Housing First, Historical Land Use, and Exclusionary Housing Policies in Seattle

Source: Seattle Municipal Archives, “Numbers and distribution of shacks by census tract, Seattle, WA”

Here are my latest two brief (5-minute) educational videos that are part of my Skid Road project and linked with my forthcoming book, Skid Road: On the Frontier of Health and Homelessness in an American City. “Ark of Refuge” is about the Housing First model of care, how Seattle has been a leader in the implementation of this model, and about the historical (and colorful) figure of Dr. Alexander de Soto and the Wayside Mission Hospital. “Shacktown” is about Seattle’s longstanding lack of safe, affordable housing and how homelessness here is tied to our city’s historical land use, municipal zoning laws, and exclusionary and racist housing policies. Please share them widely and consider using them in your own teaching and/or advocacy work.

Ark of Refuge

The Criminalization of Poverty and Homelessness

Homeless encampment between I-5 and Harborview Medical Center. Photo credit: Josephine Ensign, 2020

As our country edges towards post-pandemic individual and community life, we see clear evidence of deepening economic and racial inequities. Any walk or drive through our urban areas, from Washington, DC to Los Angeles, reveals a steep rise in visible poverty and homelessness, especially for persons of color. With this rise comes an increased push to criminalize people for being homeless. From my nearly forty years as a nurse and researcher working with homeless populations, and my lived experience of homelessness as a young adult, I know that criminalizing poverty and homelessness does not work. It only worsens the problem.

Here in Seattle, which already had one of our nation’s highest rates of homelessness and income disparities before the pandemic, tents and other temporary living structures made of cast-off materials line the hillsides along I-5, appear on sidewalks, and in green spaces such as ravines and city parks. Cars, RVs, and trucks with screened off windows and windshields—the temporary homes of vehicle residents— dot the landscape. A house next door to my own home in a mixed-income neighborhood near the university where I work, has changed from being an informal refuge for homeless squatters to a ‘flipped’ single-family home currently on the market for $1.2 million.

Early in the Covid-19 pandemic, when we were asked to shelter at home and congregate living spaces such as emergency shelters were known to flame the spread of the virus, public health officials locally and nationally moved to limit shelter capacity and placed moratoriums on both evictions from housing and homeless encampment clearances. Motels were turned into Covid isolation and recovery units for unhoused people. Despite the motels and pauses on evictions, visible homelessness increased exponentially.

Eviction moratoriums, an effort to prevent a wave of new homelessness in the economic fallout from the pandemic, although being challenged, appear to have more staying power than the hold on encampment clearances. In February of this year, the city of Mercer Island, one of the highest income ZIP Codes in the Seattle-King County area, enacted legislation to ban camping in public parks. (1) The Auburn City Council recently passed more punitive anti-homelessness legislation, allowing the charging of criminal trespassing for people camping overnight on any city property. (2) People now face a $1,000 fine and/or 90 days in jail if they fail to follow through with individualized plans aimed at either moving them into housing or at least out of the jurisdiction. Council members who voted in favor of this criminal penalty characterize the new law as “compassionate accountability.” In Seattle, a group composed of mainly business people is calling their effort to resume encampment clearances “Compassionate Seattle.” (3) They aim to secure enough signatures to bring to vote a change in the Seattle City Charter requiring the city to provide more permanent, supportive housing and simultaneously to clear parks and other public spaces of homeless encampments by criminalizing them.

Criminalizing homelessness has a long history in our country despite the fact that it has never worked. As the National Law Center on Homelessness and Poverty documents, criminalization worsens homelessness and racial inequities by weighing down already impoverished people with hefty fines, jail sentences, and criminal records. (4, 5) Criminalization diverts money away from supportive housing, and basic health—including mental health and substance use disorder treatment—that are more cost-effective at preventing and addressing homelessness. Communities that criminalize homelessness have higher rates of violence against people living or even appearing to be homeless. (6)

If criminalizing homelessness does not work, why do we keep returning to it? Part of the reason has to do with the fact that it was foundational to our country. Our various state-level poor laws, including vagrancy laws, are based on the Elizabethan Poor Laws adopted by the original thirteen British colonies. British social historian David Hitchcock points out that “Christian charity and proper punishment were delicately connected in English culture,” a connection reflected in the English Poor Laws. (7) English paupers were sent to the colonies as punishment, in what Hitchcock terms “welfare colonialism.” (8)

Benjamin Franklin, the vocal proponent of the “pull yourself up by your bootstraps” American metaphor of personal transformation through hard work, openly despised poor people and advocated for sending them to the western frontier, which at that time was Western Pennsylvania. (9) Franklin viewed this practice as a survival-of-the-fittest sort of endeavor that would simultaneously rid the East Coast cities of urban blight and disease, force the assimilation of immigrants, and improve the character and hardiness of Americans.

This westering, frontier mentality has reverberations today in Seattle, from the increase in Tiny House Villages looking eerily like the shacktown Hoovervilles of the Great Depression, to the burgeoning vehicle residents similar to the Dust Bowl’s Rubber Tramps who lined city parks, as well as the RV residents depicted in “Nomadland.” Recently, a team of human rights lawyers invoked the frontier-era Homestead Act of 1862 in King County Superior Court. (10) They were representing a homeless construction worker who lived in his truck against the city of Seattle for impounding his truck and charging him $557 in impound fees. (The city of Seattle appealed the ruling to the Washington Supreme Court, which heard arguments on March 16, with a ruling expected within a few months.)

Punishing people for being down and out and homeless is not the answer. Increased and sustained funding for safe, affordable, supportive housing, well-connected with primary health care that is inclusive of mental health and substance use treatment, is what works to address homelessness. Policies and programs led by people with the lived experience of homelessness make them more innovative and effective.


1. Sydney Brownstone, “Auburn City Council votes to create criminal penalty for camping on city property,” The Seattle Times, April 19, 2021, https://www.seattletimes.com/seattle-news/homeless/auburn-city-council-creates-criminal-penalty-for-camping-on-city-property/.

2.Paige Cornwell, “Mercer Island restricts camping on public property in near-unanimous vote,” The Seattle Times, February 16, 2021, https://www.seattletimes.com/seattle-news/eastside/in-near-unanimous-vote-mercer-island-restricts-camping-on-public-property/.

3. Daniel Beekman and Scott Greenstone, “Proposal to address homelessness in Seattle city charter met with intrigue, skepticism,” The Seattle Times, April 13 2021, https://www.seattletimes.com/seattle-news/politics/seattle-begins-to-digest-proposal-that-would-change-city-charter-to-address-homelessness/.

4. National Law Center on Homelessness and Poverty, “Housing Not Handcuffs: What is Criminalization of Homelessness?” https://nlchp.org/wp-content/uploads/2018/10/criminalization-one-pager.pdf, accessed 4-29-21.

5. Joseph W. Mead and Sara Rankin, “Why turning homelessness into a crime is cruel and costly,” The Conversation, June 20, 2018, https://theconversation.com/why-turning-homelessness-into-a-crime-is-cruel-and-costly-97290

6.National Coalition for the Homeless, “No Safe Street: A Survey of Violence Committed Against Homeless People,” https://nationalhomeless.org/no-safe-place/, accessed 4-29-21.

7. David Hitchcock, “’Punishment Is All the Charity That the Law Affordith Them’: Penal Transportation, Vagrancy, and the Charitable Impulse in the British Atlantic, c. 1600-1750,” New Global Studies 12, no. 2 (2018): 195-215 (quote, 200), https//doi.org/10.1515/ngs-2018-0029.

8. Hitchcock.

9. Nancy Isenberg, White Trash: The 400-year Untold History of Class in America, (New York: Viking, 2016)

10. Ann LoGerfo and Ali Bilow, “Washington Supreme Court to Hear Oral Argument March 16 in Case Concerning Seattle’s Practice of Impounding Vehicles Used as Homes,” Columbia Legal Services, https://columbialegal.org/impact_litigations/city-of-seattle-v-steven-long-2/.

Nurse Bullying is Real

From the Radical Nurses Group/Royal College of Nursing Archive, Edinburgh

In my almost 40 years of nursing, I have heard about, read about, and taught about nurse bullying, but I had never experienced it directly—until yesterday while working as a Covid vaccinator in a hospital setting.

The American Nurses Association (ANA) defines nurse bullying as “repeated, unwanted harmful actions intended to humiliate, offend, and cause distress in the recipient.” As I write that, I wonder why they include “unwanted” in the definition. Who in their right mind would want to be bullied? And even if that were the case, it would not make bullying okay. The ANA includes bullying in its statement on workplace violence. They point out that nurse bullying threatens patient safety, diminishes quality of care, and contributes to nurse burnout/staff turnover. Nurses who are bullied suffer a host of physical and emotional repercussions, including higher rates of depression and suicide.

“Nurses eating their young” is an oft-repeated phrase when referring to nurse bullying. I imagine that Florence Nightingale was quite the nurse bully. It seems to be ingrained in our profession and treated almost like a necessary rite of passage. Nurse bullying can begin in nursing school, with students being subjected to humiliation and intimidation by professors, clinical instructors, and school administrators. In some studies (see references below), over half of graduating nursing students report having witnessed (bystander) or been the recipient of nurse-on-nurse bullying in clinical rotations. The vast majority of nurse bullying happens in hospital settings, perhaps perpetuated by the high stress, high stakes clinical outcomes, heavy workloads, and low job autonomy of nursing within the rigidly hierarchical hospital setting.

I know that many frontline hospital nurses across our country and in other countries hard hit by the pandemic are burned out and angry after over a year of treating patients with COVID-19 and seeing so many of them die. Many nurses are tired of being portrayed as “angels on earth.” And, of course, the pandemic is far from over despite the rollout of safe and effective vaccines. Perhaps the vaccine clinic nurse manager yesterday is one of those burned out, pissed off nurses. It doesn’t excuse the bullying behavior she threw my way (I’ll spare you the details but it went way past incivility) and to a patient who, post-vaccination, asked to use the restroom (located next to the clinic) and she told him curtly that he had to wait the full 15 minutes of post-vaccine observation. Seriously, a patient is a person who has the right to use the restroom. I’d had enough and escorted the patient to the bathroom, waited outside to make sure he was okay, and then excused myself from the presence of that nurse bully. And reported her behavior in the hopes that she will be removed from that specific role and offered professional coaching of some sort. But I’m not going back to that setting, at least not as a clinician. I’ll find a better place to volunteer as a nurse vaccinator.

I’m attempting to turn this distressing experience into a teachable moment, for myself, and for students I teach. I now know from direct experience that nurse bullying is real.


Theresa Brown, “When the Nurse is a Bully,” NYT Well blog, February 11, 2010.

Cole Edmonson and Caroline Zelonka, “Our Own Worst Enemies: The Nurse Bullying Epidemic,” NURS ADMIN Q. 2019, vol 43(3):274-279.

Note: I received this message in response to this post:

“As I’m sure you know, workplace violence is a critical issue affecting not
only nurses, but patients and their quality of care. That’s why ANA
launched #EndNurseAbuse – a nationwide initiative to eliminate physical and
verbal abuse, sexual harassment, and bullying in the workplace.
#EndNurseAbuse galvanizes nurses, health care stakeholders, and consumers
across the nation to reduce violence and harassment against nurses. Visit the
#EndNurseAbuse resource center to see the video that brings to life actual
accounts from real nurses who have experienced various forms of violence and
abuse on the job. While you’re there, please take a minute to sign the #ENA
pledge and share!

Here’s the link to ANA’s official statement:

ANA Applauds Passage of Workplace Violence Prevention Legislation by U.S. House of RepresentativesMEDIA CONTACTS: Keziah Proctor. 301-628-5197 keziah.proctor@ana.org . Silver Spring, MD – Today, the American Nurses Association (ANA) applauds the U.S. House of Representatives for passing the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195).This legislation, approved by a vote of 254-166, will help to better protect all health care professionals and …www.nursingworld.org

Once a Nurse

Always a nurse, or so the saying goes. Events of the past year, and especially of the last week, have taught me the truth of that saying, at least on a personal level.

I am and have been over the course of my 39-year career (counting from when I first started nursing school), a public health nurse (TB and hypertension control nurse with the health department in Richmond, Virginia), an inpatient stroke/neuro ward nurse, a rehabilitation nurse, an HIV/AIDS nurse at an LGBTQ community clinic, a Health Care for the Homeless nurse and family nurse practitioner. I have been (still am) a nurse researcher, a nursing professor, and a writer who happens to be a nurse. Always a somewhat skeptical/critically-thinking nurse (still am), questioning our healthcare system, our profession of nursing, and our socio-political system as a country.

Ever since the COVID-19 pandemic became a reality over a year ago, like many people throughout the world, I have reassessed my professional roles. What’s essential and what’s not? Essential: teaching population health and health policy as well as possible to our future nurses; becoming even more politically engaged to speak up on important issues like racism in health care, gender-based violence, and hate crimes against LGBTQ people/people living homeless/Asian-Americans; growing my network of politically engaged, progressive nurses across the country; spreading evidence-based public health information about the pandemic/pushing back against the cacophony of mis-information and outright lies; thinking and acting like a public health nurse, which I have realized is the kind of nurse I have always been. Not essential: university internal politics; worry about being productive with the usual expectations of grant-writing and peer-reviewed journal writing. My pandemic mantra has and continues to be: accomplish less, experience more.

This past week, the day after my two-week post second Pfizer COVID-19 vaccine dose, I began volunteer work as a COVID-19 vaccinator at a local public hospital. I asked for and received an excellent nurse practitioner mentor to shadow at first to get up to speed on the proper vaccination protocol, then sat down at my assigned station and began talking with patients and giving them the vaccinations. Yesterday, the vaccination clinic nurse supervisor introduced herself (both of us behind masks, of course) as one of my public/population health students years ago. She said she is an acute care nurse who has been working on the frontlines of the pandemic “since day one.” I thanked her for her work as a hospital nurse and as a nurse supervisor for the vaccine clinic, and gently reminded her that she is doing vital public/population health nursing.

I told my husband and family members (all, except my two-year-old granddaughter vaccinated now), that working as a volunteer public health nurse at the COVID-19 vaccination clinic feels like the most important and personally satisfying work I have done in my entire nursing career. Spread the word: These vaccines save lives and livelihoods. They give us hope.

(Please note: the photograph here was ‘staged’ and contains no patient or provider information.)

My Homage to Seattle’s First Homeless Person

His name was Edward Moore, a 32-year-old sailor from Worcester County, Massachusetts. He was found half-frozen on a Seattle beach in late December, 1854. For the past seven years I have been in search of his story. I tell it in my forthcoming book, Skid Road: On the Frontier of an American City (Johns Hopkins University Press, August 2021). I tell a shorter version of it in my recently produced digital storytelling video, “Commitment.” Thanks to a 4Culture Heritage Award for funding support for this, and additional (to follow) videos related to my Skid Road project. And thanks to StoryCenter for their training and support of my digital storytelling efforts. And if you or someone you know is interested in the topic of health and homelessness, I am presenting on it at a Museum of History and Industry History Cafe event (free and virtual) on Wednesday, March 17, 6:30 p.m. Here is my new video:

One Thing Is Clear: We Are Not All In This (pandemic) Together

A year into this COVID-19 pandemic in the Seattle area, it becomes clearer to me that we live in a deeply unjust society and have a dysfunctional and unethical healthcare system. Of course, many people knew this to begin with, but the pandemic has laid bare—and continues to reveal—the inequities built into our healthcare system. Besides the now well-documented disproportional toll of the pandemic (health, economic, social, and cultural) on communities of color and people from lower socio-economic status, comes the news this week of local hospitals offering ‘invitation only’ COVID-19 vaccination clinics for wealthy (mainly white) donors. These are for-profit hospital systems as well as ostensibly religious (Catholic in this case), not-for-profit hospital systems like Providence. Interestingly, our public hospitals do not have any vaccine to give the public. Seattle Mayor Jenny Durkan has urged the Washington State Department of Health to put a stop to this unfair practice. We knew that there would be people who would ‘jump the line’ in the rough and ready rollout of the COVID-19 vaccine in the United States, but most people erred on the side of trust in our hospitals to be ethical in their role in this vast effort.

Already being cynical about the US healthcare system, this adds to my cynicism and desire for a more just, cost-efficient, and effective public option for health care. And clearly, our public health system is a shambles, not only with its continued underfunding, but also with people doing heroic work during the pandemic and getting death threats because of it. What will it take to fix these problems?

On a personal note, although eligible now (and for the past month) to receive the COVID-19 vaccine, I have managed to sign up on a waitlist managed by the King County Medical Society which promises to contact me if and when any open vaccination slots become available to me. I am not holding my (double-masked) breath. And being a longtime patient of Providence—Swedish medical system and knowing the history of Providence in the Seattle area (the Sisters of Charity of Providence ran the King County Poor Farm and Hospital which split off to become Harborview Medical Center), I keep asking myself, “What would Mother Joseph of the Sacred Heart have to say to the Providence administrators and board members who gave the vaccine to rich donors ahead of the elderly and the sick?”

Dr. Ben Danielson: Standing Up to Institutional Racism

Dr. Ben Danielson, photo by Josephine Ensign, 2015

The new year brought hope for a better year ahead. Also, it brought sorrow and anger in Seattle at the news that a beloved physician and community advocate, Dr. Ben Danielson, recently resigned as medical director of the Odessa Brown Children’s Clinic. Odessa Brown Children’s Clinic is a pediatric clinic run by Seattle Children’s Hospital. It began in the late 1960s in the traditionally Black Seattle neighborhood (because of redlining/racial restrictive covenants) of the Central District. It began from a combination of the Model Cities Program and community calls for improved healthcare access and quality for marginalized urban communities, including communities of color. Seattle Children’s Hospital was—and still is—located in the upscale, mostly gated and white neighborhood of Laurelhurst. Then, as now, there were accusations that the powers that be at Seattle Children’s Hospital were racist, that children and families of color were subjected to racist treatment–as were nurses, physicians, and other healthcare staff members of color. (Also, Seattle Children’s Hospital has been accused of not supporting LGBTQ staff and patients; see my posts on the suicide of nurse Kim Hyatt who was openly gay and who was treated poorly by administrative staff. This showed up clearly in the redacted hospital personnel files I reviewed and in conversations with her friends and co-workers who contacted me.)

According to the independent newspaper, Crosscut, which broke the news of Dr. Danielson’s resignation after twenty years as medical director, “Danielson felt marginalized and alone as the rare Black voice in a position of authority…He said Seattle Children’s would gladly place Odessa Brown, which serves mostly low-income and people of color, on a pedestal to raise money, but would not show that same level of interest when it came to daily care”

I worked alongside Dr. Danielson in the early 2000s when I was a nurse practitioner at the ‘sister’ community clinic, Carolyn Downs Family Medical Clinic. Carolyn Downs is one of our country’s longest surviving clinic begun by the Black Panthers. As a nurse practitioner who had worked at a majority Black community clinic in East Baltimore, I knew about sickle cell anemia in terms of crisis management but not longterm, chronic management. One of my teenage patients at Carolyn Downs had sickle cell anemia and Dr. Danielson helped me manage his care more effectively. Subsequently, when working on my Skid Road oral history project for my forthcoming book, Skid Road: On the Frontier of Health and Homelessness in an American City, I had the please of completing an oral history interview with Dr. Danielson. An edited version of my interview with him is available here. (The audio quality on this one is much better than the video since I wrestled with the equipment that day.)

At the end of my oral history interview with Dr. Danielson, stated, “Diversity and cultural humility and improving the lot of people who are marginalized, that happens when you do it intentionally. Waiting for people to just do it out of generosity, or out of some sense of enlightenment all of a sudden that hasn’t been there for 20 or 30 years, that won’t cut it. We have to be intentional, and we have to be creative, and we have to work hard.” He spoke of being energized and having renewed hope because of the work of young people in the Black Lives Matter movement and because of the social justice work locally of the people of El Centro de la Raza. “You’re reminded that people stepped up. They occupied. They talked about oppression and racism, and they stood up to it and made a difference.”

Get Your Words Out

Having completed reading and grading close to 150 nursing student personal narrative policy papers (based on the Narrative Matters series in the health policy journal Health Affairs) for a public/population health course, I am energized by what they wrote—and by how well they wrote about compelling and timely public health issues they have a personal connection with. The ongoing and worsening opioid epidemic and diseases of despair, immigrant and migrant health, eating disorders and other mental health issues made worse by the COVID-19 pandemic, racism, environmental justice/climate change, elder health, vaccine hesitancy, and the occupational and safety fallout from the effects of how poorly our country and healthcare system have dealt with the pandemic.

As I read many of these student personal narrative policy papers, I thought of the wise words I heard recently from the author and environmental activist Terry Tempest Williams. She said, “Anger is polemic and no one wants to hear it. Rage is a story. There’s something behind rage. Anger is a shout; rage is a simmer. A piece written out of sacred rage lasts, while an op-ed is usually anger and people wrap fish in the paper the next day.” The most effective and powerful student papers tapped into that river of controlled, simmering rage. The nursing students who wrote these papers give me great hope for not only the future of nursing but also for our collective future.

I’ve promised to help them carry their words into publication of some sort should they choose to do so. Their lived experiences, their words, their perspectives are important. Of course, some students may not have the time or energy to revise their papers and submit them for publications. Others may have personal stories and perspectives that they are willing to only share with me. That is fine and I honor their decisions. Others have written to tell me that my feedback and encouragement to publish have motivated them to pursue that. Several have told me that they are so ‘on fire’ with the content and messages of their papers that they want to work on revision and publication over the holiday school break.

So here is my advice for them and for any of you readers, nurses or otherwise, who have compelling stories to tell to a wider audience.

  1. Ask yourself if you are ready to share your personal stories to strangers—and if you are ready to receive feedback, good or bad (or indifferent) on your story, not just by reviewers/editors, but also by readers once your story is published.
  2. Ask yourself if this is your story to tell and review the ethical guidelines provided by different publishing venues. As a general rule, altering patient or institutional identities is required.
  3. Read content and become familiar with a wide variety of publishing venues to see what sorts of things they publish before deciding to submit a piece of writing to them.
  4. Sometimes it is easier to start small, with submitting a shorter piece of writing to a publishing venue you like, are familiar with, and that has a track record of providing a kind and timely response and review/decision. One of my personal favorites is Pulse: Voices from the Heart of Medicine out of Montefiore Medical Center, Albert Einstein College of Medicine. For students, submitting work to a student-led narrative medicine/health humanities journal can be a good idea. At the University of Washington we have Capillaries: The Journal of Narrative Medicine.

Dr. Alexander de Soto: Friend of the Homeless

Thanks to Hektoen International : A Journal of Medical Humanities for publishing my essay, “Gospel Argonaut,” about Dr. Alexander de Soto who was one of Seattle’s more interesting physicians and “friend of the poor and homeless.” This essay stems from the chapter, “Ark of Refuge,” included in my forthcoming (July 2021, Johns Hopkins University Press) book, Skid Road: On the Frontier of Health and Homelessness in an American City.

Gospel Argonaut

Josephine Ensign
Seattle, Washington, United States

Photo of the Wayside Mission Hospital founded by Alexander de Soto
Entrance to Wayside Mission Hospital housed on the steamboat IDAHO, Seattle, circa 1900. Photo: University of Washington Libraries, Special Collections UW6573.

Short of stature and tall of tales, Alexander de Soto was by some accounts a highly educated, skilled, compassionate physician and surgeon, and by other accounts a charlatan, medical quack, faith healer, and quixotic dreamer. Born on July 24, 1840, in the Canary Islands to the Spaniard Alexander de Soto and American Elizabeth Crane, Dr. de Soto claimed to have been a descendent of the sixteenth-century Spanish explorer to America, Hernando de Soto. He told people that as a young man in Spain he had studied for the Jesuit priesthood, fell out with the Catholic Church, and completed his education at the University of Madrid.1

In 1862, de Soto moved to New York City where it does not appear that he tried to practice medicine of either the faith or conventional sort. Instead, he became a professional gambler and a morphine addict. He lived in rooming house tenements and police station homeless shelters. De Soto cured himself of his addictions in 1890 through the Holiness Movement at the Bowery Street Mission, one of the first such missions in the country.

De Soto was living and working at the Bowery Street Mission when he caught gold fever. He led a proselytizing expedition, setting out on foot from New York City to Seattle, hoping from there to take a boat to the gold fields in the Yukon. He planned to preach on the sins of greed and debauchery in Alaska. He called their group the Gospel Argonauts.2 Upon his arrival in Seattle, likely in early June 1898, de Soto sought out local newspaper reporters to cover his missionary work.

In a half-page article titled “De Soto’s Descendant and His Proposed Christian Work” in the Seattle Post-Intelligencer on Sunday, July 31, 1898, Irving Safford described de Soto as “a little blue-shirted man” with a “cultured Castilian accent.” De Soto had plans for a floating hospital he called Christ Hospital that he wanted to have built in Seattle, transported to Dawson City, and established there as a mission hospital. “The work, it needs me you know,” he is quoted as saying, with a parenthetical addition by Safford that “he himself is a physician”—as if it just occurred to de Soto that he could become a physician as well as a captain.

At that time throughout America many people could and did become physicians, not through formal, then termed “regular” medical school training, but through apprenticeship and by simply presenting themselves as physicians. Regulation and licensing of medical practitioners were rudimentary at best, even in older cities like New York. In Washington, which had only become a state in 1889, physician licensing was just beginning.3

De Soto decided to stay in this frontier city of Seattle. He moved into an abandoned barn in the Skid Road area at the mouth of the Duwamish River. The marshy area where Dr. de Soto and his homeless patients lived was called the Lava Beds for its numerous brothels and saloons. De Soto began a Robin Hood sort of medical practice. He charged high fees for medical consultations on rich people in their homes and then provided free medical care and food for the homeless and poor in Skid Road.

By February 1899, de Soto had moved to a rented basement in a tenement building in the heart of Skid Road. He turned the basement into the Wayside Mission, presumably named for its location along the waterfront as well as for the mission’s focus on health care and other services for people who had become society’s castoffs.

After a wealthy Seattle woman died under the care of de Soto, a group of Seattle physicians accused Dr. de Soto of being a faith healer, a Christian Scientist, and not a regular physician. They pointed out that he had no documented medical education and that he had not applied for a medical license in Washington State. De Soto claimed that these physicians were picking on him because he was successfully caring for Seattle’s “unfortunate souls” when they were not.

Dr. de Soto met wealthy Seattle philanthropists and a Seattle judge who supported his idea of opening a hospital mission on a boat along the Seattle waterfront. They formed the Seattle Benevolent Association, convinced city officials to rent space to their association at the City Dock, found and bought the decommissioned former opium-smuggling side-wheeler Idaho, and proceeded to convert the boat into a hospital. De Soto likely knew about and had seen the “fresh air” boats and floating hospitals for babies and for tuberculosis patients in New York City. The Wayside Mission Hospital in Seattle opened in early April 1900.

The June 1900 United States census for Seattle Precinct 1 in Skid Road records Alexander de Soto, physician, as head of “household” of the Wayside Mission Hospital, accompanied by forty-nine “lodgers.” Of the nine female lodgers, two are listed as nurses, including head nurse, Irene Byers. Dressmaker, servant, cook, and hairdresser are listed as professions for the other women. For the men, there are six “seamen” or sailors, lumbermen, carpenters, cooks, day laborers, a steamboat captain, a saloon keeper, and a druggist.

In a late October 1900 newspaper article, Dr. de Soto is described by his “soft, feminine, gentle hands.”4 The reporter adds that de Soto’s detractors accuse him of having an “oriental imagination,” emphasizing his exotic “otherness” and perhaps Moorish influence to the majority white Seattle population. But the reporter counters this with the doctor’s “systematic plan of applied Christianity,” which had attracted many supporters of his mission work to provide medical care to those in need but “not to harbor ‘hobos.’” He is described as a “practical mystic.”

Dr. de Soto received funding directly from the city of Seattle for the care of patients addicted to morphine, as well as care for indigent patients. At the time, Seattle and King County had an agreement that the city would care for “ill paupers” if they had been in Washington State for less than six months.5 In addition, the city agreed to take care of all emergency cases since King County Poor Farm and Hospital south of Seattle in Georgetown was too far removed from the city and was not equipped for emergency care.

A Seattle area newspaper, The Commonwealth, carried an article by Malcolm McDonald on May 23, 1903. Titled “The Samaritan Spirit—Seattle’s Pharisees,” McDonald reports that the city wants to develop the land and dock where the Wayside Mission Hospital is located. “It is the only hospital in the city ready at all times to receive the poor—the utterly poor who in sickness know no relief but death or the help of the Good Samaritan.” McDonald points to the high commercial value of land along the Seattle waterfront and asks, “Is any land too valuable for the saving of a human life? Is there no room in Seattle for an institution that has pity and not profit for the motive of its existence?”

In July 1904, Dr. de Soto was forced out of his work with the mission by the city and by members of the Benevolent Association because his management became unsatisfactory. The specific concerns are unclear. Whatever the reasons for Dr. de Soto being forced out of the medical mission he had dreamed of, started, and run for four years, the floating hospital, now called the Wayside Emergency Hospital, was turned over to Fanny W. Connor and Marion Baxter, social reformers. Under their leadership, the renamed Wayside Emergency Hospital continued to operate much as before onboard the Idaho along the Seattle waterfront.6

De Soto continued to work in Seattle as a physician. At age ninety-three he married Irene Byers, mother of his two children and a former nurse at the Wayside Mission Hospital. Three years later, he died of injuries sustained in a fall in Brooklyn, New York.7

In 1907, the Idaho became too leaky to repair and the Wayside Emergency Hospital was moved to the Sarah B. Yesler building. The Wayside Emergency Hospital continued to function until 1909 when Seattle opened its own clinic and hospital downtown along Yesler Way in the Public Safety Building. On the last day of March 1909, nineteen patients were moved from the Wayside Hospital to the new Seattle City Hospital.8

Dr. Alexander de Soto and his Seattle waterfront floating mission hospital are much more than just quirky side notes in the medical history and legacy of care for homeless people in Seattle. The Gospel Argonaut, the practical mystic, through his medical mission work, forced the citizens of Seattle to not only confront the reality of an increasing number of ill homeless people in their midst but also to find innovative solutions for their care.

This piece is excerpted from Skid Road: On the Frontier of Health and Homelessness in an American City, forthcoming from Johns Hopkins University Press.


  1. Irving Safford, “De Soto’s Descendent and His Proposed Christian Work,” Seattle Post-Intelligencer, July 31, 1898.
  2. “Klondiker’s Souls,” Evening Journal, November 9, 1897.
  3. Nancy Rockafellar and James W. Haviland, “The Broad Sweep: A Chronological Summary of the First 100 Years of Medicine and Dentistry in Washington State, 1889-1989,” in Saddlebags to Scanners: The First 100 Years of Medicine in Washington State, ed. Nancy Rockafellar and James W. Haviland (Seattle:Washington State Medical Association, Education and Research Foundation, 1989), 1-26.
  4. “Dr. De Soto and His Work,” Seattle Post-Intelligencer, October 28, 1900.
  5. King County Washington Commissioners, Beginnings, Progress and Achievement in the Medical Work of King County, Washington (Seattle, WA: Peter’s Publishing, 1930).
  6. Katharine Major, “Nursing Seattle’s Unfortunate Sick,” American Journal of Nursing 6, no. 1 (1905):32-34.
  7. “Dr. De Soto, 96, Dies after Falling into Bay,” Brooklyn Daily Eagle, November 12, 1936.
  8. King County Washington Commissioners, Beginnings, Progress and Achievement.

JOSEPHINE ENSIGN, DrPH, ARNP, is professor of nursing and adjunct professor in the School of Arts and Sciences, Department of Gender, Women and Sexuality Studies at the University of Washington in Seattle. She teaches public health, health policy, and health humanities. Ensign is the author of Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net and Soul Stories: Voices from the Margins. She was a 2018 U.S.-U.K. Fulbright scholar, based in Edinburgh, for research on the history of English and Scottish Poor Laws. Her book, Skid Road: On the Frontier of Health and Homelessness in an American City is forthcoming (2021) from Johns Hopkins University Press.

The Psychology of Public Health Messaging

Source: Salt Lake County Health Department PSA

The stark, in-your-face COVID-19 public health messaging from the Salt Lake County Health Department has begun to stir controversy. In the image above, a large, white, presumably Mormon extended family is sharing Thanksgiving dinner. They are all maskless and not socially distancing. We are told that the man at the head of the table has no symptoms of COVID-19 but has had the infection for nine days. Instead of the obligatory “cheese!” or “turkey!” the woman taking the family’s photograph says,”Everybody say: I was just exposed to COVID!”

Other public health messaging in this series targets a more racially/ethnically diverse group of young people socializing together at an indoor party, and a grandmother seeing her (unknowably COVID-positive) grandson (we are told she ends up in the ICU with COVID-19 less than a week later). This series of public health images and messages brings up fascinating issues related to the effectiveness and ethics of public health messaging. These ‘ads’ are professionally produced and appear to be well thought out in terms of target groups and influential messaging to motivate people to follow public health guidelines. Thankfully, there was thought given to avoiding reinforcing negative (and false) stereotypes as to the ‘vectors’/sources of the disease, since no person of color was labeled as the identified source.

The November issue of the American Journal of Public Health includes articles on the rise of mental distress across our country stemming from the COVID-19 pandemic, the negative health effects of COVID-19-related racial discrimination of Asian Americans, and one titled “Reimagining Public Health in the Aftermath of a Pandemic” (sources below). The authors of this latter article make the case for advances in public health infrastructure, effective ways to counter misinformation, and improvements in risk communication. They state, “We already know that researchers are adept at communicating with other researchers but less skilled in reaching non-research audiences. Skilled spokespersons are needed. Generally, the public health community can learn much from business and social marketing, which tailor messages and target audience segments.” (p. 1609)

Anxiety and fear of disability and death from contagious diseases or natural disasters can be powerful motivators for individual behavior change up to a certain point. But tapping into that anxiety and fear through targeted public health messaging can backfire when it becomes too much for people to take in or becomes nagging, nanny-state background white noise.


“Mental Distress in the United States at the Beginning of the COVID-19 Pandemic,” by C. Holingue, et al, in the American Journal of Public Health, November 2020, vol 110:no. 11, pp. 1628-1634.

“Potential Impact of COVID-19 -Related Racial Discrimination on the Health of Asian Americans,” by J.A. Chen, et al, in the American Journal of Public Health, November 2020, vol 110:no. 11, pp. 1624-1627.

“Reimagining Public Health in the Aftermath of a Pandemic,” by R.C. Brownson, et al, in the American Journal of Public Health, November 2020, vol 110:no. 11, pp. 1605-1610.