A pregnant woman living in a tent near the Kern River, a 66-year-old man suffering from asthma while living in a van, a middle-aged woman bedding down in a dark, cold abandoned industrial facility in east Bakersfield.
They all have three things in common: They are homeless. They have medical needs. And each one was visited Thursday morning by a team of medical professionals practicing a type of guerrilla patient care known as "street medicine."
"There is a recognition that our health care system as it is currently designed is not accessible to a lot of people. We need to re-imagine what that system should look like," said Corrine Feldman, a physician assistant, who with her husband, Brett Feldman, are veteran street medicine practitioners from the University of Southern California who were in Bakersfield on Thursday providing technical support to the primary team from Clinica Sierra Vista.
Headed by Dr. Matthew Beare, the Clinica team met at 8:15 Thursday morning on Baker Street. By 8:45, they were walking into a hulking, abandoned corrugated metal structure in east Bakersfield — with Beare leading the way.
The bearded doctor approached gently and with respect, identifying the team as medical practitioners. He knows unsheltered individuals may react with fear or panic to groups of outsiders entering a dark, abandoned industrial facility like this one.
"This is a larger group than normal," he had cautioned the team earlier. "We need to be cognizant and not overwhelm the people there."
As he walked toward a group of makeshift tents deep in the cavernous metal building, he called out to residents.
"You guys need anything?" he asked. "We have dog food."
Dog food is a way in. But so are first aid kits, hats, socks, feminine hygiene products. Corrine Feldman call the small gifts "tools of engagement."
"They really are a link to creating a rapport," she said.
Even something as simple as shoelaces can help create a bridge between the people who need medical care and the professionals who want to provide it.
"Shoelaces not only lace up your shoes, they hold up pants, tents," Feldman said.
"And pet food, it allows them to care for another living thing," she said. "That's really critical to feelings of self-worth."
Especially when you're feeling worthless.
But condoms are also handed out, as are clean syringes. If an IV drug user is going to use needles, he's much more likely to avoid contracting HIV/AIDS or hepatitis C if he sas access to "clean points."
It's not an ideal arrangement, Beare acknowledged, but neither is living in a place with not even the most basic of creature comforts.
The inside of the abandoned cotton gin looks post-Apocalyptic, the smell of soot and wood smoke from warming fires assault the senses. A gutted vehicle squats nearby. Trash. Shopping carts. Discarded building materials are everywhere. The rustling and cooing of pigeons can be heard high above in the rafters.
There are three buildings, and as the team moves through them, each one cleaner than the first. Before the team departed, resident Victoria Rodriguez could be seen sitting on a portable folding stool as Medical student Justin Martin-Whitlock knelt on one knee and measured her blood pressure. Rodriguez was able to fill a prescription for meds thanks to the team's visits, which are weekly.
Street Medicine is designed to deliver primary and urgent care to homeless people wherever they are. When the patients can't come to you, you go to them, Beare said, under bridges, along creeks and rivers, in shelters, soup kitchens, on skid row. All care, including medications, laboratory tests and diagnostic studies, are free.
"I've volunteered two years with these guys," said Scott Dopp, who accompanied the team Thursday. "Three and a half years I was homeless. I learned a lot during that time, how to approach people, how to survive on the streets.
"It's not easy to gain their trust," he said of the unsheltered, who are often victims of crimes, and even of well-meaning clean-up crews who will sometimes throw away the meager possessions of street people.
"Dr. Beare, he's got a pretty good rapport with these folks," Dopp said.
HOMELESS PETS ALSO HELPED
Thursday's group was indeed larger that usual. It was joined by a veterinary team from the Street Dog Coalition, a nonprofit that provides free medical care and related services to pets of people experiencing, or at risk of, homelessness.
Veterinarian Allyson Hannan and Vet Assistant Evelyn Flesner provided a vaccination and deworming to a puppy outside the industrial facility Thursday morning, they talked about how important it is to protect and honor the bond between all people and their animal families.
The bond many unsheltered people have with their pets is strong, so strong that many will forego shelter for themselves if their pets are not allowed in.
"This is our first time with this group," Flesner said of the street medicine team. "But we've done visits to other shelters."
As the team moved from the industrial site to the Kern River floodplain near Oildale, it was not uncommon to see pets with many the unsheltered homeless.
BOOTS ON THE GROUND
When the team reached Riverview Park in south Oildale, they headed out on foot along trails that cut through riparian trees and underbrush near the river.
Brett Feldman, the director of street medicine at USC, was there to observe and provide technical assistance. Feldman has practiced homeless medicine since 2007 and founded two street medicine programs in Allentown, Pa., as well as USC's street medicine program in Los Angeles.
He is also the vice chair of the Street Medicine Institute, which facilitates and enhances the direct provision of health care to the unsheltered homeless where they live — in dozens of cities and countries all over the world.
Feldman's job Thursday was to provide the sort of guidance and support to help Beare and others in developing their own street medicine programs.
"The worst part of homelessness is not material want," Feldman said. "It's feeling unwashed, unwanted, uncared-for."
One of the most common ways to help those who find themselves without a home, he said, is "harm reduction."
Preventing hepatitis C, preventing infections, getting a homeless person in to see a dentist, and just showing you care are all forms of harm reduction.
"Just being present is the biggest form of harm reduction," he said.
Beare was present all morning. The doctor and his team must have walked two miles of trails, engaging everyone they saw. As case worker Maribel Bautista kept track of every medical contact, and helped set up appointments — and even transportation to clinics — Beare approached loners under bridges and couples in tents.
Some of these temporary homes had an American flag flying proudly overhead, as if the residents wanted to say, "We're still Americans! Despite our circumstances, we're one of you."
There was the couple with two dogs and a litter of eight young puppies. He was happy to take some dog food, condoms and hygiene kits, but he declined medical care — except for the puppies.
Steven Schiavone, 59, said he chooses to live in the bush. He works two or three days a week and says he has as much money as he did when he was working for a corporate wage — because he doesn't have to pay rent or any number of other costs of living in a real house.
But Schiavone had kind words for the street medicine team, and for Scott Di Stefano, who works with a group called Broken Chains, handing out an opioid inhibitor designed to save the life of someone in the thoes of an opioid overdose.
"This is God's hands at work," Schiavone said of the work volunteers and medical professionals are doing.
Beare and his team really got busy as they visited Church without Walls on Beardsley Avenue, where Ben Hanna is the pastor.
Beare and his team assisted several at the church, patients with illnesses, possible infections, and one man who reported experiencing debilitating anxiety attacks.
Watching Beare's approach, the way he forms relationships with patients who have nothing, and who may have little reason to trust a stranger, it soon becomes apparent why they do trust him. His empathy is close to the surface. His smile is like a father's or a big brother's. And his desire to help is draped across his shoulders like a stethoscope.
But he knows the need is great and that one street medicine team may not be enough.
"If others see the need and decide to join us in this effort," he said, "that would be the greatest reward."
Steven Mayer can be reached at 661-395-7353. Follow him on Facebook and on Twitter: @semayerTBC.