Nation’s first medical residency program to offer a certification in homeless medicine is in Southern Arizona

By Alex Dowd

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    TUCSON, Arizona (KGUN) — On Sundays, a guesthouse-turned-free medical clinic in downtown Tucson is packed: students, nurses, doctors, and medical residents buzz around waving good morning to returning patients and grabbing supplies from the medication rolling shelf shelves, held up by three wheels and a brick.

The patients at this clinic require a different kind of care. One that Certified Community Health Specialists’ Founder Tom Langdon Hill has practiced and researched for decades: is care for people who are unhoused or on the verge of homelessness.

This year, the training at that clinic is also being taught to medical residents at Marana Health Center. When they graduate, they’ll be the first to have a certification in homeless medicine.

The program requires 30 hours of classroom training and hundreds of hands-on experience. MHC handles the medical training while CCHS teaches the sociological side of homeless medicine.

Hill said he brings his experiences and lessons from decades in the clinic to the residents in the classroom, including, the patients never present with their actual condition, and “the first step is always to take off their d—— shoes.”

“The core to all of our teaching is videos from the street,” he said. “We want to show patient videos. We want to show what’s happening. We want people to understand exactly what’s there. It’s the only way to understand the reality of it.”

CCHS’s teaching playlist is a collection of videos where patients share their stories, ranging from vitamin deficiencies to broken limbs to chronic carbon monoxide poisoning.

“Right now we have so many people living in their cars,” Hill explained. “It’s cold. What are they doing at night? They’re running their heaters, so they’re getting chronic carbon monoxide poisoning over and over and over again, and people are missing the signs and symptoms. Because you’re not taught chronic. Chronic? It’s an acute thing. It happens at a house, and people are brought in, and they’re an emergency.”

It was chronic for Elizabeth, who is living in her car. She says she went to three hospitals before getting diagnosed correctly with chronic carbon monoxide poisoning.

“I had a window that was busted open and over a few month period, I was breathing it without knowing it,” she said. “It’s like a silent killer. So, it’s rough. It’s rough. I go to say something, and I can see the words in my brain, and I can feel emotions, but I can’t put them together. It’s really scary.”

Hill says many of the symptoms of Carbon Monoxide poisoning resemble depression and anxiety, and it’s something not usually discussed in medical school.

Dr. Josh Carzoli, CEO of MHC agreed, seeing this as an opportunity for residents of the program to learn about rarer conditions while helping out in their community.

“The traditional model of healthcare training for medical providers, they often don’t have access to learning about things like carbon monoxide poisoning or scurvy,” Carzoli said. “Through this education program, we are able to fulfill a need that exists in our community and provide more education and training to our medicine residents.”

In the MHC and CCHS partnership, MHC handles the medical side of teaching the residents, while CCHS takes on the sociological aspects of homeless medicine.

“It’s kind of like this is what these studies say about these conditions, and this is what our doctors have seen and their doctors are right there to confirm or change or say this is how we ought to do it.”

The organizations can make this program thanks to funds from Banner Health Plans community reinvestment program.

After the residents graduate, Hill is hoping they take what they’ve learned to help build a safer, healthier world. The residents feel that weight.

“I feel like I am a very-very small brick in this building, but I want to provide all the help I can provide,” said Swathi Galidebara, one of the residents in the program. She says being able to help is worth the hard work of the program.

“You are everyone here,” she said. “You are the psychiatrist. You are the family medicine doctor. You are the wound care specialist. You are just a person who’s listening to all their struggles.”

They’re learning to care for every type of patient, so that thousands just like Elizabeth can get their correct diagnosis.

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