“They just want help,” he says of the homeless. “This is the reason why I went into medicine.”
Because of a program started in December, Toledo's homeless are seeing quite a bit of Dr. Smallwood, an internal medicine physician at Toledo Internal Medicine Specialists.
Called “Project Black Bag,” the program was developed by the Neighborhood Health Association, a nonprofit organization that provides health care to the area's underserved and uninsured populations. The association provides a large amount of homeless health care through the Mildred Bayer Clinic for the Homeless in Toledo.
But Doni Miller, chief executive officer of the association, said she and others at the association realized that despite their best effort, they weren't reaching many of the homeless in the community. Many homeless people are suspicious of medical offices or decide not to get medical care for other reasons. So instead of waiting for the homeless to come to them, Ms. Miller said the association developed Project Black Bag.
Dr. Smallwood, a nurse, and a medical assistant travel to five homeless shelters in Toledo most Friday evenings and weekends. While there, the team provides medical care to the homeless and, if needed, encourages them to seek treatment at Mildred Bayer Clinic if more specialized care is needed.
“I think it's an improvement [over traditional care provided at medical clinics] because a lot of homeless have problems trusting physicians and others,” Dr. Smallwood said. “But when you're on their turf, so to speak, it sort of nurtures or enhances the relationship between you and the homeless.”
The program has had 170 patient visits in the last two months, and Dr. Smallwood said the demand for his services is clearly there - so much so that he estimates he's only reaching 30 percent of the homeless.
In addition to providing needed medical care, Dr. Smallwood said the service benefits the community's health care providers because it saves money in the long run.
Many people without insurance, such as the homeless, wait until an illness becomes so severe that they need emergency treatment. They then end up in the area's emergency rooms. The care they receive there can often be expensive, and it's usually free care because of their lack of coverage.
“If we see 50 or 60 people on a weekend, that's 50 or 60 less they'll see in the ER,” Dr. Smallwood said.
Funding for the Black Bag program comes from a three-year U.S. Department of Housing and Urban Development grant, amounting to about $148,000 a year with an option for renewal at the end of three years. The money covers the cost for supplies, administration, and some expenses incurred by Dr. Smallwood and his team.
U.S. Rep. Marcy Kaptur (D., Toledo), who helped secure the grant, called the project “a creative to addressing and meeting the health care needs unique to those who are homeless and in transition.”
“By providing primary health care directly at shelter and transitional housing sites and outside of office hours, the burden of accessing health care is relieved. At the same time, the financial burden on our local health care institutions is eased,” Miss Kaptur said, because people using Project Black Bag “will not be forced to use the hospital emergency room as their primary health care facility.”
Ms. Miller said the money came with few strings attached, other than the stipulation that it be used for homeless health care needs. She said as far as she knows, the program is the only one of its kind in Ohio. Eventually, she said, program workers hope to go out on the streets to provide medical care instead of just going to homeless shelters.