Operation Safety Net a model for national, global programs that provide medical care for the homeless

Jim Withers, who founded Operation Safety Net in 1992, says his early years of practicing street medicine in Pittsburgh were a product of his imagination.

"I made it up, and I had a philosophy that drove it. It's 'The streets have to teach health care how to meet them on their terms.' "

And have they?

"They've taught us a great deal, and they're continuing," he said. "I feel like we're in the, maybe, sixth grade at best, but we're learning."

And Dr. Withers, along with Operation Safety Net program director Linda Sheets, has shared those lessons with the rest of the world.

"Jim has certainly been a very passionate visionary," said David Deci, who in 2005 helped West Virginia University medical students form a street medicine program called the Mushroom Project that was modeled on Operation Safety Net. The Pittsburgh outreach is a program of the Pittsburgh Mercy Health System, part of Catholic Health East and sponsored by the Sisters of Mercy.

"What started as a very local response to providing care on the streets he transformed into a global movement. And Linda has been kind of the logistics, background manager who has allowed street medicine to kind of have its home and launch it into a worldwide venue," added Dr. Deci, who now is director of medical student education, the department of family medicine, at the University of Wisconsin School of Medicine and Public Health.

Both roles were necessary to the spread and success of the practice of street medicine, he said.

"Jim in particular has been tireless in making contacts with communities who were interested in providing street medicine or perhaps were already struggling with street medicine programs," he said. Dr. Withers has provided aid, encouragement and resources, "helping to energize and synergize between communities. And he has done this not just on a national level but on an international scope that's particularly amazing," Dr. Deci said.

"And then what Linda has been able to do is take that core idea in Pittsburgh and to really expand it from sort of a very personalized, low-key volunteer operation into something that has become sustainable and has had a broader impact in Pittsburgh than ever could have been imagined."

Once a group that distributed "medications and socks," as Dr. Deci put it, Operation Safety Net has gone on to provide permanent homes to more than 650 people who were once homeless.

And Operation Safety Net's expansion -- to a program with a governing board, grant funding and community partnership and assistance to other street medicine programs -- is not all that Dr. Withers and Ms. Sheets have done.

Along the way, Dr. Withers got the idea to create the International Street Medicine Symposium while he and Ms. Sheets together founded the Street Medicine Institute. The former, established in 2005, is a means of letting street medicine leaders from around the world share information and ideas. The latter was formed in 2008 to provide a way to launch street medicine programs in other cities and to advance medical education opportunities in the field.

Dr. Withers said the institute, a nonprofit, "will serve to coordinate and improve this new field of medicine globally, and Pittsburgh will probably be the flagship by example of street medicine and, hopefully, we'll be up there with the leaders quite a while."

International Street Medicine Symposium VII will be held Wednesday through Friday in Philadelphia with people from five countries -- India, Russia, Denmark, Great Britain, Canada and the United States -- in attendance. Ms. Sheets, who took Dr. Withers' symposium idea and developed it, and Dr. Deci are co-chairmen of an event expected to draw about 120 people.

"The first year we had 27 individuals," Ms. Sheets said. "The next year 50 to 60; the next year 80. Every year it's been increasing to the top of the crest around 120."

The agenda includes both lectures and field trips. Attendees will hear from two doctors from Great Britain, Nigel Hewett and Tim Robson, and a former street medicine fellow with Dr. Withers, Emma Lo, who spent six months in Calcutta analyzing the flow of patients from street level into health services.

"My friends in London have been doing some great work in terms of integrating homeless care into their larger health systems, so I'm very interested in that," Dr. Withers said.

Other programs on the agenda include a presentation on foot care and another on end-of-life care for the unsheltered homeless.

The latter, which will be presented by geriatric nurse practitioner Anna Murphy of Pilsen Homeless Health Services in Chicago, particularly interests Dr. Deci. He called the subject "an area difficult to approach but important to talk about, what may be the wishes of the person ... care setting, what resources are needed to make sure the end-of-life journey is comforting and healing for the individual."

Among the Philadelphia site visits are stops at Project H.O.M.E.'s St. Columba Safe Haven, St. Elizabeth Health Center and the Outreach Coordination Center.

Project H.O.M.E., which provides housing and services to chronically homeless men and women, was founded in 1988 by Sister Mary Scullion and Joan Dawson McConnon, and is sponsored by the Sisters of Mercy.

Pohla Smith: psmith@post-gazette.com or 412-263-1228.


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