She makes eye contact, asks how people are doing, and waits to see how they respond. The work takes medical knowledge, compassion, and loads of patience. Partovi wears normal street clothes with a little flair: She’s rarely without her dangling turquoise earrings and cowboy boots. Street docs try hard not to look like doctors at all: Withers often rubs dirt into his hair and clothes before hitting the streets. “If I’m with someone under a bridge in a snowstorm, they get the message that they matter,” Withers says. During 5-degree winter nights in Pittsburgh. On summer days so hot the pavement in Los Angeles seems to sizzle. “The cardinal rule is, you cannot wait for someone to come to you. “These are the most excluded, the most disenfranchised,” says O’Connell. The average life expectancy for those on the streets is under 50, compared to 78 for the general population. She then places dozens of pieces of gauze on top of the wound to catch the drainage, tapes up his arm, and hands him some antibiotics. She tells him it’s important to keep the wound clean and moist, but says she’ll change the dressings if he wants to come back. “It’s kind of germy in my alley,” he says. All the while, she’s giving instructions on how to change the dressings. Once it’s done, Partovi twists gauze into strips - they’re known as “Partovi twisties” in the street medicine community - and asks the resident to push them into the wound. She even demonstrates the technique in a YouTube video, not for the squeamish. She’s a pro at this: Her colleagues call her the Queen of the Abscess. She asks a resident who is shadowing her to probe a swab into the wound to see if it’s tunneling into the surrounding tissue. “You done yet?” he asks, clenching his teeth. “Oh yeah, we got half a cup out,” she says. She injects more painkiller and keeps pushing as blood and pus sluice into a plastic foam cup. Despite the lidocaine, her patient is groaning in pain. She then pushes down hard on the abscess. It’s so large, she has to pull really hard on the syringe to pull out fluid. Partovi injects the abscess with lidocaine to numb it and then unwraps a large, 60 cc syringe to drain it. “I couldn’t tolerate the throbbing,” he tells Partovi. The abscess on his left arm is the size of a navel orange and so painful he can no longer ignore it, so he’s come to a clinic run by Homeless Health Care Los Angeles, a nonprofit. He’s a heroin user, and his arms are scarred from needle marks and old abscesses - wounds that form when people miss veins, shoot through their clothes, or use dirty needles. He wears two pairs of jeans and has a long, salt-and-pepper ponytail. On a recent day, Partovi sees a 65-year-old Hispanic man who lives in a nearby alley, getting by on sweeping, recycling, and keeping watch over a few businesses. “You see things you had only seen in textbooks.” You really are in a disaster zone,” says O’Connell, who is president of the Boston Health Care for the Homeless program. “Wounds are festering, diabetes is out of control, cancer is metastasizing. There are high rates of mental illness and addiction. Homeless populations are racked with high rates of heart disease, cancer, liver disease, kidney disease, skin infections, HIV/AIDS, pneumonia, and tuberculosis. Street doctors tend to the country’s neediest and sickest. Jim Withers, who has ministered to the homeless in Pittsburgh for 23 years. James O’Connell, a pioneering street doctor who is also an assistant professor of medicine at Harvard Medical School. She has really been willing to take risks to take care of people,” says Dr. Andy Bales, recently contracted a flesh-eating strep and staph infection that cost him a bone in his foot. An acquaintance who also ministers to the homeless, Rev. Partovi has been repeatedly treated for the highly dangerous, antibiotic-resistant infection MRSA, which runs rampant on Skid Row. She treats them with dignity, often examining them without gloves. They come in with gruesome infections and abscesses hugely swollen with pus. Her patients are weary, damaged, and sometimes extremely dirty. She’s also the medical director of Homeless Health Care LA and works at Skid Row clinics, one connected to a needle exchange. Partovi, who has spearheaded the county’s smaller outreach efforts for years, joins the teams once a week. Exclusive analysis of biotech, pharma, and the life sciences Learn Moreĭying on the streets: As the homeless age, a health care system leaves them behind
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