Losing Patients
LifeLong Street Medicine doctors explain the health consequences of encampment closures on their patients
By Cole Haddock | April 25, 2026
The LifeLong Street Medicine Zone 11 team was packing up when NeNe arrived. Their white van was parked at the edge of a densely populated encampment in West Oakland. A team of providers had been offering food bags and medical services to the encampment residents out of the van for three hours. NeNe was their last patient.
NeNe had only recently found the Zone 11 team again. She lost contact with her LifeLong providers for nearly two years after the encampment she was living in by Lake Merritt was closed by the City of Oakland in April, 2024.
NeNe said that when the City came, “They tore down our homes.” She stayed awake for five days straight afterwards, trying to find somewhere else to sleep. “We don't have a fallback system. You have to constantly move to make sure that you got something to eat, somewhere to sleep, if you're going to be warm—Am I safe? Am I okay?”
When she was living at the camp, NeNe was a regular LifeLong patient. But after the sweep, her health suffered. “Moving around, bouncing from city to city, it messed with my mental and my physical health.” She says that after her encampment was closed, she developed a hernia, fibroid tumors, and severe mental health challenges.
The City of Oakland did not respond to Street Spirit’s requests for comment.
When Street Spirit interviewed NeNe, in January 2026, she was glad to see the LifeLong providers. “It took [more than] a whole year, but I’m getting everything back into rotation. I’m moving forward with LifeLong, dealing with my mental health, getting my physical health under control, and just becoming mentally and physically and emotionally stable.”
LifeLong Medical Care is a Federally Qualified Health Center, founded in 1976 by the Gray Panthers. In 2019, it launched the LifeLong Street Medicine program to meet what its founders believed was an urgent community health crisis: Unhoused people often live with dire illness, but are very difficult for traditional health services to reach.
NeNe had only recently found the Zone 11 team again. She lost contact with her LifeLong providers for nearly two years after the encampment she was living in by Lake Merritt was closed by the City of Oakland in April, 2024.
NeNe said that when the City came, “They tore down our homes.” She stayed awake for five days straight afterwards, trying to find somewhere else to sleep. “We don't have a fallback system. You have to constantly move to make sure that you got something to eat, somewhere to sleep, if you're going to be warm—Am I safe? Am I okay?”
When she was living at the camp, NeNe was a regular LifeLong patient. But after the sweep, her health suffered. “Moving around, bouncing from city to city, it messed with my mental and my physical health.” She says that after her encampment was closed, she developed a hernia, fibroid tumors, and severe mental health challenges.
The City of Oakland did not respond to Street Spirit’s requests for comment.
When Street Spirit interviewed NeNe, in January 2026, she was glad to see the LifeLong providers. “It took [more than] a whole year, but I’m getting everything back into rotation. I’m moving forward with LifeLong, dealing with my mental health, getting my physical health under control, and just becoming mentally and physically and emotionally stable.”
LifeLong Medical Care is a Federally Qualified Health Center, founded in 1976 by the Gray Panthers. In 2019, it launched the LifeLong Street Medicine program to meet what its founders believed was an urgent community health crisis: Unhoused people often live with dire illness, but are very difficult for traditional health services to reach.
Unhoused people die at roughly 3.5 times the rate of the general population, according to researchers at the Universities of Chicago, and Oxford. In Alameda County, unhoused people have an average life expectancy of just 51 years old.
The Street Medicine van provides unhoused people with wide-ranging services, including primary care, wound care, therapy, and overdose prevention. The providers establish consistent and stable relationships with their patients by building trust: Showing up consistently at the encampments and following through with the services they promise.
But LifeLong’s medical practitioners say their work is severely disrupted when an encampment is closed. They lose their patients, and months or years of medical progress can be suddenly erased. Emily Law, Nurse Manager for LifeLong Medical, put it bluntly: “Medically, we will not make any progress with that person.”
The Street Medicine van provides unhoused people with wide-ranging services, including primary care, wound care, therapy, and overdose prevention. The providers establish consistent and stable relationships with their patients by building trust: Showing up consistently at the encampments and following through with the services they promise.
But LifeLong’s medical practitioners say their work is severely disrupted when an encampment is closed. They lose their patients, and months or years of medical progress can be suddenly erased. Emily Law, Nurse Manager for LifeLong Medical, put it bluntly: “Medically, we will not make any progress with that person.”
Alameda County is divided into 14 “outreach zones,” and each is assigned a street medicine team. Zone 11 — which spans parts of North and West Oakland — is the smallest and most densely populated zone. The 580, the 980, and the 24 run aboveground, converging at the massive Grove Shafter Interchange. The Zone 11 Team finds most of their patients in the overpasses beneath the three freeways.
According to the 2020 Point-in-Time count, there were 487 unsheltered people in Zone 11. Between December 2025 and February 2026, the Zone 11 team served 120 individual patients, providing a wide range of urgent and primary care services. Dr. Ben Durant, a former LifeLong physician, described the patient population as majority male and Black. More than half of his patients were in their 50s, 60s, 70s. He noted that, “many patients had lived their whole lives in the neighborhood.”
The Zone 11 team has two providers and two case managers: Registered Nurse Olivia deBree, Registered Nurse Natalie Alger, and case managers Jocelyn Perez-Guevara and Jose Garcia. They go out three times a week in a large white van, stocked with computers, medical supplies, and an examination table. When a patient enters, the van’s sliding door closes to create a small doctor’s office. Alger explains that they’ll try to treat, “basically whatever [patients] bring to us.”
While the providers must occasionally act as emergency responders, the van predominantly acts as a primary care clinic. Many patients have regular appointments, while others walk up for the first time and ask for assistance with specific medical problems. Providers administer injectable medication, such as opioid addiction medicine, antibiotics, or psychiatric drugs. They treat mental illnesses like psychosis and PTSD with medication and therapy, dress open wounds, and manage untreated chronic illnesses by establishing treatment plans and prescribing medication. The case managers help patients navigate complicated housing and medical systems.
Many of the unhoused residents of Zone 11 already know the names and faces of the members of its street medicine team—for some patients, the relationship is years long. At an encampment, Alger explains, consistency and trust is more important than providing care.
“My overall goal is always good interactions with people that make them feel better about their day and their life in general. Secondary goals are getting them the medications they need and following up on other concerns. But none of that can happen if we don't already have that relationship. So that's always my primary focus.”
Almost all of Alger’s patients have high blood pressure and often are living at “hyperintensive crisis level” that could warrant immediate hospitalization. Extremely high blood pressure, exacerbated by stress and substance abuse, can be treated in the ER and managed with daily medications. Neither solution reliably works for unhoused patients.
Daily medications first have to be picked up from the pharmacy, and then taken consistently. Nurse Olivia DeBree explains, “About 50% of our patients make it to the pharmacy. Most people cannot take medication every day, and even a few people who can, it is usually lost or stolen within days.”
Hospitalization requires people to leave their belongings behind, and risk losing them. DeBree recalls a patient who was very sick, and needed to go to the ER, but was worried about losing his car during a prolonged hospital stay.
“I highly doubt he went,” she said. “It's a life and death choice.”
Other chronic illnesses—such as diabetes, which requires refrigerated insulin, are similarly difficult for unhoused people to manage. “If you have a chronic health condition, then everything about homelessness worsens it,” Alger explained.
LifeLong’s Street Medicine teams establish treatment plans that accommodate their patients’ needs in order to achieve better health outcomes. “There's a lot of thought that we're just running around reversing overdoses … but we really are able to establish long-term relationships with patients and treat their medical conditions in a consistent and successful way,” Durant says. But that work stops when practitioners can’t find their patients.
Encampment closures are a fact of life in Zone 11. Between 2021 and 2025, there were 429 closures in the area.
“It's frustrating,” Alger says. “If you've really made progress with somebody, and you're several steps into [a treatment plan]—referring them places, getting testing done, connecting them where they need to go—and then all of a sudden, they're gone. I can't do my job.”
Alger says this feels like letting her patients down. “We've made promises to them… They see a brighter future because we're taking care of this health issue, and now that's all come crashing down.”
During encampment closures, unhoused people lose the belongings that protect them from exposure, including shelter, clothes, and blankets. Research shows that they are also more likely to overdose. A paper published in the National Library of Medicine estimates that after a sweep, there are between 974 and 2,175 additional overdose deaths for every 10,000 unhoused people, compared to those who remain in place.
“It's frustrating,” Alger says. “If you've really made progress with somebody, and you're several steps into [a treatment plan]—referring them places, getting testing done, connecting them where they need to go—and then all of a sudden, they're gone. I can't do my job.”
Alger says this feels like letting her patients down. “We've made promises to them… They see a brighter future because we're taking care of this health issue, and now that's all come crashing down.”
During encampment closures, unhoused people lose the belongings that protect them from exposure, including shelter, clothes, and blankets. Research shows that they are also more likely to overdose. A paper published in the National Library of Medicine estimates that after a sweep, there are between 974 and 2,175 additional overdose deaths for every 10,000 unhoused people, compared to those who remain in place.
“If you're in more or less consistent medical care for serious medical problems and suddenly go months without taking any medications or addressing the issues, it's pretty much a guarantee that things are gonna go wrong,” Durant says.
“Being homeless and living on the side of the road is not a good place to be when you have medical problems, obviously,” Durant says. “But having that [spot] taken from you and losing all stability … that essentially just makes it unimaginably worse.”
The Zone 11 team tries to make their treatment plans sweep-proof. They use injectable medication: long-acting medication that a patient receives once a week or once a month, rather than pills, which are easily lost.
Ahead of an encampment closure, they also make a point practice of handing out business cards. Alger tells her patients to keep one in their pocket, and others in their bags of important possessions. “[I’ll] say, ‘when you get to your new site … find a phone, call us, tell us where you are.’” It’s rare that people call, though. Mostly, the Street Medicine Team figures out where people moved by word of mouth, or by literally driving around their zone and looking.
Finding patients eats up time, and makes the team much less productive. Staying at one large encampment for four hours during a typical shift, the team estimates that they can treat fifteen people, and hand out food and supplies to many more. But when they have to drive in between every stop, they can treat about five.
Dr. Ben Durant says that sometimes, encampment closures can expedite the process of getting connected to medical care, or housing.
“The idea that you're gonna lose your place sometimes motivates people to make a change or accept some referral that they wouldn't normally have accepted,” he said. “All of these places have their own issues … but living in a hotel room is infinitely better than living in a tent.”
Occasionally during a closure, people who are considered medically frail will be offered a bed in LifeLong’s Medical Respite Facility, where they can receive medical care for ninety days.
This is where Joel Brown lives. Joel has been living in Oakland’s Chinese Garden Park for the last ten years — an encampment that was closed ten times between October 2021 and December 2025.
“When they come, sometimes the officers might say, get your important stuff out, but more likely they're just coming in. It just makes you feel like you just mean nothing,” he said.
LifeLong’s goal is to connect patients to permanent housing during their 90 day stay.
But program staff “can't guarantee that they get any [housing] matches while they're there,” Alger explained. Despite their best efforts, “there's a lot of times when they're just like, ‘Okay, your 90 days are up. Insurance isn't approving it anymore. You're back on the street.’”
LifeLong doctors believe that housing is healthcare. When their street medicine teams are doing outreach in Oakland, one of the services they provide is housing navigation, working to meet the health needs of their patients by assisting them in the difficult task of finding housing.
Most of the time, this has nothing to do with encampment closures. It happens over the course of months or years of day-to-day outreach and trustbuilding.
This is how the LifeLong team built their relationship with Gary. Gary is a long-time Zone 11 patient who recently got housing in West Oakland. “LifeLong? Man, they my best friends. Hey, no joke, when I see the van pull through, I know: ‘I ain’t gonna die today.’”
Before Gary got housing, he had been hospitalized for heart failure. While he was in the hospital, the city closed the encampment he had been living in at Martin Luther King Jr Way and 23rd Streets.
“I wasn’t there to protect my stuff, and I lost everything,” he said. He had been holding onto a ring, and a toy cat his brother had gifted him before he passed. They were thrown away during the sweep. “How am I ‘pose to feel? … I don’t got nothin’ but a handful, and they took that,” he said.
But after heart failure and losing his belongings, Gary got lucky. He was permanently housed soon after his hospital stay. He says he may not have made it indoors without the patience and trust of the street medicine team.
The Zone 11 team strives to be stable and consistent with their patients. This follow through earns them a good reputation on the streets: The more people that trust them, the more people they can treat successfully.
“The trust is the main thing around here,” Gary says. “A lot of people will die before they get help. But when the van comes down here, when it’s right here and when they see their neighbor go up and get help, they’ll do it,” he said.
Cole Haddock is a journalist living in Oakland. This summer, he will be working as a daily news reporter for the Daily Sitka Sentinel in Alaska.