A checkup at the doctor is low on the priority list for unhoused people trying to find a place to sleep, food to eat and the other bare essentials for a life pushed to the margins. But not dealing with chronic health issues can lead to worse health outcomes.
The first thing I noticed as I walked into the encampment where Atrium Health has begun its Care Everywhere program was a cat.
LB, the woman I was there to speak with, said the kitten goes by many names around the camp, but she calls it Willow. Willow circled around LB’s feet and nudged her head against LB’s heels. LB seemed used to the bids for attention.
At the moment, LB lives in an unhoused encampment in Charlotte. Surrounded by trees that lightly buffer the sound of nearby highway traffic, a dozen or so tents make up a small community.
LB said when she was little, she loved to make forts out of blankets and pillows. She joked that, in a way, she’s doing the same thing today.
LB wasn’t comfortable having her voice recorded, but as we chatted about Willow and the decorations around her tent, she agreed to a short interview about her experience with Atrium’s Care Everywhere program.
Every other Wednesday, Atrium Health physicians spend three hours at a homeless encampment in Charlotte. They provide care to those who don’t have easy access to a doctor’s office or emergency room.
So far, LB has been at the encampment for every one of Atrium Health’s visits.
“They’re nonjudgmental,” she said. "They don’t judge us, and that’s what makes us feel so comfortable. We can open up to them and actually tell them about ourselves.”
Dr. Cortlyn Brown is an associate professor of emergency medicine at Atrium Health and the medical director for the Care Everywhere program.
“We want to make care more accessible and more consistent,” Brown said. “But really, to do that, especially with a patient population that has experienced so much stigma and mistreatment within the healthcare systems historically, you really need to build trust — because that's the true first step in helping someone engage in ongoing care and services that support stability and well-being.”
The program’s volunteer physicians come from the Department of Emergency Medicine. “It really aligns with [the department’s] mission of helping all of the patients and providing culturally compassionate care,” Brown said.
Meg Hayslip, a third-year resident at Carolina’s Medical Center, has been part of the program since it began.
“I’m there for most of our outings,” Hayslip said.
So far, Atrium Health has focused on one encampment — LB’s encampment.
“We've got our van and then we take all of our gear over into the encampment itself, and set up,” Hayslip said. “We'll walk around and let everyone know that we're there, and that we're there to be able to serve them, and provide resources. We're available for access for anybody who wants to see us.”
The team is made up of residents, attendings, medical students and patient registrars.
Chronic illnesses such as respiratory infections, hypertension, and heart conditions are among the most common ailments Atrium physicians treat in the field.
LB has a heart condition and she now receives medication to treat it from the Atrium pharmaceutical department.
“We commonly support patients with chronic conditions, so we're focusing on having medications like for diabetes, for hypertension, as well as the acute needs, like different types of infections,” said Jimmy Pruitt, Atrium Health’s pharmacy director. “So, if someone has a urinary tract infection, or if they have anything like that, we have those medications. We actually physically bring it with us.”
Pruitt communicates with field physicians to determine what medication to have in stock for the Care Everywhere program. Depending on the week and the needs of patients, Pruitt might bump up the stock of a certain drug.
Pruitt said the goal is to provide long-term access to these medications by hooking patients into the pharmacy system.
“I think that's the biggest thing, is the continuity of care,” Pruitt said. “Due to the housing status of patients, it can be difficult to keep in touch, which makes it harder to get access to and stay on medication.
“But our approach is to kind of work through those one patient at a time, and connecting them to resources, and building a plan to fit their situation for the long haul.”
The prescriptions are all paid for by Atrium Health. If a patient needs medicine the team doesn’t have in the field, Atrium sends it to a pharmacy.
“And then the next time we just have it in our…in our list to be able to prescribe and give,” Pruitt said. “We just minimize all the barriers.”
While Atrium provides access to medication and in-person care, the Roof Above organization steps in to help, as well,
“We’re the human connection piece,” said Harper Ellis, Roof Above’s director of street outreach. “We go to camps that we’re already working with.”
Roof Above is a prominent nonprofit that operates shelters, a day service center, and supportive housing facilities for unhoused Charlotte residents.
Roof Above has been building trust among encampments for years, including the one at which Atrium runs its Care Everywhere program.
“We’re there to bridge that — between our rapport [with the unhoused] and helping them get with the doctors.”
Ellis said members of the encampment were told about the program weeks before the Atrium team was introduced there.
“We went out a lot of times to kind of meet neighbors ahead of time, engage, [and] tell them would they be interested in a program like this,” she said. “That was a big part of the buy-in for a lot of the neighbors outside.”
Roof Above met with physicians beforehand as well. Ellis said they gave the medical personnel tips on how to establish trust with the patients.
“Lead with listening, lead with compassion,” Ellis said. “And kind of let the neighbor lead where they want the conversation to go. Whatever they're willing to talk about, or whatever they're willing for us to help them with, just start there.”
Roof Above brings refills of medication prescribed by Atrium Health to patients to help with long-term care.
LB is nearing the end of her stay at the encampment. Roof Above has an apartment ready for her; all that’s left is a logistical step or two.
I asked LB about her plans for the future. She said she wanted to volunteer because her experiences have motivated her to help others who might one day be in her position.
As for Roof Above and the Care Everywhere team, LB said, “They love our hearts, and they’ve surely got mine.”
