LavaMaeˣ and UCSF Street Nursing Team Provides Hygiene and Health Through Powerful Partnership
Hygiene and Healthcare: A Powerful Partnership
Every week in San Francisco and Oakland, a team of two or three nurses walks the streets alongside LavaMaeX, providing services including wound care, vitals assessments and specialist referrals to unhoused people wherever they live. Leveraging the trust LavaMaeˣ has built with the community, the nurses go directly into encampments as an integral part of the LavaMaeˣ street outreach team.
The nurses are current or former students at the University of California San Francisco School of Nursing and members of its Street Nursing team, which became the first LavaMaeˣ Hygiene+ medical partner in April 2019. Tessa Rubin, Katie Machado, Megan Grant and Taylor Cuffaro founded the team as a way to reach people who lack access to medical care or avoid seeking it because they don’t trust medical providers. Each had previous experience working with the unhoused: Machado was the UCSF Shelter Clinic’s co-director; Rubin worked at resource centers in Santa Cruz and San Francisco; Grant treated unhoused patients in a mobile clinic in Chicago; and Cuffaro helped the San Francisco AIDS Foundation as well as services that provided syringe access. They hoped to find a better way to approach potential patients.
“A medical bag and stethoscope can only get you so far,” Rubin said. “Someone at UCSF knew someone at LavaMaeˣ, so we pitched ourselves and said we wanted to provide low-barrier care to the unhoused community. Hygiene and health are an amazing partnership.”
At first, the nurses set up a table once a week at LavaMaeˣ mobile shower sites in San Francisco and chatted with guests, forging relationships, learning about their top concerns, developing trust and gaining “street cred,” Rubin said. Eventually the nurses began offering a range of services from wound care and lice treatment to reversing overdoses with Narcan. They see themselves as a step on the way to full-spectrum care and often refer guests to advanced healthcare providers as well as help them set up and commit to appointments.
The partnership between LavaMaeˣ and the Street Nursing team illustrates how complementary organizations that are committed to each other can achieve greater impact together than they would alone—especially during a crisis.
Impact: Bringing care to the unhoused through the pandemic
Pre-pandemic, the Street Nursing team offered free services near the LavaMaeˣ shower trailer, putting chairs, snacks and pet treats around a table set with stethoscopes and other tools for taking vitals. They interacted with five to 25 people in a four-hour shift, assessing fevers, treating wounds and assisting with insurance sign-ups. Guests left with a bag filled with items—such as wound or foot care supplies—that they could use until their next visit or until they could see another provider.
The Street Nursing team saw more than 530 guests from April 2019 to March 2020; over 260 were LavaMaeˣ shower users and the rest were passersby. They gave over 210 consultations for general healthcare questions, referred more than 160 people to primary and urgent care providers, and provided blood pressure checks, wound care, skin assessments and other services to the rest. That was before COVID-19 arrived.
When the pandemic hit and LavaMaeˣ paused shower services, the teams collaborated to distribute 200 COVID-19 hygiene kits per week in San Francisco and Oakland. Once the nurses acquired PPE and created safety protocols for working on the street, they adapted to meeting guests where they are and started giving health checks in both cities.
Today, they care for four to 10 people during each two- to three-hour shift and distribute hygiene kits, clothing and food. Since the pandemic began, they’ve directly helped LavaMaeˣ hand out over 4,000 COVID-19 kits to the unhoused, filled with hygiene items such as soap, hand sanitizer, shampoo and conditioner as well as face coverings, water and food.
“You’re seeing people in a more vulnerable state and you are more able to understand their experience of living” when walking into encampments, said Machado (now a registered nurse). Increased camp sweeps make consistent contacts with patients a challenge, but “our connection has been stronger because of LavaMaeˣ.”
Now that LavaMaeˣ shower services have reopened, the UCSF nurses are returning to the shower sites as well to provide a consistent place where guests can access care. “We plan to have LavaMaeˣ be our home base and continue to invest in our partnership,” Machado said. “We know how much the community has missed the showers, and we’ll support them any way we can.”
LavaMaeˣ and Street Nursing provide a continuum of care
In LavaMaeˣ, the nurses found a partner that helps them provide a continuum of care to the San Francisco Bay Area’s unhoused neighbors and that shares their approach. “Our philosophy as nurses is based on human connection and the relationships that develop between humans during care,” Rubin said. “LavaMaeˣ stands for those same values.”
The nurses particularly responded to Radical Hospitality®, the LavaMaeˣ ethos of meeting people wherever they are with an extraordinary level of care. Adopting this approach allowed the nursing team to offer low-barrier, seamless healthcare and repair the bridge between the unhoused and the healthcare system.
“These people have been burned so many times that it’s hard for them to trust the system again,” Machado said. “Radical Hospitality is about making people feel welcome, and it’s a big part of how we show up with LavaMaeˣ. We’re removing barriers and going an extra mile to make sure our clients aren’t being pushed aside.” For example, if she refers someone to a clinician, she will help them figure out the bus route to the office.
“From LavaMaeˣ, I’ve learned to deeply understand the value of having community and how to build it,” Machado said. “We take extra moments to build rapport before jumping into medical stuff. The approach is, ‘I want to build a connection with you, and if you want the service I provide, that’s great.’”
By collaborating, the teams can help more people. During one shower service, LavaMaeˣ replication community engagement lead Annie Stickel-Rice noticed that a regular guest was looking “off” and notified the nurses. It turned out that he was experiencing delirium tremens, a severe alcohol withdrawal symptom.
“We wouldn’t have known to go up to him because we didn’t have that relationship, and maybe he wasn’t ready to engage in care,” Machado said. “Annie knew he wasn’t at his baseline because she had a relationship with him, and because of that he allowed us to talk to him and intervene.”
Another opportunity to help occurred during a recent walk with LavaMaeˣ, when Rubin met a woman who asked for a pregnancy test. After it came back positive, Rubin accompanied her to prenatal appointments and encouraged her to keep going by texting with her. “I wouldn’t have been able to find her otherwise,” Rubin said. “She’d already seen a bunch of folks from other city services, and none had returned.”
With the trusted Street Nursing team by its side, LavaMaeˣ is now better able to restore dignity and fuel a sense of opportunity for people experiencing homelessness. In recognition of that success, the partnership earned a $300,000 grant from the Rita and Alex Hillman Foundation, funds that will allow UCSF Street Nursing to improve care.
“Our work takes a village,” said Stickel-Rice, “and when other organizations have the same model of care and the same level of dedication, we see a significant difference in our guests’ well-being.”
UCSF Street Nursing profile
Home base: San Francisco, CA
Team: Tessa Rubin, Katie Machado, Megan Grant, Taylor Cuffaro
Services: Blood pressure and vitals checks, wound care, lice treatment, referrals to other healthcare providers and specialists, COVID-19 kit distribution
Guests served: Over 530
Radical Hospitality tips and lessons
Everything is unexpected when you enter the environment where people live, so go with an open mind and be prepared for anything.
Talking to guests, even if it’s only weekly, paves a path toward repairing trust and getting them care.
It’s not enough to offer healthcare services; it’s also crucial to lower barriers to care by making access as seamless as possible.
Radical innovation
In spring 2019, the Street Nursing team created a course at UCSF to train more nurse practitioners to work with the unhoused. Last year, 60 people enrolled and the Street Nursing team hired one of them.
