Dr. Jill Omori faces many hurdles in delivering health care to the homeless. The Hawaii H.O.M.E. (Homeless Outreach and Medical Education) Project that she founded 10 years ago has surmounted them, one by one. It’s an achievement for which Hawaii Women Lawyers honored Omori in May.

A principal challenge, of course, is raising money. What small grants she can secure pay the salary of her one employee, a student-help coordinator, and cover expenses.

Omori herself contributes her time, as do the medical students working in six clinics and the doctors overseeing them. On her wish list is a system of electronic medical records for the patients, whose charts now reside in separate boxes for each clinic.

H.O.M.E. is headquartered at the University of Hawaii John A. Burns School of Medicine; its service sites are linked by the project’s mobile clinic, a van parked near the campus. On the website (www.hawaiihomeproject.org), it is credited with more than 4,500 patient visits, with service to 1,800 individuals.

Funding also comes from everything from bake sales and wine-tasting events to a vending machine downstairs from her JABSOM office.

Conventional granting agencies expect outcome data, and it’s hard to track health results among such a dispersed and mobile population.

“One of the nice statistics that we got a couple years ago was from the City and County, EMS (Emergency Medical Services),” she said. “They were able to look at the call rates and the pickups for the areas we were servicing, and they were able to show that they had gone down.

“That was helpful for us, because that’s one of our goals, to decrease ER visits and decrease admission to the hospital.”

Omori, 47, is married with two children adopted from the Marshall Islands. She earned her M.D. at UH before joining the medical school faculty.

She acknowledged that seeing patients who have had deeply rooted health and social problems has made her sympathetic to the needs of the homeless. Medical students need to see this up close, too, Omori said.

“They talk about wanting to help people and help the less fortunate and help the underserved. … They didn’t get insight into the problems of the homeless” before H.O.M.E. was established, she said.

“Even though inside they really want to help people, they don’t know how to do that,” she added. “They’re maybe a little bit scared of how to do that.”

QUESTION: Has your work on this project affected how you view the homelessness issue?

ANSWER: Over the years that we’ve been doing the project, I definitely learned a lot about homelessness in general, and the barriers that people face in transitioning out of homelessness.

And I think also the reasons why people become homeless and stay homeless — and the reasons why people don’t want to go into shelters and things like that — I think that I definitely have gained a lot of insight through working with this project.

Q: I guess I have to admit I’m one of those who’s flabbergasted at why anyone chooses to live outside rather than in shelters. What insight do you have?

A: I think that there are a number of reasons. Some of it deals with some of the rules that these shelters have, that it just makes it too difficult.

Q: More specifically?

A: You know, like the times: You have to check in by a certain time; some of the shelters you have to leave by a certain time. Some of the shelters have rules about pets. If they have a pet, that’s like their family, right? So it’s hard for them to leave their pet outside.

Even about how much stuff they can bring with them. For a lot of them, all the possessions that they have, that’s all they have….

Q: So, they feel it’s a bit of an indignity to put up with?

A: Yeah. … One of our patients told us, “You know, it’s like becoming homeless every day.” If you have, like, a tent, you can be there the whole time. … It’s like you’re getting kicked out every day. So, that’s hard.

And also, the shelters now, you can’t stay there indefinitely. Some of the shelters you can only stay for six months. It’s like putting them there, and then there’s nowhere for them to go. It’s not like you can get housing in that short of an amount of time, so it makes it really difficult.

For them, they’d rather just be close to work, be close to where the kids go to school.

Q: How did the H.O.M.E. project get started at the medical school?

A: After I had worked on establishing this (underserved care) curriculum, I had a course for our first-year students on homeless health care. …

At that time, most of the homeless lived in Ala Moana Beach Park, and that was the year that there was that 40 straight days of rain. And that was also the Honolulu centennial celebration, so that was the year that Mayor (Mufi) Hannemann decided to kick everybody out of the park. …

Right before they had done the sweep, we had planned to do a needs assessment of the people in the park, especially because it was so rainy. So, for three days we were going to do our outreach event, that’s when they swept the park. So, we’re like, “Omigosh!”

Luckily they got taken in by Central Union Church and Kawaiahao Church. So we went down to Central Union and did some clinics there. That was before we had even started our program.

And then a month later they opened Next Step, next to the medical school, and so we went over the day after it opened. We just did a needs assessment that day, and we started our next clinic the following week. …

Q: Do you find yourself dealing with patients’ non-medical issues at the clinic?

A: Oh, yeah. At our clinics, that’s one of the things that we stress to the students. It’s not all about making a diagnosis and giving out meds; a lot of times they just need to talk to somebody about their issues. … Because their mental well-being is just as important as their physical well-being.

Q: In the beginning, what facilities did you have?

A: When we first started at Next Step, they were so happy to have us there. They actually gave us a little room that we could store some of our things in.

And we basically just went there once a week, and we set up a tent to have more private exams. And we just kind of saw patients out in the open, and if they needed a more private exam we took them into the tent.

We were there for a little less than a year before we branched out to our second site out in Waianae. They didn’t have space for us out there, so we were lucky enough to get an old Handi-Van donated by the city. So we kind of retrofitted the Handi-Van and we took that out to Waianae.

Q: Was this a retired Handi-Van?

A: Yeah. (Laughs.) So, our van now is much nicer. I mean, we were really appreciative of getting the Handi-Van, but it had like 350,000 miles already on it, and it would kind of have mechanical problems almost every month.

But it was good. It had an exam table in there that we were able to curtain off.

Q: What year are we talking about?

A: We started at Next Step in 2006, and then we branched out to Waianae in 2007. And then from there we slowly added more and more.

Q: Kakaako and Waianae were obvious because they had established encampments. How did you decide where to go next?

A: Part of it was we were approached by people. The sites that we added were Kalaeloa, at the Hope Shelter out there.

Then we started going to the First United Methodist Church (on Beretania Street). … We started going there because a group we had been working with at Next Step, H-5, they provided meals for the homeless on every Sunday. … A lot of the unsheltered homeless went there for meals.

That was the first time we started working with the unsheltered homeless. And it was great, because it was a different kind of population, and kind of a different approach you had to take with those individuals. …

There was a lot more mental illness, and a lot more chronically homeless people.

Q: So, the patients at the shelters, there was a little bit more stability, better health conditions?

A: To a certain degree, yes.

Q: Because exposure really takes its toll, right, for the unsheltered?

A: Yeah. And you see a lot more wounds, infections …

Q: Is there any way of characterizing what’s typical?

A: Like I said, wounds and infections are probably one of our top things that we see, especially at our (First UMC) and (Institute for Human Services) clinics, and our Kakaako clinic out here.

But we see a lot of upper respiratory infections. Flu season, we see a lot of flu. And then we do see a lot of the chronic diseases like diabetes and hypertension that people are trying to deal with.

There are a lot of musculoskeletal problems we see, like backaches and joint pains.

Q: From the stress?

A: Yeah, and sleeping on the ground and having to walk all over the place. So we see a lot of foot problems, things like that.

Q: Are those problems of a greater intensity among the homeless?

A: I would say it’s a greater intensity, more complications. And also maybe earlier onset of some of these problems than you would see in the regular population. …

I think the stress does take a toll on them. Just being in this hypervigilant state all the time really raises their cortisol levels and causes them to be chronically immunosuppressed. …

Q: How do you approach follow-up and patient care when they’re away from you? How do you keep track?

A: Continuity is a lot harder in this population, but for those that don’t have a regular primary care physician, a lot of them will seek us out. So it’s not necessarily hard to find all of them. …

Sometimes we sort of know where they hang out, where their tent is or something, so sometimes we’ll go and track them down. …

Some of them also have cell phones, because there are multiple programs that give out these limited-use cell phones for homeless individuals, … but a lot of times their number changes every couple months.