London Calling: Street Medicine Crosses Pond to Share Insights, Experiences

Jazzmyn Gamble
Kara and Maire

Our Epstein Street Medicine Program has been making headlines for its innovative methods of addressing the healthcare needs of unsheltered Philadelphians. The well-earned attention merited them an invite last September to address the annual International Street Medicine Symposium (ISMS) in London. Kara Cohen, associate medical director, and Maire St. Ledger, nurse practitioner, represented the team.

Kara and Maire, in collaboration with Lydia Williams, street medicine’s family nurse practitioner, developed an interactive presentation on the effects and treatment of the drug xylazine, also known as “tranq.”

“Xylazine is the drug that is found in most of the drug supply here in Philadelphia, and exclusively in Philadelphia, in the United States. Puerto Rico and Philadelphia are the main epicenters of the xylazine issue. And so, we decided that it would be important to present it,” said Maire. The Centers for Disease Control and Prevention describes xylazine as a non-opioid sedative not approved for human consumption, and is often mixed with other drugs like cocaine, fentanyl, and heroin.

The engaging presentation was modeled on the popular 80s book series “Choose Your Own Adventure,” allowing the audience to choose their own information pathway.

“We listed all the topics that we could go over, “said Kara. “For example, if you wanted to learn about no-harm dressings, jump to this section, and if you wanted to learn something else, you’d jump to that topic. People could use our PowerPoint as a guide in their practice for follow-up care. It was like a table of contents.” They focused on their expertise on tranq-related wound care and also covered topics like Hepatitis C, pregnancy care, mental health care for people experiencing homelessness.  

“When it was over there were a lot of people that came up to us and they were asking additional questions,” said Maire.  

“It was fun! We got a lot of great feedback from people that found [the presentation] to be really helpful. It’s always the best when you can help your colleagues that are out in the field doing the same thing,” added Kara. They continued to receive follow-up emails after the conference ended.  

Over the last few years, tranq has made its way to other major cities, leaving many healthcare professionals searching for new methods to understand and manage its gruesome impact. According to the U.S. Drug Enforcement Administration, xylazine and fentanyl mixtures have been seized in 48 states.

Kara said providers have felt overwhelmed and unprepared with how to deal with the drug. “We were able to provide some training on how to recognize and treat the wounds, and how to have ongoing management and avoid amputation.”  

The pair made sure to include the moral implications of wound care for people experiencing homelessness and medical ethics. “We've seen a lot of people wanting to help. We tried to teach them how to do it in a safe, ethical, and sustainable way. It was really wonderful,” said Kara.  

They were both thrilled with their experience. “I think it was beneficial, not only for the knowledge we gained, and were able to share with others when we came back, but also to tell people, about Project HOME,” said Maire.  

Kara agreed: “I’m so grateful to have had this opportunity and to be accepted. And with everything we’ve been through it these past couple of years in Philadelphia, it made it feel like what we have experienced mattered, because we're able to use those experiences and help people.”  

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