Clean clothes, a fresh shower, and routine medical check-ups await patients as they walk through the doors of an Iwilei health care clinic. But this particular clinic is dedicated solely to Oʻahu's unhoused population. Whether they have insurance or not, the care is free.
“When I found this, man, it was like a breath of fresh air,” said Leighton Fuentes, a patient who has been coming to the clinic for about a year and a half. He got emotional as he described the kindness he's felt from the clinic's workers and volunteers.
“You don't have to just have medical problems to come here. You could just come in for a refuge to get away from the street or away from the scene, or have conversation with the people here, and sometimes that's all you need.”
The clinic is part of the Houseless Outreach and Medical Education project, also known as the Hawaiʻi H.O.M.E. project, at the John A. Burns School of Medicine at the University of Hawaiʻi at Mānoa.
The program started in 2005 under Dr. Jill Omori, who is the director of H.O.M.E. and of medical education at JABSOM. She said it began at a time when the state's homeless population was quickly growing, but the care and resources available were not increasing with them.
Her goal was to create a space that would help people without housing get access to free medical care, all while allowing her students to get hands-on practice with people who need it.
“You can have lectures and discussions about health equity, caring for vulnerable populations, and social determinants of health, but if you don’t work directly with the patients, it stays very theoretical,” Omori said.
The H.O.M.E. project is integrated into the JABSOM curriculum, meaning it is required for students and counts as part of their outpatient clinical rotations.
Emily Unebasami, a third-year medical student at JABSOM, said she wants to work in emergency medicine and knows that caring for the unhoused population will be very common in her career.
“With this population, we have to predict what they might need, not just what we know they need, because they may be walking miles every day in the sun, which would impact their health needs,” Unebasami said. “Being able to hear their stories has been very big in understanding what happened for them to get to that position and how a lot of things are really out of their control. A lot of them are really trying their best.”
The Iwilei clinic is the only brick-and-mortar location for the H.O.M.E project, but the initiative has multiple pop-up locations across the island, like in Waikīkī and Waiʻanae. It also has a van that goes out to areas on the island with large populations of people experiencing homelessness, like Thomas Square.
Some of the more common services include prescription fillings, TB tests, and vaccinations. Small procedures can be done within the clinic, but more serious or urgent needs get directed to an emergency room.
But the Iwilei location is set to be torn down when construction of the Honolulu rail system Skyline continues. H.O.M.E workers are looking to relocate the clinic, but have yet to find a replacement.
Beyond health care
Bins of donated clothes, razors, toothbrushes, and eyeglasses line the backrooms of the clinic, and they're all free for patients to take. Many of these resources are donated, while others are bought with the project's budget.
The H.O.M.E project gets the bulk of its funding through its annual fundraiser, which brings in roughly $75,000 each year. It's also partnered with the City and County of Honolulu's Crisis Outreach Response and Engagement program, or C.O.R.E., which covers the cost of the clinic’s building and provides workers who help with the services.
Lindsay Pacheco is the H.O.M.E. project's social worker who helps many start the process of establishing housing. She previously experienced homelessness and said she sees herself in the patients she serves, making this initiative that much more personal.
“Sometimes, a fresh change of clothes or a hot cup of coffee is all it takes to get them through their day,” she said.
Pacheco noted the work the H.O.M.E. project does beyond all things medical, highlighting the back-to-school supply kits, Christmas gifts, and Mother's Day care packages the clinic delivers to unhoused communities around the island.
She added how this work is an unmatched lesson in compassion and empathy for the medical students, stating that they already have the brain for it, but the heart is equally important.
“You see them actually take the time to get to know folks — learn their stories, learn who they are, and see them for the people they are, not for what their situation is,” Pacheco said.
