Breaking down barriers by making the rounds

Sandy Brekke pulls on her rain boots, straps on her backpack and clicks her out of office email alert. She’ll be working this morning, but she’s leaving her cubicle and computer behind. She’s heading to a local park in La Crosse where she’ll be providing medical care in a different way. 

A former ICU nurse, Brekke, a senior consultant with the Office of Population Health at Gundersen Health System, walks through tents and encampments — home to those who are unsheltered — calling out, “Medical team!” 

She’s joined by Gundersen clinicians Sarah Brown, MD; Robyn Borge, MD; and a couple residents. The team makes stops at several parks, as well as Salvation Army, parking garages and encampments. They carry out simple procedures like checking for abscesses using a portable ultrasound machine, distributing antibiotics and inhalers, and caring for wounds and joint injections.

Brekke said, “When we’re on the street, we see the collision between evidenced-based medicine and reality-based medicine. Whereas evidence-based medicine assumes an amount of privilege, reality-based medicine is non-judgmental.”

She says an example of evidence-based medicine is insulin therapy. Insulin is vital for folks with type 2 diabetes. But for it to be effective, it needs to be kept at a certain temperature — something that’s not always feasible for unsheltered folks.

Brekke saw the need for reality-based medicine – meeting folks where they are – during her years as executive director of St. Clare Health Mission. When she joined Gundersen in 2016, she began to see how the two organizations could partner to deliver healthcare differently. 

It was now-retired Paul Klas, MD, who made the Street Medicine team part of the resident program.

“What I was looking for was a partnership. To do that, you need someone the community trusts. Sandy became that bridge,” Dr. Klas said.

Dr. Borge, who has recently taken over as program director of the Medical Residency Program, champions the work that Dr. Klas started.

“Residents want to get outside the hospital and clinic walls. They want to make an impact,” Dr. Borge said. “They’re community minded and have a passion for caring for the underserved.”

That care, the team says, must happen outside the traditional exam room. 

“We need to change the way we practice medicine if we want to see different outcomes,” said Dr. Brown. “By changing the healthcare delivery model, we’re identifying barriers and bringing healthcare to our patients.”

To better understand those barriers, we turned to the Social Determinants of Health – that means conditions at home, within families, at work and in neighborhoods can play a role in a person’s overall health and well-being – and Gundersen’s Diversity, Equity and Inclusion pledge.

“Barriers can be things like transportation, weather and language,” Dr. Brown noted. “Understanding those hurdles requires our teams to be creative and adaptable.”

Providers are putting their adaptability and innovation into practice. Now when they visit encampments, they bring medications to help treat type 2 diabetes that are less vulnerable to temperatures. And, to break down transportation barriers, the team provides wound care on-site.

“When we see the living conditions for many of these folks, we begin to understand why a traditional healthcare system doesn’t work for them,” said Jason Larsen, executive director, St. Clare Health Mission. “When you’re not sure where your next meal is coming from, you’re just living minute to minute.”

From the streets to the farm

While street medicine is happening in downtown La Crosse, a different initiative is taking off throughout the region. 

It’s a pilot program called Fridays on the Farm. Instead of reaching the unsheltered population in La Crosse, this team is identifying needs of immigrant workers on large dairy farms.

“There’s so much potential for impact,” said Dr. Borge. “Recently, we helped 14 patients who work on a dairy farm near Sparta. None of them were receiving medical care. They were so appreciative.”

Brekke added, “We are showing future healthcare providers that there are different ways to provide medical care. By literally meeting folks where they are, we can see life through their eyes.”