A sink, a toilet, and a paper towel dispenser furnish one of the rooms where Jessie M. Gaeta works. She’s a physician, and, yes, this workspace is the bathroom. Gaeta finds herself toiling there about twice a week — reviving a person who has overdosed.
As chief medical officer at the Boston Health Care for the Homeless Program, the 46-year-old internist doesn’t spend a lot of time in her ordinary little office. One thing that draws her away is a “reverse motion detector” that flashes lights and emits a piercing screech when a bathroom occupant fails to move for two minutes and 50 seconds.
Almost always, the alarm means a person has been knocked unconscious by an injected drug and is likely to die soon if nothing is done. Gaeta wears a Narcan kit on a lanyard around her neck, always ready to save a life with the overdose-reversing drug.
In medical school, Gaeta aspired to become a doctor to the homeless the way other students dreamed of becoming brain surgeons or cancer researchers. And now, every day, her patients fascinate her with their complex life stories, astonish her with their resilience.
“I tend to just be blown away by the kind of things people went through and survived,” she says.
Another place where Gaeta works is the Care ZONE van of the Kraft Center for Community Health, a fully equipped medical clinic on wheels that hit the road a year ago.
“The van came about because I was really trying to figure out how to reach a very difficult-to-reach population: people living outside injecting drugs,” Gaeta says. “We would only see them when they ended up very sick in the hospital.”
The goal was to make it easier to for people to start treatment for addiction than to get their next fix on the street.
With $160,000 from New England Patriots owner Robert Kraft, the Kraft Family Foundation, and several other donors, a vehicle was custom-built to specs from clinicians. Ford Motor Co. donated the van, and Winnebago built the clinic.
Neatly shoehorned into a space about the size of a small camper, the mobile clinic features a reception area, a sink with hot and cold water, an exam chair (complete with stirrups and light for Pap smears), two refrigerators (one for food, one for vaccines), two laptops with access to medical records from most hospitals in the city, a printer for prescriptions, a label printer for specimens, and cabinets stocked with everything from safe-sex kits to wound care supplies to knit hats for cold nights.
There’s even a television, which wasn’t requested but turns out to be handy when people are waiting. A generator provides heat for eight hours while the van is parked.
Typically, Gaeta goes out on the van for one or two of its four weekly trips. With one clinician and three outreach workers aboard, the van stops in neighborhoods with high rates of overdose deaths: Dudley Square, the Fenway, Downtown Crossing, and the West End.
Often people are already there waiting for Care ZONE, which comes on a regular schedule and stays for four hours.
Workers also head out in pairs — backpacks loaded with sandwiches, water, and clean syringes — to search under bridges and in the dark recesses of MBTA stations for people who might need help. During the first nine months, they had nearly 3,500 contacts with people who inject drugs. The team distributed more than 36,000 needles and 1,200 naloxone kits. (They also pick up any discarded needles they see.)
During that time, there were also 250 visits for medical care inside the van, and 131 of those encounters included treatment for opioid use disorder with buprenorphine, a medication that helps reduce opioid use and overdoses. Sometimes the van transports people to a methadone clinic or a detox center.
But it’s too soon to know how many sustained sobriety.
It was this kind of street work that, back in medical school at the University of Maryland, solidified Gaeta’s career choice. In her final year, she spent several months shadowing a New York City doctor who walked the streets caring for homeless patients.
“I liked seeing patients in an environment outside of the health care setting,” Gaeta says. “I figured out so much more about them, even about their health, than I could see in the snapshots in a clinical setting. It felt like a deeper connection with people.”
Right after finishing her residency at what was then Boston City Hospital, Gaeta took over a departing doctor’s job at the now-closed shelter on Long Island in Boston Harbor. She recalls her first night, driving over the bridge as the sun set behind the city, and realizing that all of the resources she was accustomed to — colleagues, equipment, laboratories — were far across the water.
Sixteen years later, Gaeta has no intention of leaving. Amid all the suffering, she draws sustenance from the people who change their lives, reconnect with their families, move on to a better place.
“This work is more rewarding and inspiring than it is hard,” she says. “Although it is hard.”