Modesto-based group tries to keep unhoused people healthy. Here’s what it does

On a recent Friday morning, an unhoused man decided to get his finger, which was bitten by a rat, checked by a doctor in a van parked in Modesto’s airport district.

Dr. James Kraus attended to James Black’s hand, providing cleaning and advice in case of future suspicion of rabies.

“Anything we can do in the primary care office, we can do here,” Kraus told Black.

Valley Streetz Harm Reduction Program is a harm reduction initiative authorized by the California Department of Health and is based in Modesto. Established last year, the group engages in street medicine and distributes harm-reduction supplies, such as sterile water and safer smoking kits.

Harm reduction aims to enhance the health and overall well-being of individuals who use drugs, even while they are actively using. Street medicine involves delivering medical care directly to individuals experiencing homelessness and providing them with on-the-spot care.

“It’s as simple as wearing your seatbelt, not driving after drinking, applying sunblock on a sunny day,” said Dr. Andie Silva about practicing harm reduction.

Research by the National Institute on Drug Abuse shows that certain harm reduction approaches yield substantial benefits for both individuals and public health. These include reducing overdose fatalities and preventing the transmission of infectious diseases.

Additionally, such strategies can decrease visits to emergency departments and lower healthcare costs. In certain instances, they also give people who use drugs the chance to access substance use treatment and other healthcare services in environments with reduced stigma .

Officially associated with the University of Southern California (USC) Street Medicine team, they were selected as one of just four programs authorized to implement comprehensive harm reduction strategies. Over the next year, the USC team will serve as mentors to Valley Streetz as they develop their program.

The team mainly consists of Alexa Ortega, Silva and Kraus.

Ortega, who is originally from Ceres, has a background in the county probation office and as a harm reductionist. Silva, a Fresno native, is a family medicine doctor and addiction specialist.

For the past two months, every Friday, they have distributed supplies at the Rock Church Ministry, which provides food and essential items to people five days a week. No identification is required to access these resources.

The Rock Church Ministry serves about 170 people a day. On Fridays, Valley Streetz typically provides services or consultations to around 12 patients.

Valley Streetz has a van stationed at the food distribution site to offer patients free wound care and treatment in a discreet environment. Within the van, they stock muscle rubs, pregnancy tests, melatonin and a portable ultrasound machine for conducting examinations, including kidney checks and abscess assessments.

They also do house calls.

“It’s sophisticated medicine for people that aren’t even used to getting care,” said Silva.

Onsite, they distribute free harm-reduction supplies, including pipes, safe snorting kits and hygiene products. Thanks to donations from various state programs across California, such as the Narcan Project, their overhead costs remain minimal.

Additionally, the group works closely with MoPride and remains dedicated to serving the LGBTQ community.

Efforts are underway to enhance access to gender-affirming hormone therapy on the streets as syringes are also used for injecting hormones. They often wear rainbow pins to signal to those who may not be out that they are being cared for by a safe and accepting group.

Silva mentioned that during testing, they uncovered a significant syphilis outbreak within the unhoused community in Modesto.

There’s over 2,000 unsheltered people in Stanislaus County while 60% of individuals experiencing homelessness lack health insurance , which keeps them from obtaining preventive and primary care services.

“We saw an opportunity that patients were not being served,” Silva said.

Modesto’s history of harm reduction programs

Before Valley Streetz, Modesto had a needle exchange program on and off from 2008 to 2014.

Brian Robinson, who was a part of the original program, said the work they did was heavily criminalized .

“There’s a lot of politics involved in these things. There’s a lot of resistance in our country,” Robinson said.

Robinson and another individual in the group were arrested in 2009 for operating an unauthorized needle exchange.

Fortunately, now they are allowed to operate within the framework of established laws and regulations, especially considering Modesto’s lack of these services over the past decade.

Still, Ortega said the group has met some pushback from local government due to the controversial nature of harm reduction work.

Rebuilding trust with the medical industry

When they first started in February of 2023, Ortega and Silva would pack up a backpack and head to a park in Modesto to hand out Narcan to the unhoused individuals there.

Before leaving, they’d ask if anyone needed clean needles, pipes or condoms. They started returning to the same park every Friday.

“Everything we do is completely trust and rapport-based. We don’t show up to a camp or a park and expect people to trust us,” Ortega said.

Ortega observes that individuals sometimes accept resources from them to share with others elsewhere, as trust within the wider community may still be developing.

Silva said that their ultrasound device plays a crucial role in fostering trust by providing patients with a firsthand view of their health.

“There’s so much distrust in the medical system, and we bridge that by showing someone their kidneys in front of [them] and making decisions based on that,” Silva said.

Kraus emphasized the importance of being on the ground with backpacks to establish trust with patients. He noted that many unsheltered individuals feel unwelcome in the medical community due to stigma.

Above all, they’re just trying to lift the standard of care for the unhoused community, he added.

“Our goal is to meet people where they are, treat them with love, dignity and respect. If at some point they want access to some treatment for substance use disorder, we’re able to do that,” Silva said.