Doctor known for work with homeless shares lessons with Yakima medical students

Dr. Jim O’Connell has spent nearly 40 years serving patients at Boston’s Health Care for the Homeless Program.

This past week, he brought that knowledge and experience to Yakima, speaking to students and medical professionals at the Pacific Northwest University of Health Sciences. His visit was sponsored by the medical school and Yakima Neighborhood Health.

O’Connell’s work has gained national attention. He’s served as a federal official and teaches medicine at Harvard University. His efforts have changed how homeless folks access health care and are the subject of a New York Times bestselling book called “Rough Sleepers” by Tracy Kidder.

The thing is, O’Connell said, looking out over the crowd in Yakima, he never planned to be where he is now.

“I didn’t ever intend to do what I do. It was entirely an accident,” he said.

O’Connell started serving as a doctor at Boston’s Pine Street shelter when his boss asked him to take on that role for a year. The program was brand new. As a young doctor leaving his residency at a Boston hospital, he didn’t know what to expect.

“It’s a shelter. I figured ‘how hard can it be compared to the ICU?’ ” O’Connell said.

It was much harder, he said.

O’Connell said he was quickly dissuaded of his preconceptions as he learned what to focus on in homeless shelters. He expected to apply his knowledge immediately but spent his first months listening to the nurses who had been serving at the shelter for a decade.

He spent his first two months soaking his patients’ feet, dealing with cases of athlete’s foot, corns and trench foot. They took away his stethoscope.

He learned why when he met one homeless man he had seen countless times in the ICU. O’Connell had never been able to treat him there, but said the man finally opened up after interacting with O’Connell regularly for months. That led to treatment.

“It’s all about engaging people,” O’Connell said. “We call them treatment resistant when really they’re just resistant to our kind of treatment.”

O’Connell’s work and his efforts are almost always guided by the people he serves.

When he first started working at a shelter, a board of directors that included local homeless folks established needs and requirements.

O’Connell focused on their priorities. People at the shelter wanted a continuity of care – to have the same doctors serve them over time and in local shelters and hospitals.

Collaboration essential

O’Connell said he also worked almost exclusively in multidisciplinary teams that included doctors, nurses and psychiatrists. Collaboration, between health care workers and across society, are essential. O’Connell said staff members meet weekly with the mayor, local police officers and first responders to go over concerns and understand issues.

“I’ve always worked on a team where we share responsibility,” he said.

O’Connell shared his wealth of experiences and the lessons – sometimes contradictory – that he had learned through them: to respect people and honor their wishes, but to also intervene and provide life-saving care. Those lines can be difficult to navigate, he said.

His work has stretched through innovations and tragedies. Many of the people he has served and come to love live hard, hard lives that can end in tragedy. O’Connell shared photos of people he had helped treat who had ultimately died. He was in Boston when the AIDS epidemic hit.

“Everybody died,” he said. “It was horrifying to be around that.”

There were also achievements and triumphs. Some were big, like starting respite care programs for homeless patients after major medical procedures or stopping a tuberculosis outbreak. Others were smaller – getting new buildings or setting up hospital beds to have their own televisions – but they all contribute to making lives better.

Street outreach

He spoke about people who primarily live outdoors, sometimes called “rough sleepers.” In Boston, that’s between 400 and 500 people, even in bitterly cold winters.

“There are people who, for reasons that are very complicated, stay outside,” he said. “We needed a better way to get to where people are.”

Street outreach includes a van that runs through the night to get food and blankets to people outdoors. It includes going into the community with vaccines and medical treatment.

O’Connell said medical staff found that almost 80% of a doctor’s appointment could happen at a park or in a McDonald’s – at places where people might be more comfortable.

When people were uncomfortable coming in for treatment, when they didn’t trust the system, medical professionals had to spend more time talking to them.

“The investment of getting to know people,” O’Connell said. “The return is huge, but nobody thinks about it because it’s so far down the line.”

O’Connell said there is no single fix or solution to homelessness. His work revolves around solving health issues, not solving a housing crisis. But he encouraged people to invest in education, food and legal systems.

“There’s no easy solution or no one solution. It’s a mosaic of solutions,” he said.

It’s a complicated issue, and sometimes it can feel like society is less and less patient with homeless people. O’Connell urged community members to acknowledge homeless people, respect them and not let them become invisible.

“There’s nobody who’s out there because they want to be,” he said. “We have to see all these people as our brothers and sisters, aunts and uncles.”

Jasper Kenzo Sundeen can be reached at jsundeen@yakimaherald.com.