Lisa Kuettle never gets what she calls “caregiver fatigue” – the feeling a doctor or nurse may get after a day of seeing patients, a feeling of depletion and emotional exhaustion from witnessing so much illness and trauma.
Kuettle is a family nurse practitioner who provides health care to Central Oregon’s homeless people in a medical van operated by Mosaic Medical, the federally qualified health center in Central Oregon.
Over the years, she has found her homeless patients to be resilient, energizing, funny. They’re more honest than other patients she’s had.
“They’re right out there,” she said, laughing.
They have many needs, she said. “But they’re not needy.”
The medical van is the size of a large RV, and each day, Kuettle drives it to various sites around Central Oregon to deliver basic primary care for acute and chronic illnesses.
The van is at Shepherd’s Door, a men’s shelter, on Monday mornings; in the afternoon, at Oregon State University’s Cascade campus to serve the campus’ students. On Tuesdays, the van visits J Bar J Ranch, a 28-bed ranch and residential facility for young male offenders, and the Loft, a shelter and service center for homeless youth. Thursday morning, the van is at a homeless shelter in Sisters and then goes to Redmond in the afternoon to another church where a weekly dinner is served.
Bend Church homeless center is the only site the van stays for daylong sessions. It’s been serving clients there each Wednesday since January 2015, treating five to 15 people in each visit.
At Bend Church, Kuettle and her medical assistant eat breakfast with the diners at the church’s Back Door Café, which serves breakfast and also acts as a day center for nearly 150 people experiencing homelessness.
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Kuettle said she has been providing services to more homeless families lately, including homeless parents with children.
“We have a lot of people priced out of the rental market,” she said.
The van is equipped to provide basic primary care, including giving physical exams, providing well-woman exams, birth control, and pap smears, screening for sexually transmitted diseases, repairing lacerations, performing biopsies and excisions, and treating emergency conditions such as the flu, impacted ear infections, dog bites or frost bite.
“We do an awful lot,” Kuettle said.
Dental infections are among the most common conditions Kuettle treats. She also sees the full gamut of respiratory problems – upper respiratory infections, sinus infections, bronchitis, and pneumonia – driven, she said, by smoking and simply living outside in the cold and damp.
Mental illnesses are common. Scores of patients come to her showing signs of depression, anxiety and psychosis.
“People just feel overwhelmed with homelessness and things in their life that are hard,” she said.
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Illnesses that cannot be treated in the van are referred to specialty care.
Most of all, Kuettle said, she does a lot of listening.
“That’s probably my best skill,” she said. “And encouraging.”
The van’s presence each Wednesday has helped the homeless people who go to the Back Door Café feel more comfortable and willing to access medical services, Kuettle said.
“We hear all the time from our patients here at the clinic, ‘Before you guys were here, I was in the ER all the time,’” she said.
Portland has few mobile medical services: Cascadia Behavioral Health operates a mobile mental health clinic, and Outside In, a homeless youth agency, operates a mobile medical van that visits various agencies and sites around Portland. Portland Street Medicine, a new organization that intends to provide mobile medical services, has yet to start seeing patients.
In Central Oregon, people can live miles away from the nearest clinic. During the winter, people can be snowed in at their camp or unable to take the bus because it’s not running.
“You go to where they are,” Kuettle said.
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