Every Sunday morning at 8:30, a big white cargo van pulls up to Thomas Square. Students from the John A. Burns School of medicine and other volunteers follow. With stethoscopes around their necks and dressed in scrubs, they unfold plastic benches and lay out the essentials for the day–blood glucose machines, bottles of hand sanitizer, and boxes of gloves surround the cardboard carton of Starbucks coffee and snacks. After a small group huddle outlining assignments, the group of ten then waits.
Like any other first responder on this Sunday morning, they don’t know what the day will entail.
It wouldn’t be long before the houseless population would rouse awake. For a handful of patients, checking in with JABSOM’s H.O.M.E. Project volunteers are part of their Sunday morning routine. “H.O.M.E.” stands for Houseless Outreach and Medical Education. Dr. Jill Omori, MD, started the project in 2005.
“It was important for me to make changes in the medical school so students would have more opportunities to work with the underserved,” said Omori. “My ultimate dream was to have a clinic, and I thought it would take a long time to establish that, but everything happened within a year, and there was a lot of support from the students and the faculty. Everybody realized it was going to be good for the school and community.”
A Mutually Beneficial Project
Almost every day, the big white cargo van, named “The Erida,” after beloved physician Erida Reichert Klemmer, MD, takes JABSOM students out of the sanitized classrooms in Kakaʻako and into the real world. At Thomas Square, Chinatown, St. Augustines in Waikiki, or West Oʻahu, students work directly with the houseless. Their problems, mental and physical, which are so often overlooked by observers passing by in cars or walking down the street, are the center of attention at these clinics.
“A lot of the houseless individuals who come here don’t have insurance, so they can’t go to a traditional pharmacy and ask for medication. Our clinic removes a burden from their lives. They come to our clinic, get checked out, and can get their medications refilled,” said Princess Bonilla, a longtime H.O.M.E. volunteer.
It’s a win-win. Students get hands-on medical training and a real-life course in compassionate care, while some of the island’s most dire patients get the services they otherwise wouldn’t receive. Roxana Hu, a second-year medical student, was managing the clinic.
“When you operate in a free clinic setting, especially a student-run free clinic where there’s space to let you practice and learn while having mentors around you, I think it opens a different perspective on the needs of the community that you’re living in.”
Sometimes it can be as little as a fistbump, a listening ear, and a cup of coffee. It could also be as consequential as getting access to insulin or a surgery to remove skin cancer. In short, the H.O.M.E. Project is saving lives or at least prolonging them. The outreach has become a vital part of JABSOM’s identity, and shifts are now incorporated into the curriculum for all students.
“It was a pleasant surprise to be involved so early. One or two months into medical school, I shadowed while taking vitals on a patient and getting a quick medical history,” said Hu, who came from Colorado. “The hands-on experience is a reason I love JABSOM and why I wanted to come here. Putting yourself into the field is the best way to learn, but ultimately, we’re all trying to be better physicians, and you can’t do that if you’re not out there, talking to people.”
Caring for Patients as a Whole
On Sunday, most people were checking in for hygiene kits, which include shampoo, soap, a toothbrush, and nail clippers.
Others were in dire need of assistance. A little more than halfway through the clinic, a woman who was exhibiting psychiatric issues approached. Third-year students Chloe Asato, Ashley Shirriff, and Maveric Abella, calmly, confidently, and carefully assessed the patient.
“She mentioned she smoked methamphetamine and bath salts, so we have a substance use issue,” Asato said. “She’s mentioning possible sexual violence. She also had many cuts that did look infected. There were a lot of medical issues to address and psychiatric as well.”
Third-year medical student Chloe Asato provided a listening ear and helped keep the patient calm while classmates Shirriff and Abella checked the patient’s multiple wounds and performed a blood-sugar reading. All care was under the watchful eye of attending physician Dr. Cheynie Nakano, a JABSOM graduate, and a H.O.M.E. board member.
“The number of staff fosters cooperation and teamwork and allows us to target multiple patient needs at once,” Asato said. “I’ve seen many patients have mistrust, and it comes from their personal situations. First and foremost, we try to build rapport. In this case, we were trying to get her to a place where she was willing to accept the treatment from us.”
The patient was exhibiting erratic behavior at times, causing Asato to lean on her JABSOM training.
“I think we’ve all been fortunate to have finished our hospital clerkships, so we’ve had six months of this experience. Hopefully, we’ve learned from that, and we’re able to apply it to our patients here as well. I think JABSOM does a good job at trying to prepare us and make sure we’re looking at the patient as a whole and trying to take care of them the best we can,” Asato said.
Ultimately, the patient chose to go to a nearby Emergency Room, and JABSOM students escorted her to ensure she got there safely.
“A lot of it was the patient’s preference,” Asato said, reflecting on the 45-minute encounter. “We can do wound cleaning and wound dressings, but in this environment, a women’s well exam would not be something we could offer. In terms of comprehensive care, it would be best to go to the emergency room, and I think she was agreeable to that.”
The mobile clinic is stocked with all the items of a traditional brick-and-mortar clinic. Inside, an extensive supply of wound care materials, pharmacy supplies, and lab kits are an arm’s-length away for students and volunteers. As evidenced on this day, not all issues can be handled on-site. Patients are sometimes referred to one of H.O.M.E.’s four speciality clinics which provide dermatology, ophthalmology, women’s health and psychiatric services.
Saving Lives, Tackling Diabetes
Diabetes is a burden in Hawaiʻi, and it affects more than 10 percent of our population. Our houseless communities are no different. Bonilla explains that diabetes screenings are part of the routine check-in process.
“Many of them don’t realize they have diabetes until they come to our clinic. Fortunately, we have medical students who educate them about diabetes,” said Bonilla. “We have blood glucose monitors here which can read blood sugar. They might go home with medication and return in a couple of weeks to refill their medication. We can also continue to monitor their sugar level.”
Diabetes as a houseless person is hard to manage, and the H.O.M.E. clinic is typically their lone ally and refuge.
“It has to do with their situation. Many people get their medication stolen. Some come to our clinic because of distance restrictions. We also notice that some may be scared to go to a typical clinic because they don’t want to feel stigmatized, so it’s hard to control diabetes when you’re houseless,” Bonilla said.
GratitudeOn this Sunday, the H.O.M.E. volunteers would see fewer than a dozen patients. Lei Watson was one of them. Watson, who said she was houseless by choice, made her first visit to The Erida van. She was seeking a snack and a hygiene kit.
“I’ve never heard of this service before, but I’m glad it’s here,” she said.
The essential, life-saving services provided by JABSOM students and volunteers fill a critical gap in Hawaiʻi, and the students understand the importance of the mission.
“It’s great to make a difference, but I also realize and respect the responsibility we have. We are giving medical care. Knowing a patient’s health is in your hands comes with a lot of responsibility,” Hu said.
Asato was born and raised in Hawaiʻi and saw how the houselessness issue evolved over the years. On the cusp of becoming a physician, Asato is using her position to effect change one clinic at a time.
“Being able to give back to the community I live in has been a privilege. I’m working to change the stigma surrounding the houseless population. I think a lot of people are wary of interacting with them, but really, they’re people like us that need more help. I’m very glad Dr. Omori and the H.O.M.E. Project have been able to provide that for them, and I’m happy to be included in that as well.”