November 9, 2001

On a daily basis, MGH caregivers treat acutely ill and suffering patients in a variety of circumstances and settings. A team of MGH clinicians has taken their efforts in a different direction: they provide medical care and comfort to Boston's homeless population.

The MGH Homeless Clinic, created in 1988 and operating through the MGH Medical Walk-In Unit, is one of three hospital-based primary care centers for the homeless throughout the city. The clinic was formed under the umbrella of the Boston Health Care for the Homeless Program (BHCHP), which was founded in 1985 for the express purpose of delivering health care to homeless individuals and families.

At right, from left: Bryant, Nancy Doyle of the Medical Walk-In Unit, Bierer, Rampulla and Waldmann at Mousey Park.

The MGH team – led by director Michael F. Bierer, MD, MPH, and extensivelysupported by the entire Medical Walk-In Unit staff – is comprised of Nancy Bryant, RN, unit nurse leader; Caroline Melia, RN, BHCHP nurse liaison; Veronica Miletsky, LMHC; Joseph Rampulla, RNP, CAS, nurse practitioner; and Carol Waldmann, MD.

Five days per week, the caregivers see adult patients who have been or currently are homeless. The street outreach team also makes regular trips to community shelters and other locations, such as Mousey Park – a small enclave near the hospital frequented by the homeless – appraising any need for treatment and escorting patients to the MGH if necessary. A psychiatry fellow specializing in addiction services works in the clinic one day each week, treating patients who have been dually diagnosed with physical and mental disorders, including substance abuse. A social worker also is regularly on hand to provide individual counseling. A member of the street outreach team is on call at all times, in the event that a seriously ill homeless patient needs additional services. The team, operating as part of the larger BHCHP, receives additional support from MGH Community Benefits, Pharmacy, Social Services and Administration.

"The main purpose of this program is to provide continuity of care for patients who might not have a continuous lifestyle," explains Waldmann. "We help them to negotiate the system, in addition to receiving necessary medical treatment." Rampulla recalls his first impression of the program as a student at the MGH 12 years ago:

"I was touched and inspired by the plight of the people we saw coming here, and I thought, 'This is what I want to do.' "

Bierer echoes that sentiment. The first person hired under a subcontract to launch the MGH homeless clinic, he has dedicated his career to ensuring that Boston's neediest patients are treated with the same compassion, professionalism and thoroughness afforded to the general population. "Equity in health care is something I strongly believe in," he says.

In addition to launching the clinic, Bierer has developed complementary programs such as a shoe bank and a job search service for the homeless in Human Resources. He also instituted an ambulatory detoxification service in the Medical Walk-In Unit and started the MGH Committee on Homeless Programs. Last month, Bierer received the 2001 Harvard Medical School Dean's Community Service Award for his efforts.

"It has been a rich and rewarding experience, finding ways to incorporate this program into the hospital," Bierer says. "I get to work with great people every single day – both the patients and my peers."

For more information about the Boston Health Care for the Homeless Program at the MGH, call (617) 726-2707.