Though he received training from the prestigious University Of Pittsburgh School Of Medicine and has been practicing in the same area for more than a quarter-century, James Withers, MD may come off as a rather inconspicuous individual. However, a listen to any one of his videos, such as the popular TEDx Talks on YouTube, a conversation with a homeless person in Pittsburgh, or a simple search of his name or “Street Medicine” on the internet, reveals a man with a much more methodical and beneficial plan to assist those less fortunate both in his own backyard and abroad. Since 1992, Dr. Withers has challenged himself—not to mention other healthcare professionals—to provide as much high-quality care as possible to the homeless population all across his area. Thus, leading to nationwide and eventually worldwide efforts for similar forms of outreach. He was also named one of the Top 10 CNN Heroes of 2015 and was given a special “CNN Heroes: An All-Star Tribute” segment on national television in 2016. For 3 lucky podiatric medical students from Barry University—Marina Tony (MS3), Nicole Smith (MS2), and Lahari Madulapally (MS2)—the experience to work directly with a man like Dr. Withers and to put their knowledge and education into practice rather literally out for the world to see, proved to be not only successful but also humbling.
“It’s always been my dream to practice medicine for those less fortunate,” Tony mentions. “I always knew that people in difficult and impoverished circumstances could really have an improved quality of life if they just had the resources, and if I could help with that in some way, I’d feel like it was God’s work. At the same time, though, it breaks my heart when the system refuses treatment to those who can’t pay or those who miss appointments and checkups only because they don’t have insurance. That alone opened my eyes and pushed me to ask myself—how can we as physicians and students try to help people abroad when there are so many at home that need us?”
Enter Dr. Withers. Through interest and diligence after starting a newly formed sector of Podiatry Medical Missions Association (PMMA) called Domestic Medical Missions, Tony was able to contact Dr. Withers and arrange for her and her colleagues to assist Operation Safety Net in Pittsburgh, in collaboration with other professionals from the University of Pittsburgh Mercy Hospital Center. Several disciplines of medicine including internal medicine, podiatry, women’s health, infectious diseases, substance abuse and more, converge on the streets with one goal in mind during shifts of “street rounds”—a personal connection with and care for their patients.
“The team of doctors, nurses, social workers and volunteers showed me what it means to truly be selfless and help people in need with basic necessities such as shelter and health care,” states Madulapally. “They not only care about each person in the community but also know their stories and backgrounds. They show empathy and respect in order to gain the trust of these people. I learned that in order to provide the best care, we have to gain the trust of people. After street rounds, we went to the Winter Shelter at night. It was amazing to see that even in the face of adversity, people were happy and grateful.”
With supplies in scarcity and a desperate need for attention to patients with lower extremity concerns, BUSPM’s team found roles in whatever task they were given, having arrived equipped with large military backpacks full of wound care dressings, antiseptic and antifungal treatments, and other tools for tackling any pathology that came their way. And, just as it would be for any clinic or hospital rotation, students would present patients case by case to attending physicians with assessments and plans in mind.
Smith recalls her favorite experience during patient encounters:
“During our first evening at the Winter Shelter, our group had the opportunity to facilitate a station for foot washing, skin moisturizing, and nail debridement. That evening, we met a dozen men and women of Pittsburgh seeking refuge in Smithfield United Church of Christ – one of Operation Safety Net’s temporary housing infrastructures during the winter months. One of our final encounters of the evening was a very soft-spoken man named Thomas, appreciative of the opportunity to have his legs cleansed. My classmate (Lahari) and I split up washing his feet, and immediately upon rinsing his left foot, she remarked how he had an ulceration on the dorsum of his foot. I also noticed some hemosiderin staining and depositions on the backs of his calves, which were swollen and featured bulging veins. We got a PMH from Thomas and had Dr. Withers speak with him, who discussed the importance of getting examined regularly as Lahari and I ran both Homan’s and Pratt’s sign tests on him. In the end, Thomas was transported to a walk-in clinic the next day! It was truly comforting being able to put our book knowledge into immediate practice for the betterment of not only Thomas but all those we encountered during the Winter Shelter.”
Seeing the success and need for assistance has already begun to inspire more of the same in the future.
“This entire trip has inspired me to work with Barry University’s medical mission team to start some type of volunteer work to help with the homeless and underserved population,” says Madulapally. “I am extremely thankful that I had the opportunity to work with such an incredible organization and an amazing group of people.”
The Domestic Medical Missions Club at BUSPM is excited to announce that Dr. Withers has invited the students for annual visitations to Pittsburgh and will be dedicating a week for foot care to all the homeless. Dr. Withers stated that “Operation Safety Net is in dire need of three specialties: Dentistry, Psychiatry, and Podiatry”. He has asked Tony to be his main point of contact as the representative of Podiatry for his Street Medicine Institute. The students are currently working on connecting the organization to one of the top programs in Podiatry – UPMC Mercy. They are also working on bringing Operation Safety Net to their local area of Miami – where Dr. Withers said there is a true need for Street Medicine.
What started off as one man’s self-motivated obligation to society’s most neglected demographic, has transformed into an overwhelming avenue for clinicians, medical students, and patients…
What started off as one man’s self-motivated obligation to society’s most neglected demographic, has transformed into an overwhelming avenue for clinicians, medical students, and patients to take advantage of learning from unanticipated sources. Through gratitude on the part of the patient with no other course of action as well as through the students and physicians literally planting themselves firmly in their patients’ circumstances, we see the line between physician and humanitarian blur, and the disconnect between doctor and concerned patients shortens.
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It goes without saying that Dr. Withers sets an example of what the Hippocratic Oath of medicine is all about and reminds us that medicine should not be practiced as the business-driven system that it has become today. And as a result of how BUSPM’s equally-inspired students have demonstrated initiative, one can only hope to see a similar collective attitude towards direct pro bono patient care for some of society’s most vulnerable, who would otherwise have nowhere else to turn.
Operation Safety Net Providing Opportunities for Podiatric Medical Students to Reach Those Least Fortunate Through “Street Medicine”
by Joshua Ekladios
Temple University School of Podiatric Medicine
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