How one physician sought to improve health care access for Charleston's homeless

September 16, 2022
A doctor, whose face can be seen on a laptop, remotely interacts with a patient
Family physician Dr. Cristin Adams speaks with a patient who came in to be seen at MUSC Health's Telehealth clinic for the homeless. Photos by Sarah Pack

Two and a half years ago, Debra Grimes lost her vision. A scary prospect for anyone, for sure, but for a homeless woman living on the streets of Charleston, the stakes were even higher. Without the ability to see, Grimes had a difficult time providing for herself. Oftentimes, she wasn’t sure where she was, who she was with or, most importantly, if she was even safe. 

“I felt lost. I didn’t have anybody to help me,” she said through tears. “I couldn’t see myself in the mirror. I didn’t even know what I looked like anymore.”

Things kept getting tougher and tougher for her until one night, completely exhausted and lost, she laid down to rest. A few hours later, she was awakened by a police officer. She had been placed under arrest for sleeping at a bus stop. 

Grimes was devastated.

But then something incredible happened: She was connected with The Navigation Center, an organization that advocates for the homeless population of Charleston. Once she was there, staff members fed her, found her housing and coordinated her social security benefits. But they didn’t stop there. Next, they connected her with MUSC Health's CARES Clinic, an in-house telehealth-based free clinic. Once there, doctors determined that her sight loss was actually due to severe cataracts in both eyes. But the best part was it could be fixed. So they referred her to get bilateral cataract surgery. 

Marie Elana Roland, the founder of The Navigation Center, made all of her appointments, drove her to and from each surgery and helped her with recovery. 

Today, Grimes can see again.

“It’s glorious, like heaven. I thank the good Lord I got my sight back,” she said.

Thanks to MUSC Health and The Navigation Center, not only has Grimes regained her vision, but she’s gotten much-needed dental care, learned the city bus system and even started working a part-time job. 

“It’s indescribable,” Grimes said through a broad smile. “I am so happy. I thank God for all of them.”

More than 2 million people in the U.S. experience homelessness each year, with 4,000 of them being right here in South Carolina. Research has shown that the homeless population is three to six times more likely to experience illness, four times more likely to be hospitalized and three to four times more likely to die prematurely. 

MUSC Health family physician Cristin Adams, D.O., who runs the CARES Clinic, understands as well as anyone that not having a roof over your head makes a person about as vulnerable as possible. 

“As important as health is, it still doesn’t rank when you’re talking about where you’re going to sleep that night or what you’re going to eat,” she said. “So, unfortunately, for many of our unhoused population, until things get really, really bad, they just don’t get the medical attention they so desperately need.”

According to Adams, the biggest reason for this simply comes down to a lack of access to health care. This is why she pushed so hard to get this clinic up and running. But in the current climate – when the health care community is already spread so thin and overworked – Adams knew a different approach was needed. So she and her team got the idea to provide a telehealth aspect to the clinic. Thanks to her new idea, medical students, and sometimes residents, would always be on site, and through modern technology, a patient would also have access to specialists so they could get the targeted help they need.

A female medical students takes the vitals of a homeless man at MUSC's Telehealth clinic 
Medical student Juliette Gammel take the vitals of a patient as Dr. Dion Foster looks on

Thanks to their innovative solution, Adams and her staff were recently given a $15,000 Association of American Medical College’s Telehealth Equity Catalyst (TEC) award. Not only do they have plans to expand the care they provide as well as associated medical education initiatives with this funding, but it’s what the money signifies that means the most to the MUSC Health crew. 

“I think it shows that what we’re doing matters,” Adams said.

Second-year College of Medicine student Juliette Gammel, who volunteers at the clinic whenever she has the opportunity, thinks telehealth is the future of medicine. 

“I really think it’s the wave of the future,” she said. “So to be able to get to work with the technology while helping such a deserving population, it’s just an awesome, gratifying experience.”

Gammel, who wants to be a trauma surgeon one day, sees a parallel between those without a home and those involved in accidents.

“Neither one of them chose to be in that situation,” she said. “So, as a physician, to be there for them in their time of need, it’s why we go into medicine in the first place.”

Working with the homeless population does provide unique challenges, Gammel said. For instance, things a physician might take for granted, like access to charts and scans or a patient’s medical history, oftentimes just aren’t available.  

“A lot of times, you’re only playing with half the deck,” she said. “So in that regard, it’s more challenging. But even with those hurdles, there’s something about this particular patient population where you just know you’re making a huge difference in their lives. What’s not to like about that?” 

The MUSC Health telehealth clinic operates every Tuesday and Wednesday at The Navigation Center, which is temporarily located on Calhoun Street, while a new location is being built.

Adams, who has been working with the homeless population in Charleston since 2013, hopes that the clinic will continue to grow and eventually reach more and more people.

“The cause is just so amazing,” she said. “This is a group of patients who need someone looking out for them, and I’m proud that in our own small way, we’re able to provide that for them.”