June 22, 2023, David Mitchell — As the daughter of a nurse and a member of a large extended family, it might have been expected that Sarah Brown, M.D., M.P.H., would choose a career focused on helping others. The unexpected part of Brown’s story is the great lengths to which she has been willing to go to do it.
“In college, I thought I was going to become a teacher or a social worker because of my family background,” said Brown, who has two biological siblings and 23 more through foster care, kinship care and adoption. “After college, I wanted to be more intellectually challenged, and I saw that doctors have a unique role to advocate for and help the people around them.”
A friend in need came to live with Brown’s family while she was in elementary school. From that simple beginning, her parents developed a passion for “helping kids navigate traumas and keeping biological sibling groups together.”
The experience shaped Brown’s worldview, and she spent three years in human services after graduating from the University of Minnesota-Twin Cities. Still, Brown yearned to learn and do more, and she returned to school at the University of Wisconsin-Madison, earning both her medical degree and a master’s in public health. Her master’s work focused on community-based health programming and research, which influenced her perspective on the efficacy of grassroots public health.
“I think I was always going to end up in family medicine because of my background,” said Brown, who completed her training at Gundersen Health Systems Family Medicine Residency in La Crosse, Wis. “But my training in family medicine and in public health really aligns with my passion for reducing health disparities.”
A few months after graduating from residency, Brown helped launch Mobile Medicine, a partnership between the residency and St. Clare Health Mission, a local free clinic. Brown, faculty, volunteers and an assortment of learners round weekly at local shelters, parks and encampments to meet and treat people experiencing homelessness.
Brown said the program evolved from her volunteer work at St. Clare with Sandy Brekke, R.N., former director of the free clinic.
“When the pandemic started, she was just trying to keep people alive, trying to help people who were experiencing homelessness navigate increased barriers to accessing health services,” Brown said. “She’d call and say, ‘Hey, can you come look at a tooth abscess?’ And the work evolved from there.”
Brown shared her street medicine experiences with Paul Klas, M.D., who was then Gundersen’s family medicine program director.
“He saw potential for an innovative learning experience for our residents if we could do it in a safe and responsible way,” she said. “So we built a safety plan, and he volunteered his time to alternate with me.”
Brown said homelessness increased in La Crosse during the pandemic. At the same time, her health system was prioritizing efforts to help people outside the walls of its clinics, and Klas was interested in creating a community medicine program.
“All of those things aligned to let street medicine be our first project,” said Brown, whose program has cared for 350 people experiencing homelessness in less than three years. “We just started going out with two backpacks, medical supplies and a pharmacy bag. Breaking down barriers and meeting patients where they are is key to caring for this population.”
Mobile Medicine expanded its reach and capabilities last summer, when the local Rotary Club donated a mobile medical vehicle that has two clinic rooms, a bathroom and equipment. The program had previously been able to offer a limited number of procedures, like incising and draining abscesses, but dealing with wind and precipitation and creating and maintaining sterile conditions was challenging outdoors.
“We can do gyn procedures that we previously could not,” she said. “We can do Paps for people who need cervical cancer screening, STI testing, urine dips. We now have point-of-care hemoglobin and A1c machines. We have phlebotomy capacity to draw blood and then bring it to one of the local labs. All of that has expanded the scope of what we can do and the efficiency of how we do it.”
The mobile unit and a Wisconsin Rural Physician Residency Assistance Program grant allowed the residency and St. Clare to start a rural health program that visits area farms every other Friday to offer care to migrant workers.
Mobile Medicine is funded through 2024, and Brown is in the process of securing additional grants for long-term stability. Officially, Mobile Medicine represents just 15% of Brown’s job, but she said she likely spends “way more” of her own time on the initiative when she isn’t working in Gundersen’s outpatient clinic.
“I’m grateful for that protected time,” she said. “I think it speaks to my health system’s commitment to being outside these walls, and I think we’ll need more faculty time if we want this work to continue and grow.
In addition to reaching underserved patients, the mobile clinic has been a powerful teaching tool, said Brown, who brings Gundersen family medicine and internal medicine residents, undergraduate students from two local universities, and medical students from the University of Wisconsin-Madison with her.
“Residents and medical students love it,” she said. “We did a collection of qualitative reflections from learners who had impactful things to say about this work coming at a critical point in their training when their hearts had been bruised through the rigors of training during the pandemic. Working with our team reminded them of the core reasons they wanted to pursue medicine.”
Brown said she works to ensure that learners have fun and build resilience as they learn to practice in low-resource settings.
“This work can be emotionally grueling,” she said. “It’s devastating to work with a patient population whose average age of death is 50.7 years locally. It’s terrible to lose patients that you’ve built strong relationships with for inexcusable reasons in the developed world — like they froze to death in winter. There are inhumane and unconscionable ways to lose a life. Facing these realities can contribute to burnout.
“We aim to teach that in medicine, we have the ability to develop resiliency practices, to learn how to find joy and to move forward without losing our compassion or our drive to help people.”