Phoenix clinic care

PHOENIX — There’s no such thing as bed rest when you don’t have a bed. And there’s no preventive care when your doctor’s office is the emergency room.

People who are homeless struggle with several problems when it comes to accessing health care: lack of preventive care, fragmented care from a patchwork of sources, and logistical problems that come with being homeless.

Finding consistent preventive care is complicated by an array of problems that often accompany homelessness: lack of identification, medical records and transportation along with unstable mental health and inconsistent access to phones — making it hard to keep and track appointments.

Downtown Phoenix is home to a large homeless population, some of whom reside on the Human Services Campus off 12th Street. The primary care provider for many of those who live on and around the campus is the Health Care for the Homeless clinic. On Saturday mornings a student-operated clinic called Student Health Outreach for Wellness (SHOW) operates a clinic out of their facilities that offers similar services. In this way, SHOW functions as a "weekend extension," which leaders say is important because people often turn to emergency services outside of business hours.


Ernest Lynam, left, fist bumps Ryan Shelton, an A. T. Still University physician assistant student. Shelton just finished a diabetic neuropathy and foot care screening during the annual Student Health Outreach for Wellness health fair, Oct. 22. While there are many health services available to the homeless population, preventative care is often lacking.


People line the streets surrounding the Human Services Campus.


Robyn Leach stands for a portrait in front of the Cronkite building in downtown Phoenix on Sept. 30, 2017. Leach is from Glendora, Calif., but has spent the last 32 years in Arizona.

Robyn Leach, 51, who has lived on the streets in Phoenix for more than a decade, has never been able to keep a month’s supply of medication for longer than a week.

“Being homeless, it’s really hard to keep your medication,” Leach said. “Your things are either stolen or lost on an almost daily basis.”

As a result, people living on the streets end up calling 911 or going to an emergency room for a medical problem that might have been treated as part of routine health care. Left untreated, these problems can escalate and require extensive, costly care.

“I’ve had to call 911 for a breathing treatment so many times just because I didn’t have my rescue inhaler because someone stole my purse,” Leach said.

This pattern of treatment is expensive for patients as well as the the hospital emergency rooms where they find care.


A man who needs a prescription for a new inhaler waits in the lobby during SHOW's Saturday-morning clinic. SHOW runs entirely on a walk-in basis, which can be convenient, but also contribute to wait times. Leaders say those who come earlier in the morning are less likely to face long waits.

When a person needing services comes in, a volunteer “navigator” pairs up with the client, talks to him or her one-on-one about their needs, and then presents the information to a team of students and professionals from different disciplines, who then decide on a treatment plan.

“[Patients] might not even come in for, say, a foot issue, but it’s brought up in the visit and it’s treated right there,” said Mary Saxon, SHOW's director of operations. “So I think it’s just kind of treating the patient for all their needs in one sitting rather than having to go to a bunch of different places, being referred.”

This approach has special impact when working with homeless populations.

“There's not a lot of public funding for routine preventative maintenance for that population,” said Amanda Davisson, a unit supervisor at the Arizona Department of Child Safety who has been a social worker for 10 years. “They just live crisis to crisis.”


Ryan Kacey, who is staying on the Human Services Campus, talks to Student Health Outreach for Wellness volunteers senior Chandan Saini, left, and Faiz Khan. Saini and Khan are SHOW volunteers who began a project called Humans of SHOW, modeled off of Humans of New York, that aims to tell the stories of those living on an around the downtown Phoenix Human Services Campus.


A University of Arizona student studying on the Phoenix Biomedical Campus takes a sample of blood in order to test blood glucose levels. She is volunteering at the Student Health Outreach for Wellness annual health fair, which offers an array of free health services to homeless people in downtown Phoenix.


Brothers Raven and Benito Matancillas, from Chihuahua, Mexico, sit outside a building on the Human Services Campus, which provides housing, health services and meals to homeless adults. Benito, right, had just gotten new sunglasses, shoes and socks, and suggested that his brother go inside to get some as well.

SHOW's largest event of the year is its annual health fair. 

The 2014 health fair was SHOW’s first event, taking place before its Saturday morning clinic was ready to open. Although there is no patient attendance count for that year, records indicate the event drew around 50 volunteers.

By 2017, the number of volunteers at the October health fair had grown to more than 200.

The growth at SHOW's health fair is significant because its Saturday clinic is limited in how many patients it can treat. Usually, SHOW is only able to see about a dozen patients each week.

The fair offers services ranging from blood pressure checks and skin cancer screenings to foot washing stations and legal advice. Clients also received free, clean socks and shoes and items such as sunglasses and hats.

“We’re expanding in different directions,” said Christy Thomas, SHOW's director of development. 


Health Fair attendees charge phones against a wall in the Lodestar Day Resource Center on the Human Services Campus.


A student from A. T. Still University conducts a diabetic neuropathy foot screening at the foot care clinic at SHOW’s Oct. 21 health fair.


Tables are filled with donated shoes.

One of the most popular services is foot care, which is offered at the health fair and is also one of the weekly programming events.

Their last weekend foot clinic, which took place in October, drew 80 clients — almost three times the average attendance for programming events.

At the Oct. 21, 2017 health fair, clients' feet were assessed, cleaned and cared for at booths. Many people received new socks and shoes.

They were also screened for diabetic neuropathy, which causes pain or numbness in legs.

“Feet are often times really neglected by people,” said Faiz Khan, the director of programs. “It’s one of the last things that we care after, it’s one of the last things we look at, and having them cared for by someone else is a nice feeling.”


Daniel Hynes receives prescriptions at SHOW’s Saturday clinic Nov. 11. Hynes, who is from Minnesota, became homeless this year after surgeries to remove blood clots in his leg and subsequent hospitalization. He and his wife, Gloria, hope to move into an apartment soon. They left the clinic with antibiotics for a cut on Daniel's finger and two other prescriptions.


Jessica Lovely receives a diabetic neuropathy foot screening during the health fair. The foot care clinics, whether they are offered as weekly programming or at the annual health fair, are always some of SHOW's most popular activities, according to leaders.

One of SHOW's goals is to divert patients away from emergency care. The group gauges its success by surveying clients on patient intake forms. From August 2015 to March 2017, SHOW estimates it diverted $150,000 in care from emergency room visits, although that number was calculated based on a small sample of patients.

Although SHOW strives to address barriers that arise, some of the problems they face are inherent to working with a homeless population.

While she said that SHOW is “absolutely in the right direction,” Department of Child Safety Supervisor Amanda Davisson still has questions.

“We need regular preventative care, but how do we do that with people that don’t have a regular residence or ability to maintain records, or maybe don’t even have an ID?” Davisson asked.

“The solution to homeless health care is end homelessness,” she said.


A man who gave his name as Donovan talks about religion and homelessness on the Human Services Campus in downtown Phoenix.


One of the streets surrounding the Human Services Campus in downtown Phoenix. 

Although the small clinic faces challenges, those who work there find the work meaningful.

“Hearing stories is what makes me want to keep coming back,” said Audra Emmersen, an Arizona State University junior who volunteers as a navigator at the clinic. “You can find volunteer work anywhere, but this is unique.”

A version of this story was published in the Downtown Devil in 2017.

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