An initiative that started in 2021 to provide medical care to unhoused people in Kalamazoo has been able to greatly expand its services this year thanks to the addition of a mobile clinic.
Street Medicine Kalamazoo (SMKzoo), led by WMed faculty members Sravani Alluri, MD, program director, an assistant professor in the Department of Family and Community Medicine and Nic Helmstetter, MD, associate program director, an assistant professor in the Departments of Medicine, and Pediatric and Adolescent Medicine, earlier this year made a $175,000 investment in a 2018 Ford Transit van that is outfitted to serve as a mobile clinic to care for people experiencing unsheltered homelessness in Kalamazoo.
The purchase was made possible with financial support for that purpose – through Stryker support, the Lochbaum Foundation donated $25,000, and $100,000 in funding from a foundation that requested anonymity. All funds went toward purchasing, outfitting, and maintaining the vehicle, which had already been outfitted as a mobile clinic but underwent renovations to fit the needs of SMKzoo earlier this year.
The van is much more accessible, with an exam table and three separate interview spaces. It provides privacy for exams, which will immensely improve the quality of care our physicians and student doctors can deliver, Dr. Helmstetter said.
“Previously, when we were seeing our patients that are sleeping outside or sleeping in places that aren’t met for human habitation, we were doing so with our private vehicles,” Dr. Helmstetter said. “It could be very restrictive and dependent on climate, and the depth of physical exams, interviews and procedures we could do were limited by the size of our cars and the mobility and comfort of the patient. That won’t be an issue anymore with the van.”
The mobile clinic is set up so that it can be used as a sterile space for procedures such as cervical cancer screenings instead of having to construct a field medical set up outside, Dr. Alluri said. Having a space out of the elements will allow the team to do more in less-than-ideal conditions, such as drawing blood in the winter, Dr. Helmstetter said.
“It expands the kind of the routine care and the quality of care we can provide,” Dr. Alluri said. “Our patients can identify us more easily by looking for the van when they’re looking for our team. It’s about giving patients a private space if they want it for care as opposed to treating them in the open where there may be other people around.”
SMKzoo performs more than 1,200 clinical visits a year. The group of four attending physicians oversees a host of resident physicians and medical students who volunteer on a rotating basis. In addition, nine WMed students serve as student leaders.
SMKzoo's model of care overcomes systemic barriers by taking medical care directly to the people and establishing a relationship of trust and mutual respect with the unhoused community. Learners, including resident physicians and student doctors, can better understand the social determinants of health and their impacts on health status, outcomes, and care delivery. SMKzoo provides on-site delivery of essential primary care and addresses urgent health concerns. They take care of pregnant women, newborns, and children, and provide comprehensive medical care for people who experience difficulties attending office-based appointments. The team treats conditions ranging from COPD and diabetes to substance use disorder, mental illness, and communicable diseases such as hepatitis C.
The addition of the mobile clinic will provide SMKzoo with a revenue stream, increasing the sustainability of the operation. The team can bill for the services they provide using the van, Dr. Alluri said. Currently, the street isn’t recognized as a place of service by the Centers for Medicare and Medicaid Services, and services provided there cannot be billed to insurance companies. That means all the services the SMKzoo team provided before acquiring the van were offered at no charge to their patients’ insurance plans.
“Ninety percent of our patients are insured, and the services we can provide with the mobile unit are billable primary care services that would be covered by Medicaid. Being able to bill out of the van gives us hope for more sustainability of our operations.”
The team is still able to see patients on the street, especially those who get anxious in clinical settings or otherwise feel uncomfortable in the van.
“Some of our patients have really liked the van,” Dr. Alluri said. “They’ve appreciated having the space. They feel like they’re being seen in a brick-and-mortar clinic.”
Looking ahead, Dr. Alluri said the SMKzoo team wants to expand by hiring a healthcare navigator to increase the amount of case work services they can provide to patients. The team accepts monetary donations to further its mission.