SIOUX CITY | Perry Goetschius pulled a folded yellow card from his pocket while standing in a bustling dining room at the Siouxland Soup Kitchen on a Thursday night.
Written in marker on the outside of the paper card was the word "homeless," which the 47-year-old has been for two-and-a-half years. Numerous blood pressure readings were recorded on the inside.
Goetschius, who said alcohol use landed him on the streets, lives with his girlfriend under a Sioux City bridge. In the summer, they trek to the Wilbur Aalfs Library to read in the air conditioning. When the weather turns bitter cold, they take refuge at the Warming Shelter, a temporary emergency shelter for men, women and families.
"They helped us with blankets and pillows so we don't get cold," Goetschius said, motioning to Loree Steffen and Chantelle Prins, who were busy taking blood pressures and pricking fingers at a table at the far end of the room.
The nurses, who were dressed in charcoal gray T-shirts emblazoned on the back with "Street Medicine" in bright orange letters, are part of a medical outreach program in Sioux City that was inspired by Jim Withers, an internal medicine physician who began providing medical care to Pittsburgh's homeless population in 1992 in alleyways, along river banks and beneath bridges and highway overpasses.
In March, about a dozen volunteers from Sunnybrook Community Church, who are predominately health care workers, began going to various places that help the homeless and underserved, including the Sioux City Gospel Mission, the Siouxland Food Bank and the Warming Shelter. On Mondays and Thursdays from 5 to 6 p.m., the group takes blood pressures, checks blood sugars and offers basic first aid with medical supplies provided by Mercy Medical Center.
"By being part of this, I hope we can minimize patients going to the ER and people not getting the care that they need," said Steffen, who works for CNOS. "Our goal is to get out on the streets and see them whenever we need to."
A man wearing camouflage pants and a gray sleeveless shirt walked by Steffen and Prins, who stood ready at their station with lancets, cotton balls and disinfectant wipes.
"How's it going?" Steffen asked the man.
"Good," he responded with a smile, before taking a seat at one of six long dining tables and digging into the food on his plate.
A few minutes later, a man with sandy blond hair and a beard approached and said, "Thank you guys for reaching out and doing what you do."
Kevin Negaard, executive director of Sunnybrook Community Church, said the congregation is always looking for ways to make a difference beyond the church's walls.
Members provide Liberty Elementary School students with backpacks and put on their end-of-the-year carnival. They minister to inmates and staff at the Woodbury County Jail and build ramps for people who are disabled, among other things.
A year ago, Negaard said members of the congregation began engaging with a few homeless people at the Siouxland Soup Kitchen where they serve meals. One of the men they met there is now working at the church full-time as a janitor, living in his own place and doing well.
"We really believe we're called to be the hands and feet of Jesus in our community," he said. "If we fail to exist in Sioux City, would anybody notice? I think that really drives us to make sure that we're getting out into the community."
Kristi Gaither, employee health and wellness manager at Mercy Medical Center, said many members of Sunnybrook Community Church were in the audience when Withers, the founder of Operation Safety Net -- one of the first full-time street medicine programs in the country, spoke at the Sioux City Convention Center in November.
After Withers' presentation, she said she and other members of the congregation decided to launch their own program, which was dubbed "Street Medicine." They reached out to various area health and service organizations, including the Community Action Agency of Siouxland, Siouxland Community Health Center and Mercy Medical Center, to form partnerships.
"The need was there. (Withers) shined a spotlight on it," she said. "Every person is worthy of having care and love. The reason God put us here was to do this for each other."
Medical challenges abound
That Thursday night at the Soup Kitchen, around 40 people -- grade-school children, middle-aged adults, young adults and seniors -- were patiently waiting in line for a hot meal. Some were using walkers and wheelchairs to get around.
Local service agencies identified 265 sheltered homeless and 11 unsheltered homeless in Sioux City during the annual Point in Time Count on Jan. 27, 2016. The city's total number of homeless is likely to be much higher, as individuals without housing may stay with a series of friends or relatives.
Jerry Hernandez, Mercy Medical Center's multicultural outreach coordinator, has encountered homeless ranging in age from babies to the elderly, but he said the majority are between 40 and 50.
According to the National Alliance to End Homelessness, homelessness both causes and results from serious health care issues, including addiction, psychological disorders, HIV/AIDS and various other ailments that require long-term care. The organization says people experiencing homelessness are more likely to access the most costly health care services.
A report published in the New England Journal of Medicine found that a person experiencing homelessness spends an average of four days longer per hospital visit than comparable non-homeless people. This extra cost, approximately $2,414 per hospitalization, is attributable to homelessness.
"We have a homeless man who's at the Cancer Center because he's got cancer in his mouth," Hernandez said. "By (Gaither) being out there, she can see these things and help them to some degree."
Even maintaining good hygiene and dental health can be a daunting task for someone who is homeless. Being in close contact with many other people in shelters poses its own medical challenges, according to Gaither, who said contracting tuberculosis, a potentially deadly lung infection, is a real possibility.
"When you're in that situation with so many people, it's so much different than when you have your own home and can get away from it. You can't," she said. "Any communicable disease just can run rampant through that community."
The homeless and underserved aren't required to accept the medical care Street Medicine volunteers are offering, but many seem eager to take advantage. When volunteers come across a patient who needs non-emergent medical care beyond basic first aid, they call Siouxland Taxi to transport the patient to Siouxland Community Health Center. Sunnybrook Community Church picks up the tab for the cab fare later on.
"They've been appreciative of anything we've done for them," said Prins, who works at Family Health Care of Siouxland -- Northside Clinic.
After Prins strapped a cuff on Goetschius' arm, he learned his blood pressure had climbed since his last encounter with the Street Medicine team. His blood sugar levels, however, were in check. Goetschius, who works two days a week doing construction and landscaping, eats just once a day.
"I'm grateful that they come here," he said of the volunteers.