The Role of Street Medicine Programs for Management of Diabetic Foot Ulcers Among Unsheltered Individuals Living in Hawaiʻi

Abstract

Diabetes mellitus is a chronic disease that can cause a host of severe complications, such as a diabetic foot ulcer (DFU). When left unmanaged, a DFU can progress from a simple wound to a severe infection that may be treated with a lower limb amputation. There are many risk factors for developing diabetes and diabetic foot ulcers; one factor is being an unsheltered individual. This investigation aims to analyze a Maui-based street medicine program, Mālama I Ke Ola Street Medicine program, to understand the role this program plays in DFU management. A review of Mālama I Ke Ola Health Center’s Street Medicine program was completed through a shadowing experience of the program along with information provided by the program's lead community health worker. This program provides a regular schedule of wound care during their street visits, connections with a local clinic or organization, and an overall improvement in health attitude among the impacted population. Mālama I Ke Ola Street Medicine program’s lead community health worker suggests that a permanent provider on the medical team and increased advocacy for funding could add to the already successful program. While these suggestions could build upon the program, the Street Medicine team has made a significantly positive impact on Maui’s unsheltered population by increasing access to healthcare.