PHOENIX — Alfred Handley sat hunched over in his wheelchair along a major Phoenix freeway as a team of street doctors helped rehydrate him with intravenous saline solution dripping from a bag attached to a pole.
Cars raced past under the burning 36 degree morning sun while the 59-year-old homeless man with a nearly toothless smile got the help he needed through a new program from the nonprofit Circle the City.
“It’s a lot better than going to the hospital,” Handley said of the team that provides health care to the homeless. He has been treated poorly in traditional clinics and hospitals, he said, more than six years after he was hit by a car while sitting on a wall, leaving him in a wheelchair.
Circle the City introduced its IV rehydration program as a way to protect homeless people from life-threatening heat illness as temperatures regularly reach triple digits in America’s hottest metropolis. Homeless people were responsible for almost half of last year’s record 645 heat-related deaths in Maricopa County, which includes metro Phoenix.
Dr. Liz Frye, Vice President of the Institute of Street Medicine which provides training to hundreds of health care teams around the world, said she was not aware of any other organizations administering infusions on the street other than Circle the City.
“But if that’s what needs to happen to prevent someone from dying, then I’m all for it,” Frye said.
Like summers getting warmerhealthcare providers from San Diego to New York are being challenged to better protect homeless patients.
Even the Boston Health Care for Homeless Programincluded in last year’s book, “Rough Sleepers,” is now seeing patients with mild heat exhaustion in the summer after decades of treating people with frostbite and hypothermia during the winter, said Dr. Dave Munson, the medical director of the street team.
“It’s definitely something to be concerned about,” Munson said, noting that temperatures in Boston reached 100 degrees with 70% humidity during the June heat wave. Homeless people, he said, are vulnerable to very hot and very cold weather not only because they live outside, but they often cannot regulate their body temperatures because of medications for mental illness or high blood pressure, or because of drug use on the streets.
The Phoenix team searches for patients in homeless camps in dry riverbeds, sweltering alleys and along the canals that bring water to the Phoenix area. About 15 percent are dehydrated enough to require saline infusions.
“We go out every day to find them,” says nurse practitioner Perla Puebla. “We do their wound care, refill their medications for diabetes, antibiotics, high blood pressure.”
Puebla’s street team encountered Handley and Phillip Enriquez, 36, a Phoenix resident, near an overpass in an area frequented by homeless people because it’s near a free-meal facility. Across the road, an encampment of tents and shelters lined a chain-link fence.
Enriquez sat on a patch of dirt as Puebla started an IV for him. She also gave him a prescription for antibiotics and a referral to a dentist for his tooth infection.
Living outdoors in the blazing Arizona sun is tough, especially for people who are mentally ill or who use drugs like fentanyl that make them less aware of their surroundings. Stimulants like methamphetamine contribute to dehydration, which can be fatal.
Temperatures have reached 115 degrees (45 degrees Celsius) this year in metro Phoenix, where six heat-related deaths have been reported. confirmed through June 22. Another 111 are still being investigated.
“The number of patients with heat illness is increasing every year,” says Dr. Aneesh Narang, assistant medical director of emergency medicine at Banner Medical Center-Phoenix, which treats many homeless people with heat stroke.
Narang staff regularly collaborate with Circle the City, whose core mission is to provide respite care. Circle the City has 100 beds for homeless people who cannot return to the streets after a hospital stay.
Extreme heat worldwide requires a dramatic response, said physician assistant Lindsay Fox, who cares for the homeless in Albuquerque, New Mexico, via an initiative of the University of New Mexico School of Medicine.
Three times a week, Fox treats infections, cleans wounds and manages chronic conditions in consultation with hospital colleagues. She said the prospect of more heat illnesses worries her.
According to her, the temperature in Albuquerque can rise to more than 32 degrees Celsius. The temperature does not drop enough at night to allow people living outside to cool down.
“If you’re in an urban area that’s mostly concrete, you’re trapping heat,” she said. “We’re seeing heat exposure that can very quickly lead to heat stroke.”
Severe heat stroke is much more common in metro Phoenix, where Circle the City is now one of many homeless health programs in cities including New York, San Diego and Spokane, Washington.
Founded in 2012 by Sister Adele O’Sullivan, a physician and member of the Sisters of St. Joseph Carondelet, Circle the City now has 260 employees, including 15 physicians, 13 physician assistants and 11 nurse practitioners, and sees 9,000 patients annually.
Grants, donations and other gifts account for approximately 20% of the financing. Most of the rest comes from insurance payments for services provided through Medicaid and Medicare.
Circle the City partners with medical staff at seven hospitals in Phoenix to help homeless patients receive follow-up care once they no longer need to be hospitalized. It also has two outpatient clinics for follow-up.
“This collaboration allows us to provide the best outcomes for our patients,” said Craig Orsini, manager of social services at St. Joseph’s Hospital and Medical Center in Phoenix.
Often that’s a few weeks of respite care or, for less acute needs, a stay in one of the few medical beds in the downtown shelter for things like changing wound dressings. Someone who needs months to heal might go to a nursing home.
As patients recover, Circle the City works to find longer-term transitional housing, such as those for people 55 and older, or permanent housing. About 77% of respite patients are sent somewhere other than the streets or an emergency shelter.
“We try to find the best fit for people,” said Wendy Adams, community outreach supervisor for Circle the City.
Circle the City’s medical staff hands out tens of thousands of bottles of water each summer and tries to educate people about the dangers of hot weather, said Dr. Matt Essary, who works at one of five mobile clinics that stop at soup kitchens and other homeless services.
Essary said Circle the City is also considering introducing a blood analysis tool to detect electrolyte imbalances caused by dehydration.
“You can immediately see how dehydrated they have become because it’s so difficult to draw their blood,” he said. Other possible symptoms include headache, extreme thirst, dizziness and dry mouth.
“We also see a lot of people with superficial burns,” Essary said of the wounds that are common in sweltering Phoenix, where a medical emergency or intoxication can send someone falling onto a scorching sidewalk.
Rachel Belgrade waited outside Circle the City’s updated truck with her black and white puppy, Bo, for Essary to write a prescription for the blood pressure medicine she lost when a man stole her bike. She took two bottles of water to cool down as the morning heat rose.
“They make all this easier,” said Belgrade, a Native American from the Gila River tribe. “They don’t make it difficult for you.”