The Not-So-Easy Street

Service to Community: Madison has a homeless problem, and physicians Erik and Cate Ranheim are practicing street medicine to help

It’s a Saturday night and Cate and Erik Ranheim are walking down State Street on their way to a pathology department awards dinner.

Suddenly, a passerby recognizes Cate. “Dr. Cate!” the man shouts excitedly. She does a double take and sees that it’s one of her patients. He’s dressed up, wearing slacks and a tie. He tells her he just applied for a job at a nearby KFC, and updates her on his life. Suddenly, the sidewalk becomes a clinic.

Cate says she’s glad to see he’s doing well, and that if he needs a recommendation, he knows where to find her.

That would be at The Hut, a space where the couple voluntarily offer medical treatment to the county’s homeless population. It is there that Cate, a Meriter hospitalist and hematologist, and Erik, a UW Health hematopathologist, co-founded the HEALTH program, short for Helping Educate and Link the Homeless. The program is supported by St. Vincent de Paul and sponsored by the Meriter Foundation. And it’s there that so many underserved and uninsured homeless patients who have no other option for effective primary care can go when they need help.

The Hut has a full-time nurse, Barb Simons, who works with patients and, as Erik says, helps them navigate their way into the health system. Since its founding in 2009, HEALTH has served an estimated 850 patients, many of whom are referred by area shelters.

Sometimes, Cate and Erik go to find these patients. Cate recalls a time when she was led into the woods, where a man was unable to move to get assistance. She treated him there. They’ve also worked with city police and shelter directors to find people in need. “You have to be kind of creative with street medicine,” says Cate.

How does a street medicine program get started? “You just do it,” laughs Cate. “Really, literally, we bought a tackle box [for supplies]. We just did it. We didn’t really ask for permission.”

Married since 2006 and the parents of four children, Erik and Cate say they share a passion for service and see it as responsibility, not a choice. The couple had traveled to Cuba and Belize, supplying medical clinics there with basic equipment that makes a significant impact on the health and wellness of local patients. They realized that similar outreach efforts were needed to aid the homeless population in their own hometown.

“There are a lot of things you can do, for not much money,” says Erik.

Madison and Dane County have other services that effectively target homeless and underserved populations, but the Ranheims believe HEALTH is unique because its goal is to prevent illness, not just treat it, and to do so for all homeless people, not only those who qualify for programs such as Medicaid.

“There was a gap in terms of providing primary care to people in this innovative way,” says Cate.

In Madison, and around the nation, homeless patients often turn to emergency rooms for care, even for minor ailments that could be easily treated or prevented by a visit to a primary care provider. Without an income or insurance, and with no chance of receiving Medicaid, seeking basic health care is a challenge. A trip to the ER— where, by law, all patients are required to be treated regardless of their ability to pay—is sometimes the only option. HEALTH offers an alternative.

The Ranheims believe that investments in programs like HEALTH have other positive implications. They reason that street medicine programs reduce the costs hospitals are paying to treat unnecessary emergency room walk-ins.

“You’re going to pay for this one way or another,” says Erik. “Would you rather spend a little bit of money and save a bunch of money, and meanwhile conveniently do the right thing? Or are you going to not spend that money and that time and just say, ‘Well, when they come to the ER, we’ll pay for it?’”

According to Cate, around seventy-five percent of HEALTH patients identify Meriter as their hospital of choice. An in-depth financial analysis of 425 patients who utilized the HEALTH program last year found that those treatments correlated with an $800,000 reduction in Meriter’s medical costs. It’s a deal for the hospital, considering that its philanthropic arm currently invests just under $200,000 per year into the program.

De-stigmatizing the homeless population is a natural byproduct of the work the Ranheims do. For instance, homeless patients have concerns about their long-term health just as everyone else does. The couple has helped countless patients with common problems such as blood pressure and diabetes, as well as the little things that without attention can become big—and costly—like keeping feet dry to prevent ulcers in diabetics, or taking precautions against cold weather, which can be deadly in Madison’s winter climate. 
Cate says she is continually surprised by Madison’s blindness to the more than three-thousand individuals served in homeless shelters last year.

“We kind of pretend that homelessness isn’t really there,” she says. “In this very liberal, wealthy community we tolerate a disturbing amount of homelessness.”

The Ranheims hope to bring more attention to the issue in Madison and inspire others to do the same. Daughter Kendl, age seventeen, recently launched a nonprofit, FRESH Project, Inc., to share health-conscious meals at drop-in shelters, meal programs and resource centers in Dane County.

For information on financial donations to HEALTH, contact the Meriter Foundation at (608) 417-5300. To volunteer with the program, visit healthprogram.us, or email Cate at cranheim@meriter.com or Erik at earanheim@wisc.edu.

Madison Magazine’s Top Doctors survey asks physicians to nominate fellow doctors who use their knowledge and expertise to make a significant difference in the health and welfare of Madisonians. This year’s Service to Community Award honors Cate and Erik Ranheim for their tireless work with the homeless.

>> Top Doctors 2012

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