Meeting People Where They Are
Bobby Harris’08 believes in meeting people where they are. Before Covid, the nurse practitioner and public health professional hit the road each day at 8 a.m. in a large, medically modified RV. His destinations were areas of Baltimore with the highest opioid overdose rates.
As medical director of mobile medical services for Baltimore’s City Health Department, Harris and a team of interdisciplinary staff took their street outreach to people who were injecting drugs and had no access to primary health care except through an emergency room.
In two and a half years, they started about 500 people on buprenorphine treatment for opioid use disorder and now manage about 140 continuity patients with the disorder every month. They care for people whether or not they are insured, documented, or have the ability to pay.
“We’d see patients for four or five hours a day, come back to our clinic, and try to figure out what happened,” says Harris. “It was an amazing experience that really embodied the ‘meet people where they are’ mantra and the models we’ve found that succeed with people who might not have access to a traditional medical system or clinic. That experience prepared me for a lot of what we’re doing now within the context of Covid.”
Today, Harris is the site director for the Triage, Respite, and Isolation Center (known as the TRI Center), an innovative public health project that cares for people who are either homeless or without a stable place to live while they’re self-isolating or enduring Covid. The center opened in May in a historic downtown Baltimore hotel.
Social justice and public health
Both positions reflect Harris’s values and why he was drawn to public health in the first place.
At Beloit, his mentor was Professor Emerita of Biology Marion Fass, whose bottomless passion for teaching about emerging infectious diseases and HIV opened many students’ minds to public health as a profession.
“Marion put me on this path of becoming a nurse practitioner and a public health practitioner,” says Harris, who went to graduate school at the University of Pennsylvania. “I remember sitting in her office weekly, talking about health inequities. She provided the parameters and a platform to think about how to fight social injustice and to do so through public health. I can’t emphasize enough how important Beloit was in my life.”
When Covid outbreaks started occurring in Baltimore and around the world in March, Harris had to quickly convert the in-person opioid outreach program to a telemedicine service. Then he redeployed to help set up a hotel to shelter people in Baltimore who tested positive or were exposed to Covid. The patients didn’t require hospitalization, but they had no stable place to isolate and recover. That first shelter effort amounted to a quick solution to address outbreaks, and early on, no one understood the additional needs and anxieties patients would face while isolated in a hotel.
The TRI Center, which quickly followed, has a much more comprehensive and collaborative approach. In a flurry of activity, Harris says he and a team opened the center in nine days.
A true partnership
“This is truly a public-private partnership between the Baltimore Mayor’s Office, the City Health Department, the University of Maryland Medical Systems, which provides our clinical staffing, and the Lord Baltimore Hotel, where we’re taking up residency,” says Harris. “We provide health assessment and wrap-around services for people and families dealing with Covid.”
By the end of September, the center had served more than 580 people. And they keep coming. Open seven days a week, 24 hours a day, the center connects with people through referrals. Patients receive three meals a day, medical care, and case management at no charge.
Fellow Beloiter and nurse practitioner Shanna Dell’10 stepped up to take a weekend post as the charge nurse at the TRI Center, in addition to her day job.
The TRI Center is outfitted to protect patients and health care workers through sophisticated infection controls, but what really sets it apart is its approach to comprehensive care. Residents get assistance setting up future health appointments, receive the medications they need to stay healthy, and make connections with service providers that offer resources they might not otherwise encounter, such as stable shelter, primary care, mental health care, and services for substance use.
Harris talks about a family, two parents with two children, who were living in a shelter when all four tested positive for Covid. During the family’s stay at the TRI Center, the team partnered with an organization called Healthcare for the Homeless, which helped the family find permanent housing, mental health care for the mother, and a pediatrician for the children. When they recovered, they moved to a stable home.
Not all stories end this way, but when Harris reflects on what he and others have learned during the time of Covid, he sees great potential for future public health improvements, such as a housing-first approach and more integrated services, like the TRI Center and a handful of innovative centers like it across the country provide.
“If there has been a silver lining during this terrible, ongoing pandemic, it’s how our diverse and multidisciplinary team, with so many different backgrounds and perspectives, has come together to provide this service to our most vulnerable citizens,” says Harris. “I’m so proud to be part of this project and our city’s response.”
Read more stories about alumni working “In the Trenches in the Time of Covid”.