Taking it to the Streets
Midwest Street Medicine's Call to Compassion
By Alex Strauss
Midwest Street Medicine Volunteers head out to the streets from their headquarters at the Union Gospel Mission in downtown Sioux Falls
It's a bitter cold Sunday morning in January and a group of volunteers has gathered at the Union Gospel Mission in downtown Sioux Falls. Bundled up against the frigid temperatures, they're filling collapsible wagons with medical supplies like vaccines and blood pressure cuffs, along with snacks, bottled water, and cold weather gear.
Their ranks may include doctors, nurses, physician assistants, addiction specialists, pharmacists, social workers, peer support specialists, community health workers, and other caring people. Their mission - carried out twice weekly for the last year-and-a-half - is to bring help and medical care directly to one of the most vulnerable populations in the state: people who live on the streets.
A Vision of Healthcare Without Walls
The story of Midwest Street Medicine began with a chance encounter, according to co-founder, and medical director Shannon Emry, MD, a pediatrician with Avera in Sioux Falls.
"I was actually just listening to a podcast about health and health equity and stumbled onto an episode about street medicine," says Emry. "The concept just stole my heart." That spark of inspiration led her to Dr. Melissa Dittberner ("Dr. Mo"), a professor of addiction counseling and prevention at USD, and together they launched Sioux Falls' street medicine program in July 2023. Dittberner is now the executive director.
The statistics underline the urgency of Midwest Street Medicine's mission: The mortality rate for unsheltered people is 10 times that of the general population. Even sheltered homeless people die at three times the rate of people with homes, and as many as three decades earlier.
Breaking Down Barriers Through Trust
From the beginning, the team took a uniquely patient-centered approach. "One of our mantras is that we 'let the street build the program,'" says Dr. Emry, who spent the first few months handing out snacks and conducting needs assessments.
"You learn to meet people where they are at and ask them what they want from you," says RN Diane Eide, case manager, grant support, and volunteer coordinator at MSM, "We don't ever tell people what to do. We leave them in control."
Now, with those needs in mind, the team provides comprehensive care directly on the streets every Sunday and Monday morning from nine to noon. Medical interventions range from blood pressure checks and wound care to more complex challenges like help for addiction, mental health care, or medication management. They offer thiamine injections to prevent encephalopathy in individuals with significant alcohol use, administer flu and COVID vaccines, and conduct syphilis testing—particularly crucial given South Dakota's highest-in-the-nation syphilis rate.
The success of the program stems largely from the trust MSM has built with a population often wary of the healthcare system. "A history of trauma is universal among folks who are homeless," says Dr. Emry. Understanding trauma's role in healthcare avoidance has helped to shape the group's care delivery model, which Dittberner describes as deeply responsive to individual needs:
"We always start by asking people what they need," she says. "Whether that is medical care, mental health care, help with addiction, etc. If we see that they need gloves and a hat, or snacks, we'll leave these with them, too."
Apparently, this patient, human-centered approach is paying off.
"We can get people to do more than anyone else in town," says Eide. "For instance, maybe they need to go to the emergency room, but they've been reluctant to do it. We can get them there. Now, we have our regulars that recognize us from two blocks away and say, 'Street Medicine's here!' And they get excited."
A Growing Movement of Compassionate Care
Supported by grants and donations, Midwest Street Medicine teams serve about 50 people on Sundays and about 30 on Mondays, with new operations launching in Aberdeen and Rapid City. In 2024 alone, they recorded over 600 medical visits in Sioux Falls, while providing countless others with food, supplies, and support. And the people receiving care are not the only ones impacted.
"I think we gain more than we give every single time we're out there," says Eide, a former ER nurse who says caring for people's immediate needs "is like coming home".
"This work has changed my life in so many ways," agrees Dittberner. "The unhoused people in our community have taught me so many lessons about kindness and about giving back to others."
As rewarding as it is, Emry says it is not easy and often requires a mindset shift for those in healthcare.
"We know that social determinants of health drive 85 percent of health outcomes, but we still just focus so hard on the medical piece because that's what we are trained for, that's what we know how to fix," she says. "We struggle to wrap our arms around the social factors and how to help people with that piece. But we need to get better at that."