On Sunday, December 12th, 2021, Project Downtown Orlando (PDO) and the American Muslim Community Clinics (AMCC) held another mobile healthcare event. This is the third time the two organizations have come together to offer healthcare services to the homeless population in downtown Orlando. During this event, AMCC’s mobile clinic was able to provide the homeless population with general healthcare services, such as primary care services and medication refills. The mobile clinic met a great need for healthcare services in downtown Orlando, with the provider seeing more than 20 patients that day. The provider saw patients for a variety of reasons, however, the majority of patients that day came in for symptoms stemming from a very common but detrimental condition, diabetes.
As detailed by the providing physician assistant (PA) that day, many of the patients he saw suffered from complications of diabetes. The primary complication seen by the provider revolved around the foot and wound care. The PA stated that he had to clean and re-dress many wounds, which was a result of diabetes. He stated that diabetes, in conjunction with many of the problems the homeless population face, leads to a bevy of foot problems.
Studies show that among the homeless population, about 8% report having diabetes. This number is not significantly greater than the general population, however, the difference between the general population and the homeless population is the ability to care for their condition and its complications. It has been shown that diabetic patients themselves should take a prominent role in their own treatment. They should be in charge of the necessary lifestyle changes in order to manage the condition; this means managing their diet, exercise, and checking glucose levels. However, the homeless population has significant barriers in the self-management of their condition. Lack of family and social support, unemployment, mental illness, food and shelter instabilities, among other things, hinder a homeless individual from appropriately managing their condition. Moreover, diabetes self-care usually is lower on the priority list of an individual when compared to getting their next meal, or finding a place to sleep.
This inability to care for their diabetes is no more apparent than with foot issues related to diabetes. Across a variety of studies on homelessness and foot health, more than two-thirds of homeless individuals reported having a foot concern, with 25% of those individuals seeking medical attention for it. These statistics make sense when you factor in the problems unique to homeless individuals. Factors such as poor hygiene, lack of clean socks, inadequate footwear, inability to remove footwear, and reliance on walking for transportation increase the risk of a foot injury. Diabetes can result in foot injuries becoming a much greater issue.
Diabetes can exacerbate foot problems due to a variety of reasons. People with diabetes may suffer from diabetic neuropathy, which causes a loss of feeling in their feet. When you lose a lack of sensitivity in your feet, you are less likely to notice injuries. Furthermore, diabetes can lead to a lack of blood flow to the feet, which may hinder the healing of cuts and bruises. These dual complications from diabetes can lead to severe injury of the feet and may even lead to amputation.
Complications of the feet due to diabetes are a major concern of the homeless population. This was very evident during the mobile clinic event on December 12th, 2021. The PA from the AMCC mobile clinic, in conjunction with the showering facilities available at the Christian Service Center due to SALT Outreach, was able to address some of the issues related to foot health. During the clinic, the PA was able to provide foot/wound cleaning, wound redressing, and diabetic medications. This was very beneficial to the patients, but more is needed to address the root causes of the problem. The PA states that clean socks, appropriate footwear, and good hygiene will go a long way to help prevent complications from diabetes.
The AMCC and PDO mobile healthcare event is providing a critical service for the most vulnerable populations, and the patients are taking notice. Herbert Spike, a patient who utilized the services of the clinic, stated that he is supremely grateful for the services provided at the event. He states that the services provided are very comprehensive and meet a great need. Most of all, he states that he is very happy to see people who actually care, people who mobilized a successful event. He hopes that this community of care will continue to grow.
Sources:
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716851/
https://www.webmd.com/diabetes/foot-problems
https://www.healthline.com/diabetesmine/living-on-the-street-with-diabetes-how-can-we-help#1
https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2014.302330
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147925/
https://www.streetroots.org/news/2019/06/14/life-streets-foot-health-never-ending-struggle