Providing Care For Detroit's Most Vulnerable In The Middle Of A Pandemic

The estimated 14,000 people experiencing homelessness in the city need care more than ever as COVID-19 spreads.
Asha Shajahan screens a homeless person in Detroit, Michigan.
Asha Shajahan screens a homeless person in Detroit, Michigan.
Tom Perkins

DETROIT ― On a cool late March morning, family physician Asha Shajahan screened patients for COVID-19 from her makeshift downtown Detroit office: a tight stairwell in a big old Catholic church.

Outside the door, dozens of Detroit residents currently experiencing homelessness were the only sign of life during what should’ve been a busy morning rush hour in the city’s core. The patients trickling in said they didn’t think they had contracted the coronavirus, but wanted to see the doctor for some peace of mind.

Shajahan put a stethoscope to each person’s back to listen to their lungs and took their temperature. She asked them about any symptoms that might suggest a coronavirus infection. By the end of the morning, she had screened about 15 patients and was relieved to find that no one required a test.

Shajahan’s three-day-a-week clinic at the Pope Francis Center is one of the few chances for those who are homeless in Detroit to be screened or receive medical care, as the city’s hospitals and clinics are overwhelmed with COVID-19 patients. Some advocates estimate about 14,000 people in Detroit are experiencing homelessness. By comparison, New York City leads the country with about 76,000 homeless people, and Seattle has about 12,000.

“It’s important to give people access and the option to intervene if they’re having a cough or before they get so sick that they require hospitalization,” Shajahan said. “Getting out there on the street is like bringing medicine to them because they’re not able to access it on their own.”

In Detroit, 42 homeless residents who have exhibited symptoms are in quarantine in a city-owned facility as of Wednesday. So far, 21 have tested positive for the virus. At an April 9 press briefing, Detroit Mayor Mike Duggan and Arthur Jemison, the head of the city’s Housing and Revitalization Department, announced that nurses are now visiting shelters throughout Detroit, and the city is providing 15-minute rapid tests for homeless individuals.

“Homeless individuals are medically vulnerable and they’re around other medically vulnerable people,” Jemison said. “If we can protect them and keep them healthy, then we can reduce the spread.”

Providing Care Before Cases Are Critical

Across the U.S., cities are taking drastic measures to address the pandemic’s spread among the unhoused. In Los Angeles, 18 homeless residents tested positive for the virus as of April 9, and the state is quickly pushing forward with plans to house some of its homeless population in 15,000 hotel rooms. In New York City, 274 homeless people have contracted COVID-19 and 14 have died. Still, the city’s shelters remain packed.

The Pope Francis Center health clinic wants to avert such a crisis by providing care as soon as people feel sick. The center also offers hot meals, a warming station, bathrooms and a hand-washing station. In normal times, it provides other services like laundry and showers, but it has scaled back during the outbreak and adjusted to conform to social distancing rules.

Shajahan launched the COVID-19 screening program in late March, though she’s run the clinic at the Pope Francis Center for several years. Between her shifts at Beaumont East Area Family Practice working inpatient several days a week, teaching and hosting a podcast, she holds the medical clinic three days a week for about three hours each day.

A homeless services agency, Coordinated Assessment Model, then picks up anyone who has signs of an infection and takes them to a city-owned building for testing and isolation. If they test positive for the virus, they stay there for treatment until the Detroit Health Department approves their discharge.

The Pope Francis clinic also offers a rare opportunity for homeless people to receive treatment for other ailments during the outbreak. Though many access health care using Medicare and Medicaid, they face challenges in getting to a doctor right now as most of the city’s clinics are closed and emergency rooms are filled with COVID-19 patients. Some of their primary care physicians are in the suburbs or parts of the city that are difficult to reach using Detroit’s inadequate public transportation system.

On one recent morning, Shajahan gave antibiotics to several patients. A man who’d had toes on both feet amputated needed his dry and cracking nubs treated to prevent infections. Shajahan spent about 20 minutes filing the calluses and dry skin, disinfecting his feet with an iodine wash and applying an antifungal cream and moisturizer.

Another patient came for a follow-up visit. Two days prior, he was wheezing and didn’t feel or look well so Shajahan gave him antibiotics and an inhaler. On the follow-up visit, he was upbeat and reported to Shajahan that he felt much better as she pressed a stethoscope to his back.

“You look awesome!” she told him.

“Well, let’s not get carried away,” he replied with a chuckle.

Fighting Misinformation And Anxiety

Beyond screening and treatment, the clinic is a chance for homeless residents to ask questions and learn about the virus. Many only know what they hear on the street, Shajahan said, and that’s often misinformation that can be dangerous and anxiety-inducing.

Throughout this morning, residents asked the doctor how the virus is contracted, how to guard against infection, how to wash their hands properly and how to identify symptoms. She said that the city’s homeless residents are “100% taking the virus seriously” and that having access to a medical professional goes a long way to putting their minds at ease while helping to prevent an outbreak among the community.

“People’s lives have changed, and it’s the same if you’re homeless,” Shajahan said. “The things that you rely on in the past have closed, and you don’t have television, radio or newspapers for information — just the word on the street, and that can be scary.”

The increased stress and uncertainty during a pandemic can also trigger dormant mental illnesses. Shajahan said she’s seen several patients whose mental illnesses have flared up since the outbreak.

Those who visit the clinic appreciate what it does, Shajahan said. As she walked toward the Pope Francis Center on a recent morning, some people at the shelter started saluting and clapping.

“You can see the difference that you’re making and they’re so grateful,” she said. “It can just be something simple like an antibiotic that can turn someone around and prevent a hospitalization.”

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