Penn’s future doctors build trust on the streets

Three people in West Philadelphia are never far from the hearts and minds of the Perelman School of Medicine students who lead the Homeless Outreach Project (HOP). Danny, Victor, and a woman who goes by T make their beds with cardboard and blankets in the tenuous shelter of an overhang near the Hospital of the University of Pennsylvania.   

Several times a month, one or more students from the project visit the overhang. Sometimes they are on a scheduled biweekly HOP outreach walk, accompanied by a family medicine physician. Other times they’re on their way home from the hospital.  

How are you? Do you need anything? 

The students sit on the ground. They’re not in a rush. 

Danny, Victor, or T may request a certain necessity or comfort item—more water; a pair of boots; size X-large hoodies. They may talk about their day. After months of visits from the students, the individuals have also trusted them enough to share their medical concerns.  

An unsaid need, intuitively understood by these future doctors: To be seen as human beings. 

“This group right here actually treats us like somebody,” said Danny, who has been living on the street and in shelters for the past four years. Though he was initially slow to trust the students, the fact that they keep coming back “shows that someone actually cares.” 

This—meeting people experiencing homelessness where they’re most comfortable, building long-standing relationships, and tending to their needs of all kinds—forms the underpinning of street medicine. Begun in the 1990s by Jim Withers, MD, an internal medicine physician at Pittsburgh Mercy, the practice of street medicine has evolved to mean providing primary care directly to those living and sleeping on the streets—without the expectation that they must come into a traditional medical office or even a community-based clinic for future treatment.  

Street medicine is a developing specialty; Penn Medicine Lancaster General Health’s street medicine team began seeing patients in 2022. The 25 to 30 dedicated volunteers who make up HOP are doing their part to enhance awareness, among their peers in the medical community and beyond, of the impact this type of health care can have. 

Philadelphia’s 2024 “point-in-time" count reported about 5,000 adults experiencing homelessness, with nearly 1,000 of those qualifying as unsheltered, or “rough sleepers,” meaning that they spend their nights on the streets or in places not meant for human habitation.  

HOP’s regular activities include biweekly street rounds in Center City, University City, and West Philadelphia, on which the team offers toiletries, wound care kits, and other items, and  the goal is “to try to make relationships with neighbors who are unhoused right now, and ensure that they’re doing well, in whatever way that means for them,” said Setareh Gooshvar, a third-year medical student and HOP’s director of outreach. “If at some point they say, ‘Hey, I would also like to talk to you about my medical problems,’ we have the experience and knowledge to address that.” 

HOP is working to augment existing PSOM efforts that serve this population, including the longstanding University City Hospitality Coalition, which provides a free weekly medical clinic staffed by volunteer medical students and physicians. Many HOP volunteers also volunteer with UCHC, helping to provide continuity of care for patients served and volunteers with understanding of resources available through different programs.

The group also offers training opportunities for Philadelphia-area health professions students on street medicine, harm reduction, and wound care. 

The roots for HOP were planted in 2017, when a few PSOM students made regular visits to a food distribution site in the Logan Square area of Center City, simply getting to know people experiencing homelessness. After going on hiatus during the COVID-19 pandemic, it was re-founded in 2022 by medical student Tyler Lian with an expanded scope: to provide outreach in partnership with physicians from Penn’s Department of Family Medicine and Community Health, the community nonprofit Bridge Beyond, and other nonprofits across the city.   

In 2024, HOP was selected for a $100,000 Penn Projects for Progress award, given by the university’s Office of Social Equity & Community to teams of university staff, students, or faculty piloting practical projects that address social justice issues in Philadelphia.  

The year-long award allowed the group to purchase medical supplies including handheld ultrasound machines, blood pressure monitors, and glucometers for diabetes screening, along with medications for common conditions like diabetes, high blood pressure, and chronic wounds.  

It also allowed for the compensation of the family medicine physicians who walked with HOP and provided medical advice or treatment to people the group met. 

To further its educational mission, HOP used part of the award to host a regional street medicine symposium in late 2024 that was attended by health profession students and providers across medicine, nursing, and social work. Withers and Pennsylvania Secretary of Human Services Valerie Arkoosh, MD, MPH, were keynote speakers. Among the attendees, workshop hosts, and panelists, were people with lived experience of homelessness.  

Building trust in transient relationships 

The transient nature of both urban homelessness and medical school can make forming long-lasting bonds difficult, but the story of HOP and Danny, Victor, and T proves that it is possible. 

Lian met Danny, Victor, and T on one of his walks, and even as the organization went on hiatus during COVID, he kept up the relationship.   

“My first reaction when I met Tyler ... ‘He’s just a kid,’” Danny said. “I didn’t want to listen to him. But as time went on, we got used to each other and developed a relationship. He grew on me.” 

Lian graduated in June 2025 and left Philadelphia for his residency training. In his absence, Connie Yu, a third-year medical student and HOP’s co-director, Gooshvar, and others, have worked to continue the relationship by visiting the group both consistently and spontaneously.    

T told Yu that she feels the students want to make sure she and others are OK, without a need to get anything out of the interactions. Similarly, Victor shared that he feels very close to the HOP members who stop by; he likens them to family, bonded to him simply through shared time. 

Over the past couple of years, HOP has formalized its routes and increased the frequency of its walks to encounter as many people as possible and increase the likelihood of repeat encounters. On their walks, volunteers ask people where they typically spend time, or they share the group’s walk schedule in hopes of seeing them again.  

“We try to keep talking to them in the hopes that if they ever do have something that they don’t feel like they can handle by themselves, or they need help for, they can ask us. But it’s never with the assumption that, ‘I know better than you, what you might need help with,’” said Gooshvar, who joined his first HOP walk in July 2023, before his first classes had started, wanting to get to know his new city.  

The students defer to the autonomy of the people they are serving, focusing on issues they want or are ready to address. One summer, Gooshvar said, he encountered a woman with an open wound over most of her leg. He told her he was worried about her; she didn’t want to talk about it. After a few more visits, she let him know that she knew about Prevention Point Philadelphia’s free Wound Care Clinic and had the bandages she needed.  

There was something else she needed help with: She had money, but the nearby convenience store wouldn’t let her inside. “So, we would buy or bring her things that she needed,” Gooshvar said. 

Under the overhang 

Under the overhang one Saturday, Yu and HOP faculty advisor Zachary Kosak, MD, a family medicine physician, approached the group. Yu gave Victor a hug along with several bottles of water. Visibly emotional, he confided in her about something that happened that morning.  

Meanwhile, Kosak sat with Danny at a table in the courtyard, and the two men talked for a while. Kosak measured his blood pressure. The physician recommended a new medication that could help with Danny's hypertension without causing dizziness. He reached into his bag, pulled out a bottle of pills, and stuck on a prescription label that he filled out by hand. 

For months, Yu had been making weekly check-ins and bringing Victor, T, and Danny water and other basics they had requested. Then one day, Danny shared that he’d had some fainting episodes that caused him to stop taking his blood pressure medication. Yu anticipated that he would likely benefit from an alternative antihypertensive medication that could address his high blood pressure without causing dizziness. She assured him that Kosak had experience in evaluating patients with chronic medical conditions, such as Danny’s, every day in his clinic. 

It was only after that conversation and foundation of trust that Danny consented for Yu to share his medical condition with the doctor. 

“We showed up as our authentic selves and provided what we could to try to help improve their lives,” Kosak said. “And they recognized that sharing that potentially vulnerable information with us was going to be, not only protected, but also used in a way to benefit them.” 

Danny said the more that doctors can engage in such outreach, “the more they’ll know about their patients, and the better relationship they will develop.” 

Yu’s approach is informed by her experience during and after college working with incarcerated and formerly incarcerated people, who are up to 10-13 times more likely than the general population to experience homelessness.

“A lot of times, people are treated very poorly on the streets, even in just the simple act of people walking by and ignoring you, looking at you like you are less-than. You are not another human being in their eyes,” Yu said. “So, to not only be like, ‘Hey, I see you and care about you,’ but also to be like, ‘I do not judge you for any things that have happened in your life, or the decisions that you’ve made,’ that’s what I try to bring to the program.”  

Sustaining the mission 

To continue providing street medicine, HOP is currently seeking new funding sources to cover the time of physicians like Kosak and sustain its growth.  

Kosak notes that providing medicine to those experiencing homelessness doesn’t just help to identify Penn Medicine as a partner in the community. Though limited, literature on street medicine suggests it offers great value—for both the recipients and the health systems providing care. Street medicine teams have reported successful placements of people experiencing homelessness into transitional and supportive housing; undergoing buprenorphine treatment for opioid use disorder; and decreased emergency department visits and hospitalizations, according to a 2022 editorial in the Journal of General Internal Medicine.  

Street medicine “clinicians often attribute these successes to the focus on building trust with historically marginalized patients, a common challenge in standard health care settings,” the authors noted. 

In the Penn Medicine Lancaster General Health street medicine program’s first year, the average number of Emergency Department visits for the patients seen by the street team decreased by 45 percent. That said, it’s difficult to conduct a statistically rigorous study of the cost impact for hospitals, said program director and family medicine physician Jared Nissley, MD, “and that shouldn't be the only reason why we do this work.”  

Once run by volunteers, the Lancaster program has grown into a formal practice staffed by two half-time clinicians and a nurse care manager, funded by hospital investment, insurance reimbursements, and corporate and philanthropic donors. The team makes weekly visits to streets, parks, and encampments to offer care. 

“The primary reason to do this work is because our neighbors are suffering, and we need to try to change the care model to help people suffer less,” Nissley said. “Health care can be exclusionary and discriminating against folks experiencing homelessness, and the right thing to do is to adapt health care to better fit their needs.” 

While it’s possible that a consistent, trusted street medicine program in West Philadelphia could reduce emergency department usage and hospitalization rates for Penn Medicine, the future physicians at HOP’s helm are driven by a deeper mission.  

“It feels very fundamental to medicine—which is about caring for others, meeting people where they are, and recognizing them as human beings,” Yu said. “Hopefully one day, that can be the status quo.”