Healthcare for vulnerable populations

Roseanna Means, a doctor who has provided care to Boston's female homeless population via street outreach for over three decades, views the pandemic through the lens of homelessness -- and "boy, it was very hard," she says. "I saw so much fear and uncertainty and so much hopelessness and despair." During the worst of the Covid-19 surges, dressed in full PPE, Means provided medical care to hundreds of homeless women whose rate of infection was 35%, higher than the state average. "It was very scary," she says. And with many overnight shelters fully shut down as a result of the pandemic, "we knew there were a lot of women who weren't seeing us but needed us." As a result, Means, the founder of Health Care Without Walls, decided this year to open her first freestanding health clinic for homeless women in downtown Boston, a block from Boston Common. She raised $80,000 through a Broadway-themed fundraiser in February, and officially opened the doors this summer. "We're open 9 to 5," she says, and a team of nurse practitioners, physician assistants and doctors provide "gap" care to women unable to access mainstream medical systems. Her staff also helps women apply for housing, Medicaid and other benefits. Boston has about 4,000 homeless women, Means estimates, and many are dealing with chronic diseases like asthma, diabetes, hypertension, emphysema or rheumatoid arthritis -- not to mention a host of issues unique to women. "Women face a lot of trauma on the streets, and a lot of harassment. They get bullied, they get beaten up, they get raped, they get held up at knifepoint," Means says. The pandemic, with its lockdowns and closures, has created even more upheaval for the homeless population. And many more women have joined its ranks, due to job loss and other financial hardships. "The thing that I saw that is the hardest is the number of new faces," says Means, including women in their 60s, 70s and 80s who are on the street for the first time. "They were evicted despite the eviction moratorium." Especially at the start of the pandemic, when most shelters closed and women were unable to access their usual safety nets, "I was pretty helpless," says Means. "I think everybody suffered, whether you are a provider or a receiver of care." A Career Dedicated to the Homeless Means, who is also an attending physician at Brigham and Women's Hospital and an associate professor at Harvard Medical School, has long been dedicated to the homeless population. The one-time candy striper left Bennington College in the 1970s to pursue pre-med studies at Massachusetts Institute of Technology, eventually graduating top of her class at Tufts University. During her residency, right after the Vietnam War, Means volunteered with the International Rescue Committee to help Cambodian refugees in Thailand who had fled the brutal dictator Pol Pot. "I worked in the emergency tent at this camp," she recalls, seeing things like landmine injuries and amputations without anesthesia. "It's just the kind of thing that they don't teach you … certainly not in medical school." When she came back home, she canceled plans to specialize in cardiology. "I just thought, OK, I want to do something that's going to help people who have lost everything," she says. "I wanted to take care of disenfranchised people." Means began volunteering at homeless shelters in Boston, juggling that with setting up and running her own practice in primary care women's health. She was naturally drawn to the needs of homeless women -- and gradually began to understand that some women, especially those who have suffered abuse, fear being at shelters or clinics with men. In 1999, Means founded Heath Care Without Walls as a 501(c)(3) to focus exclusively on the needs of vulnerable women and children. The nonprofit is funded through grants and donations, currently operating on a $1.5 million annual budget. While she and her team spent years providing health care via street outreach or shelter visits, she began to think about opening her own clinic. And then, "the pandemic accelerated that decision," Means says. When Covid first hit, "we were cut off, but we knew there were a lot of women who weren't seeing us but needed us." After searching for a space, she signed a 3-year-lease earlier this year and just completed an extensive application process that will allow the clinic to someday help people needing substance abuse treatment. For now, the clinic is providing free health care to women who, according to Means, never "wanted to be living this horrible lifestyle." The women she helps have "a piece of my heart" -- and that's what keeps her going. "What people don't think about is that this could be you or me," she says, "because life is fragile, finances are fragile, rents are high, the cost of living is high. And that's what I say to a lot of people: There but for the grace of God go any of us."

Healthcare for vulnerable populations

A Boston Doctor Opens a Clinic to Help the Pandemic’s Most Vulnerable Homeless Women

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