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Alicia slowly pushed her rolling walker toward the corner of South Zarzamora and Chihuahua Streets, where a street nursing team had set up on a hot Wednesday afternoon.
The temperature was about 95 degrees. But the heat index made it feel like it was over 100 degrees.
The 65-year-old wore an oversized black T-shirt with sleeves cut into fringe. Across the front were the words: “Nope — not today.”
Health care workers guided her into the shade, helped her onto a folding chair and raised her injured leg. When they removed a dirty, tattered bandage, they found that her skin was badly discolored below her knee.
Alicia said the pain was causing her leg to shake.
“It hurts and I’m scared,” she said.
While wearing blue disposable latex gloves Diana Cavazos, a registered nurse, carefully examined and cleaned the wound. Cavazos is the founder of the Street Nursing Institute and a nursing professor at UT Health San Antonio.
“She has an open wound,” Cavazos said.
For people who are unhoused, Cavazos said, injuries that might be manageable in a stable home can become much more difficult to treat.
“The healing process is really, really hard under these conditions,” she said. “Because of the hydration. Because of the food they have or don’t have. The walking. The heat. The hygienic conditions.”
Cavazos told Alicia that the wound did not appear to be infected at that time. But keeping it clean would be difficult while she was living outside.
Alicia said she had previously gone to a hospital emergency room for treatment. She said hospital workers told her they would care for the wound and find her a place to recover. Instead, she said, she was discharged quickly while she was still bleeding.
“In 30 minutes, they had me downstairs — bleeding — and then on a bus,” she said. “I was crying because the people didn’t want me to get on the bus. I was bleeding, and somebody said that I had MRSA.”
MRSA is a bacterial infection that can resist several commonly used antibiotics. It can spread through contact with an infected wound or contaminated surfaces and can be especially dangerous when a person cannot consistently access sanitation, medication or follow-up care.
Cavazos applied clean white bandages to Alicia’s leg.
Street medicine teams confront those conditions directly by taking health care outside hospitals and clinics. They provide wound care, check chronic illnesses and help patients connect with treatment, medication and social services.
Several feet away, the team treated another man. Open sores covered parts of his thin, tattooed arms and legs. Workers carefully cleaned the wounds and wrapped his limbs in gauze and bandages.
The injuries were associated with injecting heroin. When an injection misses a vein, the drug can enter tissue beneath the skin or in the muscle, causing damage and creating conditions in which bacteria may grow. Repeated injections and the use of unsterile equipment can further increase the risk of abscesses and serious infections.
Also at the street aid station was Armando. He is unhoused and visually impaired.
“I am blind due to addiction and diabetes,” he said.
He said his diabetes went untreated while he lived outside.
“I was living on the streets under a bridge and never really took care of it,” he said.
Armando said he left his family as a teenager after becoming involved with a girl who was homeless.
“I chose her over my family,” he said. “I decided to stay with her on the streets because she was homeless.”
He said he began using heroin when he was 16 or 17 years old. He is now in recovery and said he is taking medication to control his diabetes.
“I’m taking care of it now,” he said.
Armando is also living with hepatitis C, a viral infection that can be transmitted through shared needles and other injection equipment.
He is receiving assistance from Corazon Ministries and staying at an affiliated treatment facility. He said he is no longer using heroin and has been prescribed
buprenorphine-naloxone, commonly sold under the brand name Suboxone, to reduce opioid cravings and withdrawal symptoms.
For Cavazos and the other members of the street nursing team, treating the wounds is only one part of the work.
Their patients may also be struggling with addiction, chronic illnesses, extreme weather and the daily instability of living without a safe place to recover.
