In 1984, while volunteering at an Indian orphanage, Dr. David Buck discovered his desire to help those most in need when he met the greatest humanitarian in human history, Mother Teresa. This unforgettable experience set him on a ten-year journey to change the way communities care for the disadvantaged.
“Mother Teresa asked us, ‘Which one of you wants to change the world?'” Buck recalled. “Inwardly, I was screaming, ‘Me, me!'”
But Buck, who is now a professor and associate dean for public health at the Tillman College of Family Medicine, J. Fertiti of the University of Houston, did not raise his hand.
“She said, ‘There’s a door for anyone who wants to do it.’ Our task is much bigger. Our task is to love one person at a time,” he said. “So I came back to the U.S. and knew I wanted to make a difference here at home.”
Buck recently reflected on his nearly 40 years of fighting the homelessness epidemic, rebuilding a fractured aid industry and challenging the medical status quo in a first-person account published in Journal of Social Distress and Homelessness.
Early in his career, just after returning from Mother Teresa’s life-altering life, Buck volunteered at the Houston Catholic Workhouse, where he learned that the biggest problem facing the homeless was access to health care. Soon after, he set up two free medical clinics and a dental clinic, but he soon realized access was not the only problem. Instead, it was the lack of integration of all the necessary services.
“There was no health care system, from primary care to secondary care, medical care to housing, food, even ID cards to transportation. it goes on and on,” Buck said, noting that there are hundreds of nonprofits, but there is no financial incentive for one service sector to partner with others, such as housing, transportation or employment.
Recognizing what he calls “a profound lack of leadership,” Buck founded Healthcare for the Homeless Houston in 1999 to promote health, hope and dignity for those affected by homelessness through accessible and comprehensive quality care. His vision was to provide pathways out of the cycle of homelessness through integrated care and collaboration and to remove these barriers to service.
“You have to go to where they are building housing, but you don’t have transport,” he said. “You have to get an ID, but it’s a different Texas agency. You have a psychiatrist here, but not your primary care doctor, and then you have to go somewhere else for medication. It’s an endless cycle.”
To further the mission, Buck founded another nonprofit, the Patient Care Intervention Center (PCIC), and partnered with the United Way, among others, to build a coordinated health care network where stakeholders share and integrate social and medical data to help make better solutions.
In the journal article, Buck suggests three strategies that should be adopted across the health care system to more effectively treat the homeless and improve health outcomes:
- Challenge funders at all levels: Charities, the private sector, and local, national, and international government grant agencies must implement funding strategies that encourage and reward collaboration among service organizations.
- Resist the temptation to add new nonprofits: Further proliferation of nonprofits will only further fragment aid. Instead, whether there is financial incentive or not, move across the aisle and form meaningful coalitions with existing players.
- Change starts from within: Reform professional culture to reward practices proven to improve key outcomes.
When asked how to build a primary care system that responds to the needs of the homeless, Buck suggested providing care based on values, not problems. It is a strategy based on cognitive behavioral therapy that can lead to changes in health behaviors.
“Imagine a typical doctor’s appointment: ‘Hello Mr. Patient, nice to see you today because of hypertension, obesity, substance use, mental illness, oh, did I mention your obesity?’ As you continue to make this statement, you become less and less motivated to make behavioral changes that could improve your health. Now compare this to a values-based approach. Who and what is most important to you? And then you get targets out of that,” he said in an interview with the journal, with article authors Nicholas Peeples and Mary Fang, both students at Baylor College of Medicine.
Buck said challenging the status quo led him to academic administration. Fertitta Family Medical College was founded in 2019 with a specific social mission to improve health and medical care in urban and rural communities where poor health is most common. Buck is part of a team that teaches medical students how to provide compassionate, value-based care (high quality at a reasonable cost) with an emphasis on primary care and other in-demand physician specialties.
In September, Fertitta College of Family Medicine students will join Baylor and UT Medical School students for the first time to work at the HOMES (Houston Outreach Medicine, Education and Social Services) Healthcare for the Homeless Clinic, one of the first student-run health clinics in the nation and the only one in the X Houston, as well as the first in a Federally Qualified Health Care Center (FQHC).
“We know what’s wrong, and now we have the tools to fix it,” he said.
His vision dates back to the day nearly 40 years ago when Mother Teresa inspired him to do what has become his life’s work. But this work is far from over, and now he hopes that the inspiration will be passed on to his students.
“We need the next generation of physicians to implement new approaches to improve the quality of care, and that’s part of our focus at UH.”