The first thing nurse practitioner Janice Kochik wants you to know is that the patients she cares for are not homeless. They are houseless.
“A person can have a home, have possessions, live with family members and pets,” she says, “but their home may not be a stable physical structure like a house. No matter what their residential status, they still deserve good healthcare.”
Working out of Central Outreach Wellness Center, Kochik and a nurse assistant operate a mobile health clinic that brings essential medical treatment and testing services to unhoused people across Pittsburgh, most often to outdoor camps on the North Shore, North Side and South Side.
Central Outreach has a strong focus on Pittsburgh’s LGBTQIA community, which is disproportionately affected by houselessness.
Kochik had spent most of her 30-year career in a traditional hospital setting covering the standard range of specialties from intensive care and trauma to emergency medicine and dialysis. In 2016, she joined Operation Safety Net, the internationally acclaimed “street medicine” program pioneered in the 1990s by Pittsburgh physician Dr. Jim Withers and headquartered at Pittsburgh Mercy.
With the recent rise in Allegheny County’s houseless population, Kochik sees an immediate need for more healthcare professionals trained to serve outdoors.
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NEXTpittsburgh: What inspired you to pursue street medicine?
Janice Kochik: About 10 years ago I decided I wanted to be a flight nurse and returned to school for my bachelor’s degree. As part of that program, I went on a medical mission to Honduras. I realized I wanted to do more outreach like this, reaching people who had difficulty obtaining normal healthcare. I didn’t know how to do it on a regular basis.
NEXTpittsburgh: And you learned about Operation Safety Net after that?
Kochik: My son was in medical school, and Dr. Withers spoke to his class. My son said, “Mom, you have to check this out!” Until then, I hadn’t known what I wanted to do was being done in an organized way. I was finishing up a master’s in nursing at Carlow University and wrote a capstone program paper on hypertension and the houseless population. After I graduated, Operation Safety Net hired me as their first nurse practitioner.
NEXTpittsburgh: What was your first impression of street medicine when you saw it up close?
Kochik: I never realized people living outside needed as much medical care as they did. They simply fall through the cracks of our normal healthcare system. There weren’t any protocols for me to follow. Fortunately, we had tremendous outreach workers who helped the medical team and provided patients with clothing, water, housing assistance, veterinarian care … all kinds of things. I learned from them how to navigate the streets.
NEXTpittsburgh: You worked with Operation Safety Net for four years.
Kochik: It taught me so much. You work completely outside. You treat people in their environment. Because you get to know them in their environment, you can deliver a different quality of care. Because you go to them, you can ensure better follow-up.
NEXTpittsburgh: How so?
Kochik: They’re not coming to an office and sitting for an hour. Or not showing up at all because they don’t have the necessary transportation. I say, “I’ll meet you on this corner in your area at this time, and we’ll do this.” They control the encounter. When our outreach van arrives, we are able to see everyone in the camp if time allows and they want to be seen. We have a broad range of services … testing for STIs and HIV and hepatitis C. We can bring people onto the van for treatment. I’m always excited to see people who return.
NEXTpittsburgh: Because you’ve built the trust.
Kochik: Built relationships that built trust. When people live outside, they don’t trust many people on the inside. It’s hard for them to open up and trust that the medical person will continue to show up. With the van, I have the ability. I get to know them and can follow up and see them as much as they want to be seen. We offer healthcare access to those who don’t always receive it due to their current lifestyle and living conditions. Being able to treat people in their own environment allows for improved health care and reduces stigmas associated with these conditions.
NEXTpittsburgh: What is your main focus now?
Kochik: I’m very focused on treatment and prevention for hepatitis C, HIV, STIs, as well as education related to harm reduction. These conditions affect the whole community, not just those living outside.
NEXTpittsburgh: You’re also an accomplished visual artist. You’ve exhibited with the Pittsburgh Society of Artists, Associated Artists of Pittsburgh and Cranberry Artists Network. Did that start as a way to decompress from your job?
Kochik: Art is definitely a catharsis. I’ve been painting off and on all of my life. I had a mural painting business for a while. About eight years ago, I found the Art & Inspiration group at Shaler North Hills Library, and that sparked me to paint more.
NEXTpittsburgh: The titles are intriguing: “Refugee,” “Reclaimed,” “Resist Oppose,” “Relax,” “Gratitude,” “Reclaim” …
Kochik: Each piece of my art is usually linked to one person. Something that happened, a situation or a person. I use found objects to do the basic strokes, things like sticks, rocks, pieces of metal. I also write poetry. I put it on the back of the painting.
NEXTpittsburgh: What can we as a society, as residents of this particular community, do to help solve the healthcare inequity street medicine tries to address?
Kochik: Having housing with running water, electricity and warmth is the first step. It is so important. If you’re not in a stable environment, how can you yourself be stable? The security of having four walls is the foundation. Without these basic amenities, it’s difficult for a person to focus on anything else.
On an individual basis, people are always asking me what we need. Shoes, socks, gloves, hand sanitizer, masks, bandages. We have college students, church members who want to help clean a camp. People anonymously drop things off at my house.
Pittsburgh has a lot of great healthcare resources, a lot of wonderful clinics serving lower-income patients and patients who are homebound. AHN Center for Inclusion Health provides healthcare for those not in stable living conditions. I think we do need more street outreach workers and medical teams. It’s good for the general community in so many ways.
I love my job. I will always be somebody who’s working with a vulnerable population. For me, it’s been a blessing.
