Medical Care from a Van: Q & A with Dr. Avik Chatterjee

Dr. Avik Chatterjee, a doctor trained in internal medicine and pediatrics, has been taking care of homeless patients out of a medical van as part of an outreach program at Boston Health Care for the Homeless for the past three years. He works out of the van two days a week, and during his short time at BHCHP, he has seen hundreds of homeless men, women and children in need of medical care. Dr. Chatterjee spoke with Spare Change News about the current issues surrounding homelessness and the public health aspects of homelessness.


What services does the van provide?

The van provides urgent care, rather than primary care. If patients require primary care, they are referred to a nearby clinic or to our main clinic on Albany Street. The van consists of a team of healthcare professionals that includes a physician, a behavioral health provider, a benefits coordinator, a case manager and an HIV/STD counselor. Each individual on the team provides a unique set of services. For example, as a physician, I do not have the skills to connect families to housing and other similar resources. Therefore, a case manager works closely with patients to look into providing such resources.


Based on the patients you see on the van, what are the main factors that can lead to homelessness?

Massachusetts has a lot of homeless families and the story of each family is different. A lot of families are forced out of homes due to financial reasons. For example, the loss of a job can lead to financial distress, which can eventually cause the loss of stable housing. It is important to recognize how easy it is to get into such a situation but how difficult it is to get out of it, since obtaining long-term housing requires thousands of dollars up front. Domestic violence is another cause of homelessness in the family shelters, with survivors and their children often not having the resources to obtain housing when they leave an abusive partner. Once you lose stable housing, other problems can follow such as substance abuse and mental illness. It is important to recognize that the housing market in Boston is unique. Sometimes, even working individuals and their families cannot afford to pay the ever increasing rental costs in Boston.


Is there a way to prevent homelessness?

Affordable housing is a significant solution. It is important to recognize that in order to really provide safe and affordable housing, several agencies and groups need to work together.  Federal, state and city officials would need to work collectively to make sure there are funds available to build enough affordable housing and to make sure appropriate voucher support is available. The city would need to work alongside the local housing agencies to make sure that housing is provided to those in need. Also, case managers and behavioral health providers would need to work together to identify high-risk families, who may already be affected by unstable housing.


What are the public health ramifications of homelessness?

Homelessness adversely affects health and overall well-being. It is more difficult to take care of health issues when one is affected by homelessness. We know that the homeless have the highest mortality rates compared to other groups in the country. Drug overdose and cancer rates are very high in the patients we take care of. Homelessness makes mental health and substance abuse issues worse. The homeless often can’t afford medications or aren’t able to carry them around so their chronic medical conditions worsen. Historically, in Boston, we have seen outbreaks of tuberculosis and meningococcal infections among the homeless. Additionally, homeless children are more likely to be affected by respiratory infections, overweight and malnutrition and iron deficiency anemia.


What can be done by public health professionals to address homelessness?

Public health professionals could address homelessness through governance, not just at the local level but also at the state and federal levels. Families that are unstably housed could be identified ahead of time so that they can receive the necessary care and attention to prevent homelessness. Another issue that is commonly evident in homeless families is the lack of nutritional meals. Many homeless individuals don’t receive long-term nutritional meals. We are working in collaboration with community organizations in Allston on a program to provide nutritional meals to families affected by homelessness.


We constantly see programs that are providing resources for the homeless, such as food stamps and housing vouchers. Yet, homelessness continues to be a serious issue. Why is that?

None of the benefits include support for long-term housing. The wait time for housing vouchers can take up to years. Even if the individuals have housing vouchers, sometimes they can’t find availability or landlords won’t accept their vouchers. Programs that provide money upfront to support the first and last month’s rent as well as the security deposit often do not provide support for a long enough period of time, so families are at risk of becoming homeless again.


In addition to long-term housing, what else, in your opinion, could help to address homelessness?

Housing policies have been successful in addressing housing in subpopulations such as homeless veterans. In order to successfully provide housing and voucher assistance for all homeless people, there needs to be a large-scale commitment from the federal, state and local governments. Additionally, more attention should be given to vulnerable populations such as those who are newly released from prisons. Many incarcerated individuals who are released from prisons after 20 or 30 years have a difficult time integrating into the current system. Programs to help with their transition could significantly reduce their chances of being affected by homelessness.


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