A unique downtown medical clinic works to care for homeless patients’ long-term needs
Dr. Eric Chen rarely knows who he’ll see in his exam room during a shift at downtown Salem’s Homeless Outreach and Advocacy Project.
The morning of Wednesday, Sept. 10, one of his patients was nearing a crisis. He’d already visited Salem Hospital’s emergency room 15 times in the last three months, and was showing symptoms of psychosis. If Chen didn’t act fast, the patient was bound for another trip to the hospital.
But, as part of Northwest Human Services, Chen could get the man the help he needed within a few keystrokes. Their newer downtown clinic didn’t have the long-acting injectable medication needed, but their West Salem clinic did. It was only a matter of getting the patient across the bridge.
“It took me 30 seconds to instant message this (West Salem) nurse practitioner and be like ‘Yeah, this guy is not in good shape. If we don’t medicate him or do something, he’s going to be in the ER again tonight, tomorrow night,” Chen said.
The pair organized a shuttle to get the man to the West Salem clinic that same day. At an emergency room, Chen said he may have been instructed to make his own appointment in a few days, which would have been a challenge for him.
More and more people are getting needed medical help at the downtown day center, known as HOAP.
For several years the center has brought doctors, medical assistants and nurses over from Northwest Human Services’ West Salem location to work downtown. In response to demand, the frequency of its downtown clinics has gone from a few times a month to twice per week.
That morning, Chen saw six patients. One had no current complaints, but wanted to establish care. Another had some stomach discomfort after a summer surgery, and needed help getting health care coverage as a Spanish speaker. Another had concerns over a rash. One was accompanied by a Chihuahua.
On Mondays and Wednesdays from 8:30 – 11 a.m., anyone can walk into the center and see a doctor. The clinic is funded through insurance payments and grants. There’s more need than resources, staff said, and the appointment spots for the day usually fill up fast.
HOAP is located at 694 Church St. N.E. See the full list of services and hours here.
The center provides meals, laundry, showers, mailboxes, phone charging stations and connections to social services to about 140 people a day Monday through Thursday, and around 50 on Fridays when its services are exclusive to women and nonbinary people.
The day center sees about 650 unique faces every month, according to KayLynn Sathujoda, program manager. They see an average of 30 new people per month.
That Wednesday, the small clinic was bustling with activity. Dozens of people, some with pets in tow, waited on the sidewalk outside.
Inside, staff members and volunteers hustled through the narrow hallways carrying clothes and greeting people. One man ate his brunch in the lobby as Tracy Chapman’s music played through the clinic’s speakers. About 10 people lined up for a serving of enchilada in a back room.
It was a busy morning, but not as busy as the downtown clinic can get, Chen said. Since it was closer to the beginning of the month, people still had Social Security money to spend and SNAP benefits to feed them. It gets busier as the month wears on and people run out of options.
Many people who come into the clinic are dealing with acute or chronic pain caused by homelessness, said Transitional Programs Director Shanta’ Frisbee. HOAP’s providers will make sure they have access to other services they need, like follow-up health care, signing up for the Oregon Health Plan and shelter access.
A common visit, she said, is from someone who walks days at a time in shoes that are too small. They come to the clinic with bent toes and sores, which can lead to infections. Along with a doctor’s visit that considers their life experience, they’ll be able to walk away in a pair of donated shoes that fit and a visit with social services.
“Typically, you’d be like, ‘Oh, let’s just take care of that (sore).’ But our clinic, with all the integrated wraparound services recognized, let’s do: ‘Oh, you have high blood pressure, oh, you’re diabetic,’ Frisbee said. “So we really try to focus on what’s the core root, not just the symptom.”
Their staff are trained in trauma-informed care, and work knowing that many of their patients have anxiety about seeing a doctor built from negative prior experiences.
“In a lot of medical situations, based on the stigma and the bias of those that are homeless, they often don’t get heard,” Frisbee said. “The moment they walk in the door asking for help, that’s a huge step, it’s huge. People don’t like to ask for help. And when you get to the point of pain, and you’ve been self-medicating, or you’ve been seeking other coping mechanisms, to come in and ask for help, we want to be able to support that.”
Such consideration helps catch medical issues before they worsen, too.
“There was a case not too long ago where somebody (overdosed) from meth, and had been complaining about stomachaches for months. And then realized that they already had stage four pancreatic cancer,” Frisbee said.
When applicable, the clinic will ask Northwest Human Services’ street outreach team, which includes a registered nurse, to meet someone on a sidewalk or in a park for a follow-up appointment. They also work with pharmacies to distribute doses in different amounts, like a week at a time, for people concerned that their pills may be lost or stolen.
People also get as many chances as they need, added Sathujoda, the program manager.
“If they’re having a bad day and it’s just not working out, we’ll try again in two days. Or we’ll try again next week. It’s OK,” she said.
Non-medical staff, including Sathujoda, will sit with someone during their doctor’s appointment if they’re feeling anxious. The doctors will allow cats, dogs and the occasional rabbit into the exam room, too.
Many of the patients don’t enter the day center expecting to see a doctor, either. Some just come for brunch, or to use the bathroom. But when staff sit down with them to check-in, some decide that they might as well get a free check-up and establish a primary care provider.
They’ll also learn about all the available resources, which include help getting documents like ID cards, signing up for the Oregon Health Plan, or connecting with specialty care like Salem Gastro or Northwest Senior and Disability Services.
“It opens up their mind, right? Because when you’re in survival, you’re not thinking about ‘What I need help with.’ You’re like: ‘Where’s my meal? Where’s my bed? My shoe’s broken,’” Frisbee said. “It’s just immediate (needs). Let’s expand that train of thought.”
About one in four people who come through the day center’s door ends up getting some form of social service, Sathujoda said, an increase from prior years. Last year, about 61 people a month connected with social services through the day center, and this year it’s been about 164 a month.
And more and more people are coming in, she said. In the first half of 2024, they saw about 1,700 visits downtown. That has increased to 2,400 in the first half of this year.
A major difference between the work downtown and in the more established clinic in West Salem, Dr. Chen said, is that many of the patients are walk-ins rather than scheduled.
“You have to be flexible here, knowing that anyone can walk in and complain of whatever,” he said.
The day center plans to soon remodel the cramped downtown space to reflect the increased use of the clinic. Leadership plans to make the central space look more like a doctor’s office than a cafeteria, with lounge chairs, and establish a separate space for eating. They’re also planning to upgrade the exam rooms, according to Stephen Goins, chief operations officer.
They’re also piloting telehealth services so people who are unable to or uncomfortable leaving their encampment can speak with a doctor.
“There’s so many situational and contextual barriers that that’s a really exciting component too, because again, we’re going to where the clients are. And I feel that that is something that’s only going to become more of a focus with the way that the current situation is in the world,” Frisbee said.
Frisbee, who experienced homelessness growing up, said that what sets their clinic apart is staff training about the unique challenges of being homeless, and personal experiences like hers. Their ultimate goal is that the medical care will help someone stabilize enough to stay in a shelter, and ultimately move into a place of their own.
“It could take a week, two weeks, six months. We’ve been working with somebody for a year. But we don’t give up, and we keep showing up, and it’s building that rapport. I don’t see that at any other medical clinic,” Frisbee said.
While the clinic has been working to help people stabilize, they’ve anecdotally seen an increase in their clients being harassed for being unsheltered. They said some clients were nervous to come back after a string of eggings near the day center this summer.
“It was really hard for folks because it was around their safe space,” Sathujoda said. “That was tough.”
Sathujoda said that social isolation and a lack of community impacts people’s health, too.
“This is a community issue,” she said. “It’s easy to look at us and say, ‘You guys solve it.’ And I’m like, ‘I can’t solve it.’ I need every single neighbor and every single organization and every single person to come here and be a part of the solution.”
Frisbee said she keeps a list of the people she’s helped through HOAP, which keeps her coming to work even when it gets tough.
A recent addition is a man in his 80s, who lost much of his ability to speak after having a stroke. He was having trouble moving, too, and was living in a field off of Highway 22. Through the work of the team at Northwest Human Services, he just got approved to move into a care home.
“He’s toured it, he likes it,” she said. “To have seen somebody, to know by name as a regular who’s doing the best they can at that age, it tears my heart. And now, there’s actually a room with a bed and service for him. It just reminds me that it’s not always instantaneous. The system has its own pace.”
Contact reporter Abbey McDonald: [email protected] or 503-575-1251.
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Senior Reporter Abbey McDonald joined the Salem Reporter in 2022, where she covers homelessness and housing. She previously worked as the business reporter at The Astorian. A University of Oregon grad, she has also reported for the Malheur Enterprise, The News-Review and Willamette Week.
