Student Reflection: Impact of Covid-19 on the Homeless

As the pandemic continues to surge on one year after the first case of Covid-19 was diagnosed in America, certain individuals continue to be affected disproportionately. This virus does not discriminate between those who have means to protect themselves and those who live day-to-day not knowing where their next meal is coming from or if they will be safe and warm overnight. The unsheltered population is particularly vulnerable to Covid-19 as their barrier to healthcare is already higher than those with a roof over their head.

When I had a high-risk Covid exposure, I was able to immediately isolate in my room, with ready access to online grocery delivery and a warm bed to rest in. I could give my immune system the best shot it had to fight. When healthy, I work with the homeless population weekly at Tampa Bay Street Medicine (TBSM) Clinic. When I got sick, I reflected on how different my experience would have been without the comfort of the indoors and the ability to Google any symptoms I had to get a better understanding of the disease. It is sobering to think about vulnerable individuals, helpless and often overlooked, facing the challenges of a global pandemic that has already taken more American lives than World War 2.

Unsheltered Covid-19 patients have more adversity to good health outcomes than patients with similar symptoms at any other point in recent history. Although research on Covid-19 is being churned out as fast as possible, we simply don’t have long term data to guide treatment options for these individuals. The constellation of symptoms associated with Covid-19 is ever-evolving, broad enough to include everything from fever, myocarditis, and dermatologic manifestations to chronic fatigue and dysautonomia.

People suffering from Covid-19 have to weigh the benefits of isolating and taking time off work versus the risk of being unable to feed their family. Others must navigate telehealth visits without a computer. They may pay exorbitant fees to have the latest treatment regimen while receiving inpatient hospital care, only to see the research tout a new drug as the mainstay for preventing long-haul symptoms a few months later. Many jobs can transition to work from home, but many also require in person interactions and will never be able to fully operate from behind a screen. What happens to individuals who develop chronic fatigue but are the sole breadwinner for their family from their healthcare income? Will the entire family then become unsheltered and find themselves on the street?

These times are unprecedented, and it is vital for healthcare workers to take into consideration the physical and mental strain that the socioeconomic impact has on Covid-19 patients, particularly the unsheltered. Our vaccine distribution efforts should actively include the homeless population when we think about individuals over the age of 65 years and those with chronic medical conditions.

Through TBSM, we try to get masks, basic hygiene supplies, socks, over the counter medications, and medical attention to those on the street who will otherwise go without. We are currently in the process of registering patients for the vaccine to be administered in a couple weeks. While the vaccine is an exciting initiative, seeing how grateful our patients are for masks and socks always puts my problems into perspective. Because of this pandemic, being mindful of our patients who may not have a home to go to after leaving the hospital is of greater importance than ever before from both a public health and humanistic standpoint.

Kim Menezes is a third year medical student and current Vice President of TBSM. She previously served as a TBSM Clinic Director.

The TBSM Refugee Clinic Origin Story

During the summer of 2019, I attended a national family medicine conference and witnessed a panel of international medicine physicians talk about their interests and jobs. When we got to the Q&A portion of the session, someone asked the panel what they loved the most about their jobs. One physician responded that she recommended to each person in that room to find an aspect of medicine that they loved and were passionate about, and to capitalize on it throughout their career. This was something beyond a person’s chosen specialty; it was a unique inspiration or passion shaped by experiences and interests. She gave examples of this being certain goals like universal healthcare or specific branches of medicine like narrative medicine, or even particular demographics.

I have always been very passionate about was refugees and the care they receive upon entry to their new countries. Growing up, I had both family and friends who were displaced and became refugees, particularly from Syria and Palestine. This population endures constant distress and oppression – from the dangers they experience in their homelands and the struggle of leaving what they love to the challenges of finding safety, entering a new country, and rebuilding their lives. I have met doctors and engineers who were forced to work in gas stations when they arrived in their new home. I have met women who left their mothers or siblings behind with the horrible knowledge that they would never see them again. These people had their entire lives turned upside down and there was so little being done for them. This patient population is my passion.

When I returned to Tampa, I started doing research on how I could volunteer and provide some form of medical care to refugees in the community. I found a Tampa Bay Refugee Task Force meeting and attended, hoping I could learn more about which opportunities were available. I spoke with Janet Blair, head of the Task Force, after the meeting, where she explained the state of medical care for this population. Upon entry to the U.S., refugees are given a maximum of eight months of Medicaid before they are expected to find a full-time job with benefits or live without any form of insurance. At the time, no free clinic or programs were in place to assist with this disparity in the Tampa Bay Area. Upon learning all this, I met with Dr. Lynette Menezes, Director of the International Medicine Scholarly Concentration, Janet Blair, and Dr. Lucy Guerra, Co-Director of BRIDGE Clinic, to discuss how to combat these health inequities. After many more meetings and phone calls with various refugee service providers in Tampa, it was determined that the best course of action was to create a free, volunteer-run clinic for refugees and asylum seekers without any form of health insurance.

Now the job was to create a free clinic and determine the logistics, location, and volunteer base needed. The best course of action was to attempt to operate under an existing USF Health organization, and we decided Tampa Bay Street Medicine would be a great fit. TBSM has a long history of helping underserved communities in Tampa through various initiatives run by student volunteers. As for location, the generous Dr. Marian Menezes, a pulmonologist and BRIDGE Clinic physician, facilitated a partnership with Advent Health. We decided the clinic would be held once a month in the evening, when physicians and medical students could volunteer their time. With the logistics settled, the other pieces started to fall into place. Many medical students who heard of this initiative offered their services to volunteer and I began to create different roles for various medical students to help the clinic run. Students were needed for scheduling, clinic check-in, patient visits, and follow-up; moreover, we were providing all of these services in Swahili, Arabic, and Spanish??. Soon, we began to get patient referrals and eventually had our very first refugee clinic on February 26, 2020. The clinic offered comprehensive medical visits, prescriptions, labs, imaging, preventative care, and hygiene kits.

The growth of the clinic was challenged by the COVID-19 pandemic. We had only run our first clinic before COVID-19 limited our activities. At this point, medical students were no longer allowed to see patients, which required us to find more volunteering physicians while the students attempted to make everything else run smoothly. Despite many hurdles, we gradually became more efficient and grew substantially.

Today, we have 14 primary medical student volunteers, a pharmacy volunteer, and several attending and resident physicians who volunteer regularly. In addition, we have four upperclassmen medical students who volunteer each month to provide direct patient care, helping them further their medical knowledge and cultural competency with this patient demographic. We also have a clinical psychologist, Dr. Amber Gum, who provides free mental health services at each clinic. We are constantly striving to improve, with our next projects hopefully including collaborations with the USF Psychiatry residency program and the USF Health Physical Therapy school.

This clinic has faced several challenges since its inception, but due to its dedicated and passionate volunteer base, it has thrived and become an invaluable resource for refugees and asylum seekers in Tampa Bay. True to those words of the initial panelist, this clinic has shown that passion and commitment to what we love is the key to fulfillment and long-lasting change.

Grace Benmhend is a third year medical student at USF Morsani College of Medicine and TBSM Refugee Clinic Director.

Happy Holidays from TBSM!

Thank you to all who supported TBSM throughout this challenging year. Here's to a healthy 2021!!