Taking medicine to the streets

Sitting in a bustling cafe bordering Boston Common, four medical professionals prepare for a morning of patient visits. The smell of scrambled eggs and burnt coffee fills the spaces between them as they discuss their clients' medical problems: heart disease, cancer, full-body rashes, chronic pain, cataracts, depression, and schizophrenia.

Their clients are ''rough sleeps," homeless people living in the streets of Boston, said Patrick Perri, a physician in the street team of the Boston Health Care for the Homeless Program.

Crimes such as the attack last Sunday in a North End park, in which a homeless man was set on fire, shine a spotlight on the importance of what they do.

''We build relationships" with our clients, said Perri, who was joined at the table by Cheryl Kane, a registered nurse; Jill Roncarati, a physician's assistant; and Eileen Reilly, a psychiatrist.

Not a single one is wearing a stethoscope, scrubs, or even a name tag. Instead, they wear sneakers, blue jeans and -- on wet days -- rain jackets.

The goal of their work is ''not about changing people, but reducing harm," said Perri, who is one of some 250 staffers at the health care program, a nonprofit organization started in 1985 by Dr. James O'Connell.

Twenty years ago, ''homeless men and women were just receiving episodic care," said Kane, 54, who also serves as the group's development director. ''The hope was to get to know them, figure out their medical needs, and find a way to treat them."

The organization treats 9,000 patients a year and has about 70 clinics throughout the city, with some based in area hospitals -- including Massachusetts General Hospital, the Boston Medical Center, and the Lemuel Shattuck Hospital, Kane said.

The organization's other clinics are located in adult and family shelters, and recently began fund-raising to renovate the Mallory Building into an all-service facility that will pull many of its services into one space, said Linda O'Connor, the healthcare program's capital campaign director.

''We are $2.2 million toward our goal of $12-15 million," said O'Connor. ''We plan to break ground in the summer and be in by fall 2007." She said the Mallory Building, located at the corner of Massachusetts Avenue and Albany Street, will allow the healthcare for homeless program to provide care to an additional 500 people at the McInnis House and another 2,000 at the clinic each year.

But when their patients cannot come to see doctors, the doctors go to them. An outreach medical team links clinics to the street community in a ''continuity of care," said Reilly, the psychiatrist.

''We're one spoke in a very large wheel," Perri said. Physicians, nurse practitioners, social workers, and psychiatrists comprise the street team that roams Boston neighborhoods on foot, train, or van throughout the week -- making informal doctor's visits with new and old clients.

''We make sure that at least someone is out each day," said Kane, but they do take the weekends off.

Perri estimated that 5 percent of Boston's homeless population lives on the streets. While some have fallen through the cracks of the shelter system, others choose to stay outside year round.

The 31-year-old doctor regularly asks himself: ''What is it that's preventing some people from being in a shelter?"

While some of his patients have substance abuse issues and mental illness, others are simply independent spirits or think living on the streets is safer.

In their minds, ''it's easier to live outside by their own rules," said Perri.

Umbrellas opened and hoods covered heads as the four stepped out into the rainy Friday morning. Roncarati, 37, hauled a backpack filled with her gym shoes, aspirin, a stethoscope, and a thermometer. She regularly updated her colleagues of their clients' moves, as they paged her on her Blackberry.

''I like that it's a physical job," said Roncarati. ''I like having to figure things out in a different way."

At the corner of Arlington and Boylston, Kane tugged at a blue tarp draped across cement steps. No one was home. ''Nice tarp," said Kane.

As the team crossed the street, a man sitting on a ledge selling Spare Change newspapers immediately stood up, grinning broadly. Kane exchanged greetings with a homeless man they all knew -- one of several patients who worked small jobs on the streets.

''The best thing is when someone trusts us enough to tell us their stories," said Kane. ''There's very little difference between me and them. We all want the same things."

Those things can be as simple as a safe place to sleep or warm clothing, but -- as was displayed in last Sunday's attack -- the homeless cannot take them for granted. Kane has known Scott Capella, the 30-year-old burn victim, for years and described him as a ''quiet man" who ''minds his own business and stays to himself."

''He's in really good spirits and he's receiving great care," said Roncarati, who has visited Capella regularly in the hospital since last Sunday. Judging by Capella's story, Roncarati described the attack as ''probably just another random act" of ''homeless on homeless" violence.

Kane said some of her clients are scared. But, she said, ''the city has really been responding beautifully" by giving people a number to call in case of emergencies and sending around an overnight van to encourage them to stay in shelters.

Surveying Boston Common and the Public Garden with the team, 50-year-old Reilly -- who describes herself as someone who helps ''people with brain illnesses" -- said most of her clients have schizophrenia or depression.

''With schizophrenia, there is a part of the brain that doesn't recognize illness," said Reilly, explaining that her patients are often paranoid, lack trust, and lose contact with their families.

Throughout the morning, team members discussed the progress of patients, many of whom use their first names only and decline to give their date of birth or other personal data -- making it difficult for the team to keep detailed medical records.

Finally the four reunited at a coffee shop nearby and updated one another on their patient visits. The rain had picked up again.

''I never had a time where I didn't want to come out," said Kane, the registered nurse. ''Working on the street is my sanity."

Leslie Spoelstra can be reached at ciweek@globe.com.