In the May 6 issue of the Journal of the American Medical Association (JAMA), two Schweitzer Fellows for Life — Saul J. Weiner, MD and Stefan Kertesz, MD, MSc — join forces, delivering a compelling editorial on the Housing First approach to ending chronic homelessness. As their editorial explains,
Housing First offers permanent housing to homeless individuals or families, with few requirements for participation or success in rehabilitative activities such as medical, addictive, or psychiatric treatment. In contrast, traditional approaches require homeless persons to demonstrate such success before providing long-term housing support or helping clients obtain their own housing on the private market. The traditional approaches have worked for many persons but have failed repeatedly for others, especially those who have lived for years on the streets or in shelters.
. . .
Housing First is grounded on the premise that individuals who have stable housing will have reduced need for other public resources, saving taxpayers money.
Weiner and Kertesz’s thoughtful piece is an eye-opening read (particularly when they point to new studies suggesting that “at least some large US cities cannot affort not to house some who live on their streets”). Their ultimate conclusion? That “the challenge now is to determine which subgroups of the homeless population could benefit most from Housing First, a valuable new approach—if not a panacea—in the quest to end homelessness.”
This editorial isn’t Weiner and Kertesz’s first collaboration — far from it. The two men served together as Lambarene Schweitzer Fellows in 1992 and quickly found that they were kindred spirits. “Apparently [ASF President] Lachlan Forrow had figured out we’d become close friends before we’d met,” Weiner says.
“Saul has told me he was quite sure right away that we would become good friends,” Kertesz adds. “In fact, we journeyed together to Lambarene from Boston, and became very close friends, a close friendship that has endured to this day, 17 years later. We travelled to participate in each other’s weddings. We continue to check in with each other frequently. It’s been especially interesting to me that so often we have been able to assist each other in thinking about how to translate our concern for the care of underserved population into relevant discussions of health policy, and into research that will ultimately change policy.”
The time Weiner and Kertesz (now an ASF Board Member) spent as Fellows at the Albert Schweitzer Hospital in Lambarene was a crucible that shaped their views on the intersection of medicine and service. “The experience in Lambarene helped me to crystallize my sense of vocation of caring for patients who come from different cultural and economic backgrounds,” Kertesz says. “It made clear to me that this was work where I truly enjoyed being helpful, and I relished the challenge of translating medicine into a novel context.”
“The experience illustrated for me how complex institutions and communities can be,” Weiner adds. “One could easily paint a candid and negative portrait of the hospital…Or one could romanticize and idealize the place. Neither would be fair or accurate. Learning to adapt — and even thrive — in complex health care environments — was an early lesson that I have been practicing ever since.”
When Kertesz and Weiner traveled to Africa as Schweitzer Fellows in 1992, the U.S. Fellows programs (of which there are now 11) were just getting off the ground. Now, 17 years later, Kertesz and Weiner are part of a vibrant network of Schweitzer Fellows for Life who carry their commitment to service far beyond their initial Fellowship year.
Both Kertesz and Weiner view this network as a potentially transformative force, both for the health professions and the communities they serve. “It has turned the organization into a national force for promoting the values that are associated with Albert Schweitzer — with practical benefit to thousands who are served by the innumerable projects and programs funded over the years,” Weiner says. “The Network sustains a community of shared values which may inspire fellows to continue to address issues of health disparities throughout their careers.”
“I gain encouragement from my contact with Fellows for Life, from reading their stories and from the opportunity to attend the Annuals Fellows for Life conference 2 years in a row,” Kertesz adds. “More than once, I have found that my work on homelessness and underserved care brings me into contact with people who either have completed Fellowships in other parts of the country, or who work with organizations that sponsor Fellows. Our mutual connection to the Fellowship sometimes helps foster confidence and a readiness to work together.”
And Kertesz and Weiner’s mutual connection, with its roots in their time together in Lambarene, continues to reverberate. “One evening I completely decompensated after seeing a few too many kids die of malaria, dehydration, tetanus etc.,” Weiner recalls. “I became extremely anxious that I might have malaria, despite little evidence that I did, and had a severe panic attack (I’ve since learned that the Mefloquine I was taking may have been the culprit but that side effect was not known then).”
“Stefan calmed me by walking me around the dirt road that circles around the entire campus over and over all night until the sun rose,” he continues. “Stefan’s example of supportive friendship at a time when I was most vulnerable is one that I have never forgotten, and that reminds me why people who give generously of themselves have the greatest impact on the lives of others. I also appreciate that the same openness and engagement in caring for patients is the essence of a healing relationship.”