MANY OF THE HOMELESS SEEK MEDICAL CARE ONLY WHEN THEY CAN’T FUNCTION WITHOUT IT. And that care happens primarily in the context of emergency room visits, when problems are often beyond the reach of treatment.

That lack of primary and preventative care has repercussions. “The street population has the highest crude mortality rate of any subpopulation in America,” says James J. O’Connell, an MGH physician and president of the Boston Health Care for the Homeless Program.

O’Connell began his outreach to the homeless in 1985. Today, Boston Health Care for the Homeless sees 12,000 patients a year and runs 60 shelters and outreach sites.

In a talk at the Paul S. Russell, MD Museum of Medical History and Innovation, O’Connell discussed the challenges of meeting patients who kept no permanent address and who shied away from traditional avenues of care. He recounted discovering that one of his patients had developed a multidrug-resistant strain of tuberculosis that had spread to other inhabitants in the close quarters of the shelters.

O’Connell and his colleagues had to see that the patients took their medications four times a day, but finding them every day proved almost impossible. The clinicians found themselves enlisting partners around the community, including shopkeepers and bartenders at some of their regular haunts, who would help them take their medications.

Such techniques for reaching the homeless have been influenced by community tools used in developing countries. “We had to use third world principles to try to take care of it,” says O’Connell.

Listen to O’Connell’s talk here.