By: Drs. Ashley Ryles and Natalie Kirilichin, Health Policy Fellows, Department of Emergency Medicine, George Washington University Hospital

As the dust settles after some moments of unrest, we emerge with a greater sense of respect for those that continue to do amazing work for the city of Baltimore. Earlier this month, a group of emergency physicians / health policy fellows from George Washington University and the University of Maryland embarked on a journey to visit Baltimore City Health Commissioner Dr. Leana Wen and her staff.  While visiting we developed a deeper appreciation for the hard work and powerful initiatives that continue to take place in this great city.

The day consisted of a tour that exposed three strategically positioned treasures.

Our first stop was the Druid Health Clinic on West North Avenue, in the city’s Penn-North neighborhood, located across the street from the now famous CVS store. Not only does this facility provide medical and dental resources, it offers immunizations that protect our youth. However, one the most inspiring services offered was found within its STD clinic. During our tour we were fortunate to meet three African American men that have revolutionized the way HIV care is delivered. Between the three of these men, a broad range of services are rendered. Prospective patients may come to the clinic to have testing performed on-site or can take advantage of an STD testing van that circulates throughout the city. For those persons that test positive for the virus and do not return to the clinic for follow-up, these men make visits to individual homes with intent to provide confidential results and guide patients into care. Moreover, these men may provide transportation to and from appointments to ensure health care is given to HIV-infected individuals.

The themes of community outreach and unconditional regard for one’s neighbor carried into our next visit: the Needle Exchange Program at Mount Street and Westwood Avenue. In a small, unmarked van, health workers are slashing rates of HIV and hepatitis transmission by providing clean, free injection supplies and education to heroin users.  What’s more, the community buys in.  Though clients aren’t held to a 1:1 exchange and supplies aren’t capped, roughly 80 percent of the needles distributed are returned.  A steady flow of individuals presents, greets our group of strangers head-high, returns protected needles, and leaves with a new supply and safe injection bundle. Each is offered education on overdose reversal and a free prescription for intranasal naloxone, a powerful opioid antagonist. Anecdotes of rescued friends and family echo inside the vans’ tiny walls. In truth it feels more like a town hall meeting than an active disease intervention strategy. The incredibly educated, approachable, and respected staff is world-class. Each engaging member could work anywhere, but chooses to be here, helping fellow citizens.

Our next stop filled us with hope not just for city stabilization, but, for true evolution. At Safe Streets Mondawmin, we meet two men and one woman who quite literally transformed their lives in response to a higher calling to save Baltimore’s youth. Safe Streets, based on Chicago’s CeaseFire model, utilizes incredible leaders who were once former criminals as credible messengers to prevent homicide and other violent acts. One staff member, a self-described “Stick-up Boy”, recounts his 19 gunshot wounds and stabbings, 12 surgeries, countless hospitalizations, and decades in prison as a means of building street credibility. He’s got his ear to the ground and he’s trusted. He knows the system and its politics so intimately that he’s optimally poised to save a kid with far less insight from a life like his former. Ten years and two graduate degrees later, he describes the evolution of local gangs as spillover from a prison-based protection strategy like a screenplay and we don’t want to blink. We’re humbled to be in his presence, to shake his hand, and realize that for every patient we treat, he’s out there preventing another from hitting our trauma bays and gradually shifting the paradigm of his city.

We left the day inspired and blown away by the impact individual determination and a supportive infrastructure can have on a community. Baltimore’s solidarity is unparalleled, and its public health outreach programs should serve as examples to other municipalities. We are truly grateful for the unique opportunity and insight into Dr. Wen’s agenda and to have met the incredible people at Druid Health Clinic, Needle Exchange, and Safe Streets.