Dermatology and BHCHP Collaboration

"Ernesto
Dr. Ernesto Gonzalez examining a patient at one of a Boston Healthcare of the Homeless clinics.

Mass General Dermatology is honored to be part of the Boston Health Care for the Homeless Program’s (BHCHP) mission to provide the highest quality health care for all homeless men, women, and children in the greater Boston area.

Skin disease is common amongst people experiencing homelessness, and untreated disease can lead to hospitalizations and infections.  Mass General Dermatology is committed to providing high quality dermatologic care for the patients of BHCHP through the collaborative programs discussed below.

Clinical Services

Dermatologists Provide Care to Boston's Less Fortunate - Massachusetts General Hospital, Boston, MA

In 1998, Dr. Ernesto Gonzalez began providing free dermatologic care at Boston Health Care for the Homeless Program (BHCHP). In 2009, a formal collaboration between BHCHP and the Harvard Dermatology Combined Residency Program was forged.

In this partnership, attending dermatologists from Mass General and Brigham and Women’s Hospital provide high-quality dermatology specialty care through a patient-centered, service-learning model.
Directed by Dr. Jennifer Tan, our team offers a weekly clinic at BHCHP’s outpatient clinic in Boston's South End and monthly clinics at various family shelters. We offer outpatient management of chronic skin diseases such as eczema and psoriasis, diagnosis of skin cancer and  treatment of acute conditions commonly seen in the homeless population, including infections and infestations.

More than 600 unique patients have been served by this program. We are indebted to the clinical services by dermatologists from Mass General, and Brigham and Women’s Hospital, as well as the in kind dermatopathology services donated to our patients.

The Mass General and BHCHP clinical relationship continues to grow and new endeavors include expansion of clinical services to additional BHCHP sites, pediatric dermatology care for children experiencing homelessness, innovative Women's Wellness Programs, a teledermatology pilot program and a partnership with the CareZone Van to provide dermatologic services and build trust among the community of individuals who call the streets of Boston their home.

Skin Cancer Screenings

Given the chronic sun exposure that many people experiencing homelessness face, screenings are particularly important for detecting skin cancer early. On an annual basis, our staff provides skin cancer screenings for patients staying in the medical respite center at BHCHP.

We also provide formal screenings several times annually for women participating in the BHCHP HER (Health. Empowerment. Resources) Program. Routine skin cancer screenings are also offered during our weekly clinic hours.

Teledermatology

In December 2018, Mass General Dermatology launched a new teledermatology initiative that will allow our staff to provide consultative services for men, women and children served by BHCHP's family team, medical respite center, CareZone van and street team providers. This program is co-directed by Dr. Tan and Dr. Shinjita Das and is  sponsored by the Mass General Telehealth Program and a generous grant by the Mass General Executive Committee on Community Health.

Women's Wellness Programs

"Spa Days" – On a monthly basis, a group of medical students from nearby schools currently offer relaxing treatments such as face masks, hand massages, and foot soaks to women experiencing homelessness. These "spa" therapies  promote relaxation, self- care and and self-confidence and are paired with skin care education intended to reduce chronic dermatologic disease and promote skin cancer awareness.

"Spa Days" are supported by the Schweitzer Fellowship, Tufts' Tisch Fund for Civic Engagement, Asutra and Massachusetts General. In March 2017, employee  of Mass General’s Dermatology department contributed makeup, beauty, and personal hygiene products to participants in the Women's Wellness Programs.

We found that women experiencing homelessness were sharing makeup, leading to infections, and discovered that by taking the time to help women gain confidence, they are more likely to talk about other health issues, such as substance abuse disorders. Skin wellness and education seem to be effective ways to engage this vulnerable population.

Jennifer Tan, MD
Dermatologist


Mobile Health Partnership

The Kraft CareZONE is a mobile health service combating the opioid crisis by providing preventative care, addiction services, and harm reduction to individuals not well-connected to health care. Dermatology was recruited to participate in the CareZONE Van given a high rate of skin infection associated with intravenous drug use, and the observation that skin disease could be a unique point of engagement for individuals struggling with addiction. Our staff currently offers teledermatology services to the CareZone Primary Care providers, as well as street consultations on an as-needed basis.

Education

Harvard Dermatology residents and medical students have the unique opportunity to spend time in the Dermatology clinic at BHCHP. The goals of participation include teaching residents to deliver care in a limited resource environment, emphasizing the importance of collaborative public health initiatives and promoting an understanding of the dermatologic needs of patients experiencing homelessness.

Academic Achievements
Dermatologists Provide Care to Boston's Less Fortunate - Massachusetts General Hospital, Boston, MA

• Sheu J, Gonzalez E, Gaeta JM, Bharel M, Tan JK. Boston Health Care for the Homeless Program-Harvard Dermatology Collaboration: A Service-Learning Model Providing Care for an Underserved Population. J Grad Med Educ 2014;6(4):789-90.
• Ongoing studies

In The News 

If you would like to make a gift to support our efforts, please contact Anne C. MacLean, acmaclean@partners.org, or call 617-643-0463.