An expanding initiative between Newark and the Rutgers New Jersey Medical School is bringing health care - and hope - to the city's unhoused population
To the casual observer, the white box truck parked along Frelinghuysen Avenue in Newark on a recent morning might have looked more like a Mister Softee ice cream van than a doctor's office on wheels.
But to Lavanya Kamineni, an advanced nurse practitioner at Rutgers Health, the vehicle represents something else entirely: dignity in health care.
"Even though our clinic is literally on the street, we still want to maintain as much privacy as possible, so our patients can have a secure space to talk," said Kamineni, the lead nurse aboard the city of Newark's Homeless Outreach Medical Unit. "That's why our mobile unit is here."
Since September, Kamineni has been among a team of Rutgers New Jersey Medical School (NJMS) practitioners who, in partnership with the city, are bringing health care to those experiencing homelessness where they live. Four times a week, Kamineni is joined by a clinical social worker and a street outreach worker to canvas Newark's Arts and Education district.
Their goal: To build trust and improve health outcomes in a population that is short on both.
"Many homeless people, in Newark as elsewhere, have psychiatric issues or substance use challenges, which means they don't get the health care they need," said Kamineni, who received her master's degree in nursing from Rutgers in 2014. "We're here to shift that reality."
Homelessness takes a devastating toll on health. In the United States, those who are chronically unhoused have a life expectancy that is three decades shorter than the general population. Yet, despite the presence of many health resources serving the homeless in Newark, there remains a large gap in access.
City and Rutgers Health leaders have teamed up to address these shortcomings.
Launched as part of Newark Mayor Ras Baraka's homelessness initiative, "The Path Home," the mobile unit conducts psychiatric assessments and provides care for acute issues such as infections and filling prescriptions. Team members also refer patients to other services as needed.
Novneet Sahu, an associate professor of emergency and family medicine at NJMS and medical director for the mobile unit, said he and his colleagues had long wanted to bring the concept of street medicine to Newark. The opportunity presented itself about two years ago, he said, when the city approached NJMS leadership about delivering health care to the unhoused.
In the first six months, support has been strong, Sahu said. The Newark Alliance has identified potential new streams of funding through downtown businesses and community leaders. In January, the mayor announced plans to expand the program and add two more mobile units to the city's fleet. All three will be managed by Rutgers Health.
"We know that our unsheltered Newark residents experience high rates of chronic disease, serious mental illness and substance abuse," said Luis Ulerio, director of the Newark Office of Homeless Services. "These conditions are further exacerbated by the persistent state of housing instability that many experience on our streets. We are tackling this head on by bringing services directly to those that need them most."
Several elements make the street medicine program in Newark unique, said Sahu. For one, the city's approach is aimed at preserving patient autonomy and empowering those in need. Second, by linking a housing initiative with health care and social services, city officials are building a model of street medicine for other municipalities to emulate.
"Helping someone get off the street can be a very long process - years in some cases," Sahu said. "But consistent engagement does lead to a healthier, and housed, population."
On most days, Kamineni and her mobile clinic colleagues canvas around or inside Penn Station, where many people who are homeless seek warmth during the winter. Several patients a day avail themselves of the unit's services, she said. Establishing a rapport with patients takes time, but already she's seeing changes.
"There was this one patient recently, a man who has been on the streets for more than 20 years," Kamineni said. "He has always resisted care. One day, we had to send him to the emergency room, where he ended up being involuntarily admitted. When we sent him, I wasn't sure we were doing the right thing. But after he was discharged and returned to the street again, he stopped by the van for something else. He's coming back for help. That's a success story."
