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Dr. Jim Withers is a Street Medicine pioneer. He founded Operation Safety Net in 1992 to offer a profoundly different experience for both the providers working on Street Medicine teams and people experiencing homelessness. His goal is to create healing human relationships grounded in “reality-based healthcare,” which meets people where they are in life.

Dr. Jim Withers was looking for a starting point to build healing relationships on the streets of Pittsburgh. He wanted to begin from the outside. He circumvented the hospital system and found someone to learn from: “Mike,” a man homeless for 7 years. Dr. Withers began Operation Safety Net, part of the Pittsburgh Mercy Health System and Catholic Health East, in 1992.

“I tried to put aside all of my own preconceived notions and absorb where this man was at,” says Dr. Withers. It turned out to be a very different experience from what he expected as he explored and searched for other people living in shelters and at sites where care was delivered. Ultimately, he relied on Mike and together they built a Street Medicine outreach group based on his experiences and observations.

“This is a journey you have to go on. You have to make a choice. Do you go on to the truth? Or do you keep your nose clean? Do you really ground yourself in someone else’s reality and move toward reality-based healthcare?” explains Jim.

At first, Mike requested that Dr. Withers keep his status as a physician hidden until he became part of the fabric of the homeless community because there was a great mistrust of doctors at the time. He disguised himself to blend into street life, stayed quiet, and became an observer of the environment and the people. He operated in this manner for months before inviting nurses to participate. At that point, they began active medical service outreach as a team to assess needs and provide care, including referrals to hospitals and additional necessary services and housing.

The process was organic in nature. People experiencing homelessness were happy to work side-by-side with medical professionals as equals. Dr. Withers shares the powerful story of one man he encountered, whom he calls “Richie”:

He was alone and slowly destroying himself, but appreciated our company. He was coughing. I was afraid he had tuberculosis. I wanted to get him care. We tried different ways to help him. . . . One night it was raining. I did not want to walk and I was thinking about Richie. He felt that he was the garbage that he slept among. To me that was an important concept and I suggested to my colleague, Mike, “Let’s see if we can facilitate something different.” We took the garbage bags away that surrounded his place on the street. . . . I remembered that someone had donated carpet. We got the carpet and laid it down. Carol came back and gave him a haircut and a tetanus shot. He had a bottle with flowers. During this process, he stopped drinking. He got into a facility in 5 weeks. We went to visit him for an evening. We asked him about his family photos and he said he had left them. We returned to get them. He just stopped and really looked at the place and said, “How could a human live in a place like this?”

So, here is a person flailing, angry, and barely surviving. He needs grace and for someone to say, “I love you just the way you are.” Operation Safety Net offers this compassion and love as a way off the streets.

As a healthcare professional, Dr. Withers wants to create a place for students to practice reality-grounded work, a practice that transcends books. He sees that the street is one of many possible avenues for this journey. The need is overwhelming. People living on the street are who they are and what they are. They are human and require a human response. He talks about the value of “companioning,” or allowing the people he walks with to guide him in the healing process. Being within visual distance of someone allows for engagement; bonding is essential. He describes “liberating yourself and the patient from the structure of systems.”

Dr. Withers candidly warns that lines can blur in field work and there are vulnerabilities to merging into life on the street. He explains that you can lose your bearings and sense of self; it is important to have the support of people who share the same value system. He continues, “On the street it is vividly important to let people know that you respect them and that you are listening. Those things are like water in the desert. You just have to sit on your hands and make it clear that you are listening and that they are being heard. It is just magic. The most angry people transform.”

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SAMHSA
2011
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