Taking it to the streets

Patricia Gaddy sleeps sitting up in her walker.

After about 20 years without stable housing, she has learned how to survive on Springfield’s streets. But health problems have made that harder.

Gaddy has heart problems, high blood pressure and a history of blood clots in her legs. A problem with her knee makes it difficult to get back up if she lies down, so she sleeps sitting up.

When she got sick in the past, she said, she went to the emergency room.

Now, she has another option.

Dr. Kami Harless comes to her.

Harless has treated Gaddy’s leg problems, prescribed antibiotics and helped refill her heart medication. But when Gaddy talks about the physician, she focuses less on prescriptions than on time.

“She checks you all out and she takes time talking to you, more than the hospital does,” Gaddy said. “You can tell her more than you can tell the hospital.”

Gaddy is among the patients being served by SIU Medicine’s new Street Medicine Program, which takes primary care directly to patients experiencing homelessness.

The program, which is being funded by a five-year federal grant totaling $2.5 million, began in June. A medical team travels to outdoor living areas and other places frequented by the unhoused. Rather than waiting until a medical problem becomes serious enough for an emergency room visit, the goal is to treat patients where they are and connect them with ongoing care.

“The most challenging thing about street medicine is that it has to be adaptable,” Harless said. “It has to change every day. You’re never going to show up to the same place and see the same people.”

The team may visit the Washington Street Mission, The Salvation Army, St. John’s Breadline, the area around Lincoln Library or partner with outreach workers to locate people sleeping outside.

“We’re going to go to where the people are,” Harless said.

The medical problems they treat are often commonplace — infected wounds, sore feet, joint pain, diabetes and high blood pressure. Treating them becomes more difficult when a patient has no bed, bathroom, refrigerator, telephone or permanent address.

A foot wound, for example, may provide the first connection. The team treats it, returns to change the dressing and checks whether an infection is improving. Eventually, the conversation may expand to diabetes, hypertension or substance use.

Harless measures success with a simple maxim: “The goal of a first visit is a second visit.”

“Sometimes that visit is just a conversation,” she said. “You don’t even get into the medical stuff yet.”

That emphasis on trust began before SIU formally launched the program.

Ronetta Buckner, street outreach coordinator for Heartland Housed, worked alongside Harless for about a year and a half as the physician got to know the patients. 

At first, Buckner said, Harless didn’t talk much about medicine.

“It was more like just her really getting to know them, about their lives, their issues, things that they have been through,” Buckner said.

“We were consistent of going out like every week and checking on people,” she added. “When we said we were going to be there for someone, we showed up.”

Buckner has seen the persistence pay off.

One man living outside had feet in such poor condition that he couldn’t wear shoes and initially wouldn’t see a doctor. Harless kept visiting, calling him by name and listening to him.

Eventually, he allowed her to treat his feet.

“He can now wear shoes. He got an ID,” Buckner said. “Something that may be so small to us is like moving mountains to them.”

Jarid Brown, director of Washington Street Mission, said he has seen people who avoided medical care for years begin regularly seeing a doctor because of the program.

“It takes a special person to be able to work with a population that has a lot of medical needs, that has addictions, that has mental illness,” Brown said. “It takes a great deal of patience. It takes the ability to de-escalate, and you have to be likable.”

Some people may take months or years to trust someone trying to help them.

“We’ve seen people that won’t talk to anyone for years who like their team enough that they’re now engaged in healthcare,” Brown said.

Harless’ approach is deliberately informal.

“She’s there in her jeans and her SIU T-shirt. She’s really engaging and wants to know about their lives and how they got here,” Buckner said. 

“When you’re out with her, it’s not even like she’s a doctor,” Buckner added. “It’s just like she’s somebody who cares about people.”

But the medicine is conventional. The street team is connected to SIU’s federally qualified health center and can write prescriptions, order X-rays, make specialist referrals and perform procedures.

For many people Brown encounters, healthcare has largely meant the emergency room. Having medical providers reach people before their conditions become emergencies, he said, “makes a tremendous difference.”

Homelessness creates other obstacles. A patient may not have a telephone for a specialist to call. A Medicaid renewal notice may go to an old address. A referral can be closed after repeated calls to a disconnected number.

“If you don’t have an active phone or a mailing address or an easy way to get around, you’re going to slip through those cracks really, really easily,” Harless said.

The program also trains physicians. Second-year SIU family medicine residents are doing monthlong street-medicine rotations as part of a federally funded initiative.

Harless, a Springfield High School graduate who became involved in mobile outreach during her residency in Seattle, said the experience can teach young doctors something difficult to learn inside a conventional clinic.

People experiencing homelessness, she said, are no different from patients sitting in an examination room.

For Gaddy, the lesson is simpler. She is still trying to find somewhere to live. Until then, she has a doctor who knows where to find her and who will take time to talk to her.

She summed up the relationship in five words:

“Yeah, that’s my friend.”  

This article appears in 2026 Fall Guide.