Five days after giving birth, Melissa Crespo was already back on the streets, recovering in a damp, litter-strewn water tunnel, when she got the call from the hospital.
Her baby, Kyle, who had been born three months prematurely, was in respiratory failure in the neonatal intensive care unit and fighting for his life.
"This is a really impoverished community and the big thing right now is maternity care and prenatal care," said Kyle Patton, a family doctor who leads the street medicine team for the Shasta Community Health Center in Redding, about 160 miles north of Sacramento in a largely rural and conservative part of the state.
Street medicine isn't new, but it's getting a jolt in California, which is leading the charge nationally to deliver full-service medical care and behavioral health treatment to homeless people wherever they are. "Even if there is all the money and space to build it, local communities are going to fight these projects," said Barbara DiPietro, senior director of policy for the Tennessee-based National Health Care for the Homeless Council. "So street medicine is shifting the idea to say, 'If not housing, how can we manage folks and provide the best possible care on the streets?'"
Patton is treating Crespo for mental illness and addiction and has implanted long-acting birth control into her arm so she won't have another unexpected pregnancy. He has also treated her for hepatitis C and early signs of cervical cancer. Street medicine takes off Patton is a young doctor. At 39, he's on the leading edge of a movement to entrench street medicine in California, home to nearly a third of all homeless people in America. He has specialized in taking care of low-income patients from the start, first as an outreach worker in Salt Lake City and, later, in a family medicine residency in Fort Worth, Texas, focused on street medicine.
"We didn't even realize our system was denying those claims, so we updated thousands of codes to say street medicine providers can treat people in a homeless shelter, in a mobile unit, in temporary lodging, or on the streets," said Jacey Cooper, the state Medicaid director, who this month leaves for the Centers for Medicare & Medicaid Services to work on federal Medicaid policy.
"It's a better use of taxpayer funding to pay for street medicine rather than the emergency room or constantly calling an ambulance," said Katherine Barresi, senior director of health services for Partnership HealthPlan of California, which serves 800 homeless patients in Shasta County and contracts with Shasta Community Health Center.
Miller moved to Redding 15 years ago from Portland, Oregon, after losing patience with the homeless crisis there, and tries to help, handing out shoes and food."I get what they're trying to do," he said of street medicine providers. "But there's a lot of questioning in the community around what they do. There's no accountability."
County welfare agencies have little choice but to separate babies from their mothers when substance use or homelessness presents a risk to the children, said Amber Middleton, who oversees homelessness initiatives at the Shasta Community Health Center. She has overdosed "more times than I can remember," she said, and credits naloxone, an opioid overdose reversal drug, for saving her life repeatedly.
He also administered a pregnancy test and discovered she was already a few months along. "It's rough out here. There's no bathroom or water. You're nauseous all the time," Darby, 40, said. "I want to get out of this situation, but I'm terrified about getting clean, the detox, having my baby." But the prospect of getting clean felt daunting. Clifford, the father of her child, and an Iraq War veteran with a traumatic brain injury, had overdosed the previous day and needed five doses of naloxone to come back. "We saved your life, man," Patton told Clifford.
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