Dr. Mary Marfisee, a family medicine physician and assistant professor of medicine at UCLA, provides medical care to unhoused individuals on Skid Row, Los Angeles. Her work includes street medicine rounds and serving as the family medical services director at the Union Rescue Mission (URM).
Health Challenges Faced by Unhoused Individuals
Individuals experiencing homelessness often prioritize finding stable housing over addressing health concerns, leading to the progression of minor health issues like infections, cuts, or chronic conditions into more serious problems.
Specific Challenges for Unhoused Women
Women experiencing homelessness face particular health challenges and limited access to resources. A 2024 RAND study indicates that Skid Row's unsheltered population is increasingly older and female, demonstrating significantly lower physical and mental health compared to sheltered individuals. This disparity is attributed to factors such as inadequate insurance and transportation, with access to basic services like gynecological and prenatal care being especially difficult.
- Union Rescue Mission's internal studies revealed that approximately 87% of women were not up-to-date with preventative pap smear or mammogram screenings.
- Patients frequently encounter obstacles when trying to schedule appointments; one patient required nine months for a mammogram appointment due to issues with identification and insurance.
- One patient, who had experienced decades of lower abdominal pain, was found to have an intrauterine device (IUD) placed 32 years prior that had not been removed and had become embedded in her lower uterine wall. This discovery prompted Dr. Marfisee to seek improved women's health screening services.
Union Rescue Mission's Women's Health Initiative
In response to these challenges, Dr. Marfisee launched a women's health initiative at the Union Rescue Mission in December.
- Phase 1: Regular town halls are conducted with medical student interns to educate women about preventative screenings for cervical and breast cancer.
- Phase 2: URM is partnering with a local hospital to deploy a mobile health van to the shelter twice monthly. This initiative aims to offer free pap smears and mammograms, with an estimated capacity of up to 100 breast exams per visit. Research indicates that unhoused women have a breast cancer mortality rate nearly double that of the general population, largely due to late diagnoses.
The mobile health van component of the initiative has encountered logistical delays, including scheduling conflicts for the van driver and requirements for medical waste disposal, delaying its implementation by three months. Dr. Marfisee is optimistic about overcoming these challenges and anticipates beginning patient screenings by February.
Ongoing Outreach
Dr. Marfisee continues her street outreach efforts, providing care and identifying individuals for subsequent follow-up, such as an older woman in a wheelchair observed in a park on San Julian Street.