While PATH providers often do not have medical training, they regularly encounter consumers who face health issues. This section of Assessing Health, Promoting Wellness provides an overview of common health issues among people experiencing homelessness.

Homelessness is a marker for illness. People living on the streets and in shelters are more likely to get sick, their health issues are more likely to be severe, and they are more likely to stay sick for a longer period. When someone experiences homelessness, recovery is very difficult.

As a provider of care, you may encounter a person experiencing homelessness who is sick. The following section provides information that can help you know what to do. It draws extensively from Dr. David Werner’s book Where There Is No Doctor, as well as from The Health Care of Homeless Persons, edited by Dr. James J. O’Connell. While the intent is not to make you a medical provider, it will help you take part in caring for the men and women experiencing homelessness that you meet in your work.

A responsible part of caring for others is to know and work within your own limits. We offer this information to help you help others to improve their health. Remember that health is more than not being sick. It is well-being in body, mind, and spirit. With that concept in mind, you can find the balance between prevention and treatment. Within this balance, one of the most important skills that you can use is your kindness. Where will you begin?

How to examine a sick person

There are certain things to ask and to look for in anyone who is sick. These things to look for include the symptoms that the person feels or reports, as well as the signs that you notice when you look at the person. Begin by asking:

• What bothers you most right now?
• What makes you feel better or worse?
• How and when did this illness begin?
• Is this the first time this symptom happened or did you have this experience previously?
• Do you have any pain?

If the person has pain, ask them about the location, duration, and intensity of the pain. Because every person experiences pain differently, it will be important to find out how much pain the person has. A simple way to do this is to ask the person to rate the pain.

You can ask, “If 1 is no pain and 10 is the worst pain that you ever had, on a scale of 1 to 10, where is your pain right now?”

Look at people carefully. Observe how they move, breathe, and their clarity of mind. If you know them, ask yourself if they look different from the way you usually know them to look. These factors will give you important information to help you to help them.

As a non-medical provider, no one expects you to diagnose medical conditions
However, knowing signs and symptoms to look for can assist you with the following:

• Consulting with a medical professional when one is not available in person
• Providing feedback to people you see to help them understand the need to seek medical attention
• Talking to individuals about basic self-care when they have no interest in or ability to access medical attention
• Developing a comprehensive assessment for services planning
• Increasing your comfort level and knowledge so that you can assist persons better in seeking medical care
• Helping people to self-assess their own health and wellness

We strongly encourage all human services providers to take first aid and cardiopulmonary resuscitation (CPR) training so that they have independent certification to perform basic medical interventions. The intent of this guide is not to replace those trainings and certifications. Remember, never practice beyond your clinical training and ability.

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Additional references:

Dickson, M. (updated 2010). Where there is no dentist: A book of methods, aids, and ideas for instructors at the village level. Berkeley, CA: Hesperian Foundation.

Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.

National Healthcare for the Homeless Council. (2009). Shelter health: Essentials of care for people living in shelter. Nashville, TN: Author.

O'Connell, J. J., Swain, S. E., Daniels, C. L., & Allen, J. S. (Eds.). (2004). The health care of homeless persons: A manual of communicable diseases and common problems in shelters and on the streets. Boston, MA: Boston Health Care for the Homeless Program; Nashville, TN: National Health Care for the Homeless Program. Not available in print, but available for download at www.bhchp.org/BHCHP%20Manual/index.html

Werner, D., with Thurman, C., & Maxwell, J. (updated 2006). Where there is no doctor: A village health care handbook. Berkeley, CA: Hesperian Foundation.