For people living on Phoenix’s streets, keeping insulin cold or protecting a prescription can be nearly impossible. One doctor is rethinking what healthcare looks like when survival comes first.
In 2012 Dr. Robert Fauer started giving the homeless what he thought was objectively the most helpful, things like money and blankets. During the COVID-19 pandemic he gave out handwipes
Today, as medical director of Phoenix Street Medicine, Fauer sees how the challenges of homelessness often block medical care.
LOOKOUT writer Jack Fernandez spoke with Fauer at an outreach event Phoenix Street Medicine held alongside Shot in the Dark, a harm-reduction organization. Fauer explained why traditional healthcare often fails patients without stable housing, how street medicine forces doctors to rethink their training, and why housing remains the most effective treatment he knows.
LOOKOUT: You often describe healthcare for people experiencing homelessness as "virtually undoable." Why?
Dr. Robert Fauer: You can treat them, but they lose their medicine. It gets stolen. They get beat up. They don't have a place to keep anything.
I once found a box of insulin next to the dumpster with an ice pack. Somebody had probably just been discharged from the hospital, tried to keep it cold, and then had no way to store it.
Editor’s note: The City of Phoenix Park’s Code of Conduct restricts people to store personal belongings in public spaces. In December last year, they made those rules enforceable by police, resulting in misdemeanor charges if violated.
People have so many immediate needs that managing diabetes or blood pressure becomes almost impossible. They're worried about where they're going to sleep, where they're going to eat, whether they're going to be safe.
Some people wait in line for breakfast, then lunch, then methadone, then a healthcare appointment. Eventually they just leave because they can't spend the entire day waiting.
It’s almost not human. So, I personally haven’t found the answers to this.
LOOKOUT: If medicine isn't the biggest need, what is?
Dr. Fauer: Housing. The fastest way to improve someone's health is to get them housed, get them reliable food, and address their mental health and substance use.
That's more important than trying to micromanage blood pressure or diabetes.
We do a lot of wound care because that's what people need right now. But until somebody isn't worried about survival, medicine only goes so far.
LOOKOUT: How has that changed the way you practice medicine?
Dr. Fauer: You have to stop thinking like a textbook.
My students are learning to ask, "What is this person's life actually like?"
Maybe they're LGBTQ. Maybe they're homeless. Maybe they're another marginalized person. Whatever it is, you have to understand what they're dealing with before you decide what's realistic.
I can't stand cookbook medicine.
LOOKOUT: What does street medicine look like in practice?
Dr. Fauer: In the summer it's shade, water, and something to sit on.
People are sitting on 150-degree concrete. We give out UV-coated umbrellas and thick blankets they can fold up to protect themselves from burns.
We do a lot of wound care because people are constantly walking, falling, getting infections. We treat what's in front of us while recognizing we can't solve everything.
Other physicians have told me people lose executive functioning after just a couple weeks on the street. I believe a lot of that comes from sleep deprivation. You're sleeping outside, worried about your safety all night.
Our job is to keep people as healthy as we can until they can get off the street.
LOOKOUT: How have recent city policies changed your work?
Dr. Fauer: We used to give out food, we won’t give out food anymore. I used to carry medicines with me. I will not do that anymore. I may, down the road, and just leave it in the vehicle. I gotta see how this ordinance will be enforced.
One or two weekends ago we got hassled by the police because a neighbor made a complaint. I just imagine if one of my students got arrested.
LOOKOUT: What would happen in that instance?Dr. Fauer: I could get kicked out of the university and lose my funding, and space.
LOOKOUT: What kinds of care do people need most often?
Dr. Fauer: Almost everything comes back to wounds.
People are walking constantly. They're getting burns, cuts, infections. Sometimes we're improvising solutions. I once built a custom wheelchair seat for someone with an amputation and a severe ulcer just to relieve pressure on the wound.
LOOKOUT: What's one thing you wish people understood?
Dr. Fauer: Treat people experiencing homelessness like human beings.
One thing that always strikes me is that cities build dog parks so dogs have a safe place to exist, but we're reluctant to create spaces where people can safely receive medical care.
That says something about how we value people.
LOOKOUT: Where do you think things are headed?
Dr. Fauer: There are more people experiencing homelessness every year, and more universities are recognizing they need to train future doctors to care for them. The need isn't going away.
Southwest Recovery Alliance leader Arlene Mahoney says Phoenix's approach to homelessness and drug use puts lives at risk by limiting access to harm reduction services.
Robert McElhose has spent 15 years surviving on Phoenix’s streets. He shares what it takes to make it through another day, and what the city's new ordinance means for his ability get help.
East Sunnyside block watch president Jeff Tisot supports Phoenix’s parks ordinance, arguing that outreach should focus on getting people into housing and treatment—not keeping them in public spaces.
The court's rollback of LGBTQ+ rights are proving successful for certain businesses that receive taxpayer funds.
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