Alfred Hundley reclined in a wheelchair on the side of a major Phoenix highway, with the help of a street medical team keeping him hydrated with intravenous saline dripping from a bag hanging from a pole.
As cars whizzed by under the scorching 96-degree morning sun, a homeless 59-year-old man with a barely-a-toothed smile was getting the help he needed through a new program run by the nonprofit Circle the City.
“It’s a lot better than going to the hospital,” Handley said of the team that provides medical care to homeless people. He said he’s been treated poorly in traditional clinics and hospitals more than six years after he was hit by a car while sitting against a wall and ended up in a wheelchair.
Circle the City introduced the intravenous hydration program as a way to protect homeless people from deadly heatstroke as temperatures regularly top 100 degrees in America’s hottest urban area. Of the 645 heatstroke deaths in Maricopa County last year, which includes the Phoenix metropolitan area, homeless people made up nearly half of them.
Dr Liz Frye, vice president of the Street Medicine Institute, which trains hundreds of medical teams around the world, said she was not aware of any other organisation providing IV infusions on the streets.
“But if it’s necessary to do that to keep someone from dying, I’m all for it,” Frye said.
As summer warms up, health care providers from San Diego to New York are facing the challenge of better protecting their homeless patients.
Even Boston’s homeless medical program, profiled in last year’s book “Rough Sleepers,” is now seeing patients with mild heatstroke in the summer after treating patients for frostbite and hypothermia in the winter for decades, said Dr. Dave Munson, medical director for the street team.
“It’s certainly a concern,” Munson said, noting that temperatures in Boston reached 100 degrees Fahrenheit and 70 percent humidity during a heat wave in June. Homeless people are more vulnerable to very hot or very cold weather, he said, not only because they live outdoors but also because they often can’t regulate their body temperature due to mental illness, medication for high blood pressure or street drug use.
Phoenix teams are searching for patients in dry riverbeds, steamy alleyways and homeless camps along the canals that supply water to the Phoenix region. About 15% of patients are dehydrated enough to require intravenous saline drips.
“We go out every day to look for patients,” said nurse Perla Puebla, “and also treat wounds and refill medications for diabetes, antibiotics and high blood pressure.”
Puebla’s street team encountered Hundley and 36-year-old Phoenix native Philip Enriquez near an overpass in an area frequented by homeless people because of the proximity of free food establishments, across the road from an encampment of tents and lean-tos lined up against a chain-link fence.
Enriquez sat on the dirt as Dr. Puebla started the IV drip and gave him a prescription for antibiotics and a referral to a dentist to treat a tooth infection.
Living outdoors under the scorching Arizona sun can be tough, especially for people with mental illnesses or who use sedatives like fentanyl that make them less aware of their surroundings. Stimulants like methamphetamine can cause dehydration, which can be deadly.
Temperatures in the Phoenix metropolitan area have reached 115 degrees this year, and as of June 22, six deaths from heatstroke have been confirmed. Another 111 deaths are under investigation.
“The number of heat stroke cases is increasing every year,” said Dr. Aneesh Narang, vice director of emergency medicine at Banner Medical Center Phoenix, which treats many homeless people with heat stroke.
Naran’s staff frequently works with Circle the City, a 100-bed facility whose primary mission is to provide respite care for homeless people who have been hospitalized but are not recovered enough to return to the streets.
Lindsay Fox, a physician assistant who works with homeless people in Albuquerque, New Mexico, through an initiative led by the University of New Mexico School of Medicine, said the extreme heat worldwide calls for a dramatic response.
Fox works three times a week, consulting with colleagues at the hospital to treat infections, clean wounds and manage chronic conditions, and she worries that there could be an increase in cases of heatstroke.
Temperatures in Albuquerque can reach a high of 90 degrees Fahrenheit, and the temperature doesn’t drop enough at night for people living outdoors to cool off, she said.
“When you’re in an urban area and you have a lot of concrete, the heat gets trapped,” she says. “You’re exposed to so much heat that you can get heatstroke very quickly.”
Severe heatstroke is more common in the Phoenix metropolitan area, and Circle the City now runs a number of health programs for the homeless in cities including New York, San Diego and Spokane, Washington.
Founded in 2012 by Sister Adele O’Sullivan, a physician and member of the Sisters of St. Joseph Carondelet, Circle the City currently employs 260 people, including 15 physicians, 13 physician assistants and 11 nurses, and sees 9,000 patients annually.
Grants, donations and other gifts make up about 20 percent of funding. Most of the rest comes from insurance payments for services provided through Medicaid and Medicare.
Circle the City works with medical staff at seven Phoenix hospitals to help homeless patients get aftercare once they no longer need to be hospitalized, and it also staffs two outpatient clinics for follow-up care.
“This partnership allows us to provide the best outcomes for our patients,” said Craig Orsini, social work manager at St. Joseph’s Hospital and Medical Center in Phoenix.
Many stay in one of the few medical beds at the downtown shelter for a few weeks of respite care or, for less urgent needs, wound dressings, etc. Those whose recovery takes several months may go to a skilled nursing facility.
While patients recover, Circle the City works to find long-term temporary shelter or permanent housing for people over the age of 55. About 77 percent of temporarily sheltered patients end up on the streets or in places other than emergency shelters.
“We try to find what’s best for people,” said Wendy Adams, community outreach supervisor for Circle the City.
Circle the City medical staff distributes tens of thousands of water bottles each summer and educates people about the dangers of hot weather, said Dr. Matt Essary, who works at one of five mobile clinics that stop outside soup kitchens and other services for homeless people.
Essary said Circle the City is also looking into implementing blood-analysis tools to detect electrolyte imbalances caused by dehydration.
“It’s very easy to tell how dehydrated someone is because it’s very difficult to draw blood,” he said. Other symptoms include headaches, extreme thirst, dizziness and dry mouth.
“We’ve had a lot of people with superficial burns,” Essary said of injuries that are common in scorching Phoenix, where people fall on searing sidewalks due to medical emergencies or poisoning.
Rachel Belgrade was waiting outside a modified Circle the City truck with her black-and-white puppy, Bo, for Essary to write her a prescription for the blood pressure medication she lost when her bike was stolen. She was given two bottles of water to cool down as the morning heat grew.
“They make everything easier,” said Belgrade, a Native American from the Gila River tribe. “They don’t make it hard for us.”