It’s 6 a.m. on a Tuesday when Stanley Stinson throws open the door to Covenant Community Care’s offices in Southwest Detroit. Yellow light pours over the cement stoop nearly hidden in darkness. It’s 20 degrees outside. The wind, a serrated knife. Time to get out there, he says, a bit restless. He’s been counting inventory since 3 a.m. — medical supplies, blankets, tarps, food items, warm clothing — preparing for the day while fielding messages from women in the community, who text throughout the night.
Stinson is the lead on human trafficking outreach at Covenant Community Care, a faith-based, health center based in Southwest that provides medical services regardless of people’s ability to pay. An EMT and recent nursing graduate of Concordia University in Ann Arbor, Stinson volunteers with the nonprofit’s Homeless Outreach Program, or “street team,” one he helped to create.
In this role, Stinson sends a text once or twice a week to more than 100 people. Hey, it's outreach. How’re you doing? Do you need anything? Any medical concerns? Have you been to the clinic? Women text back: I need two blankets, something to eat, warm clothes, a ride, infection relief, help getting an I.D. He says he wants to find folks who need care, any kind of care, and do whatever he can to meet those needs. Not far from trending restaurants, pulsing casinos, and high-rise lofts, Stinson looks for the hidden, the displaced, and discouraged.
He checks his charts, zips up supply bags, and pulls on his hat and gloves. His team works with about 136 women, he says. “Most of our ladies entered [trafficking] at 12 or 13 years old. So it wasn’t a choice.”
In the predawn hour, Stinson finishes loading the van and shuts the trunk. He climbs into the driver’s seat. Before turning the key in the ignition, he says a prayer, asking to be led toward need and equipped to bring help. “Even if it’s just a loving word or the ministry of your presence, Lord,” he prays, before turning out onto West Grand Boulevard headed toward Vernor Highway.
Care that extends
Covenant Community Care's street team meets patients where they are to provide health care.
Going beyond clinic walls to minister to those in need is a daily mission for Covenant’s organization. It’s one of a few health centers that bring primary care access to Detroit’s displaced residents. Nearly 2,000 individuals live on streets or in shelters across the city, according to the most recent “point in time” count available, taken on Jan. 30, 2019. Reported by the Homeless Action Network of Detroit, the number increased 11% from 2018. It may still miss folks not easily seen, like the women who Stinson texts.
As a Health Care for the Homeless provider (HCH) since 2013, Covenant works with about 1,200 homeless individuals a year, in and outside its six clinics, to provide medical, dental, and behavioral health services. This number reflects only those willing and able to go through a traditional intake process, which doesn’t incorporate many of the interactions made with unsheltered folks, lots who’ve lost IDs, says Sam Young, Covenant’s chief development officer.
At places like downtown’s Pope Francis Center, The NOAH Project near Comerica Park, and Manna Community Meals at St. Peter’s Episcopal Church in Corktown, Covenant’s street team offers weekly clinics where medical staff address a full range of needs, from dental to foot and wound care. Caseworkers on the team help individuals establish housing, transportation, lost documents, primary care doctors, insurance, and substance abuse counseling. Sometimes, what’s provided first is much simpler: a pair of boots, warm socks, or a hat and gloves.
The team also seeks out those far from the system, the “rough sleepers” who live under bridges, in alleyways, abandoned buildings, parks, and boulevards; the trafficked and prostituted women who often stay in nearby drug houses. Stinson says the work is emotionally hard. They lose folks every year to overdose, hyperthermia, or the combination of two or more chronic diseases such as high blood pressure coupled with diabetes.
It’s not enough, he says, to point folks toward the clinic, or to offer one-time care. “For every person we encounter who has an issue or a problem, we cannot leave them until we have a good plan, and a backup plan, and probably a backup plan to that,” he says. This requires finding out where people sleep at night, what kind of shelter they have, what their medical needs are, and where they can be found at certain times for care. "A lot of our rough sleepers don’t have phones," he says.
Stanley Stinson and his street team members seek out those far from the system, the “rough sleepers” who live under bridges, in alleyways, abandoned buildings, parks, and boulevards.
Financial support from individual donors and faith-based foundations like Adrian Dominican Sisters allow the street team to do whatever they can to care for those they encounter, says Covenant Community Care interim CEO Josyln Pettway. “If the patient says the most important thing for them right now is a pair of boots,” she says, “some folks would say well, that's not a clinical need, why are you concerned about that?” But in working with a vulnerable population, it’s critical to not impose a plan of care, but to listen carefully, she says, and respond to what a patient says they need.
Pettway says the health center is waiting to hear this spring from the federal government about a new access point grant. It would provide funding, $650,000 to turn Covenant’s West Grand Boulevard administrative offices — the homeless outreach base — into a clinic specifically serving 1,000 additional homeless patients, on-site and through a Health Resources and Services-related mobile clinic. Expanding their capacity to offer primary care linked with the street team’s work is important, she says.
Being able to connect patients with primary care is one way the Covenant homeless outreach team stands out, says Jedidiah Bell, president of Street Medicine Detroit, Wayne State University’s medical school-run outreach program. They also have “an incredible presence on the street,” he says, and “provide an essential point of contact and referral service” for his team. “They’ve repeatedly proven to us and to patients that they care and will show up.”
Follow-up appointments, Bell says, especially for infection are serious, and hard for vulnerable patients on the street to remember, and to get to. Covenant’s commitment to locate homeless patients, and bring them to hospital and clinical appointments “sounds small, but it’s actually not,” he says, “it’s massive. We don’t provide any transport like that.”
The Covenant street team regularly collaborates with Wayne State and other street medicine groups in the city, sharing patient charts and brainstorming how to collectively increase the footprint of homeless care. Bell says the consistency Stinson, along with team members Jeff Hunt and Mark Schroeder, forms with patients is a large piece of that collaboration. As for the work the Covenant outreach program does with vulnerable women, Bell says, in the area, that’s unique to their group. “They are definitely the experts there,” he says.
Care that pursues
In 2013, Stinson was hired as a medical assistant at Covenant’s Southwest Detroit health center. Living then in South Lyon, and now in Brighton, he stopped often on his way into work. His colleagues say he’d pull over to buy someone a cup of coffee, or to ask them how they were doing. Sometimes they were wounded, and Stinson gave impromptu medical care.
There were also clinic patients physically homebound, or like many Detroiters, stranded in a city where 25% of residents have no car. He began to make house calls, taking long lunches and volunteering extra hours to check on patients discharged from the ER, folks missing appointments, new and expectant mothers. The community paramedicine program Stinson created increased health access for Covenant’s patients. Many, he was surprised to find, were homeless. House calls morphed into outreach. Stinson’s passion for people on the perimeter was contagious.
Angie Kilp, a part-time physician assistant at Covenant, joined Stinson on the street in 2014. Together, they searched out people under nearby overpasses, in homeless tent communities, and around abandoned buildings to offer care for medical and basic needs. What began in one, and then a team of two, has grown today to include six employees and about a dozen rotating medical volunteers.
Wound care is a big part of street care, Stinson says, but sometimes patients end up needing CPR, epinephrine injections for severe asthma or allergic reactions, nebulizer breathing treatments for respiratory conditions, or Narcan to reverse drug overdoses. On some runs, “exit bags” are given, plans are made for a bus ticket, a ride to rehab, or to family. People do leave this life, he says, “But it takes time. It takes a couple years.”
He tries to encourage people to visit the clinic because, he says, that’s definitive care. “Once they get clean, and get on their own, accessing resources is the first thing they’re going to need to know how to do.” Until then, he says, it’s about being a safety net.
The years Stinson spent free falling, going uncared for and unseen, are what make him stop and notice others. Born premature, drug addicted, and discarded by his young mother, Stinson says he was in a mental hospital at 4 years old. He was tossed from one foster care situation to the next before spending his junior and partial senior year living in the woods of Council Bluffs, Iowa, along the Missouri River.
From there he walked 2 miles to high school and to his job at the local pizza place. The staff there was kind to him, he says. But, he returned to the woods each night, alone. In dangerously low temperatures, he sought protection inside trash cans or the basement of a nearby apartment building. In the mornings, he traveled to school early to shower in the boys’ locker room before the other teens arrived.
“No one engaged with me on the street when I was homeless,” Stinson says. “Not one Christian, not one person. That’s why I’m engaging with others.”
A disabled army veteran who served in Iraq, Stinson knows a first touch may be the last. He’s drawn toward those who won’t go to shelters and soup kitchens; who don’t fit into any system of care. “I’ve been abandoned a lot,” he says. “That's why I'm the pursuer. I pursue at all costs. I'm going to try to do as much as possible in that first encounter because there's no guarantee we're going to meet again.”
During the week, Jeff Hunt partners with Mark Schroeder, a retired Sterling Heights firefighter paramedic and the program’s other full-time employee.
While Stinson is well versed in crisis, Hunt, who is the homeless outreach program manager at Covenant, says his goal is to offer folks continuity of care. Hunt served previously as part-time chaplain at Covenant, where his wife, Sara, also works as a nurse. He says in that role, and others there, he battled with restlessness, and a longing to do more. It was Stinson who continually asked him to come onto the street team.
In the homeless outreach position, Hunt found a surprising fit for both his personality and his heart. “Outcomes” in serving a vulnerable population can be “frustrating” and hard to measure, he says, but regularly being on the street, and ministering to people in their greatest need is where he needs to be. “I just feel God in this work,” he says. “God’s heart for the poor is revealed throughout the Bible. It’s kind of like a preferential position that they hold in his heart.”
During the week, Hunt partners with Mark Schroeder, a retired Sterling Heights firefighter paramedic and the program’s other full-time employee. Beyond shelter visits with Covenant staff, they spend most days making hospital visits, driving folks to appointments in and out of Covenant’s care, helping them apply for social services, and more.
Mark Schroeder and Jeff Hunt assist a patient at St. Peter and Paul Jesuit Church where the street team has a weekly clinic.
“We can’t fix everything,” says Schroeder, following a visit to Detroit Receiving Hospital where his patient had a toe amputated. Schroeder says he looks for signs that he’s making a difference, and sometimes he sees them, but often he doesn’t. “Occasionally people get out of rehab, and get back with their lives again,” he says. “But, for a lot of folks, they’re addicted, they’ve got a mental illness. Mostly both. How do you fix that?” he asks. “It’s pretty hard.”
Consistently showing up and building a rapport makes it possible for a person to begin to trust, he says. “Once that’s happened, sometimes they’ll let us take the next step with them. It can’t be about success. We hope they know somebody cares.”
That hope is evident when you see Stinson washing feet and cleaning ears, says Pettway, “and Jeff and Mark, their tenderness, their kindness and gentleness toward people. Nowadays, there’s so much controversy about what the love of God looks like,” she says, “but when you see the work of the whole team,” the providers that go out to give health care, and those able to connect with people and bring them into addiction recovery, “there isn't a debate about whether or not that matches up with the love of Christ.”
“This [work] is inherently messy. To meet the day-to-day needs goes beyond the compliance guidelines of a federal health center,” she says. “This is where the element of trust comes in, whether it’s with Jeff, Mark, or Stanley. If you were to try to scale this to cover the entire city,” she says, “it would alter the dynamics of the trust … [the team is] able to establish with people. What we’ve learned is that it’s a significant amount of relationship building that allows a homeless person to become a patient.”
Care that shepherds
During the Friday night and early-morning drives, Stinson — and often Hunt — lead female medical volunteers up and down Michigan Avenue, Vernor Highway, Fort Street, and surrounding neighborhoods, pulling along curbs, into parking lots, and behind drug houses to offer women medical care, warm clothing, bagged lunches, blankets, hot chocolate, a kind word, and if wanted, prayer. After several years, the women know the van and the team.
Jeff Hunt and nurse volunteers search neighborhood streets to offer women medical care, warm clothing, bagged lunches, blankets, hot chocolate, a kind word, and if wanted, prayer.
Women like “Jackie” (her name has been changed to protect her privacy). “Jackie” has been working with the street team for a couple years.
On the early Tuesday morning drive, she meets the Covenant van in the dark outside the house where she stays, and asks for a couple blankets for herself. She runs them inside, darts back out, hops in the van, and begins to direct Stinson as he drives. The two have a partnership. Jackie receives care from the street team and offers help in return. After she pays the $2 entry fee to go inside a nearby drug house, one she wouldn’t normally visit, she tells women the Covenant van is outside. They trickle out into the dark, following the footpath to the road to get bottled water, clothes, something to eat. Then Jackie heads home.
“We gained trust by getting to know each other,” she explains, before going into the house. “My getting medical services from them and helping extend these to others in the community. There's a lot of medical issues in IV drug use and in this kind of a lifestyle. These guys are very unbiased, non-judgmental, and right there (she snaps her fingers) doing exam professional medical care on things such as abscesses and infections,” she says. “Or STDs, they help promote safety with that as well.”
Before she leaves she mentions Narcan. “Oh, I can't forget that, saving lives, so many,” she says. “Oh, with just myself. Just myself,” she repeats, “I can tell you many stories.” As he pulls the van away, Stinson says that in 2019, his team gave out 500 doses of Narcan used to revive people. “When someone overdoses at a dope house, they’re probably not going to call 911,” he says.
Being consistent and building a relationship over time is important with patients like Jackie, who are stuck in addiction and don’t have clear systems of support, Stinson says. Sometimes he and Jackie talk together about options, about rehab, about her ideas for the future. These lives are complicated, he says, and filled with things hard to understand if you haven’t experienced them. Likely, there’s a fear there, like if she got clean, what would she do next, where would she go? We know those things can be figured out, he says, but they have to believe it also.
Persistence is key, Stinson says. He doesn’t want them to give up on themselves, even when things are laborious, even when they meet resistance. By continuing alongside Jackie, and offering her encouragement and care where she’s at, he and his team won’t give up either.
Staying connected with patients on the street over several years requires Stinson to keep track of where they go. He charts diligently on outreach runs, and sends email updates to volunteers, asking for prayer for those in Detox/Rehab, Jail, Prison, Recovery and Missing. He charts real names, street names, locations and processes of care. Each month he runs missing patients through local prison and jail systems. He checks morgues, dope houses, hospitals, and online sex ads. “If they aren’t anywhere, we hope it’s because they’re doing better,” he says. But either way, he says, he keeps searching.
“Stanley would be doing this if Covenant Community Care didn't exist,” says Pettway. “But I don't know that Covenant Community Care would be on the street to the extent that we are without Stanley, in terms of going to seek people out, people who are forgotten, people who aren't tied to some part of the system. If you are completely isolated,” she says, “that seems to be where Stanley’s heart is.”
While there are stories of renewal, Stinson says there are also those the street team hasn’t been able to help. Over the last two years they’ve lost 15 to 20 people from overdose alone. That's why it's important to share the stories of hope, like that of Carisa Casper, whose message to the team over the holiday season, Stinson says, was “so powerful because it reminds us to keep going.”
In a text message to Stinson, she writes: “It takes something special to reignite someone’s hope and very will to live. And you have successfully done so with me. Your outreach program, all of you that I spent time with as individuals, were massive stepping stones on my road to recovery. You made a huge impact on me that was the difference between where I am now ( healthier, sober, content, inspired) to where I literally would have been (an urn) had I not been found by you guys that Christmas Day, two years ago. I am ever grateful that you noticed me out there and stopped. You catalyze hope, and change, and love to people that have a need for it whether they know it or not! In case you ever doubt what you guys do, just know that you mattered to someone.
All my heart,
In a text to Model D, she writes: “I was compelled to make sure [the Covenant street team] knew their meeting with me is the reason I still have breath in my lungs today. And joyful ones, when I never thought I’d feel that again.”
For a person to call or text to say they're alive, and doing well, and that their life is changed, is so encouraging, Stinson says. “Praise God for that. It makes me want to keep going and to share this with nursing students, and providers, and other students and professions. I really believe we could see this happen more if people were actually trained.” He says he’d like to be a part of furthering street training, which is similar to first responders, in that it doesn’t leave without clear direction and progress toward solving a problem. He says that Schroeder was the one who pointed that out to him and he never forgot it.
“We have to go find them,” he says, “we have to go to the people. That’s like the big quote in a lot of street medicine programs. I don’t remember who said it, who cares, Jesus came to us. He’s our example.” Trying to follow that lead Stinson says, “It’s what I want to do for the rest of my life.”
All photos by Nick Hagen except where otherwise noted.
Disclosure: The author's father is a Covenant founding member and part-time employee who does work in the community and engages employees.