Homelessness Visible

IMG_4667Our latest point-in-time count of people experiencing “absolute” homelessness in King County tallied 12,112 homeless individuals on January 26th, 2018 (see the All Home King County‘s 2018 report “Count Us In”). By the term “absolute” I refer to the fact that they use the strict HUD definition of homelessness, which excludes the considerable number of people (especially teens and young adults) who are couch-surfing, doubled-up with friends or extended family members and who do not have a safe, stable, affordable place to live. In this respect the HUD definition differs from the official definition of homelessness for healthcare services funded through the U.S. Department of Health and Human Services (see the various definitions compared here by the National Health Care for the Homeless Council).

The 12,112 homeless individuals counted for 2018 represent a 4% increase over the 2017 homeless count (which represented a 19% increase from the 2016 count). Some politicians claim that the slowing percentage increase in people experiencing homelessness can be counted as progress—although as a reality check, the 4% increase in homelessness is much larger than the total population growth for King County. The most recent published statistics show a 2.3% population growth for King County for 2016-17 (source: Washington State Office of Financial Management). As another significant reality check, the homeless count survey methodology changed considerably for 2017 such that comparisons with 2016 numbers should not be made.

Significantly, the 2018 homeless count found that over half (52%) of homeless people were unsheltered the night of the count, with many people living outside in tents and in vehicles. Having participated in the survey this year, I can attest to the difficulty of finding and assessing whether or not parked vehicles are being lived in between the 2-5 a.m. timeframe the day of the count. It is much easier to count the number of people staying overnight at an emergency shelter. And homeless people living in tents tend to find thickly wooded areas in which to live—and not, as in the photograph above, more visibly along well-lit streets and bike paths. But for all of us who live, work, study, and play in Seattle and throughout the rest of King County, we didn’t need the official homeless count to tell us we have a growing problem. We have homelessness, abject poverty and despair, quite visible.

Note: In a series of subsequent posts I will address intriguing, intelligent, and excellent questions which I have received lately about our homelessness crisis. They were too numerous and complex to address in one post.

 

 

Prostitution: Exploitation, Not Work

IMG_2219A few weeks ago I participated in a powerful healthcare system training titled “Beyond Sex Trafficking: Responding to Commercial Sexual Exploitation and the Role of Healthcare Systems.” Commercial sexual exploitation is the exchange of sex acts for money, or for anything of monetary value, including basic needs such as food, clothing, or shelter. Therefore, it includes survival sex, pornography, escort services, exotic dancing, stripping, and street or hotel or house-based prostitution. Often referred to as “sex work,” this is a mighty misnomer, because it is not a form of work; it is exploitation and violence. And it is gender-based violence since most, but not all, of the victims are girls and women, and the overwhelming majority of buyers are men.

The evidence is clear: no matter what city or county or country (including countries where prostitution is “legalized” and regulated and sanitized), upwards of 90 percent of “sex workers” have histories of childhood sexual abuse, untreated post-traumatic stress disorder, and are disproportionately persons of color from lives of poverty, including homelessness. They often come from backgrounds of violence and exploitation, and once they are in the “life” of sex work, they are once again victims of violence and exploitation. And those male buyers of sex? They are disproportionately white and well-off financially. Many buyers are married and occupy high status positions in society, including doctors, lawyers, and politicians. Another interesting fact is that the majority of buyers of sex at some level feel remorse and would like to stop.

The conclusion is clear: There is no such thing as a happy, healthy hooker. Julia Roberts’ character of a prostitute in Pretty Woman is a sick, twisted version of the Cinderella fairytale—a romantic comedy that has nothing to do with true romance and that is decidedly not funny.

Healthcare providers, including nurses and physicians, are on the front-line of caring for victims of prostitution and all forms of sex trafficking and exploitation. We need to learn about these issues and do something about them. A terrific new online healthcare provider training module series on human trafficking (includes sex trafficking) using a public health approach is SOAR, which stands for Stop, Observe, Ask, Respond. Offered free-of-charge through the Department of Health and Human Services, Administration for Children and Families, Office on Trafficking in Persons, it includes three training modules (for CE/CME): 1) SOAR to Health and Wellness, 2) Trauma-Informed Care, and 3) Culturally and Linguistically Appropriate Services.

For any nurse, physician, social worker, teacher (and other professions specified by law) in Washington State, it’s important to note that mandatory reporting of known or suspected child abuse includes commercial sexual exploitation of children (CSEC) and teens under 18 (1-800-ENDHARM  https://www.dshs.wa.gov/report-abuse-and-neglect). In Seattle/King County, there is the CSEC Hotline: 855-400-CSEC with community advocates 24/7 for sexually exploited youth ages 12-24 in King County; and the Human Trafficking Hotline (24 hrs) at 888-373-7888. Also in King County we have the innovative and nationally-recognized resource, Stopping Sexual Exploitation: A Program for Men. 

Sources and Further Resources:

Ending Exploitation Collaborative/ References and The Harm of Sexual Exploitation 

Organization for Prostitution Survivors 

National Human Trafficking Hotline

Polaris Project

The Life Story, including the powerful video for healthcare providers Medical Emergency 

 

Summer Reading Challenge 2018

IMG_4854This is the third installment of my annual summer reading challenge with a social justice (and feminist) slant. These ten library books include ones related to my current research and writing project, Skid Road: The Intersection of Health and Homelessness, as well as works by women authors I am delighted to discover. Here they are in the order (bottom up) they appear in the photograph. Happy—and meaningful—summertime reading!

  1. Race and Medicine in Nineteenth and Early-Twentieth-Century America, by Todd L. Savitt (Kent, Ohio: The Kent University Press, 2007).
  2. Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles, by Emily K. Abel (New Brunswick, New Jersey: Rutgers University Press,
  3. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health, by Alison Bashford (New York: Palgrave Macmillan, 2004).
  4. Body and City: Histories of Urban Public Health, edited by Sally Sheard and Helen Power (Burlington, Vermont: Ashgate Publishing Company,  2000).
  5. Good Woman: Poems and a Memoir 1969-1980, by Lucille Clifton (Brockport, New York: BOA Editions, Ltd., 1987.
  6. Woman’s Place: A Guide to Seattle and King County History, by Mildred Tanner Andrews (Seattle: Gemil Press, 1994).
  7. Whose Names Are Unknown: A Novel, by Sanora Babb (Norman, University of Oklahoma Press, 2004).
  8. How to Suppress Women’s Writing, by Joanna Russ (Austin: University of Texas Press, 1983).
  9. Half a Yellow Sun by Chimamanda Ngozi Adichie (New York: Anchor Books, 2007).
  10. Purple Hibiscus, by Chimamanda Ngozi Adichie (New York: Anchor Books, 2003).

Stories Matter

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“Stories matter. Many stories matter,” states author Chimamanda Ngozi Adichie in her powerful TED talk “The Danger of the Single Story.”  Adichie points out that listening and clinging to a single story—about a person, a place, a situation—creates stereotypes, and, in her words, “the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story.” She goes on to say, “The consequence of the single story is this: it robs people of dignity; it makes our recognition of our common humanity difficult; it emphasizes how we are different rather than how we are similar.”

I thought about Adichie’s wise words earlier this week as I moderated a hospital-based panel discussion on service provision and community advocacy to end commercial sexual exploitation and sex trafficking. The panel and the day-long training for health care providers included personal stories of survivors of sexual exploitation. None of the survivors remotely resembled Julia Roberts in the “modern Cinderella story” movie Pretty Woman, which reinforces the common stereotype of the high-class and empowered hooker. Instead, the survivors told stories of trauma and violence which both preceded and accompanied sexual exploitation.

In my introductory talk about why this topic matters, I linked to an important storytelling video geared towards healthcare providers on The Life Story website, “Medical Emergency.”  I appreciate how this particular video weaves together the stories of women in their own voices. Advocacy is not about speaking for those less fortunate, less powerful, but of using our own power and privilege to amplify their voices, their stories. Our job as healthcare providers, as compassionate citizens, is to step back and listen respectfully.

Another powerful story came to me today via a colleague who sent me the link to this NYT Op-Docs Season 6 video “We Became Fragments” directed by Luisa Conlon, Hanna Miller, and Lacy Jane Roberts. Through their video, they step back, listen, and then amplify the voice and words of Ibraheem Sarhan, a young Syrian refugee now living in Canada. I love how this short video highlights the importance of competent and compassionate, trauma-informed teachers and healthcare providers. When one of Ibraheem’s teachers gives an in-class assignment to write about their family, the teacher gently points out to Ibraheem that he doesn’t have to write about his family if it is too painful a topic. The teacher must know that a bomb in Syria killed Ibraheem’s mother and siblings and left him with a shattered leg. Ibraheem tells us that when people ask him about his visible leg injury, “they don’t know how much my heart burns when I tell my story.”

Stories matter to the teller and to the listener. What we need more of in this world is for all of us to increase our capacity to listen to a multiplicity of stories and within those stories to recognize our common humanity.

 

 

Worksite Metaphor

IMG_2562This past week I spent time cleaning my office at work, recycling (shredding) the detritus of an academic life: tenure and promotion materials,  teaching evaluations, student papers, and my own papers. I do this periodically to ensure there is never too much of me—of my identity—at work, not from a pathological paranoia, but rather from a desire to maintain healthy boundaries. Or at least that is what I tell myself.

But during the cleaning and sorting I found a hand-written draft of a prose poem that I wrote many years ago during a workshop I taught on narrative medicine. It was in response to a close read and discussion of Jane Kenyon’s poem “The Sick Wife” and her husband Donald Hall’s poem “The Ship Pounding.” As Carol Levine writes in “Two Poets: One Illness,” the poems “…offer a rare view of the same illness from the perspective of the patient (Jane Kenyon) and her husband and caregiver (Donald Hall), both distinguished poets.” (Journal of General Internal Medicine, March 2010, 25(3): 275-275.)

In Hall’s poem he uses the metaphor of a ship to describe his experience in the hospital when his wife was sick. He concludes with describing the hospital as “the huge vessel that heaves water month after month, without leaving port, without moving a knot, without arrival or destination, its great engines pounding.” I used as an accompanying writing prompt for workshop participants to write a description of their own metaphor for their particular work site. What is your metaphor for your own work site? Here is what I wrote (and found while cleaning my office—and have now shredded):

Dusty, moldering storage closet

door with stuff behind

forgotten cast-offs

old files labeled for people and departments and programs that died long ago

textbooks for subjects that are no longer taught

a ceramic statue of Florence Nightingale holding her lamp

beside a bowl of nectaries

people who have retired but won’t leave

people who should retire 

computer parts, old landline phones, stenographic paper

which is what exactly?

My office—bare–no books

A few seashells

I can leave, clear out in a moment

Not closed inside a storage closet.

 

 

 

Dear Flo: What Nurses Week Means to Me

IMG_4737Happy National Nurses Week to all you dedicated, compassionate, hard-working nurses out there! While you’re enjoying your free cinnamon bun and coffee, I hope you will pause to reflect on your work and on what truly fuels your continued passion for nursing (or where the heck that passion has gotten to if you have lost it).

And if you have time to read more than patients’ chart notes or community outreach notes, I hope you will pick up and read a “real” book written by nurse authors. We may be a small group compared with the vast number of physician authors, but we are growing in strength. I am proud to be a nurse and I am proud to be a nurse author in the company of some amazing, inspiring people.

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As far as living nurses go, there are many who inspire, innovate, and influence me. One of these is Ruth Watson Lubic, the nurse-midwife, MacArthur “genius” award winner, and founder of the Family Health and Birth Center, located in one of the poorest neighborhoods in Washington, DC. She walks the talk of what nursing can and should do well, to “treat everyone like a human being,” to create a community-based health center where “everyone who walks in that door feels love.” Plus, she has combined direct nursing service with upstream policy work as succinctly depicted in this brief video. (And she is a way cool elder who has her own Hip Hop Saves Lives song and video!)

The American Nurses Association Ethics and Human Rights Statement of 2017 states that “Nursing is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice.” It goes on to proclaim that “Nurses must always stress human rights protections with particular attention to preserving the human rights of vulnerable groups, such as the poor, the homeless, the elderly, the mentally ill, prisoners, refugees, women, children, and socially stigmatized groups.”

I am a proud nurse educator and (most days) count among my blessings, the opportunity to work with the amazing, smart, creative, and compassionate future nurses. Like the students yesterday at the Nurses Week event at Shoreline Community College. And like these University of Washington School of Nursing students at our Doorway Project pop-up community cafe who spent a sunny Sunday afternoon washing the feet of homeless young people. Dear Florence Nightingale, happy birthday and happy Nurses Week! As Florence Nightingale nurse scholar Tony Paterniti, PhD, RN states, Nightingale wasn’t only the lady with the lamp, she was also a “woman with a mission.” (Check out Dr. Paterniti’s fascinating digital archive collection on Florence Nightingale through Texas Woman’s University.)

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Life in the Swamp: Float, Don’t Flail

P1020499Community-engaged scholarship is mucky business. It takes a high tolerance for—and even delight in—ambiguity, lack of clear paths, no solid ground, simultaneous decay and incubation, annoyingly loud squawking ducks, tail-thwacking beavers stirring the mud, and skunk cabbage. Oh yes, the putrid smell of skunk cabbage. Skunk cabbage reminds me of the people who seriously pluck my nerves, who irritate me, yet somehow must serve a useful purpose (for instance, as food for bears coming out of hibernation in the case of skunk cabbage).

Community-engaged scholarship is not for the faint of heart or the fastidious or the unprepared. I’ve learned and re-learned these lessons many times over my thirty-plus years of such work. There always comes a point of crisis, with the inevitable interpersonal and inter-agency power plays coming to a head. In these times, (which I am in the midst of currently with the particularly complicated Doorway Project) when my default mode is to fight back against the stealthy, submerged weeds of the swampland territory of this work.

But then I remember my Red Cross swimming safety instruction as a teenager. When swimming in swampy rivers and the underwater fingers of submerged plants begin to grasp your limbs, threatening to pull you under—instead of fighting them (thus tightening their hold), you are instructed to relax and float. The threatening underwater plants will then release you to the surface where you can gently scull your way back to the safety of shore. Float, don’t flail.

It is useful to have wetlands and swampy areas near at hand to visit and remember these sorts of lessons for life and for community work. (Not to mention, of course, the myriad positive environmental aspects of wetlands.)  I’m fortunate to have Yesler Creek in my (literal) backyard and Yesler Swamp (where the creek empties into Lake Washington) only a mile from my home. Yesler Swamp has undergone a restoration process (ongoing) spearheaded by a campus-community group (Friends of Yesler Swamp and University of Washington Botanic Gardens) and is now a refuge for wildlife—and for humans who need a respite from the bustle and hassle and skunk smells of academic and city life.

Swamps are terrific metaphors for community-engaged scholarship, especially scholarship that deals with wicked problems such as homelessness. I return time and time again to the wise words of Donald Schon, author of The Reflective Practitioner: How Professionals Think in Action (Basic Books, 1984) among many other important works:

….The research university is an institution built around a particular view of knowledge, as the following dilemma helps to make clear:

The dilemma of rigor or relevance.  In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.  The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.  The practitioner is confronted with a choice. Shall he remain on the high ground where he can solve relatively unimportant problems according to his standards of rigor, or shall he descend to the swamp of important problems where he cannot be rigorous in any way he knows how to describe.

Nearly all professional practitioners experience a version of the dilemma of rigor or relevance, and they respond to it in one of several ways. Some of them choose the swampy lowland, deliberately immersing themselves in confusing but critically important situations. When they are asked to describe their methods of inquiry, they speak of experience, trial and error, intuition, or muddling through. When teachers, social workers, or planners operate in this vein, they tend to be afflicted with a nagging sense of inferiority in relation to those who present themselves as models of technical rigor.  When physicists or engineers do so, they tend to be troubled by the discrepancy between the technical rigor of the “hard” zones of their practice and the apparent sloppiness of the “soft” ones.

People tend to feel the dilemma  of rigor or relevance with particular intensity when they reach the age of about 45. At this point, they ask themselves, “Am I going to continue to do the thing I was trained for, on which I base my claims to technical rigor and academic respectability? Or am I going to work on the problems — ill formed, vague, and messy — that I have discovered to be real around here?”  And depending on how people make this choice, their lives unfold differently. (Donald Schon, “Knowing-in-action: The new scholarship requires a new epistemology,” 1995, Change, November/December, 27-34.)

Here is to all of the swamplands and swamp workers of the world. Let’s keep mucking around together and remember: when things get particularly tough—float, don’t flail.

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