Medicine under the tent: Bringing dignity to Vallejo’s streets

The rhythmic squeeze of a blood pressure cuff mingled with animated, overlapping conversations under the pop-up tents. A volunteer handed out granola bars while another explained medication instructions. At the osteopathic manipulative treatment (OMT) tables nearby, my classmate gently palpated a patient’s spine, listening with her hands.

This was street medicine in Vallejo, California, where our Gold Humanism Honor Society (GHHS) team from Touro University College of Osteopathic Medicine-CA (TUCOM) brought osteopathic manipulative treatment (OMT) to neighbors living in tents, cars or transitional housing. Over the course of multiple outreach days, including a special Dignity Day event and typical street medicine sessions, we would treat more than 20 people. Not in a sterile clinic, but right there, where they were.

The medicine in our hands

Humanism means being fully present with another person, listening deeply to their story and letting them know they are truly seen and cared for. As osteopathic medical students with over 200 hours of specialized training, we had learned to use our hands as instruments of assessment and healing.

OMT employs gentle, precise movements to restore balance and support the body’s innate ability to heal. When we performed myofascial release, we applied sustained pressure to restrictions in connective tissue, feeling it soften under our hands. When we balanced the autonomic nervous system, we worked with specific anatomical structures, addressing the diaphragm or sacrum, using the anatomy as a doorway to influence physiology and restore nervous system balance.

With reverence, we provided therapeutic touch; one of the deepest forms of listening, yet one requiring mutual trust. Many patients told us that despite past traumas making it difficult to relax, they felt safe with us, sensing the intent behind our touch.

Before each event, our team completed trauma-informed care training developed by Nicole Peña, DO, senior associate dean, associate professor of osteopathic neuromusculoskeletal medicine (ONMM) and chief academic integrity officer at TUCOM. Dr. Peña’s work shaped how we approached this vulnerable population. Drawing from her residency training in the Bronx and years of clinical practice, Dr. Peña created a training video that blends trauma-informed care with OMT principles to honor the wholeness of each individual.

“The unhoused may not always articulate their trauma, often normalized through lived experience,” Dr. Peña explained. “Fostering a safe therapeutic space is paramount.”

Her training taught us to adapt traditional OMT approaches through deep, nonjudgmental listening, “using not just our ears, but also our hands, presence and beingness to create a sense of safety.”

We learned to use indirect techniques, following the body’s direction of ease, and moving at the patient’s speed, pressure and tempo. Soft-tissue techniques served as a gentle introduction to safe, therapeutic touch, particularly for those who were guarded.

We positioned ourselves beside patients rather than hovering over them, fostering collaboration rather than authority. We communicated clearly, explaining actions before initiating touch and reassuring patients they could stop treatment at any time.

“The examination process itself becomes a tool for connection with intentional, supportive touch that feels like a nurturing hug rather than an abrupt grasp,” Dr. Peña taught us.

By reading nonverbal cues and respecting boundaries, we learned to adapt techniques to each patient’s comfort level.

“I emphasize recognizing the miracle of each patient’s existence, and letting their inherent health, not our ego, guide the interaction,” said Dr. Peña.

This training ensured that consent, comfort and safety guided every interaction and that as trainees, we grew not only in clinical skill, but also in empathy and cultural humility.

3 students, 3 lessons

Finding light in the darkness

During a typical street medicine day, a nearly blind young man with a surprisingly joyful disposition came to us for care. He shared his struggles with a progressively worsening genetic condition, a recent car accident and subsequent assault. During examination, I felt how much tension his body held; his muscles guarded and breathing shallow.

Over our session using osteopathic manipulative medicine and myofascial release, his breathing deepened and his shoulders dropped. By the end, he was visibly relaxed, smiling and reporting pain relief.

Another patient had undergone lobectomy and lived with persistent headaches ever since. After our OMT session using gentle techniques, she looked at me with tears in her eyes; it was the first time she’d experienced relief since surgery.

“How can I keep getting this treatment?” she asked, but there was no easy answer. She had no regular healthcare access, no assigned physician and no clear pathway to continued care.

When pain lives in the nervous system

On another street medicine day, family medicine resident Caroline Lahti, DO (then a medical student) treated a young man in a shelter with acute shoulder and neck pain.

“His anxiety was palpable,” Dr. Lahti recalled. “Even gentle touch made him flinch.”

Despite targeted treatments, the pain persisted until Dr. Lahti and her partner shifted focus. Instead of treating the pain site, they worked to balance his autonomic nervous system, helping his body move from hypervigilance to safety. Only then did his tension dissipate, bringing relief to his shoulder.

“This reinforced my understanding of OMT’s role in addressing a patient’s neuropsychological state,” Dr. Lahti reflected. “For patients facing significant stressors, especially in vulnerable communities, OMT may be invaluable. Creating a safe environment attuned to both emotional and physical needs can offer a rare moment of rest and healing.”

Caring beyond limits

During a special Dignity Day event, Rishikesh Menon, DO—then a fifth-year osteopathic medical student and academic medicine fellow, now an emergency medicine resident—observed and later described his first experience as transformative.

“Kindness and generosity of spirit was abundant,” Dr. Menon said. “Every volunteer was genuinely happy to be there.”

He treated a former winery laborer with chronic arm pain from a workplace injury two years prior. Without access to imaging or doctors, the man had resigned himself to constant discomfort. During examination, Dr. Menon realized the patient needed imaging to confirm nerve injury, but had no way to access it.

“I quickly reached the limits of what OMT could accomplish,” said Dr. Menon. “I spent time massaging his elbows. He hadn’t had treatment for over two years. I wanted him to know that even though I couldn’t fully eliminate his pain, I cared about his wellbeing.”

“As a physician-in-training, I feel limited when patients aren’t connected to the healthcare system,” Dr. Menon continued. “It’s a tremendous challenge.”

Yet that moment embodied GHHS values: compassion through presence, even when solutions are incomplete.

Why OMT matters here

Our supervising physician, Traci Stevenson, DO, views OMT as both medical and moral imperative. She noted that “chronic pain is particularly common in unhoused populations.”

Treatment options are limited, pain management centers scarce and opioid use complicated by theft and loss while navigating encampment life. The barriers to receiving care, too, are enormous: no transportation, no phone for appointments, uncertainty about insurance (letters go to nonexistent mailboxes), lack of finances and healthcare system mistrust.

“Street medicine operates on an extremely limited budget with minimal equipment,” Dr. Stevenson said. “But two valuable, easily transported assets we have are our hands and our understanding of OMT.”

Living on the street under chronic stress (sleeping upright in vehicles or on the ground) contributes to chronic muscle tension and related pain.

“We provide treatment at point of care when no other options are available,” explained Dr. Stevenson. “OMT is not only valid and available; it’s also cost-effective.”

But for Dr. Stevenson, OMT offers something beyond pain relief.

“The unhoused are often misunderstood and judged, leaving them isolated and lonely,” she said. “Therapeutic touch provides connection, dignity and shared humanity. This aligns with the osteopathic tenets, which recognize a person is a unit of body, mind and spirit. We not only address physical pain but also build human connection that speaks to mind and spirit as well.”

When the system works against healing

Yet Dr. Stevenson confronts a harsh reality: Vallejo’s encampment sweeps erase the progress made by street medicine and Dignity Day events.

“The displacement has literally led to ‘missing people’ we’d worked long to establish trust with and connect to healthcare,” she said. “Entire encampments are cleared overnight with no idea where people went.”

For those they do find, the team starts from square one, renewing lost medications. Patients needing intensive care can’t go due to fear of losing possessions.

Each sweep forces restart after restart. The sweeps disrupt established healthcare, leaving people at higher risk and costing the system much more long-term.

The gaps are stark: inadequate treatment for chronic diseases, especially hypertension and cardiovascular disease, are even more prevalent and deadly in the unhoused community. Routine labs, screenings or vaccinations are all difficult to arrange.

“People are increasingly afraid to leave encampments due to removal or robbery concerns, so even when we navigate healthcare services, they often can’t go,” said Dr. Stevenson. “If we really want to improve healthcare, we need to provide stable housing first.”

Structure and function: Medicine as social justice

Dr. Stevenson often returns to a foundational osteopathic principle: structure and function are integrated and reciprocal.

“This includes the structure of our society,” she explained. “In a medical structure measuring success by patients seen, labs ordered or medications prescribed—merely ‘fixing’ physical ailments—we miss the real underpinning of healing, which is harder to measure but much more real.”

She points to evidence-based solutions like Milwaukee’s Housing First approach, showcased in Beyond the Bridge.

“Simply bulldozing encampments doesn’t solve the problem; it makes it worse. When we strengthen our communities’ structural foundation with compassion-based policies like Housing First, we improve their function and the health of everyone within them,” said Dr. Stevenson.

She borrows from Chef José Andrés, who provides meals in crisis zones worldwide: “Build longer tables, not higher walls.”

Dr. Stevenson dreams of Vallejo’s stakeholders coordinating to apply best practices addressing the housing crisis with dignity and hopes TUCOM will help lead Housing First initiatives.

“When people have stable housing, we can effectively help them address healthcare needs. Structure and function [are vital],” she said.

What comes next

For our GHHS team, these events, from quarterly Dignity Days to regular street medicine sessions, embody our oath to keep humanity at medicine’s heart. We maintained contact through street medicine’s ongoing outreach, building relationships spanning months or years. Some patients transitioned to stable housing and traditional care. Others returned each time because it was their only consistent healthcare access.

Dr. Stevenson hoped students would learn that “as osteopathic physicians, we recognize the importance not only of writing prescriptions and ordering labs but also of advocating for the entire person’s health.”

We cannot resolve every structural injustice in one afternoon. But we can create moments of safety, comfort and dignity that ripple outward. We can listen, with ears, hearts and hands. We can bear witness and respond with compassion. And we can use our voices as physicians and citizens to advocate for desperately needed policy changes.

As we packed away our tents, I thought about the woman asking how to continue treatment, the young man ready to follow up, all the patients we might lose after the next sweep.

This is medical humanism: hands extended, hearts open, meeting people where they are—then working to change the systems that put them there.

One session at a time. One patient at a time. One policy change at a time. Until everyone has a stable home and consistent access to care.

Related reading in the Journal of Osteopathic Medicine:

Characterizing traumatic brain injury in unsheltered homelessness: prevalence of TBI and cognitive sequelae in individuals utilizing street medicine