Dr. Hans Bruntmyer practicing backpack medicine for our friends on the street during the early days of SMSA

What is Street Medicine?  

It's exactly what it sounds like. 

Quite simply, street medicine is the provision of patient-centered, reality-based healthcare outside the traditional clinical setting.

It can be thought of as an old-fashioned house call where the roof over someone’s head might be a bridge, a tarp, a tent, the canopy of trees, or the open sky.  There are no refrigerators to store medications.  No running water to keep wounds clean or attend to personal hygiene needs.

No easy access to transportation, making trips to clinics and pharmacies difficult or impossible.

Due to the austere conditions and realities of street life, street medicine efforts cannot provide comprehensive care to our unsheltered friends; rather, teams aim to build meaningful relationships by caring for acute needs of patients where they live and coordinating more robust care in the community for issues outside the scope of a street medicine practice.

Beginnings of Street Medicine San Antonio

Dr. Hans Bruntmyer, a retired military emergency medicine physician, had a career that largely revolved around being comfortable with the uncomfortable and he was no stranger to practicing medicine in austere environments.  When he and his family relocated to San Antonio following his military retirement, he was moved by the obvious need for improved access to medical care for the most vulnerable in our society- those who lack shelter, transportation, basic safety and support.  He was already familiar with the Street Medicine movement, originally founded by Dr. Jim Withers of Pittsburgh, and began networking with Dr. Withers and other Street Medicine program directors in 2015. 

During the next few years, Dr. Bruntmyer began to see the reality of creating a Street Medicine San Antonio (SMSA) program and, in January of 2019, Dr. Bruntmyer began leading “backpack medicine” teams onto the streets of San Antonio to care for unsheltered individuals.  Those first “Street Rounds” began with a single physician and student volunteers.  The organization has now morphed into a team of multiple physicians, advanced practice clinicians, nurses, and a behavioral health component – Street Therapy, in addition to countless volunteers of varying levels of training and across a range of professions.  Despite his experience to that point, Dr. Bruntmyer could not have imagined the relationships formed or personal and professional growth that would be experienced by himself and all of the volunteers. 

Current operations

SMSA has grown in size and scope over the past five years.  Medical students from the University of the Incarnate Word School of Medicine, our flagship partner, are now joined by TIGMER psychiatry residents, UT Health internal medicine residents and nursing students, among other local programs.  

In early 2021, SMSA transitioned from paper charting to an EMR.  This has aided in building patient trust and ensuring continuity of care when seen by multiple providers.  The same year, we were also approved for limited medication resupply through two international medical non-profit organizations.  

We regularly liaise with a handful of community organizations, both receiving patients and referring them for services including ID retrieval, housing, and rehabilitation.  When patients are ready to establish primary care, we refer them to free clinics, community hospitals, and specialists, as needed.  

In late 2021, Dr. Bruntmyer appointed co-medical directors - Dr. Patrick Muehlberger and Dr. Brian Dillon - in his place. They are also emergency medicine physicians who have served with Street Medicine since early 2019.  

In the summer of 2022, Imago Dei Par Vias (IDPV) was formed as the non-profit association which oversees SMSA.  Dr. Muehlberger, Dr. Dillon, Amy Moore, PA-C, and Tiffany Juarez, LCSW, also members of SMSA, serve on the board of IDPV.  Tiffany Juarez leads the Street Therapy team.   

The way ahead 

Quite literally, only God knows. 

In the Spring of 2023, SMSA began providing regular patient care at San Antonio's newly developed permanent supportive housing community - Towne Twin Village (TTV).  TTV is in the process of building a permanent clinic, where our organization plans to collaborate with local medical education institutions to provide care.  In May of 2024, we will host the 3rd annual Texas Street Medicine Symposium at the UIWSOM campus in San Antonio, TX.  Last, but not least, our board is pursuing funding to create a wholistic street medicine team, including medical, behavioral health, and social services. 

Despite the many changes the organization has gone through and the plans for the future, the ultimate goal of SMSA, care for San Antonio’s most vulnerable, has not changed.  

Our beliefs have been challenged and our training stretched to its limits and beyond. There is no way to know what’s on the horizon, but we welcome it.  We look forward to the blessings, the challenges, and the friends we’ll work alongside as we serve some of the most vulnerable in our community.

Dr. Brian Dillon performing an incision and drainage

Pre-medical student Ben Dawson and UIWSOM OMS2 Christine Saleeb performed wound care 

From left to right, UIWSOM OMS2 Xyruz Villariz, pre-medical student Reagan Gately, and nursing student Julianna Vasquez perform a patient evaluation