Treating Homeless Women In Boston: Six Questions For Dr. Roseanna Means

Dr. Roseanna Means provides free care for homeless women in Boston

About 99% of homeless women in Boston have been beaten or raped, so providing them with medical care requires a good deal of compassion and a slightly unorthodox approach. Dr. Roseanna Means started the nonprofit, Women of Means, in 1999, when she realized that help for the homeless was primarily geared toward men and overlooked the specific medical needs of women. The organization, which provides free medical care for 2,500 homeless women in 8 Boston-area shelters on the city’s streets, relies on a network of 20 volunteer physicians and six paid nurses. Earlier this month, Dr. Means was presented with a Community Health Leaders Award for her work by the Robert Wood Johnson Foundation. I spoke with her about the growing population of homeless women who are over 70 and why she often begins a patient’s treatment with a foot massage.

Q: How does a pedicure constitute medical care?

A: There is so much trauma among these women, they’ve been beaten up and gang-raped and abused, so if you take the traditional approach, and put a blood pressure cuff on them, it’s like another assault. I just sit on the floor, put their feet in my lap, shave their callouses and do a foot massage. I humble myself to them.

So many people ask, “Why don’t you just charge Medicaid for all your visits?” That’s not our model — there’s no billing code for some of the stuff we do. Some of the women are psychotic, and they’ve been through so much stigmatizing because of it, so the next step isn’t to send them to a psychiatrist, it’s “Let’s get a cup of coffee for you and talk.” It’s about building a relationship. Once the trust is there, they’re open to meeting with one of our volunteer psychiatrists.

I’ve been seeing a woman for 10 years and she never spoke to me. This spring, she asked me for a cough drop, and then went back to her dissociative state. Just this week I saw her and I said, “Barbara, can I get you something?” and her face lit up, for the first time, and she said, “Can I have some cream for my hands?” Eventually something clicks and they decide you’re OK.

Q: How did this all start for you?

A: I’m a primary care doc at the Brigham, I’ve been there for 30 years. In 1990 I started working with Boston Health Care for the Homeless, a federally qualified health center without walls. I loved it, I stayed with them for for 8 years, and then in 1998 I left because I really wanted to do something on my own that targeted women.

We live in a city of wealthy hospitals and hospital systems, but I started Women of Means because homeless women weren’t using the primary care system — 80 percent of homeless dollars in this state go to men, even though women go to the doctor far more than men. Women who are homeless don’t go to homeless clinics, it’s demeaning, some of the guys in the waiting room are the guys who beat them up. These women are running for their lives, just trying to stay warm and get fed and take care of their children and we’re trying to make them come to us.” I just decided something has to change, we can’t expect women to come to us. It’s like Harvard, they say, “You come to us and we’ll give you the best care” — but these women can’t access that care because of a myriad of unperceived barriers. My program was designed to take away all the barriers and take the health care directly to the patients.

Q: How is the organization funded?

A: We are funded through private donations, corporations and foundations. It’s a difficult funding environment — we went to all the health plans and hospitals and asked for money but they all cry poor. Except the Brigham.

We have a half million dollar budget and take care of 2,500 women and children. Our program is entirely volunteer. We go to 8 centers in Boston, Dorchester, Roxbury and Newton [one center is exclusively for teenage mothers who have at least one child and are escaping domestic violence.] We put out a clipboard and it’s first come, first serve. There are no time constraints and we’re there almost every day during the week.

Q: What is the range of treatment you offer to the women?

A: It’s primary care. Everything from sore throats and backaches, to injuries from being beaten, raped, attacked. We’ve diagnosed cancer, and diagnosed serious disease, like diabetes. A woman I take care of has a cardiac arrhythmia. We do anything acute, flu shots, we can write prescriptions. We just don’t have our own clinic space, so we operate out of make-shift closets and back rooms. We’re homeless too.

Q: I understand you are now targeting elderly homeless women for care?

A: Yes, out of the 2,500 homeless women we follow, about 200 are over 70. When we get them to the doctor, we hear them say, ‘I wanted to go to the doctor, but they didn’t want to see me, I wasn’t worthy.’

Q: What are your plans for the future?

A: We recently had to cut back, lay off some nurses, and we need desperately to bring on more nurses. We have a waiting list of doctors who want to volunteer, but we don’t bring them on unless we have the nurses to provide continuity. We’d love to hire two more nurses, but that’s $150,000.

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