“Good morning, LifeLong street medicine,” Emily Law calls out as she knocks on the door of an RV parked in West Berkeley on Tuesday morning.
Law, a registered nurse, was visiting the Eighth and Harrison streets encampment with social worker Elese Lorentzen and community health worker Mukund Raguram to offer COVID-19 tests to its residents. The three colleagues make up one of LifeLong Medical Care’s five street medicine teams that provide health care and case management to unhoused communities in the East Bay.
Raguram was recently named a “COVID-19 hero” by Alameda County Health Care for the Homeless (ACHCH) for his work during the pandemic. In April, he and Law became founding members of the team, just as the severity of the coronavirus pandemic became clear.
“It was important for us at the end of the year to take a moment and really appreciate how this community has shown up in an exceptional way,” said Lucy Kasdin, director of ACHCH. “The silver lining of COVID-19 in our community is that it has really brought providers together in a way that has not existed before.”
ACHCH recognizes outstanding community members every year, but felt it was important to create a new category for those who faced the challenges of the pandemic, Kasdin said. Raguram was one of eight COVID-19 heroes recognized by the organization for 2020.
“Mukund really stood out to us in that he had been doing work for a number of years, but he really was exceptional in that the street health team that he is a part of, they actually launched in the midst of COVID,” Kasdin said.
Kasdin noted that Alameda County, unlike other counties, has not seen widespread COVID-19 outbreaks among its unhoused residents, which she credited to the tight-knit community of activists, health care workers and organizations that provide services to the homeless community.
Raguram firmly resists the idea that he, individually, deserves any more recognition than the rest of his team. Their work is “interdisciplinary,” he said. His wealth of community connections complements Law’s medical expertise, he said, and Lorentzen’s behavioral awareness and case management. Along with nurse practitioner Olivia De Bree, who travels with the team with part-time, each person fulfills their role with profound respect and compassion for their patients, Raguram said.
“None of this happens in isolation,” he said. “There’s such a density of talent. It’s really motivating and inspiring to be surrounded by people who are so good at their job.”
“We aren’t operating in a vacuum,” Law confirmed. “Everyone comes from their own amazing place of knowledge.”
Building trust through respect
As the street medicine team set up their equipment Tuesday — a plastic folding chair, a wheeled box of testing supplies — a woman approached them, frustrated, and told them she’d made plans to meet with them twice and had been stood up both times.
“I accept that. I’m not going to deny that. Can I make time for you today?” Raguram asked, and the pair crossed the street to talk while Law and Lorentzen offered a COVID-19 test to Stephan Hopson, 65, who lives in the encampment at Eighth and Harrison.
“A lot of our clients just want to be treated like a human being.” — Elese Lorentzen
While Lorentzen retrieved a vial, swab and biohazard bag, Law explained the test to Hopson. Gesturing through her mask and face shield, she showed him how she would swab his throat in two spots and in both nostrils, and Lorentzen handed Law each piece of equipment as she was ready. Afterward, the trio discussed how Hopson would receive his test results when they were ready.
“Consent is so important,” Law said later. Many of their patients have lost trust in the health care system through repeated negative experiences, she explained, and the way to regain that is through clear communication, honesty and respect.
“A lot of our clients just want to be treated like a human being,” Lorentzen said.
Their respect and care shines through to Lene Santos, 36, who has lived at Eighth and Harrison for four months with her mother, Baxinha Silva, 70, and sister Dira. Santos has met the street medicine team several times. Last week they gave her a flu shot and helped with Silva’s health insurance, Santos said.
“They are so amazing. They care about us,” Santos said. “The ladies (are) perfect, one thousand percent,” she added.
Santos and her family are also providing care for their community. A table outside their RV was stacked high with pasta, applesauce, beans and other staples, free for anyone to take. Jeremiah Garrett-Pinguelo, a volunteer with Berkeley’s free shower program, helped her set it up and restocks it regularly.
Raguram returned to the team as Law and Lorentzen provided a COVID-19 test for Michael Chevalier, 60. He’s worried about the virus because he has diabetes, he said, and he’s avoiding shelters to stay safe.
Chevalier had a persistent cough that qualified him for Operation Comfort, which provides hotel rooms to unhoused people with COVID-19 symptoms or high-risk conditions. While Law and Lorentzen walked down the street to offer more tests, Raguram explained that a bus would pick Chevalier up at an agreed-upon location to take him to a hotel in Oakland, which he can leave whenever he wants.
The daily, person-by-person work of the street team is a “Band Aid” against the vast structural roots of homelessness, and “burnout is real,” Ragruam acknowledged. In November, the street medicine team met with around 150 patients. They successfully found housing for only three of them.
“For me personally, it’s about redefining success as a very small-scale thing,” he said. “Something as small as going to the DMV is huge,” and celebrating those successes with patients is a balm against the team’s daunting task.
Health care on the street
LifeLong has five street medicine teams which serve Berkeley, Oakland, Albany and Emeryville. The two Oakland teams launched in mid-2019, and when the model proved effective, three more teams launched in April, July and September of 2020. The interdisciplinary nature of the teams is pivotal to their success, said Brenda Goldstein, chief of integrated services at LifeLong.
“A person’s health and wellbeing relates to everything about them, and especially about the social resources, financial resources, food and housing that they have,” she said. “If we really want to support our community to achieve health, we really need to focus on the social determinants of health.”
Law and Raguram both leapt at the chance to join the street medicine team in April, Goldstein said, and Lorentzen rounded out the team in September. As the Bay Area’s lockdown highlighted the vulnerability of its homeless residents to the virus, Law viewed the team as a way to make a difference.
“It was exciting to have the opportunity to help out in any way,” she said.
If there’s any silver lining to the pandemic, it’s that COVID-19 has drawn attention to how a community’s health is inextricably linked to its most vulnerable residents, Lorentzen said.
“We have a shared concern, it’s not about an individual’s health concerns,” she said.
“It’s pushed some movement from the state and locally looking into ways to get people off the streets,” Goldstein added.
Still, that’s cold comfort against the broader difficulties posed by the pandemic.
“It’s definitely added stress. Just things you wouldn’t necessarily think about ahead of time. Like, how do staff drive together in a van and stay safe?” Goldstein asked. “It’s an overlay of stress to work that’s already really challenging.”
As the street medicine teams begin to think about when and how they’ll roll out COVID-19 vaccines to their patients, Goldstein is caught between optimism and resignation as she considers the twin crises of homelessness and the pandemic.
“The crisis of homelessness isn’t going away. The pandemic — I think at this point we see some light at the end of the tunnel, but we know that the homeless crisis is still going to be there,” Goldstein said.