Interview with Kendall Fisher of the Street Medicine Institute

Dr. Jim Withers founded the Street Medicine Institute (SMI) in Pittsburgh in the early 1990s. Since then, the institute has helped spark a global movement by bringing healthcare directly to people where they live. This patient-led, trauma-informed model shifts traditional power dynamics and restores dignity to people marginalized by society. Kendall Fisher is the executive director.

Q: Tell me a little about yourself and your professional background.

 I’ve spent most of my career focused on community-based outreach and crisis intervention, and looking back, there has always been a consistent theme of going directly to where the people are. I put myself through college working full-time nights and weekends at a domestic violence shelter. It was an eye-opening experience, but I learned that there were severe systemic limitations. There were always far more people who could benefit from resources than any single shelter could house, and individuals could never stay long enough to fully resolve the deep crises they faced.

Q: For those unfamiliar with the organization, what is the history and core mission of the Street Medicine Institute?

Our founder, Dr. Jim Withers, was working as an emergency room physician in Pittsburgh. One night, an unsheltered man came into the ER who severely needed to be admitted to the hospital for extended care. Dr. Withers worked incredibly hard to convince him to stay, but the man ultimately signed himself out against medical advice. He simply did not feel safe or comfortable in the hospital. He had survived terrible, disrespectful experiences in traditional clinical settings in the past, entirely because he was experiencing homelessness.

A few days later, Dr. Withers returned to work and overheard his colleagues discussing a “John Doe” who had been brought in deceased. It was the same man; he had frozen to death on the streets of Pittsburgh. That was a defining, pivotal moment for Dr. Withers. He realized that if people experiencing unsheltered homelessness were too traumatized or unwelcome to come to the healthcare system, the healthcare system had a moral obligation to go to them.

To do that right, he knew he needed guidance. He found a formerly homeless individual and asked if he would guide him out onto the streets. The man agreed but gave Dr. Withers two strict rules: “Don’t dress like a doctor, and don’t be a jerk.” Dr. Withers agreed, and in 1992, they began walking the streets, visiting encampments, and delivering medical care under bridges and along riverbanks. He focused entirely on building trust and providing high-quality care where people lived.

Eventually, he brought the operation out of the shadows, partnered with his hospital, and launched a formal program called Operation Safety Net. As word spread, healthcare providers from other cities started reaching out, asking how they could replicate this model. Dr. Withers and his early team didn’t want to “own” or franchise the movement; they wanted to empower local communities to own it themselves. To facilitate that knowledge-sharing, they launched the International Street Medicine Symposium in 2005. That annual symposium became the foundation upon which the Street Medicine Institute was formally established.

Q: How has the Street Medicine Institute grown since those early days, and what does its structure look like today?

We have evolved from a grassroots initiative into a highly structured, globally influential national and international non-profit. The annual International Street Medicine Symposium remains our flagship event. It’s a three-and-a-half to four-day conference that draws between 400 and 500 practitioners, researchers, and advocates from multiple countries every single year.

Beyond the symposium, we now offer specialized expert consulting services, clinical guidelines, a comprehensive research catalog, and a full-day “Street Medicine 101” training program designed to help emerging teams establish safe, effective practices.

I serve as the Executive Director based here in Cincinnati. We have a Program Director operating out of Los Angeles, a Clinical Director who is a practicing physician in Chicago, and Dr. Withers continues to serve actively on our board and as our Medical Director. Our broader board of directors is truly international, with members spanning from Los Angeles and Texas all the way to Copenhagen and Pittsburgh.

Additionally, we house two vital auxiliary coalitions. The Street Medicine Educator Coalition focuses on developing curriculum standards for academic institutions and medical schools that want to teach street medicine to the next generation of physicians. Then we have the Street Medicine Institute Student Coalition. Honestly, those students put the rest of us to shame. I have no idea how they manage the grueling demands of medical school while simultaneously organizing extensive webinars, advocacy initiatives, and direct street outreach. They do phenomenal work.

Q: Can you explain what you mean by alternative care protocols or clinical guidelines tailored for the street? What makes street medicine fundamentally different from traditional medicine?

Traditional medical training teaches providers how to diagnose and treat diseases, assuming the patient lives in a stable environment. Street medicine requires an entirely different cognitive framework because it is a fundamental value shift. We describe it as being “patient-led” rather than just “patient-centered.” We rely heavily on trauma-informed care because almost every single individual surviving on the streets has experienced profound trauma, either before or during their homelessness. We don’t march into an encampment telling people what they need to do; we build trust, listen to what they want, and let the patient guide the care plan.

Logistically, this means rewriting standard clinical protocols to fit the realities of unsheltered life.

Consider medications that explicitly require refrigeration, or doses that must be taken three times a day with a full meal. If you live in an alley or a tent, you don’t have a refrigerator, and you likely don’t have a reliable schedule of three-square meals a day. Street medicine requires providers to look at the entire lived experience of the patient and tailor the clinical intervention, so it is actually humanly possible to adhere to it in an unsheltered environment.

Q: You mentioned a seed grant program that helps local communities launch their own initiatives. Can you share how that program operates?

The Seed Grant Program is something we are incredibly proud of, and it has been a major driver of the movement’s expansion. We initiated the program back in 2021 to provide communities with the foundational infrastructure they need to get a new street medicine program off the ground. Every year, we issue a formal Request for Proposals (RFP). We receive anywhere from 20 to 30 highly competitive applications from communities across the country.

Q: How did you personally get connected with the Center for Respite Care here in Cincinnati?

That connection happened beautifully and organically, and it was a direct result of my role with the Street Medicine Institute.

Our local team had a very close working relationship with Dr. Joe Keesler at Neighborhood Health. Shortly after we connected, Neighborhood Health hosted an open house to celebrate and showcase their new facility, including their updated pharmacy and clinical spaces. I attended the open house, and as you can imagine, events like that naturally draw a concentrated group of deeply passionate, like-minded, community-oriented advocates.

Q: How do street medicine programs and medical respite facilities like the Center for Respite Care collaborate within the community’s healthcare safety net?

They are completely codependent components of a functional safety net. In any city with an effective continuum of care for the homeless population, street medicine teams and medical respite centers form a constant, bi-directional referral loop.

When our street medicine teams are out in the field—whether they are under an overpass or deep in an encampment—they frequently encounter patients who have advanced medical needs that cannot be safely managed on the ground. These might be individuals recovering from major surgeries, people needing intensive wound care for severe infections, or patients managing acute illnesses that require a stable, clean environment to heal, but who don’t meet the strict criteria for an acute hospital stay. In those critical moments, having a dedicated medical respite facility like the Center for Respite Care is lifesaving. We can refer those patients directly to the Center, knowing they will receive high-quality medical oversight in a dignified, stable environment.

Conversely, when patients complete their recovery at the Center for Respite Care and are ready to transition back into the community, the Center can hand their ongoing care plan off to the street medicine teams. If a patient leaves respite but returns to an unsheltered living situation, our street teams can find them in the community to conduct follow-up clinical checks, manage their medications, and ensure they don’t experience a relapse that forces them back into the emergency room. This collaboration bridges the gap between the hospital and the street, ensuring no one is simply abandoned to heal in the dirt.

Q: What are your overall impressions of the Center for Respite Care and the culture of the organization?

I have been consistently amazed by them. If I had to boil my impressions down, two things stand out clearly: their compassion and their sheer, unyielding competency.

First, from an emotional standpoint, spending time around the Center is incredibly restorative and refreshing. Every single person associated with the organization—from Laurel to the clinical staff, the frontline workers, and the members of the board—consistently and unequivocally puts the humanity of the clients first. This is not the kind of career path an individual chooses to get rich, so you expect a baseline level of dedication, but the sheer emotional generosity and passion the staff brings to work every day is stunning. They treat every client with profound respect.

Q: Is there an aspect of medical respite care that you feel the public fundamentally misunderstands or is unaware of?

Almost everyone has undergone a medical procedure or has a family member who has gone through a major surgery or illness. I tell people: Think about the exact day the hospital discharged you and sent you home. I vividly remember when my own partner was discharged after suffering a broken neck. I looked at him and thought, “I cannot believe they are letting you leave the hospital in this condition.” He still required intensive monitoring and assistance. But he had me to take care of him. He had a warm bed, a clean roof over his head, running water, and reliable food.

It makes me incredibly sad to realize how many major cities across the world completely lack this resource, and it makes you wonder what is going on in our world that we could allow human beings to do that to one another. The existence of the Center for Respite Care shouldn’t have to feel “lovely” or extraordinary—it should be the absolute baseline standard of human decency in every single society. But because our systems are broken, the fact that the team in Cincinnati has fought as hard as they have to build, fund, and sustain this center is an incredible achievement. They are providing essential human decency where the rest of the system fails.