HL20: Jim Withers, MD—Bringing Tender Care to the Mean Streets

In May 1992, Withers teamed up with outreach worker Mike Sallows, a one-time denizen of the streets, to take healthcare delivery to the curbsides, back alleys, and bridge bottoms where many homeless people live. "Without a handbook on how to do this I used to dress up like a homeless person and go out with Mike at night. He allowed me to visit the camps and abandoned buildings, which just opened a whole world for me," Withers says. 

"Mike chastened me that I better not look like a doctor. I just wanted to start fresh. I didn't want to come in with my own answers or presumptions. For me it was my own personal frame of reference that I really wanted to start with a clean slate," Withers recalls of his first days practicing "street medicine."

"It didn't take long before I realized I had a moral obligation to respond to unmet medical needs—and they were profound. So I began to put things into a backpack. It made sense to have some antibiotics and bandages and some referral information, and I could see how cost-effective it was to not have these folks cycle through the emergency room over and over."

In his two decades of outreach Withers has learned that reasons for homelessness are as varied as the homeless people themselves. "Each individual is different. You just don't know until you ask someone," he says. "There are certainly things that are common in the street population: Mental health problems that are untreated; addictions that get you on the street and that people pick up when they find themselves in that situation. There is a lot of history of abuse and particularly child abuse in their past."

Withers says many homeless people have undergone severe psychological trauma from life on the street and the issues that brought them there.