Care Beyond the Boulevard (CBB) has been providing mobile medical clinic services to individuals experiencing homelessness on the streets in the Kansas City metro for over four years.​ With a mission of compassionate health care for all, CBB’s Big Green Bus​ mobile clinic and volunteer corps of practitioners and volunteers are out seeing patients four times a week. When the pandemic arrived in our city, Mayor Quinton Lucas and the KCMO City Council were vocal with their concerns about our homeless neighbors and marshaled resources to strengthen an already fragile safety net. Likewise, CBB stepped up to the challenge of keeping our patients, practitioners, volunteers, and partners healthy and safe in these unprecedented times. We immediately began developing protocols and navigating the challenging supply chain. Some of our local partners that provide food, clothing, and other essentials to homeless persons either closed temporarily or operated on a limited basis. Many nights our patients were more concerned about their next meal, obtaining clean clothing, or finding a place to shower than they were about their asthma or cellulitis. And they were scared … very scared. On those nights, we provided emotional and mental health support at the Big Green Bus. “We believe there is enough for everyone but resources are unequally distributed and structurally contained for the privileged class. Our work in street medicine is defined more by the values that guide our daily lives than by the medical care we deliver.” Our new protocols include establishing a safe distance between volunteers and patients as they line up for treatment. We do this by: Creating chalk lines at every point of entry to our services, our provider line, our pharmacy, and the hospitality line Having practitioners in PPE at all times Requiring patients to wear a mask Treating more patients on the street rather than in the bus Taking temperatures of patients, practitioners, and volunteers each night On our Monday night clinic at Micah Ministries, we transitioned to an outside treatment area, placed chairs in the parking lot to encourage social distancing, and worked with our partner to help guide safe systems so they could continue food services. For years, CBB has been blessed with generous donations of supplies but nothing could have prepared us for the first weeks of the pandemic. It was not unusual to go through a hundred thermometer probes a week. We required surgical and N95 masks for those treating high-risk patients. We struggled in obtaining gloves as we changed them between each patient contact. Hand sanitizer was something we had routinely had on the bus, but our use tripled, and there was a national shortage. Fewer patients tested positive or were presumed positive than originally feared. However the need to treat other health problems continued and even intensified. If a patient struggled with asthma, it was imperative that we get meds to them, so we had to keep our pharmacy well-stocked at all times. We treated many more wounds than usual since our patients were not using the ER out of fear of being exposed to COVID.​ ​ We are concerned about a second wave of exposure as our patients were discharged from hospitals into the community to access feeding programs, clothing closets, day centers, and other community services. We know the importance of planning for public health concerns and as a result have already received enough flu vaccines to get us through the upcoming season. Kansas City displayed its generosity during the pandemic, and CBB was grateful to receive several first-time funding awards (including one from Health Forward). Online donations and support from individuals increased significantly; supporters rallied to provide supplies and equipment. We have found our place in the community and will continue to use our voice to advocate for our vision of a community where all have access to quality health care despite financial or social circumstances. As COVID-19 and its disproportionate impact among people of color revealed the fatal outcomes of our failed health care system, the past months have revealed the fatal outcomes of racism.​ On a daily basis, those of us at Care Beyond the Boulevard grieve and bear witness to the violence, marginalization, and oppression of excluded people right here in Kansas City. We see the bruises and scars, and we feel the emotional pain. We believe there is enough for everyone but resources are unequally distributed and structurally contained for the privileged class. Our work in street medicine is defined more by the values that guide our daily lives than by the medical care we deliver.

"It was my first night handing out socks, I had been instructed to give what was needed but not to be frivolous because we had a lot of stops that night and socks are always a huge request. The man that approached the bus was close to my age and really tall. He asked for socks and I handed him a pair, smiled, and asked if he needed anything else. He smiled back and said he needed two more pairs of socks - the big thick ones - for his shoes. I shook my head (of course they're for your shoes, silly) but I reached back into the bus for two gray, super-thick sock rolls and handed them to him. He was delighted and said that he wasn't trying to be stingy, he needed them for his shoes. I laughed it off but he wasn't having it. He sat down next to me and took the shoes off of his feet...two stumps really, not feet. Every single toe was missing. He stuffed the rolled-up socks I had just given him into the tip of his shoes and slid his foot back in and said, 'See? For balance. You know, it's not the day they freeze, it's the days after that hurt the worst. The dead part just keeps dying and if they don't get those toes off you can lose your whole foot or even your leg.' He must have seen my look of horror but he just smiled and said, 'KK and you guys helped me with my toes or I would've died. The socks I learned from myself.' He stood up with the help of the bus's back door and said, 'don't ever think we want more than we need...where would we put it anyway?' He laughed and then he was gone. Lesson number one on sock night." -CBB Volunteer It's warmer now, our cold snap is over and yet all any of us can think is ..."it's not the day they freeze." The toes come off days later, after unimaginable pain and suffering. Peeling off dead tissue, treating frostbite while standing IN the snow. Mentholatum in the mask, breathe through the mouth. Toes, so small and yet they cause such large amounts of pain. If the way you stay alive is by walking, what do you do when you can't walk? If they have to walk to get to our bus for help what do they do if it is too painful for them to leave their tent? So we brace ourselves, prepare our volunteer list, stock our bandage shelves, fill the bus with fuel and we go find them. We know their pain, we know them by name, we will find them. Compassionate Healthcare for All

In solidarity with people around the world, Care Beyond the Boulevard voices its anger at the continued targeting of black Americans. Black lives matter and we abhor the structural racism and implicit biases that perpetuate inequities in health care, criminal justice, education, and economic self-sufficiency. The disproportionate impact of the COVID-19 pandemic among people of color and the murders of George Floyd, Breonna Taylor, and Ahmaud Arbery are recent examples of racism and structural violence in the United States. We stand with the families and friends of local murder victims like Ryan Stokes, Cameron Lamb, and Donnie Sanders and await the justice that they deserve. On a daily basis, those of us at Care Beyond the Boulevard grieve and bear witness to the violence, marginalization, and oppression of excluded people right here in Kansas City. We see the bruises and scars and we feel the emotional pain. We believe there is enough for everyone but resources are unequally distributed and structurally contained for the privileged class. Care Beyond the Boulevard commits to the following actions in our fight for equity and justice: We will listen. Please email us at info@carebeyondtheboulevard.com to share ways in which we can improve equity within our organization. We will educate ourselves and the street medicine community about the racial disparity among the black unsheltered homeless population and equip ourselves and the organizations that we are in contact with on ways to erase that disparity. We at Care Beyond the Boulevard come from disparate backgrounds but have a common goal. Our work in street medicine is defined more by the values that guide our daily lives than by the medical care we deliver. These values are inclusivity, solidarity, justice and love. We practice inclusion medicine; all people - regardless of race, ethnicity, gender identity, or religion - are worthy of our care. We listen and allow our rough-sleeping friends to define our priorities, rather than forcing them to conform to our agenda. We stand in solidarity with the people we serve, immersing ourselves in their reality. The harsher their reality becomes, the more we strive to share their burden. We bear witness to injustices inflicted on them almost daily, challenging their very right to exist in our city. Finally, we understand that of all the things we can do, creating more love is always the most important. In solidarity and with love, The Care Beyond the Boulevard Board

She was crying and shaking, eyes damp slits, hat and mask and coat covering all except her wringing hands and worried forehead. Anxious and depressed, she had been out of meds for months. It's possible they helped but at this point she can't remember. All she knows is that most Mondays she can't even convince herself to leave her camp. A few times she had paced outside the church's fence, watching the people, deciding who the triage person must be, trying to map out a clear path, before giving up and hurrying back home. But this time she had done it. Perhaps she was desperate enough, arrived before it was too busy, saw a friendly face- it doesn't matter, she was here now, first checking in, then getting her vitals and symptoms documented, then being directed to the empty metal folding chair against the church wall, the one facing me. I listened as she shared some of her many worries, her trauma, all of it visible and wordless in her prematurely aged face. She faced outward, scanning the parking lot, asking me to be sure no one came near, saying that there are too many people here. I asked Maddie to keep an eye on her, making sure that no one bothered her and that she didn't run away before I could get her medications. Kay and Mary filled the prescriptions and I hurried back outside. Gone less than five minutes, she had moved my chair in front of hers, stacking her bags on top of it and around her as a shield. She was relieved to receive the little bottles and I encouraged her to come back. See it was easy- come back next month! A quick smile as she sprinted out to the sidewalk and around the corner, dodging and weaving. There are countless stories like this. People who wouldn't ever receive care without CBB, like the one last week where KK, Sharol, Bethany and I worked on a man's toes for nearly an hour, ancient toenail dust accumulating into dunes on the exam table as the shapeless mess was clipped, pulled and ground down to something more recognizable. He laughed and smiled and looked forward to his next date when he could take his socks and shoes off and dance to Stevie Nicks. It's a gift to be able to participate so intimately in others' lives. There are holy moments and the lines between giver and receiver are blurred. All of us have the opportunity to do so if we try.