A prescription only works if someone has a place to keep it.
For many people who are unhoused, storing medication, keeping wounds clean, attending appointments, and getting rest aren’t possible. Medications are lost or stolen, and dressings can’t be changed regularly without access to clean water or supplies. As a result, common conditions like skin infections, chronic wounds, and asthma can worsen or return.
Street medicine addresses this gap by adapting care to real living conditions.
On Instagram, family physician and emergency physician Jill Wiwcharuk (Street Doctor Jill) shows what this looks like in practice. In her videos, she describes the day-to-day realities her patients face and how those affect their health. She explains how street sweeps displace people and interrupt care without addressing the causes of homelessness, and why standard advice like returning for follow-up depends on whether someone can actually come back. For her patients, the issue is whether medical advice is practical and usable in their daily lives.
Her approach reflects this. Street medicine functions as a link between clinical care and community settings for people who are underserved due to social and economic barriers. Care is simplified and delivered as much as possible in a single visit, since follow-up isn’t guaranteed. Physicians may choose medications that don’t require refrigeration, provide supplies directly, and avoid treatment plans that depend on multiple appointments. The focus is on what patients can realistically follow.
This model is also used locally. In Kingston, the Street Health Centre operates year-round to serve people who have difficulty accessing standard care. In addition to its clinic, it delivers services through the Portable OutReach Care Hub, a retrofitted RV that brings health and community services directly to priority groups, such as those experiencing homelessness. This reduces common barriers such as transportation, identification requirements, and appointment scheduling that prevent people from being seen.
The need for this care is acute. A 2024 report found that the number of people experiencing homelessness in Kingston increased by 133 per cent over three years, from 207 people to 483. Life expectancy is also significantly lower, by approximately 30 years, than that of the general population. For many, Kingston’s emergency department and urgent care centre have become the main point of access. In these settings, patients without stable housing have reported being treated as “less than human” by healthcare providers, along with poor communication about wait times, diagnosis, and treatment.
Homelessness and health are closely connected. Some conditions, such as schizophrenia, can contribute to housing instability. Others develop or worsen as a result of homelessness, including skin infections, injuries, and chronic disease complications. Even routine treatment becomes difficult. Managing diabetes, for example, requires regular meals, refrigeration for some types of insulin, and safe storage for supplies—conditions that are often not available.
The Street Health Centre serves people who are homeless or precariously housed, as well as those who may have been incarcerated or are at risk for infections like Hepatitis C. These groups often face overlapping challenges, including unstable housing, low income, and higher exposure to trauma.
Care is also trauma-informed. Missed appointments and inconsistent treatment are accounted for, and substance use is managed through harm reduction. This helps patients stay connected to care within a system that often does not accommodate their circumstances.
The Centre also connects patients to housing support, mental health care, and income assistance. These supports are important because many health problems are tied to living conditions. Treating an infection without addressing where someone sleeps or how they access food may mean the health problem will return.
Street medicine can reduce pressure on the healthcare system. Managing issues earlier and in community settings, it helps prevent complications that would otherwise lead to emergency visits or hospital stays. Some programs have reported reductions in emergency visits by up to 75 per cent and hospitalizations by 66 per cent.
It also shows a gap in how healthcare is designed. The system assumes patients have stable housing, storage, and transportation, but with rising homelessness, that isn’t always the case. When those conditions aren’t in place, care becomes difficult to deliver.
By meeting patients where they are, street medicine makes treatment more practical and improves access and trust for some of the most vulnerable patients.
Tags
harm reduction, Kingston, public health
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andrew swan
What I find disturbing here is the fact, and it is a fact, of how many unhoused people and often those with issues like schizophrenia, are treated with indifference or are even looked down upon because of their life situation, by the very same people whom they are turning to for help, namely many who work in the healthcare field, and in particular, the emergency department at Hotel Dieu Hospital, for I have witnessed this mistreatment personnaly several times. What these people who think they are above others should remember is this: whenever you find yourself looking down upon another person, or are even tempted to, remember Who is above you looking down upon you.