Jim O’Connell

After 40 years at the helm of nonprofit Boston Health Care for the Homeless Program, Jim O’Connell likes to remind himself — and his colleagues — that they’re not saving the world. 

Yes, the program has a longtime reputation for building bridges between unhoused people and clinicians at Massachusetts General Hospital, building sufficient trust to convince “rough sleepers” to be treated in the streets or visit the hospital. But they’re not even close to ending the crisis.  

He and other clinicians at the nonprofit have a “small little mission in the world,” said O’Connell, the founding physician of the program. ”It’s not solving homelessness, but it’s caring, as best we can, for those who are currently suffering.” 

The collective efforts of O’Connell and his colleagues are the subject of journalist Tracy Kidder’s 2023 book “Rough Sleepers,” which recounts the work of the nonprofit’s Street Team in caring for unhoused people in Boston, both medically and emotionally, over the course of five years. STAT spoke with O’Connell about what his work with unhoused people has taught him about the connections between community and health, the diagnostic power of feet, and palliative care. — Ambar Castillo

You told Tracy Kidder, about the time you started to take photos of unhoused people, that you “started to think loneliness is really what drives much of what happens in our world.” What has your work this past year reminded you about the role of loneliness in our Covid-era world? 

The isolation that came along with Covid, where everybody had to be distanced, I think gave most of us a glimpse of how lonely the homeless world can be. What is striking about the poverty you see among homeless people is, they have no money, but they also are isolated, and have very little support from family or friends. When they come into the hospital, and we take care of them, they have no visitors. We spend a lot of time in our program trying to make sure we visit people when they’re in the hospital, take care of them when they’re there. 

We’re realizing that filling the gaps of that loneliness, giving people a community or helping them find a purpose, just becomes a real, important part of health.

You mentioned to Kidder the power of feet — both in building relationships with your patients and as a kind of diagnostic tool for health and longevity. Could you speak to that?

I never wanted to do [anything with feet] — that’s what I had to do when I first started. The nurses at the shelter wouldn’t let me do my doctor stuff. They were pointing out that if you just meet somebody and you say, “Hey, how are you? What’s going on? Are you thinking bad thoughts?” Nobody wants to share that with you because it’s a little too personal, and they won’t say anything to you until you get to know them. 

So the nurses had this brilliant thing where they’d invite people in who had been walking around all day, and then standing in line to get stuff, and they would soak their feet. I had to do that for the first month or two that I was working in the clinic. I got to see what lots of different feet look like, and you start to realize that, wow, you learn a lot about what’s going on with someone just by looking at their feet, their toenails, you can see all the frostbite, you can see what we call immersion foot [when feet are wet for a long period of time]. All those things can be potential avenues for big-time infections. So taking care of the feet is really important.

And most important, I’m sitting on the ground and somebody’s sitting in a chair. So you’re not invading that really scary world where a lot of homeless people just are too paranoid to have you get too close or ask too many questions. But they all are happy to talk about their feet, like, “This hurt, that doesn’t hurt.” We think of it as kind of a window into the soul. If you take good care of somebody’s feet, it opens up the whole opportunity to learn more about them.