A Clinic on Wheels for the Homeless

Tarife, who grew up in suburban Rockland County just outside of New York, received a master’s degree in nursing from Columbia University. He worked for a private practice in the South Bronx, but resented the demands to pump patients in and out quickly. “We were forced to act like machines,” he says. Tarife’s wife, Valerie Voon, remembers how private practice disagreed with him: “If he [needed] to spend extra time with one person, [he’d] do that rather than have outstanding numbers of seeing a hundred patients in a day,” she recalls.

A friend told Tarife about a job opening on the MedVan almost five years ago. Now, he can’t picture himself doing anything else.

Still, he insists that he tries not to bring work with him when he returns to his home in Bayonne, New Jersey, each night. But he can’t help it. Sometimes abnormal lab results require follow-up on the weekend, and other issues arise that beg his attention.

Conry, the van’s pharmacist, remembers a phone call from Tarife late one evening. He asked Conry about the drug regimen for one of their HIV-positive patients. “I could just tell he was wrestling with the best choice of therapy for this person.  And you know, it was on his own time. That’s typical of Ellery,” he says.

But that’s in between playing video games with his 10-year-old stepdaughter, spending time with his wife and parents, enjoying a cigar and going to the gym. Tarife shrugs nonchalantly as if to show that the quiet lifestyle is just fine with him. He works long days, supplementing his Project Renewal hours with a part-time position at a drugstore’s urgent care facility to cover some bills.

What’s important to Tarife is the job satisfaction he gets from the MedVan. Unlike private practice patients that he often found demanding and unappreciative, on the MedVan “the clientele is more receptive to what we do. A lot of them are grateful if we just give them a pair of socks.”

Socks and foot powder and vitamins are so-called “engagement tools” for the van staff to get people on board in hopes of starting a dialogue about long-term health needs they may have.

Many patients come to Tarife with chronic problems such as high blood pressure, diabetes and high cholesterol. But the MedVan’s medical tools and supply of pills alone are not enough to keep homeless patients healthy against the odds they face. “There needs to be some sort of initiative on their part to take action on their health,” says Tarife of his patients.

When patients become involved in managing their own care, Tarife sees that as success. He tells of a diabetic male patient who was homeless and addicted to drugs when he started coming to the MedVan. Tarife would give him pills to control his diabetes – they don’t need to be refrigerated, but they also don’t work as well as insulin does. The man sobered up and found a job and an apartment. Now he uses the more effective insulin and regulates his own intake.

But the many factors that keep people living on the streets make healthcare for the homeless a problem that’s far from being solved. Addictions and mental illness often detract from attempts to make health a priority. Tarife is patient when a visibly drunk man enters the exam room, but after a brief session of incoherent answers, he sends the man away with medicine for his cough and a request to return next time without drinking.

Lifestyle factors are not the only complications in Tarife’s work, though; sometimes the illnesses themselves become too much. Tarife has seen several patients with Hepatitis C, a liver disease, on the MedVan one week, only to learn the following week that they have died. He tries to reassure patients going through difficult times. “To treat them optimally is impossible. You try to recommend the best therapies and follow-up to make sure they do what they’re supposed to do,” he says. The recommendations depend on the most urgent needs, which sometimes can include a drug rehabilitation program or mental health treatment.

Tarife’s years on the MedVan have shown him a new reality. “You know, it could happen,” he says. He could end up on the streets any day. “So I don’t really see myself as different [from my patients]. I guess I’m luckier in the sense that I’m not where they are.”

And where they are is a place that complicates any endeavor to stay healthy. David Higgins doesn’t return the following week to get his pneumonia shot. One can only wonder what kept him away. “He’s like many patients we see,” says Tarife. “They will come in one time and then not show up for six months or a year. Maybe he is feeling better, maybe he is in a shelter, maybe he was hospitalized and has another doctor…”

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Medical care for a different New York City population.