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Homelessness recently took on a new meaning to a group of UNLV School of Medicine students involved in a class project in southeast Las Vegas.

Instead of people who live permanently on the streets, sleeping on sidewalks or in the parks, they found people who are homeless about one week each month. These people either work at low-paying jobs or rely on government assistance. Either way, the money they get covers only about three weeks of living expenses. For those three weeks, they live in the motels along Boulder Highway and purchase food at nearby stores. The other week, they are on the streets.

Changing Perceptions

“I was blown away, surprised to see how many people were living like that,” said Harrison Shawa, a first-year student in the medical school’s second class. “I just never thought of people knowing they’d have enough money to stay in a place for three weeks and then be homeless for the rest of the month. Out of money, they’re not eating right and more apt to be a crime victim.”

Shawa was part of a team engaged in Immersions EMT/Population Health, a six-week course. All of UNLV’s first-year students are required to become certified by the end of the course as emergency medical technicians (EMTs) and then participate in EMT calls. But the course also requires them to explore a neighborhood and learn how to conduct a community health assessment, a major tool used in population health to determine areas of need and possible realistic intervention targets for positive change. 

Dr. Laura Culley, the UNLV School of Medicine associate dean for community engagement, notes the course exposes students to the “downstream” and “upstream” aspects of medical emergencies. “Downstream” refers to medical emergencies that doctors encounter, such as a sexual assault, and how to manage those situations. “Upstream” refers to the conditions that can contribute to those emergencies, such as homelessness.

Recently, several teams of students made presentations to other students, faculty, and also officials who represent the neighborhoods in which the students conducted their studies. Using slides, the students outlined neighborhood demographics, resources, crime, educational opportunities, safety conditions of roads and sidewalks, the presence of recreational opportunities, and the variety of food products available in nearby stores.

Better Understanding

Shawa, along with Lauren Ostler, James Lovett, Tes Yadete, and Donnis Davis, said they came to understand why there were so many pedestrian accidents near Boulder Highway and East Tropicana Avenue.

“Six-lane crosswalks are just too wide for some people to negotiate in a hurry,” Shawa said. “You have to keep that in mind as a physician when you tell people without a car to go to a particular store or pharmacy or whatever. And some sidewalks just end.” 

Like Shawa, Ostler said the project taught her how helpful it would be for a physician to understand the background of a patient who lived in the area.

“By understanding these people and their lifestyles, I could tailor medical treatment to them,” she said. “Say we have a patient who is overweight but is afraid to go outside and exercise because of gang activity in the area. We learned there is a lot of gang activity from people in the neighborhood.

“I could set up exercises for (the patient) to do at home — have him walk stairs instead of taking an elevator. And if he’s only been getting bad processed food at a (convenience stores), I could let him know about healthy foods at nearby food banks.”

Davis said a physician who understood that a patient came from an impoverished background would never prescribe medications that were out of his financial reach.

Critical Knowledge

“What really hit home to me is how you have to understand what people are going through to be a good family physician,” Davis said. “The treatment plan you’re going to have to set up is something on the less-expensive end. And you’re going to have to spend a lot of time educating because you can’t assume that all people know what you mean. Many of them haven’t had the opportunity for a good education.”

Lovett said it is critical for physicians to understand the resources in a neighborhood where people often are on foot. “You don’t want to tell somebody to exercise in an area controlled by gangs. The more you know about an area, the better.”

Ostler said the area around the Whitney Recreation Center needs new, affordable housing and a crackdown on sex trafficking.

After learning from one resident about a man who made money through prostitution of young girls, Shawa said one way that physicians may be able to help change lives for individuals is to work more closely with police and to get involved with planning agencies.

“Students are trying to get themselves integrated into different planning organizations,” he said. “We want to make a difference.”