What Most People Get Wrong About Homelessness (From a Doctor on the Streets)

MO If you care about where your money goes to, if you hand that five, ten, fifty, hundred dollars out the window and you're like, I care where this goes to. Maybe don't do it. Right. But if you're like, I know you're going to get whatever you need today with this money, you need to feel happy with that.

MELISSA Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion and half the time you can't tell what's legit and what's just good marketing and we get it. We're in it too. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode we bring in the people who actually do this work. Providers, practitioners, the experts who see clients and patients every day. We ask the questions you'd ask if you were sitting across from them so you can find the right people, make better decisions and feel confident about what's out there, whether it's peptides, gut health, water quality, ADHD, biohacking, or something you've never heard of. We're covering it. So let's get into it. Let's get dialed in.

MELISSA Today, I'm sitting here with the executive director, Dr. Melissa Dittberner, Mo Dittberner, Midwest Street Medicine. It's been an amazing experience this morning out in the field with you today. The work that you're doing every day. Tell me a little bit about Midwest Street Medicine. Someone who has never heard of it before. What is it?

MO Yeah. Thanks for coming out with us, by the way. I appreciate having you along. Street Medicine is essentially going to the people. Right. And so we bring medical, mental health, addiction care to the streets, to people who are experiencing homelessness, looking for our most vulnerable population, the unsheltered, but also people who live inside the shelters, just to make sure that they have the care that they need and understand where the connecting pieces are to other care that they might need as well.

MELISSA So what gaps were you seeing here in Sioux Falls that were not being met before you started this organization?

MO Yeah, I would say my big pull was addiction care, making sure that people that are struggling with addiction know what the path looks like to getting themselves into recovery or making to the next step of whatever they want to do next, but just trying to make sure that people don't struggle with addiction if they don't have to.

MELISSA So addiction is in all walks of life. Do you serve any anyone who's suffering with addiction or is it a certain population?

MO No, people that are struggling with addiction, addiction can definitely reach out to us and we can kind of help you triage where you might need to go next.

MELISSA Okay. So what you had mentioned, I watched your TED talk and you had mentioned you had gone to LA, you'd gone to Skid Row, check some things out. What happened to you when you were there that changed your life?

MO And I don't know, I think it was watching my kids interact with people in a way that they were just like, I want to give with that like want of a child, like the compassion and empathy of a kid, you know, and it kind of brought me back to what it's like to be able to do that at the time. I didn't really have and have a lot to give to be really honest with you. And so it was kind of like a dream to be able to get into a space where I could be stable enough to be able to help other people. And so after, you know, a few years, I got some grants and done some outreach and just kind of understood the landscape just a little bit, just enough to kind of get my feet wet, handing out Narcan and doing trainings and snacks and things like that. And then when I met Dr. Shannon, I was like, oh man, this is it. This is when it starts. And so, yeah, it's just been uphill since then in the best way.

MELISSA So tell me about how did you meet Dr. Shannon? What was kind of your connection and then how did this get started?

MO Yeah, so a mutual friend actually connected us. I live in Hawaii in the summers. I teach out there. And so I met her via Zoom and she was saying, hey, I listen to this podcast and I want to start this thing. And do you want to take this ride with me? And so I don't really recommend starting a nonprofit with an absolute stranger, but it's been amazing. Like we've you know, we've really like focused on our communication being just blunt and abrupt and whatever needs to happen happens. And we're really honest with each other. We know that clarity is kindness. And I think that's what's taken us through the journey together in a way that really is able to help people and create a team that is really good and can just do what we all want to do. And that's help people.

MELISSA Yeah, it's funny. They say when you start a business, it's like especially with another person, it's like a marriage. And so you sort of had a blind date and just did it. Yeah, I just sometimes married a right on that first day. Sometimes things work out. You never know.

MO They do for sure.

MELISSA So I'm curious when you think about the work that you're doing on a day to day basis, if someone says, well, what is what do they do? And of course, no day is ever the same. Right. But how would you describe it high level to someone who's like, so what is that? What does that look like?

MO Yeah. So in the morning we get together where we do a huddle. We talk about what we're looking for for the day, you know, ways to make sure that we're being appropriate with our language, helpful communication and conversations with our volunteers. We get into separate groups. We grab wagons and backpacks. Medical people have all their supplies. The wagons have string cheese and oranges and water and other supplies that people living outside might need. And then we have this integrative team that goes out and does care on the street. So we'll walk to 10th and Cliff or right in front of the Bishop Dudley or go inside the Bishop Dudley or the other missions, parks and libraries and just anywhere that people are is where we go and ask them what they need. And then we try and triage on the spot what they might need or what their concerns are or how we can get them to the next place or appointment or sometimes they end up, you know, writing in the ambulance. So it just kind of depends on what we get into.

MELISSA So tell me about your story. What led you here?

MO Yeah. So I am a person in long term recovery. I struggle with methamphetamine and alcohol use in my past. And after I went to USD for a long time to learn a little bit more about it, I finally got myself in a place where I could give back. And so I've been trying to positively impact people who struggle with addiction in any way I can, whether it's research or doing outreach or peer support training or whatever it can be. I just really want to be that person that I needed when I was struggling.

MELISSA Yeah. So when you're what do you see in the streets of Sioux Falls often? What do you see most often that you would maybe would surprise some people?

MO It's really a lot of wound care. Unfortunately, I've seen a lot of limbs go missing in the last couple of years that people have had to get removed via infection. And so that was really shocking to me at first. And I think I've been doing this long enough now that things aren't shocking me anymore, which I don't know if that's good or not. But just the like the rate of alcohol addiction is pretty high to be able to be able to get them access to care is pretty important. And then mental health concerns, you know, people who are really struggling in psychosis who don't have a safety net anymore. And we recognize that we have now become their safety net and we don't take that lightly. We want to make sure that we get them access to medications or supports or whatever that that needs to be, because we recognize that they don't have anybody else in their corner anymore sometimes. And we want to be that for them.

MELISSA Yeah. So how does your organization fit in, you know, with with other organizations that might provide mental health?

MO Yeah, great question. So I like to say that we're a conduit to care, right? We don't do all the things here. We need to be able to triage them enough and build that rapport and trust to get people to the next step. And so that's really what our role is. And some people we end up being their primary care because they just won't get care any other way. That's not our goal. Our goal is to get them to the other awesome organizations who are already doing that work. We just kind of, you know, find them where they are and get them where they need to go.

MELISSA Gotcha. Gotcha. So what does your team look like? Who's all on your team?

MO Yeah. So people starting with people who have lived experience with homelessness, people addiction, mental health, peer supports who have been there, done that. CHWs, cultural leaders, doctors and peers, just everybody in the alphabet soup of medical nurses, just everybody, mental health, addiction. Then we have other people come in today. We had East River Legal. I think you guys saw Waukea that stop to make sure everything was OK when there was a man down. So just kind of a little bit of everybody comes on the team that's in the community to to come out on rounds to say, is this a good fit? We do telehealth services with people so they can get CD assessments in different ways to just make connections. Everybody's kind of adjacent to our team sometimes, but be able to zoom them in if we need to.

MELISSA What's a CD assessment?

MO Oh, chemical dependency assessment. So that's the first step to getting into treatment is you have to have your assessment. OK. And it is often the hardest step to find. So to be able to get those to us where it's a little closer for people is a huge win that we've had recently.

MELISSA So many people on the street or many people that have addictions or other issues might not have insurance. Right. So how do you navigate that?

MO Yeah, zero cost to anyone. There is no bill, no cost to care with us. Everything is free, everything, everything. We do help people get Medicaid if they're eligible for Medicaid. But access to medications, even if it's our most expensive addiction medication, all access that people need to the to the medications and the care that they need.

MELISSA And that's all funded like through donations.

MO Yeah, mostly generous donations from amazing people that are in our community. And then, yeah, we apply for just about every grant. We can try to get our hands on to support what we're doing. Community foundations and different federal grants and things like that as well.

MELISSA So I'm here with Bob Santella, MD. You're a medical doctor. Tell us what brought you to your helping with the Midwest Street Medicine team. You volunteer a couple of days a week. Tell us what brought you to this work.

BOB Well, before I retired, I'm a retired physician. Before I retired, I've always been interested in the social determinants of health. And I used to speak to my students about it. And I retired and I worked for Habitat for Humanity also. And I did a few things in and I thought, well, I'm not using my skills at all. So I heard on Kello, I heard about Midwest Street Medicine and I contacted Dr. Emery and asked if they could use me and said, yeah, we you could we only have me one doc. You could be a second doc. And so then to turn to two and a half years ago, I started and it's been very good. It's a different kind of medicine.

MELISSA So for those that aren't familiar with social determinants of health, what that means, tell us what that is. Maybe give us examples.

BOB So the things that determine your health that aren't typically established in the clinic or treated with medicine. So your income, whether or not you have a house, racial bias, you know, if you've had abuse in your life, mental illness that isn't treated in the clinic, all those things, all the so-called ills of society have statistically determined your health about 60 percent of the time more than me giving you a medicine.

MELISSA Quick break. This episode is brought to you by Vitality Growth Labs. If you're a health or wellness practice and you're wondering why your phone isn't ringing in the way it should be, Vitality Growth Labs builds the systems to fix that. Get found, build trust, fill your calendar, AI authority stacking, videos that connect with your clients, real tools, strategy and execution that results in real revenue. Visit VitalityGrowthLabs.com or check the provider directory at VitalityGrowthLabs.com slash the directory to find a trusted wellness provider near you. All right. Back to the show. I'm going to ask you a spicy question because sometimes people say, well, you know, if you're you should just pull yourself up by your bootstraps, figure it out. I had to do that. I didn't have it easy either. What do you tell that population?

MO Yeah. So oftentimes people don't even have boots to pull up their bootstraps. Right. And I think we don't remember that. It is terribly difficult to be able to be in a situation where you have nothing. And as you get on the street, that nothing gets even less. Right. Like you might have had your phone and then somebody stole your phone. You can't even get your medication. Somebody steals your medication. And so just when you're like at the bottom, sometimes you can get kicked even further. And I can't imagine living without my cell phone. And then I'm like, get a job. OK. Well, how do I get a job when I don't have a cell phone? And if my address is the Bishop Dudley, am I going to get a job when I fill out this application? And if I don't have my ID and I don't have a bank account, how do I get a job? Right. There's so many barriers to what it looks like. And yes, sometimes people may have made poor mistakes to get there, but that doesn't negate the fact that they're there and they could use a little help to get to the other side of that. And sometimes that just really can look like a sitting down and goal planning. OK, what do you what do you want to do? What's your goals? Cool. And now let's reverse engineer that and figure out what is the first steps to that. And once we get that done, we're going to celebrate for a second and then we're going to move on. What's the next step? And yeah, it just and sometimes it can be a cancer diagnosis. It can be, you know, things that bring people to the streets that you didn't even think about or mental health concerns that come up when you're, you know, in your teenage years that you end up on the street and just have no other choice to live there. So a little compassion goes a long way to be able to recognize that that people are here for a myriad of reasons. And you cannot tell by looking at them what that reason is.

MELISSA Yeah. What is harm reduction?

MO Yeah. So harm reduction is essentially just reducing harms. Right. It's death prevention. So it can look like a lot of different things. All of us have been to a harm reduction center. I presume if you're over the age of 21, a bar is a harm reduction center that was created to keep people healthy or to keep people safe while they're drinking. So you're not supposed to drink more than four to five drinks. You know, you're supposed to make sure that people are safe. The old padding on the front of the bar was a thing. So you didn't bonk your head. Right. So just created for a safe environment for people who use alcohol. Harm reduction looks different for medicine. Right. So it might be vaccines or different preventative medicines for other diseases. And then harm reduction for people who use drugs might look like, you know, clean needles if they're using a needle or it might and keeping some of those other harms away. Right. HIV, AIDS, infections, different things that could come up. It might look like helping them go from injection use down to using a pipe. And I know some of these things people get really like, oh, God, I can't believe this is a thing. But if we can take them down in levels of severity or levels of danger, then we can get them to a place or maybe, you know, not using is going to be OK. Or harm reduction might look like using heroin and then getting them to just smoking cannabis. And yes, maybe cannabis. Maybe they don't have a cannabis card, but let's look at the levels of, you know, severity here. And harm reduction often looks like getting people medications that are struggling with addiction as well to go from, you know, heroin use to suboxone is a very good transition. And and it's the gold standard of care. So making sure that we're meeting people with the care that is current, too.

MELISSA I think this is the first time I've ever thought of a bar as a harm reduction center. Usually it's the opposite. Those were about it. So that's interesting. So you have a PhD. Tell me about your, you know, your your background, what you study, what you have. Are you continuing to to do research?

MO Yeah, there's research happening across the hall right now. So I study mostly addiction addiction and psychology is what I teach. I love prevention and then I'm also an entrepreneur. And so I love the entrepreneurial piece of it. And so I do research not only to find ways to bring things to market to help people, but just to better understand what addiction looks like and maybe even what care looks like or help looks like, whether it's our own or not. So I do research on tattoos as healing. Why do people get tattoos, the placement of it? And just understanding what grief looks like in terms of addiction, PTSD, trauma, all those different things. And then currently the research that's across the hall is neurostimulation for trying to figure out if trans-irregular basal nerve stimulation is helpful for people who are struggling with addiction, hoping that once we get that vagus nerve toned that it will allow people to, you know, go from like a heightened state down a little bit. So when an incidence comes up, it's not a compulsive action to go back to addiction, but rather that they have the gap there to be able to think and breathe through and use other coping strategies. So looking at impulse control, addiction levels, craving and all those different things to see if we can find a non-invasive way to help people who are struggling with addiction.

MELISSA So that the vagus nerve thing comes up a lot in different conversations that I have in the Health and Wellness podcast. So what is your vagus nerve reset or toning? How does that work?

MO So it's an electrical stimulation through the ear. So it's placed on the tragus. The tragus on the left side is the only way that you can actually stimulate that nerve from the outside of your body. And so we're placing a small current on the ear that stimulates it and helps that that vagus nerve.

MELISSA Oh, wow. And what are you seeing so far? Can you share anything?

MO Yeah. So people are like when they are done with the. The actual stimulation, the whole process is over. They're like, man, I wish I could continue to do this. My mental health is better when I'm doing this. Like just some really cool, some really cool feedback. So I'm excited to see what the what the results are. We're trying to figure out how much stimulation do they need and how often do they need that stimulation? We know the research says that it's there's some implications that it works really well with this population, but trying to figure out exactly what we need.

MELISSA How many people do you think come to like the library to use the restrooms and hang out during the day?

MO Yeah, I mean, it depends on what the weather is, right? This is kind of a place to take shelter in the winter and in the complete heat. But people come in here to use the library to apply for jobs and do all other things. You don't get to get a break, be able to sit, be indoors. And they may not be able to be indoors anywhere else. So I bet that I bet we see a lot of people coming through the doors all day long.

MELISSA So what do you do? You've got a wagon, you have water. You've got like I saw chapstick or something in there. You've got some other things. What's all in the wagon?

MO So the wagon is filled with, like you said, a little bit of everything. But we have our basic components, which is string cheese, oranges and water. OK. And that's really our trust builder. That's why I can get the conversation started. It allows them to know that we care. You hear right behind me, you want some cheese, right? It allows them to know that that we care about them. And it's just a bridge to conversation. And after that comes, hey, we got some pretty awesome doctors here today. Do you need any help with medical, mental health or addiction care? And what can that conversation look like? So we kind of prompt all of our volunteers to be able to offer those three things because you never know what might be going on. You can't see if somebody is struggling with mental health or addiction or medical need often. And so being able to just open that door. And sometimes it looks like asking a lot of times, too, right?

MELISSA Yeah.

MO So and they may see us, you know, 50 times come to the library, but never once talk to us. And on that 50 first time, they're like, hey, I need a thing. And we just want to make sure we're there for that 50 first time.

MELISSA So if there's people out there watching this and they are excited about the work that you do, they want to get involved, maybe they're a little like, I'm not sure if this is the right fit for me. What would you say to them?

MO Yeah. So I think if you have the background to be able to be helpful in any of the addiction, mental health or medical space and you have even like an inkling that you might be interested, please reach out. And not only in Sioux Falls, Rapid City, Aberdeen and Pier as well. We have locations there, too. And if you're you know, there's other ways to help, too. Right. You can follow us on social media. You can like everything we ever post. You can watch for the things that we're in need of. You can drop off your old shoes and we're going to be needing towels soon. We're going to be getting a shower trailer so people have the dignity of a clean shower once a week. But there's lots of ways that you can you can help for the little needs that we have. Oh, always monetary donations are always, you know, helpful. But yeah, just supporting us along the way, telling people about us. If you see somebody on the street that you care about, that you know that they need help, give them our number 605-250-1000 and they can reach out to us and we can get them help or call us and let us know. So there's lots of little ways to help. It doesn't have to be a gigantic thing. But I think the most would go back to what you asked earlier and just being being kind to people or experiencing homelessness is is a pretty great place to start if none of those other things reach out to people.

MELISSA I have some myth busters that I want it. I want some some facts, factor fiction, I guess you can tell me. Because these are common things that we come across online that people say, well, giving people money. So I'm going to read them to you. You can tell me what you think. OK. Giving people money on the street enables them. False.

MO Absolutely false. I would I would say that giving people money on the street helps them. Now, if you care about where your money goes to, if you hand that 5, 10, 50, 100 dollars out the window and you're like, I care where this goes to, maybe don't do it. Right. But if you're like, I know you're going to get whatever you need today with this money, you need to feel happy with that. Sometimes the things that people get is alcohol. And the reason that they get alcohol is because they're struggling with addiction. And the only way to not go into withdrawals and get sick is to drink again. I've had to tell people on the street where they were waiting to get into treatment. You have to drink until you go because you could die from withdrawing from alcohol without the medical interaction that you might need. So false. But also, yes, they may be getting absolutely everything that they need with the money that you get them to stay healthy until they get to the next place.

MELISSA OK, so homelessness is a choice. You don't have to be homeless if you don't want to.

MO Yeah, I've met zero people who have ever chose this life. I've met people who say they want to continue to stay homeless because they don't think they can get off the street because they don't think they don't know how. Right. And I there's a lady that is housed right now that I didn't think she was so hard about like, I will be on the street the rest of my life. And she's doing fantastic inside of a home. But it was really getting her to know that she was worthy of a home, that we would help her once she got into the home to be able to care for it and understand what it looked like to take care of a home and pay for it. But sometimes people just don't they don't think they deserve it or they don't think they know how to handle it.

MELISSA So helping enables the lifestyle.

MO Helping enables people to stay alive. Yes.

MELISSA OK. Here. Yeah, I love that period. So there is also a perception that street medicine duplicates what shelters and other nonprofits already do.

MO Yeah, I don't believe that. I think we're adjacent to what they do. And I think we bring an extra flair to what they do for sure. But we're not housing anyone. We house zero people here. So we're not replicating what the shelters do and shelters don't have medicine. We bring that. Also, the thing that is the coolest about what we do is we go to the people and shelters can't do that either.

MELISSA But everybody everybody's doing their part for sure. Homeless people just need to get a job.

MO Yeah, I told you what some of the barriers to getting a job could look like. So yeah, yes. And lots of them want to. But they don't have their identification because it's been stolen or they can't find a copy of their green card, even though they are, you know, American citizens. And, you know, the millions of different things that get in the way. But the cell phone is the big one. How do you apply for a job? What does that look like? And what if your address is a place that people may not want to hire you because you're living there. So there's a lot of barriers to getting a job. And I've not met anyone that says that they don't want to work. It's that they don't have all the things in place to be able to get a job.

MELISSA All right. Last one. You can just go to the E.R. if you get sick.

MO Yeah, I don't think that's what we want. Right. We don't want that to be. Those are one of the things that we measure the amount of visits that we can keep from happening. Right. Today, I know you saw us call the ambulance, but that is last case scenario. All right. We try and triage them best we can get them to Falls Community Health or get them to the E.R. We try not to call the ambulance. We don't have to. We're really hoping to decrease the services. And the E.R. is not a one stop. That is not where we want people to go. We want them to understand what the system does look like. Come to us if it's something small. If it's wound care, we can help you with that immediately. Right. But if it's something that's out of our scope that, you know, our people can't handle that day, we will get you to Falls or we'll get you to the emergent care that you need. But we don't want to have the ambulances going when they don't need to go. And we don't want to have the E.R. is clogged up with costs and things that could be handled elsewhere. In the last year, via our presumptions about what street medicine does and other street medicines, we've saved two million dollars in Sioux Falls for that type of care. So those are the things we're trying to get people to not do is just go to the E.R. Right.

MELISSA If you had a billboard and if I gave you a billboard right on the busiest streets of Sioux Falls, what would that billboard say? What do you want people to know?

MO And that's a great question. Homeless people are people.

MELISSA I love that. Yeah, that's good. So last question, if there's people out there that say, like, what is your most important need, your biggest need right now, like we can get everybody to fill your pockets or hallways with something in particular, what would that be?

MO Yeah, good question. Weather's changing. Weather's always changing. Yeah. And so we have to stay abreast of what's going on. Right. So it might be umbrellas and ponchos here for a little bit as we get into the spring. It could be sunscreen, bug spray, every travel size thing that you could need. Anything you would put in your suitcase to go on a vacation, anything that you would put in your camping gear to live outside. All those little things are helpful because essentially these people are living outdoors. So anything you would need to live outdoors and a mini size helps them be able to just use it and not have too much carry on their back. I have to think about that, too. You know, everything that they have lives on side their back. So we want it to be small and easy. They can come back often to get things that they need rather than trying to carry around a bunch. So book bags, shoes, clothes are always something, you know, and appropriate clothes like sweatpants and shirts, not dress clothes. We don't need any of that or dress shoes. We don't need any of those things, although like little medicine things, Tylenol ibuprofen, antacids, hydrocortisone, just like little things that, you know, they're not don't have the availability to go get, but are super helpful. Those are all things that could be helpful for us.

MELISSA That's amazing. Well, thank you so much for the work that you do for an incredible team. And for I mean, a morning that was like, I think, very eye opening for all of us and just, yeah, you're doing incredible work here. Thank you so much. Thank you. I'm happy. I'm able to do it. All right, Mo. So if someone wants to get ahold of you, where do they find you? What do they call if they've got goods they want to drop off? How do they do that?

MO Yeah, you can call 605-250-1000. OK. Or you can reach out to us on any of the social media sites or you can email us at info at MidwestStreetMedicine.org. And those are all the ways you can find us.

MELISSA All right. Well, make sure to put all of that information in the show notes below. So if you're watching this and you want to engage, we'll put all of those links in the show notes. Just hit the description and you'll see the information for Midwest Street Medicine. Yay. Thank you. Thank you. Hey, that's our show. If someone came to mind while you were listening to this, if you thought, hey, my sister needs to hear this or I should send this to my mom or my buddy would get a lot out of this, please share it with them. Just hit the share button and send it their way. You never know what one conversation, one episode or one piece of information can do for someone who's been looking for answers. And if you haven't subscribed yet, please do it now. It takes two seconds. It's free. And it means you won't miss an episode. We've got incredible stuff coming up and I don't want you to miss any of it. And if you're a health or wellness provider and you want to be on the show, we'd love to hear from you. There's a link in the show notes to get in touch. We're always looking for people doing interesting work who want to share what they know. And one last thing I get asked all the time about the products and brands I actually use. So I put together a list of sponsors and favorite products that have worked for me and my family. If you're curious, that link is in the show notes, too. Thank you for being here. And I really mean that. I'm Melissa Goodwin. The line is open. See you next time.