Tel Aviv’s street doctors try to bridge the healthcare divide
Health professionals volunteer to help people living rough.
Tel Aviv, the hub of Israel’s high-tech industry, a cultural center and bustling metropolis, is also plagued by homelessness, substance abuse and sex trafficking, and has a large migrant population. Beautiful and welcoming for some; for others, living a few houses or blocks away, slums that are the stuff of nightmares.
But even those experiencing homelessness deserve basic medical care, so how do they get it?
Ronnie-Lee Sneh, a social worker with a background in global community development, found her calling closer to home than she expected. After returning from a six-month stint in Uganda in January 2020, her plans to work full-time in Africa were upended by the COVID-19 pandemic. Driven by a desire to help, she began working in local homeless shelters.
It was during a lockdown in July that a pivotal encounter changed her trajectory. Unable to locate a particular person in the shelters, she finally met him on the street. When she offered her services as a social worker, his response was blunt: “I don’t need a social worker, I need a doctor. I’m in pain.”
This interaction sparked the idea for Street Medicine Tel Aviv (SMTA). Today, the organization boasts 50 volunteers, including doctors, nurses and medical students, all committed to eliminating healthcare disparities among the homeless.
Breaking down barriers to healthcare
The challenges faced by those experiencing homelessness in accessing healthcare are multifaceted. “While many have medical insurance, practical obstacles often prevent them from utilizing these services,” says Sneh.
“Lost or stolen identification documents, lack of funds for transportation, absence of a phone to schedule appointments and financial constraints preventing them from purchasing even subsidized medications, all contribute to this healthcare gap,” she adds.
In addition to the financial aspect, there is also a major social factor that prevents most of those experiencing homelessness from seeking medical care, she said. “There’s a significant stigma associated with seeking medical help. Many individuals have had negative experiences with the medical establishment, feeling looked down upon or mistreated.”
SMTA aims to break this stigma by meeting people where they are, building trust and fostering relationships.
“We go to them, we see them for who they are and provide them with care while showing them respect and dignity, and that plays a big part in their accepting our help,” Sneh explains. “Ninety-five percent of the people we treat are Israeli citizens.”
Dr. Inbal Sharon, a general surgeon and volunteer with the organization, emphasizes the importance of this approach.
“We help them, but they also help us,” she says. “They help me open my heart, and they give me a new perspective on life. It’s a symbiotic relationship that strengthens both sides.”
The Street Medicine Tel Aviv approach
The organization goes on “rounds” twice a week, usually on Monday evening and a weekday morning. A typical team for rounds consists of five to six people led by one of the organization’s volunteer medical doctors, a professional acting in a social work capacity and several medical students.
They carry medical kits, hygiene supplies and snacks to help break the ice. They are careful not to carry anything sharp, especially syringes, which can be stolen or even used against them by some of the less friendly people they meet, or those suffering from addiction.
The team provides all the medical services that they can on location, which include administering antibiotics, changing bandages, removing stitches and cleaning wounds.
The team members assess whether the situation is immediately life-threatening, in which case they facilitate hospitalization. Convincing people to seek hospital care can be challenging, as many fear withdrawal from substances while waiting for treatment.
Sharon describes the challenges of performing medical procedures in non-sterile environments.
“It’s like working in the Third World,” she says. “The treatments I give usually save a limb. If I don’t operate, the person will lose a limb in a week or two. So, it’s a question of what is worse. The person is already suffering from infection, they won’t be any more infected by the lack of sterilization, so it is often better to save the limb than wait for them to agree to go to hospital. Most people we interact with will only go to the hospital as an absolute last resort to save their lives.”
Complex needs
SMTA serves a diverse population, including members of the transgender community, migrants, addicts and women involved in sex work. Many of the women they encounter are pregnant, presenting additional healthcare challenges.
The organization provides support during childbirth and postpartum periods, often accompanying women to the hospital. They also ensure that mothers are aware of their options, including the possibility of terminating pregnancies.
“One of the women I treated was a woman in her late 20s who had given up her daughter for adoption after the girl was two years in foster care,” recounts Sharon. “The emotional toll of this experience, compounded by another pregnancy and abuse on the streets, was almost too much for her. She was dealing with another pregnancy and had been beaten by other people on the street.
“I told her that she could abort this new pregnancy, but she refused to do so. When she gave birth, I went with her to the hospital; she had no one else to go with her and advocate for her, and no one should go through the birth of a child alone.”
Ethical challenges and building trust
Operating in this environment presents numerous ethical dilemmas. The team must navigate complex street hierarchies and sometimes interact with people who exploit others.
Sharon described having to maintain a cordial relationship with pimps to gain access to women who need medical care, despite her anger and frustration.
“We can’t fix all the problems, but we can do what we can,” she says. “These women want the treatment, and even though most human beings would want to throttle the man who exploits her and beat her up, if we do so we would lose access to treating her and helping her.”
This delicate balance extends to their relationship with law enforcement. While the police are aware of many of the locations where homeless gather, SMTA maintains confidentiality to preserve trust with the communities they serve.
“The police know where these things are taking place, so we don’t have to report it to them, and if we do report it then we lose the trust of the people we treat and they won’t let us treat them any longer.
“The police often close these places down on Mondays and they open up again on Thursdays. Like many other cities in the world with slums, it isn’t a question of closing these places down, it is how far you keep them away from the rest of the citizens. We do what we can to help those we can, and that is our guiding ethos.”
Impact and future goals
The organization has seen notable successes. In the past two years, the volunteers helped five people enter detox treatment programs. While statistics suggest many will return to the streets within two years, the team believes in providing opportunities for change.
The impact of their work is evident in the words of their patients. “M.,” a homeless man in his 70s, says, “The team gave me the prescriptions for the medications that I needed. They are doing holy work, and we need people like them here.”
“H.,” a young woman regularly visited by the team, adds, “The fact that the team comes all the way to me and helps me, gives me a push. The next time they come to visit me, I want to be better so that I don’t let them down, otherwise all their treatment would have been for nothing.”
Looking ahead, Sneh dreams of expanding the organization’s reach to serve every homeless person in Israel who needs medical care. She envisions mobile clinics equipped with the necessary medical equipment and the development of specialized hospital departments that integrate social support with medical care.
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