Selkregg Award mobile foot clinic project helps UAA students reach out to homeless

You see them throughout Anchorage - camped in the woods, walking through downtown parks, standing at intersections with their cardboard signs - and there are many more you may not see because they're staying in a shelter or mission, squeezed in at the home of family or friends, living in a car.

These people walked diverse paths in their lives before substance abuse, mental illness, divorce, domestic violence and other trauma or a costly clash with the court system knocked them out of the security and warmth of a fixed home and family. They're vulnerable to violent predators and thieves, to cold, snow and rain, and to hunger, pain, and sickness.

"I think sometimes we become immune to the homeless people that we have here in Anchorage," said Jamie Elswick, a WWAMI anatomy instructor and 2017 Selkregg Community Engagement & Learning Award winner. "You may see someone that you drive by every day on your way to work but you maybe don't think how is that person getting food, or a place to sleep, or health care."

'You can't just talk it'

Elswick is part of a contingent of UAA health faculty and students that decided to reach out and help these vulnerable people. Her $5,000 award will build on a foot- and wound-care service-learning partnership Dr. Michele Burdette-Taylor, a UAA nursing professor, launched earlier this year at Central Lutheran Church.

The project will help medical and nursing students gain valuable "street medicine" expertise while earning credit; volunteers include community nurses, nursing students from all levels and graduate students. The providers work at the clinic to provide hygiene, assess for blood flow and sensation, and conduct interventions such as reducing calluses, clipping nails and fitting for donated shoes, inserts, and socks. Nurses are on hand in case a person at the clinic needs care for ulcerations, diabetes-related foot problems or other medical issues that are outside a student's skill set.

"We should not be teaching nursing in a classroom," Burdette-Taylor said of the growing UAA-WWAMI-community collaborative efforts. "You can't just talk it."

Pastor Jeff Hackler of Central Lutheran says the church does a lot of work with the neighborhood's homeless population, offering a cold-weather shelter, cooking classes and a "listening post" - a safe place to go to talk with someone.

"This seemed like a nice fit with some of the other things we do," he said. "It was not even on my radar that they would be in need of a foot clinic, but [Burdette-Taylor] said for the homeless people that's a big issue."

In fact, medical literature reflects the fact that foot care for homeless people is a major nationwide public health issue with repeated emergency room visits, chronic wounds, amputations, and even loss of life due to lower extremity infections that spread throughout the body.

Grants from UAA's Center for Community Engagement & Learning and Wheat Ridge Ministries support Burdette-Taylor's work. Brother Francis Shelter also offers a foot- and wound-care clinic.

"They're very enthusiastic about the results they've seen working with the folks at those clinics," Elswick said. "The thought was to be able to branch out into a mobile clinic, because sometimes people don't have transportation, or their foot care is so poor they're not able to get to a location. That's another goal of the program is to have more providers, more flexibility by having a mobile clinic. It's covering a gap in treatment."

Elswick's Selkregg grant will make it possible to train 10 volunteer students (six from WWAMI, four from the UAA School of Nursing) to provide foot care as well as pay for kits of needed self-care supplies - socks, powder, wipes, nail clippers, granola bars, soap, sanitizer - that the students will take wherever Anchorage's homeless people tend to congregate.

"I've had the opportunity to work with underserved populations in different countries and occasions, and it seemed like a really good plan to put in place here in Alaska," said Elswick, a Denver native who has worked with cancer patients as well as underserved populations in Scotland and Mexico. "Everyone should have the right to adequate health care. It really supports the community if it's all-inclusive for all residents."

Burdette-Taylor has conducted foot- and wound-care courses in San Pedro Sula, Honduras, since 2007. "Nurses worldwide can make a difference with basic preventive skills for foot and nail care, for prevention of falls, wounds and amputations," she said.

Providing meaningful experiences

Why is foot care the focus of Elswick's and Burdette-Taylor's volunteer work?

"Feet that aren't healthy, it's definitely difficult to get around and have good quality of life," Elswick said. "You always know when your feet are hurting."

"When your feet hurt, your whole body hurts," Burdette-Taylor said. "Feet are the most vulnerable part of the whole body and the most valuable, especially for the homeless."

People who are homeless tend to spend much of their days on their feet, frequently walking miles in a day. Walking these miles in the cold, through snow or rain, in poorly fitted shoes, means feet will likely get and stay wet, setting up an individual for wounds, infection, amputation and possible death.

"Moisture builds up, the skin starts breaking down," Elswick said. "That can lead to other things if not addressed quickly. Ulcerations are a great example of that. Potentially, if it goes on long enough you can have some pretty severe open wounds and that creates a route for infection anytime you have skin complications or breakdown."

Working in these clinics for the homeless gives nursing and WWAMI students the opportunity to offer hands-on help. The proposals for the grants were specifically designed to offer academic service-learning and community-engaged opportunities.

"They're doing assessments as well - a thorough foot examination, checking pulses, evaluating sensation and strength of the foot and ankle, and checking for a history of diabetes, which can complicate foot health," Elswick said. "There's a whole protocol of things they would be doing."

Elswick says she likes to see students getting involved in community-outreach experiences from the beginning of their medical training.

"They'll be looking back on these experiences they're having with these folks," she said. "They're going to think about those over and over again in the course of the time that they're practicing medicine. It's so very enriching in that sense."

Written by Tracy Kalytiak, University of Alaska Anchorage

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