It’s been about eight years since the Hawaiʻi Island Community Health Center started doing street medicine, but it wasn't until 2023 that it became a full-time program.
“We went from doing it once a month to doing it multiple days a week,” said street medicine patient navigator Nate Hakeem.
He and a nurse, Miki Villaverde, canvas from Waikoloa to Ho'okena. The services range from wound care and physician referrals to insurance enrollment and recovering essential documents.
Hakeem explained that many of the people they help get their items stolen, or they lose their phone or identification. That makes keeping up with routine health care difficult.
“Anything we can do that helps with social determinants of health, just enabling services that help people get the referrals they need,” he said.
“Whether it's [Supplemental Nutritional Assistance Program] benefits, whether it's [state Department of Human Services], whether they're looking for identification that's been lost, whether they're trying to get back to the mainland, whether it's helping them follow up on their referrals or their appointments — you have them get set up through their medical transportation, working with enrollment to make sure they have insurance,” Hakeem said.
Over the last year, the street medicine program has increased its reach. In 2024, they had 365 patient encounters. As of this August, they've already had 300 this year.
One of the recent changes is setting up a mobile health unit in Ocean View at St. Jude's Episcopal Church, where the closest clinic is about half an hour away.
Hakeem attributes the expansion to a more streamlined process since hiring Villaverde. UnitedHealthcare Community Plan of Hawaiʻi awarded a grant to help pay for the nurse position, and also helped with maintenance and equipment for their mobile health unit. Since Villaverde is a registered nurse, she's able to do follow-up care in the field.
“For instance, a patient has been seen by a doctor for a wound and we run into them again like a week later," he said. "Well, Miki can do the follow-up care for them on the spot where as I can't do that.”
“So anytime a patient's treated by a provider, up to 30 days afterwards, they're allowed to have a nurse care follow up. So we get out there on the streets and when we see a patient who's had a recent visit, we can do the follow up right then and there,” Hakeem said.
Hakeem emphasized that the biggest barrier that many people face is finding housing. That's why he says it's important for them to connect patients with other service providers like Hope Services.
“It takes the whole community to solve this issue. And we can't work in these silos where this is what we're doing. We have to work with each other,” he said.
“Know what you're good at and what you're not good at," Hakeem said. "We are medical care. That's primarily what we do. So I can't house somebody, but I recognize as someone who's houseless, if we're to get them housed, that's going to solve a lot of their issues.”
He hopes that in the future the program will get increased funding to hire more people to expand the street medicine program to Hilo.
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