Background: Caledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane, was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided by the University of Pretoria's Department of Family Medicine between 24 March and 6 April 2020. Methods: This study uses a narrative approach to restory situated, transient, partial and provisional knowledge. Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of selected healthcare first responders directly involved in the shelter. Results: The impending lockdown generated intense interactions by UP-DFM to prepare for the provision of COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian residents. Conclusion: The Caledonian shelter is an account of organisational resilience in the face of homelessness and substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and the imperative of including OST in essential primary healthcare.

Background In complex health settings, care coordination is required to link patients to appropriate and effective care. Although articulated as system and professional values, coordination and cooperation are often absent within and across levels of service, between facilities and across sectors, with negative consequences for clinical outcomes as well as service load. Aim This article presents the results of an applied research initiative to facilitate the coordination of patient care. Setting The study took place at three hospitals in the sub-district 3 public health complex (Tshwane district). Method Using a novel capability approach to learning, interdisciplinary, clinician-led teams made weekly coordination-of-care ward rounds to develop patient-centred plans and facilitate care pathways for patients identified as being stuck in the system. Notes taken during three-stage assessments were analysed thematically to gain insight into down referral and discharge. Results The coordination-of-care team assessed 94 patients over a period of six months. Clinical assessments yielded essential details about patients’ varied and multimorbid conditions, while personal and contextual assessments highlighted issues that put patients’ care needs and possibilities into perspective. The team used the combined assessments to make patient-tailored action plans and apply them by facilitating cooperation through interprofessional and intersectoral networks. Conclusion Effective patient care-coordination involves a set of referral practices and processes that are intentionally organised by clinically led, interprofessional teams. Empowered by richly informed plans, the teams foster cooperation among people, organisations and institutions in networks that extend from and to patients. In so doing, they embed care coordination into the discharge process and make referral to a link-to-care service.

Peer review declarationThe publisher (AOSIS) endorses the South African 'National Scholarly Book Publishers Forum Best Practice for Peer Review of Scholarly Books'. The manuscript was subjected to rigorous two-step peer review prior to publication, with the identities of the reviewers not revealed to the author(s). The reviewers were independent of the publishers and/or authors in question. The reviewers commented positively on the scholarly merits of the manuscript and recommended that the manuscript be published. Where the reviewers recommended revision and/or improvements to the manuscript, the authors responded adequately to such recommendations.v Research JustificationThis scholarly publication is intended to contribute to an emerging body of knowledge on street homelessness in the South African context. The target audience comprises research specialists focusing on finding solutions for homelessness; however, it would be accessible to a diverse readership. It offers both conceptual frameworks and practical guidelines for a liberative and transformative response to homelessness. It brings together authors from a wide range of disciplines, fusing the rigour of researchers, the vision of activists and the lived experience of practitioners. This volume traces the causes and identifies the diverse faces of street homelessness in South Africa today. It critiques singular solutions and interrogates the political, institutional and moral failures that contribute to the systemic exclusion of homeless persons and other vulnerable populations from society. It then proposes various rights-based interventions as part of a radical re-imagination of how street homelessness can be ended, one person and one neighbourhood at a time. In 'facing homelessness', we face the other, and in facing the other, we face ourselves. Grounding this exploration in the thought of Emmanuel Levinas (1969:207), it is appropriate to recall his words: '[T]he Other faces me and puts me in question and obliges me'. The political, institutional, moral and personal obligations that confront society in the face and presence of street homelessness, urban vulnerability and deep socio-economic inequality have to be considered, embraced and accounted for. However, these are not merely philosophical mutterings, as a liberationist framework prompts imaginative actions for change. The immersive and in-depth social analysis by the authors steer researchers in the direction of new ways of doing and being that could indeed demonstrate concrete, viable and sustainable alternatives to the exclusionary realities that are so visible in the face of street homelessness. 'Finding inclusionary, collaborative solutions' is therefore the sub-title of this publication, indicating its intention to contribute to solutions-based scholarship aimed at radical forms of social inclusion and achieved through broad based and creative collaborations by all spheres of society. Drawing on local and global lessons learnt and the specific lessons from successful and failed responses d...

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