It's 7 o'clock on a frigid Monday night. All bundled up, a half-dozen members of Operation Safety Net begin their three-hour trek at the Red Door, St. Mary of Mercy Church, Boulevard of the Allies and Stanwix Street. The homeless come here for meals, and so this is where Dr. Jim Withers and his team begin making their rounds.
In his trademark dark jacket and thick boots, a heavy green backpack slung over one shoulder, Withers approaches his patients deferentially. Armed with "what the street has taught me," he says, he carries a blood-pressure cuff, stethoscope, wound-packing material, sanitizer, antibiotics and so on. Opening the consultations with the soft-spoken offer of warm, dry socks, bologna or peanut-butter-and-jelly sandwiches, he'll ask how his patients are, whether he can take their blood pressure, or to see the wound that's oozing pus.
Sometimes the opening gambit is nothing more profound than a simple "How's it going?" to a person filthy and burrowed into rags or newspapers.
"We try to let the person define his own comfort with us," Withers says.
Withers and his Operation Safety Net crew -- medical students, volunteers, and the indispensible Mike Sallows -- visit Downtown's back alleys, the undersides of bridges and the lee of buildings. They make their house calls in the silent, shadowy, sullen places where men and women are likely to creep away from what Satchel Paige called the social ramble.
Withers jokes that Sallows is his Indian guide, the last of the Mohicans. Sallows -- who sports a bandanna, earring, beads and a turkey feather in his hair -- is indeed of Native American heritage, Seneca with a soupçon of Iroquois and Mohawk. Having been homeless himself in the '80s, he's extraordinarily sensitive to these people: where they live, how they think, what they need.
When he got back on his feet, two decades ago, "I went out on the street," he recalls, "looking for people who were radically underserved."
Sallows found plenty of them. Realizing the problem was bigger than he could handle alone, he went looking for a physician to help.
Enter Jim Withers, who says he "wanted to find a classroom which would force me and my students to work with people on their terms."
"He showed up," Sallows says with a shrug. "That was 20 years ago. He's never left."
Within a year, Withers founded Operation Safety Net. Part of the Pittsburgh Mercy Health System, OSN boasts 20 paid staffers and 200 volunteers. Headed by program director Linda Sheets, OSNers do everything from paperwork to stockpiling sleeping bags and boots for the homeless. "Every day I am driven by the questions, ‘What can I do to help them?'" Sheets says. "‘What resources can I pull together to get them a high level of care?'"
They need nothing less. Tonight Withers & Co. will find a witch's brew of horrors: malnutrition, diabetes, cancer, brain bleeds, blood clots, hypothermia, STDs, tuberculosis, maggot-infested wounds, mental illness, substance abuse.
"Increasingly," Withers sighs, "we're seeing the results of the economy."
Having combed the Mon Wharf and Point State Park, Withers and his team swing through the Cultural District. Under the 16th Street Bridge, they find a man coughing up what Withers euphemistically calls "nasty stuff."
"It's reality-based health care -- backpack medicine," Withers says. "The whole idea is going to someone else's reality. If you don't make the journey, you can't solve any of the health-care issues.
"People treat us extremely well," he adds. "They trust us, and we trust them. We feel we're part of the community. Community is the whole shebang."
Over the years, having walked the equivalent of a few times around the Earth's circumference, the members of Operation Safety Net have seen as many as 100,000 people. They've gotten some 800 of them into housing. And there is one stat of which they're particularly proud: "Because of the boots and socks we give out, we've had no frostbite amputations in eight years," Withers says.
The goal was to offer a model "that would challenge and change the self-image of the health-care system," Withers says. "We wanted to create a concrete example of health care that would have legs."
And already, the idea has traveled all over the globe. Some 2,000 medical alumni have graduated from Withers' outdoor classroom, and Operation Safety Net has been discussed at international conferences. It has now been replicated in 82 cities around the world -- from Calcutta to Anchorage, Santiago to London.
"Street medicine," Withers says, heading for the underside of the Clemente Bridge, "is definitely a global movement."