Stepping outside the unique hub composed of the University of Miami Miller School of Medicine and Jackson Hospital, it's not hard to find rows of tents, mats, and cardboard, where many of the underserved populations in Miami-Dade County reside.
In an effort to bring awareness and aid to such communities, Miami Street Medicine, a mobile clinic launched by Dan Bergholz, a third-year student at the Miller School, aims to make a lasting difference.
For Bergholz, street medicine was an initiative he wanted to bring to life since his college days at the University of Colorado. The experience that set the idea into motion was his interaction with an unhoused woman who lived nearby and was developing a small toe wound from her unmanaged diabetes.
Despite his efforts to help get her connected with a physician, the woman refused and ended up needing her foot amputated. Like many homeless persons, she faced barriers to care due to past traumas, disabilities, mental health, lack of insurance/ID, prioritization of basic needs and difficulty navigating the system.
The experience left a lasting mark on Bergholz desiring a call to action.“I soon learned about the creative and emerging health care delivery model called Street Medicine,” Bergholz said. “Dr. Jim Withers pioneered it to address the unique needs of the unsheltered population on their own terms and turf. It’s perfect for establishing a therapeutic relationship for folks like that woman. I consumed all the publications from the Street Medicine Institute and similar organizations, sought mentorship, and spent more time on the street until the pieces fit. I had found a passion in Street Medicine and applied to medical schools looking to start a program.”
Bergholz wasted no time starting the initial phase as he interviewed the unsheltered Miami population about their needs and strengths. It became clear that by identifying and treating those needs early and right there on the street, MSM would reduce unnecessary cost and suffering for everyone in Miami.
Instilling High Standards
From the start, Bergholz knew to instill the same high standards of care expected in the hospital or clinic setting. The materials and internal structure would be detailed in over 200 pages of policies and protocols to guide the clinic. It would take thousands of hours of diligent back-end work before launching Miami’s first street medicine clinic.
“I created Miami Street Medicine hoping it might serve as a model for the power of loving compassion,” Bergholz said. “On the first day of medical school, I asked the class if they were interested and was fortunate to assemble a brilliant team. We got to work refining our services and the systems to sustain them.”
While this free clinic model is hard to argue against, MSM couldn’t stay tied to its former parent organization due to disagreements on the function and future of the clinic. COVID-19 put them at an impasse resulting in the clinic being cut nearly two years into production, losing funding, insurance, supplies, and 501(c)3 status, all at the height of the pandemic.
Starting over was a major challenge, but it ultimately allowed MSM to rebuild the way it was intended. While rebuilding, MSM gained faculty support of Armen Henderson, M.D., M.B.A., assistant professor of medicine at the Miller School, and founder of the Dade County Street Response. MSM previously collaborated with DCSR for their COVID-19 street response efforts providing outreach medical care, tents, and COVID testing.
One of the collaboration highlights resulted in fundraising a full-service shower site in St. John’s Missionary Baptist Church located in the underserved community of Overtown. It was open for eight to 12 hours a day for eight consecutive months serving thousands of people throughout the pandemic. Besides showers, the site served as a testing area where more than 500 people were tested, along with the distribution of 500 tents, masks and thousands of pounds of clothes/food/supplies.
“Dr. Henderson and I reconnected to discuss MSM’s situation and the shared vision for an ambitious social service organization,” Bergholz said. “He invited me to co-chair his nonprofit, DCSR, and bring the street medicine team and clinic infrastructure over there. We got to work together, more determined than ever to restructure both programs for a formal merger.”
Together, they’re continuing to demand a health care model that embraces everyone — even if they have to make and remake it themselves.
MSM in Action
Presently Miami Street Medicine offers wound care, health screenings, medications, and case management. The team is serving local encampments every week with hundreds of curbside consults this year. Rather than moving too quickly and overpromising their targeted population, the organization focuses on building a sustainable clinic with the highest standards of care.
MSM isn’t only focusing on immediate needs, but going deeper to challenge the stigma homeless populations face. Most recently, Sabrina Hennecke, third-year M.D./M.P.H. student at the Miller School and head voice of advocacy work for MSM, wrote an opinion piece for the Miami Herald where she tackled the criminalization of homelessness. She points out how rather than offering opportunities to get people off the street, the city is more focused on distributing signs, make threats and trashing personal belongings while scattering people needlessly.
“At best, unsheltered individuals have become invisible people,” Hennecke said. “At worst, they are condemned to a life of disability, and stigma, forgotten by a system built not for them but despite them. We aim to advocate for this population and our patients in any way we can. We want to amplify their voices on issues through further opinion pieces, resolution writing, policy pushes, and collaborative work. We are doing education and training seminars for medical professionals, aiming to raise awareness, and understanding of the unique demands and needs unsheltered patients can have.”
MSM plans to use its momentum to research local barriers to care, ED utilization and offer a “Street Classroom” elective for the Jackson Emergency Medicine Residency program. They are also building out the disaster relief street medicine response with the whole DCSR coalition. Other plans for the clinic include hiring full-time case managers, offering mental health support, vaccinations and organizing a mobile unit for more robust services, such as women’s health.
“Overall, though, the strategy is simple," Bergholz said. "Continue going to the people, building trust, filling the cracks between existing pillars of support, and making careful improvements to our services. Love for our neighbors on the street is always the mission.”