key: cord-0837058-o5j9ot6h
authors: Milam, Adam J.
title: Protecting Our Most Vulnerable Populations During the COVID-19 Pandemic
date: 2021-02-02
journal: Acad Med
DOI: 10.1097/acm.0000000000003954
sha: 0b530f6e0b09cff0519b35c6d4c3b9d7627d334d
doc_id: 837058
cord_uid: o5j9ot6h

nan

to assemble and consist of: a 5-gallon bucket with a spigot drilled into its side functioning as a basin and faucet, hosiery containing antibacterial bar soap, a spray bottle of diluted bleach solution, and a base. We received donations from local stores to construct 6 stations. With input from our preceptor and local social service providers, we chose key locations for the stations: 2 at soup kitchens and 1 in a homeless encampment. Encampment residents then requested an additional 3.

During the Spring and Summer of 2020, we refilled and sanitized the stations twice weekly, which also provided us with an opportunity to learn from the homeless population. We saw excitement, heard gratitude, and witnessed increased hand hygiene from those who are medically disenfranchised. While simple, the stations required relationship building to be effective. One station went unused for 2 weeks. We used the teach-back method to show an affable, older gentleman proper hand hygiene using the station. His face brightened as he turned the spigot and warm water poured out. He exclaimed, "I'm going to tell everyone about these stations!" When we returned, the water basin was empty, and a personal bar of soap was placed neatly nearby. This experience demonstrated the power of community engagement to build trust and affect personal health behaviors.

Our team has now expanded to include additional student volunteers who have continued to maintain the stations. We received inquiries from health professions students from across the country asking for instructions on how to construct their own stations. We also communicated with city officials to expand the program and improve its sustainability.

These stations were an interdisciplinary community effort that have become integral to health maintenance for some individuals experiencing homelessness in Detroit. We hope this initiative will spark a conversation on social determinants of health and patient empowerment.

Funding/Support: The authors would like to acknowledge Street Medicine Detroit and Detroit Street Care for essential organizational support in this project, as well as donations of materials from the Home Depot and Target.

Other disclosures: None reported. After packaging and setting up the products early on Sunday morning, I walked outside to catch a breath of fresh air. The scene that lay before me was unimaginable. Snaking around the full block was a line of several hundred people clamoring to receive food that they desperately needed. In front of me was the beginning of the line, and the end was somewhere around the corner. The pantry used to be open once a week and would feed the locals that needed an extra hand. Now, during the COVID-19 pandemic, the pantry is open every day and is struggling to keep up with the sudden explosion of hungry people. Thousands more Americans are being furloughed each week, and the rise in hunger is a major issue.

I have 2 main points. First, medical students and trainees across the United States must realize that their kindness, time, and effort are needed. We need to dedicate the hours that are now free because of medical school closures to volunteering. Food pantries and soup kitchens are desperately short on volunteers, and we must rise to the calling. Through this, students can increase their engagement with and understanding of underrepresented and marginalized groups while also providing humanistic and compassionate care.

Second, the magnitude of this hungry crowd is a harbinger of the many health issues that may develop with loss of income for so many. Health care is often compromised in disadvantaged individuals because of the unavoidable time and monetary constraints. Learning about this firsthand through volunteer efforts will give medical students an enormous advantage in understanding the intricacies of different populations and how they were affected by COVID-19. In the future, medical schools should incorporate lessons on community volunteering into curricula on dealing with pandemics.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Second-year medical student, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; email: jgrunhut2019@ health.fau.edu; ORCID: http://orcid. org/0000-0002-8104-9679.

Protecting Our Most Vulnerable Populations During the COVID-19 Pandemic To the Editor: Nobel Laureate Pearl S. Buck wrote, "The test of a civilization is the way that it cares for its helpless members." There are over 36,000 homeless individuals in the city of Los Angeles. 1 In an attempt to prevent the spread of COVID-19, the city allocated $20 million for relief efforts, "including emergency shelter and supplies." 2 Nearly 30 newly established emergency shelters are staffed with nurses who screen residents for symptoms of COVID-19. The residents are provided with 3 meals, a cot, and a bin for their belongings. Additionally, they can have their clothes laundered and showers are available on-site. This pandemic presented a golden opportunity to connect our most vulnerable residents to vital resources in the community. The city called on local health care organizations, including UCLA Health and Cedars-Sinai Medical Center, to provide medical care at the emergency shelters, and residents are connected with mental health services and case managers to assist them with finding more permanent housing.

As a medical provider at several of the shelters, the experience has been eye-opening and has inspired a range of emotions-from sadness to triumph to awe. The good: Our team has been able to connect shelter residents with medical homes to help them manage chronic medical conditions, most commonly hypertension and diabetes (which are both comorbidities associated with COVID-19). 3 The city has also been able to place some residents in long-term housing. The bad: There are many residents with undiagnosed and/ or untreated medical problems that will lead to preventable sequalae. The ugly: Residents describe stories of neglect, mistrust of the health care system, and an inability to tend to their basic human needs.

The city has provided significant funding to "slow the spread of COVID-19 by helping people who are experiencing homelessness come indoors." 2 It is easy to assume that this influx of funding for our homeless population was provided to keep the city safe and not necessarily to meet the needs of the homeless population. Yet, we still have a great opportunity to address the needs of one of our most vulnerable populations, improve our health care system, and change the status quo. As a physician and public health practitioner, I hope our nation uses this occasion to care for this often overlooked population, both now and when the pandemic resolves.

will open thousands of temporary shelter beds for homeless Angelenos as part of COVID-19 response

Does comorbidity increase the risk of patients with COVID-19: Evidence from meta-analysis

Acknowledgments: The author would like to thank Michele Rigsby Pauley, who serves as the lead for Cedars-Sinai's mobile clinic, as well as the members of the clinic team.Funding/Support: None reported.Other disclosures: None reported.