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It’s easy to forget about the feet. High blood pressure, a cough, a rash, an infected cut, asthma, diabetes-things you’d expect a doctor to notice when treating a homeless patient. But it’s easy to forget about the feet.

Roseanna Means ‘76, SM ‘77, remembers. On a chilly October morning, she greets a thin, elderly woman named Roberta shuffling into the conference-room-turned-exam-room at the Wellness Center at Rosie’s Place, a sanctuary for poor and homeless women in Boston’s South End. Means listens as Roberta describes her symptoms: she can’t swallow, and she gags when she tries to eat or drink anything, even water. Means and a medical resident begin their examination, taking vitals and gently quizzing their patient. When did you eat last? Has anyone ever told you that you have an irregular heartbeat? Can I examine your feet? That question gives Roberta pause, and she raises her eyebrows with an expression that seems to ask, Why would you want to do that? Feet take a beating when they are your only means of transportation, the doctor explains, eyeing Roberta’s thin socks and ragged shoes.

Means slips Roberta’s worn loafers off and removes her socks. The doctors aren’t sure why swallowing is painful for Roberta, and the abnormal rhythm of her heart worries them. Her feet, however, are in good shape. Means massages the arches, notes the discoloration on the toenails. Sugar diabetes, she thinks. She gently clips Roberta’s toenails and slips new socks over her feet. Roberta seems relieved by the doctors’ soft touch and assurances that they won’t do anything without her consent.

“For homeless people, one of the most powerful things they can do is say No,’” says Means. For doctors who treat homeless patients, she says, the most powerful thing they can do is respect that answer.

Means learned that lesson after she joined the paid clinical staff at Boston Health Care for the Homeless. She also learned why male patients outnumbered women three to one: Women who had become homeless through “economic demise” felt humiliated, and they thought that using a homeless clinic sent the message to the world that they were failures. Others had fled violent homes and didn’t want to be discovered. And a few had come for treatment following physical or sexual assault on the streets, only to find their abusers among the patients in the waiting room. So in 1999, Means launched Women of Means, a nonprofit organization that places doctors and nurses in women-only homeless shelters in the Boston area, such as Rosie’s Place. Means’s goals at the outset were simple but ambitious: she wanted to offer homeless women medical care in places they would feel safe. She wanted to staff the program with unpaid volunteer doctors (doctors with Boston Health Care for the Homeless are paid), and she wanted to create a medical rotation for medical and nursing students, to expose them to a population they might not otherwise see.

The care Means can offer homeless women like Roberta is limited to exams, over-the-counter medication, written prescriptions, and the recommendation to go to a hospital-today. Roberta, however, offers little assurance that she will seek the recommended follow-up care once she arrives at her final destination in Maine.

“We’ve increased the chances that she’ll get help, but there’s no guarantee,” Means says. Nonetheless, providing limited care in a safe environment can make a great difference.

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Tagged: Biomedicine

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