On the streets of Albuquerque, UNM’s street medicine team cares for the homeless

Under a white tarp in a parking lot at the intersection of Zuni Road and Tennessee Street, Mark Alvarado wrapped a bandage around Brian Rodrigues’ foot.

Rodrigues has an infection in his leg. It’s his second time seeing the University of New Mexico’s street medicine team, of which Alvarado, a student physician assistant, is a member.

The team approached Rodrigues after seeing him limping in the park with a swollen leg and no shoe, he said.

On Tuesday, the swelling was down, Rodrigues said. He probably wouldn’t have seen a doctor if not for the street medicine team, led by Lindsay Fox, a physician assistant and a professor at the UNM School of Medicine.

“She’s very thoughtful,” Rodrigues said. “She’s good people.”

Fox started treating people living on the street in 2021 out of the back of her Subaru, she said. Today, her team includes two trucks, doctors, physician assistants and students, who drive through Albuquerque offering care to people experiencing homelessness.

“It’s just so hard to access health care,” Fox said. “So that’s why we’re bringing it to the people.”

On Tuesday, Fox and her team set up in front of a Catholic charity in the International District, bandaging wounds and treating infections as a line of more than 30 people formed to see them.

Fox’s patients often come to her with lesions, broken bones or psychosis. The people she’s known for a long time trust her, she said, but with some, she has to work to earn their respect.

“I had one woman — we could only get within half a block of her and she’d start yelling expletives and throwing (stuff) at us,” Fox said. “But I would just inch closer every week.”

Now, she said the woman has a place to live, takes psychiatric medication and greets Fox with a hug when she sees her.

According to some estimates, a minimum of 1 in 3 adults who are homeless has a serious mental illness, though actual numbers may be far higher, according to the mental health group Treatment Advocacy Center.

According to the city’s estimates, there are up to 4,000 people living without shelter in Albuquerque — and 1,000 more living in shelters and motels.

UNM’s street medicine team encounters patients with a host of psychiatric disorders — among them, untreated schizophrenia, bipolar disorder and depression, said Dr. John Kavanaugh, a street medicine psychiatrist at UNM. Almost everyone he encounters has a history of severe trauma and PTSD, he said.

The team can visit patients for months before they accept treatment, sometimes in the form of oral pills or long-acting antipsychotic injections, which stay effective for weeks or months.

“We have half a dozen patients Downtown who, every time I see them, they’re like, ‘Hey, can I get my shot?’” Kavanaugh said.

Most of the time, Kavanaugh said he can find his patients for their next dose, though there is always a risk that they won’t be able to locate them when it’s time.

“We always weigh that risk of us not being able to find them again with the risk of doing nothing today,” he said.

Denise Thomas, an opioid education and prevention coordinator with Albuquerque Community Safety, estimates the majority of people on the streets at any given time have a substance abuse disorder. Representatives from ACS often accompany UNM’s street medicine team, offering social services and rehab, though convincing people to go can sometimes be a challenge, Thomas said.

“When you’re tired, call me,” Thomas said she tells people. “This is when you know someone’s really ready.”

In patients with addiction, where relapse is common and sobriety is hard-won, Fox said she and her team celebrate small wins.

“If we can go from 20 fentanyl pills a day to 10 fentanyl pills a day, that’s a win for us,” Fox said. “If we can just keep Blueberry from losing his shoes, that’s a big win.”

The team at UNM is part of the Street Medicine Institute, a global network of mobile clinics providing care for people who are homeless. More than 85 countries and hundreds of cities now have their own street medicine clinics, and more are popping up all the time, said Dr. Jim Withers, the institute’s founder.

“I love that in Albuquerque, their work’s tied into education and the future,” Withers said. “It’s a really powerful partnership.”

Withers, now at Pittsburgh Mercy, was credited with starting the modern street medicine movement in Pittsburgh in 1992, and has spent his career caring for the unhoused.

For some of the people he trains, the emotional toll of the work can be difficult to shoulder, he said.

“Sometimes, the thing I think that weighs on people — and they don’t realize how much it’s weighing upon them — is not just the death and suffering, but the hatred that people have towards people on the street,” Withers said. “It’s one thing to die in an alley painfully. It’s another to die in an alley painfully and be hated for it.”

For Fox, when the work begins to take its toll on her, she looks to her patients.

On Tuesday, Fox was visited by a woman whom she says she’s known for five years, a sex worker who is homeless. Fox said she worries about her often. Sitting under the tent with Fox, the woman began to cry. Fox grabbed a tissue and wiped her tears.

“If she can do what she does to stay alive,” Fox said, “I can take care of myself, and show up, and be there for her.”

UNM's street medicine team in action