On a Wednesday this fall a man pulled his collar aside to reveal a large abscess on his neck to a doctor. The patient was sitting in the back of Lincoln Hospital’s Street Health Outreach and Wellness (SHOW) van, one of 2300 New Yorkers who have engaged with the unit since it launched last June.
It was immediately clear to Dr. Juliet Widoff that the man should have been in the hospital getting IV antibiotics. When she pressed him about why he hadn’t gone to the emergency room to get the wound cared for earlier, he said that he was “not willing to do that” and that he’d been waiting for Dr. Widoff’s shift in the SHOW van since the previous Sunday.
For Dr. Widoff, the medical director of the SHOW unit who worked in syringe exchange initiatives in the 1980s and ’90s before becoming a doctor, this patient encounter was affirming but also left her conflicted.
“He kept reiterating how he’d been waiting and he knew he could come to me,” she said, sitting in the exam chair in the back of the van. “I was proud and thrilled that he felt I was trustworthy enough to take care of him. I couldn’t ask for more than that. I mean, I could. I could ask for a way to make our hospital feel that way for folks, too.”
The van parked at 226 E 144th St. near Canal Place from 9:30 AM-4:30 PM Wednesdays and the same times at 147th St. & Willis Avenue on Tuesdays, Thursdays, and Fridays is a lifeline for unhoused patients who are often hesitant to use regular medical services.
The SHOW unit provides primary care services like vaccines, wound care, and screenings for hypertension and diabetes. But crucially, because its staff takes building relationships with unhoused people to be a core part of its mandate, the van also provides these patients essential supplies like shoes, hygiene products, snacks, and harm reduction kits which include Narcan, Fentanyl test strips, Xylazine test strips and education on how to use them. During winter months, the unit’s staff hand out warming supplies like mylar blankets, neck gators, and gloves.
The philosophy behind SHOW and the street medicine movement in general, Widoff explained, dictates that “You can’t show up for folks who have felt judged, rejected, mistreated, misunderstood, and say, ‘Here, I’m going to manage your medical situation.’”
According to NYC Health + Hospitals, between April 2021 and June 2024, the eight SHOW teams spread across the city have engaged with 216,000 New Yorkers, delivered 21,000 medical consultations, 9,000 vaccinations, and 60,000 social work interactions. NYC Health + Hospitals plans to launch a second Lincoln Hospital SHOW unit some time in 2025.
Roving
One of the key tools the SHOW van’s staff uses to build relationships with unhoused people in the South Bronx is talking walks around the neighborhood, focusing on the patient population in a 1-mile radius around the hospital. On these roving walks, staff hand out supplies and speak with people about the services the van provides, keeping a watchful eye on the street. While roving in October, peer specialist Andre Jordan passed an unhoused woman he had never seen before. He asked addiction counselor Jose Capo, “Do we know her?”
SHOW’s Program Director Andy Cook said these roving hand outs of non-medical items can create a patient relationship. He described a patient who the roving team had encountered in the street many times, but who never sought medical services in the van. When the roving addiction counselor said “I have a new pair of shoes and a new set of socks for you… that opened [the medical relationship] up..”
The van’s staff pointed to its partnership with BOOM!Health, a non-profit that provides services to people at “high risk of illness, addiction, homelessness, and poverty” as key to its success building relationships with unhoused patients. The SHOW van parks across the street from BOOM!Health on Wednesdays.
“They have been here doing this work for a very long time,” said Widoff. “So the fact that we kind of made this collaboration happen was essential for us to be considered potentially trustworthy folks.”
Context
The concept of street health outreach teams is not unique to NYC Health+Hospitals, which began operating outreach vans as part of its mobile testing efforts during the COVID-19 pandemic, and expanded into broader-based medical services for unhoused people in the intervening years, according to Cook.
Locally, BronxWorks operates a Homeless Outreach Team that provides psychiatric services to unhoused people, the Acacia Network runs a mobile medication unit, Planned Parenthood operates a Project Street Beat van several days a week, and in September St. Ann’s Corner of Harm Reduction met resistance when it proposed a mobile clinic of its own to Community Board 2.
The Future
The SHOW team hopes to do more of the work that they already feel is going well. Widoff noted that the SHOW team is working on securing approval to run more complex lab tests in the van, adding that she hopes hospitals and clinics adopt the outreach practices to hesitant patient populations whose trust SHOW has won over.
“Can you see how close we are to the hospital?” she said, gesturing at Lincoln Hospital from the front window of the van. “I will see people [in the van] every week and for them to make it that two block span to actually come into the hospital to come to the clinic, I might as well be telling them to come visit me in California.”
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