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Detroit — On a cold, dark January night, five medical students and one doctor from Michigan State University's College of Osteopathic Medicine, dressed in highlighter-green vests and wearing backpacks stuffed with red medical bags, descend into the bowels of Hart Plaza.

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"Detroit Street Care!" Ellie Small, leader of the group, announces with a friendly lilt in her voice as she walks among the tents and blankets. "Is anybody home?"

Keegan Hamm, sitting on a concrete bench, lights up at the sight of the vests. 

Hamm's home for the night is the six blankets he's collected over two years of homelessness. They cushion him from the cold ground below, and there's enough of them for the 54-year-old to wrap himself up completely.

"I'm by myself," Hamm says. "I don't have friends where I can say 'let me come stay a couple nights.'"

Small and another volunteer sit with Hamm, look him in the eye while he talks and ask follow-up questions about how he's doing. The exchange ends with a hug and a promise the group will see him again soon. 

The ultimate goal of Detroit Street Care is to build a bridge between people on the street and the medical services they may be hesitant to access, either for financial reasons or from bad past experiences. The winter cold makes people not want to take shoes or shirts off for examinations or readings, but it doesn't take away the need for conversation.

"What we're doing in the winter is a lot less directly medical," Small, 23, explains.

What elevates the group's work beyond social outreach to street medicine is the presence of a doctor.

Dr. Marjan Moghaddam, D.O. has been making the rounds with the group since last summer as a means of giving back.

Moghaddam, 37, teaches at MSU's osteopathic college and has a family medicine practice within the Henry Ford Health System. 

"It's not always about getting medication or treating medical maladies," Moghaddam said. "It's more about being somebody that they can talk to and somebody that they know."

Helping with health

When a medical issue does present itself, the students defer to the doctor. 

"Sometimes we refill medicines for patients if they can't get their primary care doctor, and they're going to run low on their blood pressure or diabetes medicine," Moghaddam said. "We have a patient we give insulin to, to make sure he's taking it for his diabetes. So there are people who regularly count on the street medicine teams to get them their medications that they can't get ... themselves."

In 2018, 10,744 people were homeless in Detroit at some point in the year, according to the Homeless Action Network of Detroit's State of Homelessness Annual Report.

More than 2,200 people in Detroit are chronically homeless, which means — like Hamm — they've been without housing for a year or more. 

Not that he plans to stay that way. 

"I wanna get out of this cold," Hamm says. "I want to get off these streets. I want to feel human again."

Shelters, he found, are not a great fit — too many people, too much volatility, often over issues as small as what's on the TV or who gets what chair. 

Steven Christopher, general manager of Delmar, the restaurant where Hamm works, says Hamm shows up every day he's scheduled and does a good job while he's there. 

The restaurant closed during a recent snowstorm. Christopher tried to reach Hamm via phone, email and text, to tell him not to come in, but was unable to. Hamm showed up. 

"Every day before he leaves, he asks if we need anything," Christopher said. 

No scrubs rule

Dr. Richard Bryce, 39, has been faculty adviser for Detroit Street Care since its founding in 2015. 

Bryce said street outreach is more about the practice of humanity than the practice of medicine.

"I would say the vast majority (of times) we're not offering them anything medical," said Bryce, who still makes rounds with the group. "Sometimes we're just talking and learning about their life." 

More: HUD grants $73 million to combat homelessness in Michigan

That connection is the founding philosophy of street medicine. 

When Dr. Jim Withers started making the rounds on the streets of Pittsburgh in 1992, a man who shepherded his path offered two words of advice: "Don't dress like a doctor, and don't act like an (expletive)," Withers recalled. 

Early in his teaching career, he said, the medical profession was "not able to wrap our heads around the lives, the realities of the people in our community, the people we should be serving."

"I needed a classroom where I would be forced and my students forced to see through the eyes of excluded people," Withers, now 62, said.

The streets were that classroom; his patients were the teachers. And so he went out into the streets to serve the homeless, dressed as one of them.

That reach-the-patient-where-they-are mentality has become a staple of street medicine ever since, as the movement has expanded to 85 cities in 15 countries, according to Withers' Street Medicine Institute, a nonprofit that works to bring health services to the homeless.

The no-scrubs, no-white coats rule is a constant for those groups. Detroit Street Care's vests and medical bags put a consistent face on a large and rotating cast of volunteers.

"They know that we're going to come out, so I think it gives them some reassurance," Moghaddam said. 

But it isn't always easy. Trust takes time to build, Small said.

"There was a gentleman that I met about two months ago. The first time I talked to him, he wanted nothing to do with us. The next time he opened up a little bit more, but still didn't want anything," said Small. "The next time he asked for body wipes. And then it became socks."

Eventually the group was able to provide him with medical care for his feet.

"And now when we sit down we have nice, long conversations," said Small. "We have laughed together and we've cried together and I've been worried about him when I couldn't find him."

jdickson@detroitnews.com

Twitter: @downi75

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