Manager Mike Bush said that roughly 60 percent of the hotel’s population is men over age 50. Many are day laborers and others are on Social Security. After paying rent ($19/night, $120/week, $360/month ) there isn’t always much left over.

Bush called The Night Ministry street medicine program “a huge asset not only to the city but to people who don’t have access to medical assistance. Some of them are forced to go without medical help to pay rent, so that small issues could turn into big ones that didn’t need to. And when people come by, offer up a sandwich or fruit, it’s a huge blessing."

Leo Milner, 68, asks to have his blood pressure taken. It’s normal. One man also learns from Hibbard how to access his veterans’ benefits.

The van makes a stop at State and Madison streets because of a request on its dedicated phone line.

Aaron Brinkman, MD, a volunteer for the last several years, said he had treated a facial abcsess — a frequent malady — that night. He called in a prescription for topical antibiotics and gave the patient an initial supply in case he couldn’t get it.

He also treated a nail fungal infection, and gave someone else an inhaler.

Respiratory infections account for a lot of Brinkman’s cases, thanks to the environment: bird droppings and exhaust on Lower Wacker Drive, for example. Congestive heart failure is a result of excessive alcohol use. Endocarditis, in which bacteria enters the blood stream and seeds the heart valves, can occur with long-time intravenous drug use.

“We’re accustomed to their style,” Brinkman said. “It’s not easy for them to get into a clinic and they’re not always treated well at a hospital. We’re not judgmental.”

Vincent Bobo, a client at State and Madison, said the street medicine program helps him with medication, foot care, toiletries, socks, underwear, clothes, shoes, fresh rigs, IDs, tents, sleeping bags, coats – “actually with everything. A lot of times when I didn’t have insurance, they helped me out with an inhaler. I tell people to donate to them because they really put their heart in it.”

Bobo, 50, has been homeless for nine years while in and out of prison. He said he sneaks into public restrooms to wash up, change clothes and shave, so that people do not even know he is homeless. He is on a housing list and hoping to hear soon.

Bobo sleeps under a downtown bridge, but in extra cold weather, he rides the L. Sometimes he catches the street medicine crew at Forest Park.

Back at Forest Park in March, Nick, 37, said the street medicine program does a good job. “It helps to get food, stay safe with what we do.”

With harm reduction supplies for drugs?

Yes, Nick said. He has ridden the trains in the two months he’s been homeless, “since everything fell apart on me. I lost my home, job, family.”

Nick said he’s not yet ready to get off drugs and supports himself as a panhandler. He receives a sandwich and bottle of water, socks and underwear from Belton.

Socks and underwear help, said another man, because when you wear the same clothes for weeks staying on the train without a shower, at least you can change the innermost layer.

“Right now I ain’t got no job,” said a 54-year-old man. “I will get some food here ’til the work picks up. I do painting and dry walling. I am going to go to Home Depot and try to get work now.”

Dan said he comes to the street medicine program for something to eat. He subsists by panhandling and paying to stay with a friend. Otherwise, he rides the trains or goes to a shelter. At almost 60, he’s been homeless for five years since his mother died and the family sold her home. He has been on the list for housing for six months.

Nurse practitioner Carole, meanwhile, has just finished treating someone’s feet. It had been raining, and homeless people always have their shoes on, so their socks get wet. It’s something that housed people take for granted.

The street medicine program provides whatever they need when they can’t access medicine, Carole said, from seizure disorders to refills on diabetes or blood pressure medicine that they can call in to a pharmacy. It might even be as simple as ibuprofen for an aching back or knees that they couldn’t otherwise afford.

“It’s a bridge to services,” she said. “We point people in the right direction.”

Phil from February is sitting on a bench. His whole demeanor is lighter.

The street medicine program got him off heroin. Suboxone was supplied through his Blue Cross and picked up on a Wednesday night. Twelve days was all it took. He’s been sharing this information with Blue Line sleepers he meets.

“It’s tricking your body. You don’t even know you’re being good to yourself. I haven’t bought dope for two days.”

People do heroin the first time to get high, Phil said, but after three days in a row, they’re hooked. They continue using it only so they don’t get sick. “The high is gone. Mostly you fall asleep. Then everyone steals your stuff. I lost three brand-new cell phones in two weeks.”

As a carpenter, Phil has a lot of clients. Now, he said, he can go back to work without having to worry about being dope-sick. Yes, he would have to keep on taking suboxone. Possibly, he would need some other itch to replace heroin. Maybe weed.

“Maybe get married and have kids,” he said.