Category: Public health

Homeless Feet Come Full Circle

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Josephine Ensign/ foot care at Cross-Over Clinic, Fall 1986, from Freedom House brochure.

“I did a lot of foot care at the clinic… Of course, it had its Biblical roots, but there was something about foot washing that most people found comforting and even pampering…I knew that having your feet cared for could somehow make you feel better all over…Almost all the homeless patients I saw had foot problems. They had to walk around town to get to different agencies, meal sites, and day-labor pools. They walked in the rain and the snow and the heat, usually in ill-fitting, secondhand shoes with dirty, holey socks, and carrying heavy backpacks.”~ from my book Catching Homelessness: A Nurses Story of Falling Through the Safety Net, pp 86-87.

In this excerpt, I was referring to homeless patients I cared for when I worked as a nurse practitioner at the CrossOver Clinic in my hometown of Richmond, Virginia in the mid to late 1980s—over thirty years ago. But I could be (and indeed, am now) writing about currently homeless people and foot care here in my adopted hometown of Seattle, Washington.

There is this brief part of a haibun (prose mixed with haiku) reflection I wrote after helping with a foot clinic at ROOTS Young Adult Shelter in the University District near where I work: “Tonight in the homeless shelter a 19-year-old man from Georgia says, ‘My momma always told me not to go barefoot and I didn’t listen. That’s why my feets so bad. And I have to walk everywhere on them now.’ He reaches down and gently rubs his brown gnarled feet soaking in a white plastic basin. His feet are darkly scarred and calloused: the feet of an old man.

walking barefoot/we find our way/though cruel paths scar”

(From Soul Stories: Voices from the Margins, in the haibun/chapter titled “Where the Homeless Go”).

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And there is this description of a foot care clinic I helped with at Mary’s Place, a downtown Seattle women and children’s homeless drop-in center: “The most delightful—and tender—foot clinic patient we had that morning was the petite three-year-old daughter of a young North African immigrant mother. The child pushed around a pink plastic toy shopping cart from the shelter’s playroom, and she wore a dress, bright striped tights, black Mary Janes, and a huge pink feather boa around her neck. She came and sat on a metal folding chair while one of the students washed her mother’s feet. The little girl wanted her own feet to be given the same attention, so her mother removed her shoes and tights. Baby toes! So cute!… I wanted to scoop her up and protect her from the traumas, the abuses of the world. But, of course, I knew I couldn’t do that. It made me sad to watch her toes curl up in delight as she splashed her feet in the basin of soapy water.”

(From Soul Stories: Voices from the Margins, in a chapter titled “Walk in My Shoes.”

IMG_0678And finally there is this King5 TV news report on the University of Washington School of Nursing foot clinic I helped with a few days ago (“UW Nursing Students Host Tent City Welcome Party” by Heather Graf, January 13, 2017). Rusty, the homeless resident of nearby Tent City 3 (currently on the UW campus), told the nursing student working with him that he had never felt so pampered. Small things go a long way. They always have and always will.

University Student Mental Health

Version 2In these uncertain and anxiety-provoking times, our universities have an increased responsibility to support student mental health and wellbeing. This is not about the issues of “spoiled and coddled” Gen Xers, helicopter parents, and the endless debates over the use of trigger warnings in higher education. This is about having a positive impact on not only our future workforce, but also our future leaders and change agents.

William Pang, a second-year student at McGill University in Montreal, wrote a moving NYT op-ed piece “The Season to Be Stressful” (December 19, 2016). He discusses his experience of learning to deal more effectively with overwhelming anxiety exacerbated by the highly competitive atmosphere of his university. He states, “I don’t think we should demonize an entire generation as reliant and narcissistic. We should instead celebrate a generation that is coming to realize the importance of initiating conversations about our mental health.” It is dismaying to read through the NYT comments to Pang’s op-ed piece with so many people basically telling him to buck up and become an adult.

The photo above is of me with the amazing UK nurse and PhD student Josephine NwaAmaka Bardi  with her social media campaign, “Raise Awareness of Mental Health in Higher Education” (#RAMHHE)  I met NwaAmaka Bardi this past September in Seville at the 5th Annual International Health Humanities Conference: Arts and Humanities for Improving Social Inclusion, Education and Health. She also works in the area of mental health cafes as an effective alternative community mental health service. London’s Dragon Cafe is a good example of a creative, welcoming, and supportive community cafe with a focus on mental health and wellbeing. It would be great to have a similar community cafe open to university students.

Universities UK is developing a mental health framework for universities to embed mental health and wellbeing across all university activities with the goals to decrease stigma and increase access to a variety of mental health and wellbeing services. (See: “New Programme to Address Mental Health and Wellbeing in Universities” December 2, 2017.) They point to the need of “getting universities to think about mental health and wellbeing across all their activities, from students and teaching, through to academics and support staff.” It doesn’t end with the provision of mental health and support services for students but needs to permeate the entire campus.

Doris Iarovici, M.D., a psychiatrist at Duke University Counseling and Psychological Services has written a book titled Mental Health Issues and the University Student (Baltimore: Johns Hopkins University Press, 2014). Although geared towards college mental health professionals, it includes useful information on the variety of mental health issues that our students face in universities—from anxiety, drug and alcohol problems, sexual assault, eating disorders, and relationship problems, to depression, suicide, and schizophrenia. She concludes by stating, “If we provide a range of services, including individual, group, and community programs, we will be in step with the goals of health care reform to focus on both prevention and optimizing outcomes.” p. 219

Commit to Mental Wellbeing

 

As we begin a new year, my wish is that we commit to mental health and wellbeing. This should start with our own individual mental wellbeing, but we need to use that as a base for supporting the mental wellbeing of our families and our communities. In the midst of so much turmoil, anxiety, bigotry, misogyny, and xenophobia in our country and our world, nurturing mental wellbeing is not a luxury—it is a necessity.

An essential ingredient for mental (and physical) health and overall wellbeing is social inclusion and a sense of belonging to a caring community. The adverse health effects of increasing population-based levels of social isolation and loneliness are now being highlighted. Dhrav Khuller, M.D. writes in “How Social Isolation is Killing Us” ( NYT December 22, 2016) that social isolation and loneliness, is linked in recent studies to a 29% increased risk of heart disease and a 32% increase in stroke.

Objective measures of social isolation include quantity and quality of social network ties, as well as living situation (living alone, whether housed or homeless). Loneliness is a person’s perception of social isolation and is, therefore, a subjective measure. Researchers point out that loneliness and social isolation are often not significantly correlated even though we commonly think of them as such. A recent large meta-analysis (a study of research studies) that included 70 independent prospective (following people longitudinally) studies representing 3,407, 134 participants, revealed a significant effect of social isolation—whether measured objectively or subjectively— on mortality. The researchers for this study also found that the largest detrimental effects of social isolation were for middle-aged adults as opposed to older adults. They call for social isolation and loneliness to be added to lists of public health concerns. (See: “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review” by Julianne Holt-Lunstad, et al. in Perspectives on Psychological Science, Vol 10, issue 2, March 11, 2015.)

In the U.S. we are good at doing yet more research documenting the adverse health effects of social isolation and loneliness; we are not so good at finding constructive and sustainable ways to intervene. Many industrialized countries, including the U.K., Australia, New Zealand, Spain, and Canada are way ahead of us in terms of implementing cost-effective, community-based interventions. (See: “Researchers Confront an Epidemic of Loneliness” by Katie Hafner, NYT September 5, 2016.) In the U.K. there is the Campaign to End Loneliness. In New Zealand there is the public mental health campaign that I love: the All Right? campaign implemented in the aftermath of the Christchurch earthquakes. And addressing gendered issues, there is the Men’s Sheds movement that began in Australia and has since spread to the U.K., Ireland, Canada, and New Zealand. Another lovely and creative community-based solution I learned about this past year is the Art Hive (La Ruche d’Art) in Montreal, as well as in many other communities, including in Spain. My other wish for 2017 is that we learn from these sorts of programs and find ways to implement them in our own communities.

** A note on my (intentional) spelling of wellbeing as one un-hyphenated word: I find it both fascinating and telling that all English-speaking countries except the U.S. have moved to the use of “wellbeing” instead of the Americanized “well-being.”

Evicted

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“In languages all over the world, the word for ‘home’ encompasses not just shelter but warmth, safety, family—the womb.” ~Matthew Desmond

Part of my Summer Social Justice Reading Challenge included reading Matthew Desmond’s powerful nonfiction book Evicted: Poverty and Profit in the American City (New York: Crown Publishers, 2016). Although I finished reading the book a month or so ago, I’ve been letting my thoughts about it percolate before writing a review.

First, it is a formidable book, with the hardcover edition being 341 pages with an additional 62 pages for a detailed “Notes” section. Since the author is a Harvard University professor and Evicted is based on his PhD dissertation research, the scholarly weightiness of the book is not surprising. As Desmond points out, there has been a dearth of research on the practice, policies, and consequences of eviction on individuals, families, and groups in the United States. Through his research and policy work, he seeks to address this issue. He has established the Just Shelter website to highlight additional stories of evictions around the country and to direct people to ways of helping at the local and national levels. For that I admire him.

In an effort to tell the stories of people he studied and lived amongst (in order to study them), Desmond uses a third-person detached narrative approach similar to the one used by Katherine Boo in Behind the Beautiful Forevers: Life, Death, and Hope in a Mumbai Undercity (New York: Random House, 2012). In the “Notes” section he acknowledges that he declined to write in the more current first-person ethnographic narration, a “…postmodern turn in anthropology, which focused attention on the politics and biases of the author.” He goes on to invoke “classic” policy-relevant ethnographic books, such as Elliott Liebow’s Tally’s Corner: A Study of Negro Streetcorner Men (New York: Little, Brown &Company, 1967), in which he claims the authors “are hardly on the page.” (p. 405) This is a strange statement, since Tally’s Corner is written in first-person, despite it also being written from Liebow’s dissertation. 

Evicted reads more like a novel (Sinclair’s The Jungle comes to mind) than a heavy-duty social policy book. But as a reader, I was distracted by the frequent use of derogatory descriptors of people (moon-faced, redneck, etc.) and the fact that I could easily tell the places in the story where the not so behind the scenes author would play the role of the Great White (male) hope and bail people out of difficult spots. In the “Epilogue,” Desmond acknowledges both of these issues, but not in particularly convincing or reassuring ways. For instance, he mentions that people sometimes call him on the fact that he includes not so savory details about “poor people” and he replies that it doesn’t help anyone to try to gloss over realities—and that the tendency of kind-hearted liberals to portray poor people as saints is belittling and disrespectful. I agree, but there’s no need to describe people in a pejorative way.

The strongest part of Evicted comes in the “Epilogue: Home and Hope.” It is here that Desmond does an excellent job of highlighting the negative health effects of eviction on people, including the higher rates of depression and suicide among recently evicted people. And he has these things to say about the role of home for all of us: “The home is the center of life. It is a refuge from the grind of work, the pressure of school, and the menace of the streets.(…) The home is the wellspring of personhood. It is where our identity takes root and blossoms (…) When we try to understand ourselves, we often begin by considering the kind of home in which we were raised. (…) America is supposed to be a place where you can better yourself, your family, and your community. But this is only possible if you have a stable home. ” (pp. 293-4) Yes, housing is health care and yes, everyone deserves a safe and stable home.

Who Will Tell the Story?

DSC00528“My hometown of Richmond, Virginia is a city anchored to its past by bronze and marble Confederate shrines of memory, by an undying devotion to the cult of the Lost Cause. I was born and raised in the furrowed, relic-strewn Civil War battle fields on the city’s tattered eastern edge. A captive of its public schools, I was taught official Virginia history from textbooks approved by the First Families of Virginia. But I came to understand the shadowed history of my state by caring for its outcasts.

These lessons began while I was in nursing school. The modern hospital of the Medical College of Virginia curled around the former White House of the Confederacy like a lover. My clinical rotations were nearby in the crumbling brick former colored-only hospital, which then housed indigent and homeless patients, as well as prisoners. Most of these patients were black, so I called it the almost-colored-only hospital. The prisoners, shackled to their beds and accompanied by brown-clad guards, were from the State Penitentiary, located across town. One of my patients was a death-row inmate. When I spoon-fed him his medications, I was simultaneously afraid for my own safety and ashamed of being an accomplice to murder. I knew I was nursing him back to health only to return him to be killed by the state. I wanted to talk to him, ask about his family, about his life in and outside of prison, but the stone-faced armed guard loomed over me. I knew from experience not to discuss my ambivalent feelings with my  nursing instructor. She considered these to be inappropriate topics. I wanted to finish nursing school as fast as I could, so I kept silent.” (pp. 57-58, from my forthcoming medical memoir Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, Berkeley: She Writes Press, August 9, 2016.)

I was reminded of this passage from my book this past week as I read the NYT article “Who Will Tell the Story of Slavery?” (Lorne Manly, June 29, 2016). Manly describes the (sadly to me, oh so familiar) political dueling going on in my hometown of Richmond over the location of the National Slavery Museum. Former Virginia governor L. Douglas Wilder (our nation’s first elected African-American governor, who was more recently also the Mayor of Richmond (2005-9), wants to establish the museum in the former First African Church (now owned by the Medical College of Virginia/Virginia Commonwealth University and located next to the main hospital I describe above). But the current powers-that-be, including the current Mayor Dwight C. Jones, want to locate such a museum at the historic site of the notorious Lumpkin’s Jail, a former slave prison, dubbed ‘The Devil’s Half-acre,’ the site of which was recently located and excavated. (see the Smithsonian Magazine article “Digging Up the Past at a Richmond Jail,” by Abigail Tucker, March 2009.)

The Richmond indie bookstore, Fountain Bookstore, where I’ll be doing a Catching Homelessness author event (Tuesday October 11, 2016 at 6:30 p.m.), is located a few blocks from the site of the former slave prison in the Shockoe Bottom area of Richmond. Perhaps I’ll include a reading of this section of my book. And not keep silent anymore…

The Pebble in My Shoe

IMG_1805“I write about what most fascinates me right now,” said John McPhee, by way of Robert Michael Pyle, both amazing trail-blazers, or perhaps trackers, of that strange beast that is creative nonfiction. McPhee has written books on subjects such as oranges, the island of his Scottish ancestors, family doctors, college basketball players, the shad as Founding Father fish, and the history of the birch-bark canoe (my personal favorite). Pyle, who is also a biologist, a lepidopterist (butterfly expert), and founder of the Xerces Society for invertebrate ecology (saving our butterflies and bees), has written about butterflies and trees and Big Foot and life. My favorite contemporary female trackers of, or perhaps more fittingly, expanders of the boundaries of creative nonfiction are Terry Tempest Williams and Rebecca Solnit. When Women Were Birds: Fifty-Four Variations on Voice (New York: Farrar, Straus, and Giroux, 2012) by Williams and A Book of Migrations (London: Verso, 211) by Solnit remain two of my all-time favorite books.

Each of these great writers of creative nonfiction sweep us along on explorations of their own current fascinations, obsessions, questions–the pebbles in their shoes, as one of my writing mentors, Stephanie Kallos puts it so aptly. What is it that you carry with you, that at each step insistently reminds you of its existence? The pebble of obsession doesn’t have to be a large rock-sized, inscribed with the muse-whisperer one as shown in the photo here (my historian son made that for me a few years ago–coolest present ever!). But is should be of sufficient significance to be likely to matter to other people besides yourself.

My pebble, my obsession, is and has been for many decades now, the wicked problem of homelessness. I call it a wicked problem, not so much because it is evil or immoral (which I happen to think it is), but because it is so vastly complex a problem that it defies easy solution. Hence, all the well-meaning but expensive and time-consuming ’10 Year Plans to End Homelessness’ implemented (much more than 10 years ago now) in so many U.S. cities, and that largely failed. The term ‘wicked problem’ was coined by two UC Berkeley professors of urban planning, Horst W.J. Rittel and Melvin M. Webber, to describe difficult social policy issues such as poverty, crime, and homelessness. (Read their still surprisingly relevant journal article “Dilemmas in a General Theory of Planning” Policy Sciences (4), 1973, pp. 155-169.)

Rittel and Webber write, “As distinguished from problems in the natural sciences, which are definable and separable and may have solutions that are findable, the problems of governmental planning–and especially those of social or policy planning–are ill-defined; and they rely upon elusive political judgment for resolution. (Not ‘solution.’ Social problems are never solved. At best they are only re-solved–over and over again.)” (p. 160)

But who would we be, as individuals, as a society, if we didn’t even try? That is the core question, the obsession, the pebble in my shoe.

Place-based Health and Well-being

P1010527If you have to be poor and homeless, don’t be poor and homeless for long. If you have to be poor and homeless, learn how to fill out all of those food, health, and housing support forms before you become poor and homeless. If you have to be poor and homeless, chose carefully which city to be poor and homeless in.

That’s my take-home message from this past week’s top public health news stories, as well as from my recent trips to the underbellies of both Los Angeles and Cleveland. If I somehow were to become poor and homeless again, I would want to be poor and homeless in my adopted hometown of Seattle. Seattle has its problems, but as a major U.S. city, we somehow manage to do many things right.

First, the buzz created among health policy-minded people and even laypersons from a recent article in JAMA reporting research results indicating that individual health behaviors like smoking and lack of exercise among poor people in the U.S. are the most important correlates of their diminished life expectancy compared with higher income people.

The April 10, 2016 JAMA article, “The Association Between Income and Life Expectancy in the United States, 2001-2014” by Stanford University economist Raj Chetty and associates, used an impressively large dataset of 1.4 billion deidentified tax records; Social Security Administration death records; rates of self-reported smoking, obesity, and exercise from the CDC’s Behavioral Risk Factor Surveillance Survey; Medicaid claims data; national/regional data on major urban ‘commuting zones,’ urban area per capita government spending, fraction of the local population that are college graduates, average housing price, and level of socio-economic neighborhood segregation. The researchers claim to have found weak to no correlations between life expectancy and many of the classic social determinants of health, while finding a strong correlation between individual health behaviors (especially smoking) of the poor and life expectancy. Although, in digging into this quite dense article, it becomes apparent that being poor in some urban areas and regions of our country is much worse than in others. The 10 states with the lowest life expectancy for the poorest people form a belt across our country: Michigan, Ohio, Indiana, Kentucky, Tennessee, Arkansas, Oklahoma, and Kansas. Their data indicate that it is much better to be poor if you live in urban areas of California, New York, or Vermont. And they report that the strongest protective factors for people people include the percentage of recent immigrants (long known to be healthier when they first arrive to the U.S. but we somehow beat the healthy living out of them), higher local government expenditures per capita, and the fraction of the local population with college degrees.

Life expectancy was not shown to vary by access to most health care, but it was positively associated with level of preventive care. The level of residential segregation by socio-economic level mainly negatively impacted the life expectancy of people in the top income bracket. That finding should be getting much greater emphasis in the press: to all the richie-rich people who live in gated communities, believe in trickle-down economics, and do everything they can to avoid (or to invest in) impoverished areas near where they live, are paying the price by shortening their own life expectancies–and the life expectancies of their family members.

But it is important to read and digest the JAMA editorial in the same issue, “The Good Life: Working Together to Improve Population Health and Well-Being” by Steven H. Woolf and Jason Q. Parnell. As they astutely point out, the Chetty study has several major flaws (that, not surprisingly, were largely unnoticed and ignored by mainstream media). First, the researchers of the Chetty study used life expectancy at age 40 years instead of the more usual and robust life expectancy at birth. They also excluded people with no reportable income on federal taxes (thus, most all people experiencing homelessness), and they excluded people who live in rural or urban/commuting areas of less than 590,000 persons. Woolf and Parnell also point out that the Chetty, et al research report–and the way the researchers structured the study–“ignores both upstream determinants of individual health behaviors and the poor measurement of other pathways.”

Woolf (a physician) and Parnell go one to claim “that everyone seeks a good life,” of which health is an essential component, “but a good life also involves productive work, emotional and spiritual well-being, supportive social relationships, and a clean and safe environment. (…)  Inequity, a term that can engender political controversy, is giving way to the language of opportunity and the more positive, bipartisan message that everyone deserves a fair chance at the American dream. Education is seen as an answer, not only for better health but also to combat poverty, crime, racism, the loss of blue-collar jobs, and many other social challenges. Many sectors are targeting early childhood, a pivotal age to shift life trajectories, giving children tools for success in education and careers and breaking the cycle of poverty while also preventing illness, behavioral disorders, substance abuse, and violent crime.” Woolf and Parnell exhort their (mainly) physician readers to use their “gravitas” to advocate for local improvements in the social determinants of health. They (annoyingly) leave out the essential role of nurses and all other members of the health care team. But, okay, it is JAMA after all.

Chetty was a researcher on an earlier study on variations in upward mobility of children growing up in different urban areas. In a July 22, 2013 NYT article, “In Climbing Income Ladder-Location Matters,” David Leonhardt used the study’s findings to compare children’s income mobility if they lived in Seattle versus Atlanta (at the time, the two cities had similar median incomes). Leonhardt writes, “The gaps can be stark. On average, fairly poor children in Seattle — those who grew up in the 25th percentile of the national income distribution — do as well financially when they grow up as middle-class children — those who grew up at the 50th percentile — from Atlanta.” The researchers of this study outlined four main factors which were linked with upward mobility for children growing up in poverty: 1) living in less socio-economically segregated neighborhoods, 2) living in a two-parent household, 3) access to better public elementary and high schools, and 4) higher levels of civic engagement, including in religious and community groups.

I leave you with some uplifting, positive, encouraging (and yes, nurse-centric) news related to this topic. The cost-effective, evidence-based Nurse-Family Partnership program is again in the news. I’ve written about this amazing program before (see “More Babies! Nurse-Family Partnership” January 29, 2012). The New Yorker, in a March 1, 2016 post titled “One of the Stranger Jobs in Texas,” links to a recent “The New Yorker Presents” film by Dawn Porter titled “Lone Star Nurse.” The film follows the work of former teen mother turned public health/ Nurse-Family Partnership nurse Nicole Schroeder as she visits “her girls” in Port Arthur, Texas. I say we need many more Nurse-Family Partnership nurses like Schroeder and much fewer high-end, elective surgery hospital nurses. 

 

 

 

Down and Out in L.A.

IMG_6660Los Angeles, what with its population of over 40,000 people who are homeless and with the nation’s largest concentration of chronic homelessness, is an interesting (and distressing) city to live in. Or to visit. Unless you limit yourself to staying within the sanitized realms of either Disneyland or La-la Hollywood-land.

I was in downtown L.A. for four days recently to attend a national writers conference, but also to see if I could get some sort of context to the problem of homelessness in this giant car-centric sprawl of city–a city like no other. Not being from Los Angeles, it is difficult to decipher what is real and what is just another stage set. Where else would Don Draper (Jon Hamm) of Mad Men saunter through a writers conference and serve as guest editor for a literary magazine’s special edition on advertising writing? (Yes, this really happened, and yes, he is even more handsome in person.) And where else would car crash scenes complete with dazed people staggering around with bloody heads happen right outside one’s hotel? (Yes, this really happened as I was trying to walk from my hotel to an art museum–I almost stepped in to help out with the human carnage before I realized it was actually a stage set.)

On my first day in L.A. I noticed these curious ‘private property’ bronze plaques all over the sidewalks. They basically say, “Move along all you tempest-tossed tired and homeless. Move along. You don’t belong here.”

 

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And these homeless- deterring benches at bus stops. Although–look closely–this one comes with its own food pantry. A man pushing a shopping cart nearby who stopped to inspect these cans told me that people drop off food for the homeless and that cans of vegetables don’t get picked up very quickly. He happens to like vegetables and took all the cans.IMG_6614 I had arranged to do a site visit at the Homeless Health Care Los Angeles‘ Center for Harm Reduction in the heart of Skid Row in downtown Los Angeles. The director, Mark Casanova, graciously gave me a tour of the facility and talked with me about their work. I’ve visited the Insite safe injection center in Vancouver, BC, so I thought I knew what to expect. Insite is North America’s first and only legally-sanctioned safe injection site and syringe (‘needle’) exchange, although several cities in the U.S.–including my hometown of Seattle–are considering opening one to help address the current heroin epidemic. (See Seattle Times article, “Heroin, cocaine users in Seattle may get country’s first safe-use site,’ by Daniel Beekman, April 4, 2016 for more information.)

 

IMG_6656Visiting the L.A. Center for Harm Reduction with Casanova while it was in operation was an eye-opening experience for me even though I have long been ‘sold’ on the concept and practice of harm reduction: treat people in a non-judgemental and respectful manner and work beside them to find ways to minimize harm to themselves and to other people. From a public health perspective we know that this approach works to save lives and protect everyone’s health.

The eye-opening part was mainly the sheer scale of the need for services such as those provided by the Center for Harm Reduction. They have a syringe exchange that must be one of the largest in North America in terms of quantity of ‘needles’ exchanged. They serve an average of 145 people per day. They also have an on-site wound care clinic and soon will add an on-site drug treatment program. And they have a very successful overdose prevention program where they train clients in the proper use of Naloxone (also known as ‘Narcan’), a non-addicting prescription drug that temporarily blocks and reverses the effects of opioids (prescription opioid pain medications, as well as heroin). Naloxone is available in either an injectable form or a nasal spray. So far, the Center for Harm Reduction, through their own on-site staff and through their street-based program, have prevented over 400 overdose deaths. Here is a photo of the current map showing their overdose reversals. Remember, one of these lives saved could have been your daughter, son, friend, etc.

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Notice the sign in the photo below, asking clients to report police harassment, especially in terms of confiscation of either their syringes or Naloxone/Narcan. Los Angeles has a problem with criminalizing homelessness. Not just with bizarre ‘Private Property’ bronze sidewalk signs and with arrests for and confiscation of drug paraphernalia,  but also with a limitation on the ‘size’ of homeless rough sleepers’ personal belongings. The day before I toured the Center for Harm Reduction, L.A. City Council had just passed a resolution limiting the rough sleepers to whatever personal items (including tents, blankets, sleeping bags, clothing, and food) to what can fit into a 60 gallon container. They say the rest will be confiscated and destroyed. IMG_6618

On a much happier, up with people note, I was impressed by the fact that the Center for Harm Reduction has a companion Healing, Arts and Wellness program next door where they provide space for arts and writing programs, karaoke, a lending library, yoga, acupuncture and cranio-sacral treatment, Zumba fitness classes, and life-skills training. Here are some of my photographs of this very health-promoting space and artwork by participants. Thank you Mark Casanova and all the wonderful staff of Homeless Health Care Los Angeles for all the important work you do.

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Home is…

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Community blue tarp tapestry/ Soul Stories project. Photo credit: Josephine Ensign, 2016

Home-less-ness. Un-homed. Being without “a fixed, regular, and adequate nighttime residence.” 

Where did you sleep last night? Was it in a warm, dry, and safe place?

If you were asked to summarize the essential meaning of home to you in one word or in a brief phrase, what would it be?

As human beings we have to have rest–and sleep–in order to not only thrive, but survive. Sleep is the ultimate letting go and trusting that we will not be disturbed, that we will be okay until we awaken. The trust we have through undisturbed sleep generates hope.

What does it mean to be homeless when home was never a safe place? In such cases, it is not possible for young people to ‘runaway’ from home; they can only run towards home.

Housing, ‘home-ing,’ is a form of health care. The people at the National Health Care for the Homeless Council summarize this connection with the following:

  • “Poor health (illness, injury and/or disability) can cause homelessness when people have insufficient income to afford housing. This may be the result of being unable to work or becoming bankrupted by medical bills.
  • Living on the street or in homeless shelters exacerbates existing health problems and causes new ones. Chronic diseases, such as hypertension, asthma, diabetes, mental health problems and other ongoing conditions, are difficult to manage under stressful circumstances and may worsen. Acute problems such as infections, injuries, and pneumonia are difficult to heal when there is no place to rest and recuperate.
  • Living on the street or in shelters also brings the risk of communicable disease (such as STDs or TB) and violence (physical, sexual, and mental) because of crowded living conditions and the lack of privacy or security. Medications to manage health conditions are often stolen, lost, or compromised due to rain, heat, or other factors.”

For those of us fortunate enough to be currently housed and ‘homed’ in a ‘fixed, regular, and adequate [and safe] nighttime residence’–for those of us who are able to have adequate, safe, undisturbed, restorative-of-hope sleep–let us all remember (or imagine if we’ve never experienced it) what it is like for people who go without these essential human needs. And let us use our rest, our trust, our hope to fix this ‘wicked problem’ of homelessness.

___________

Notes:

  • The blue tarp tapestry shown in this photo is from my Soul Stories project, and specifically from the ‘Way Out; Way Home’ installation art (in progress). I ask people who view/participate in this installation to contemplate the meaning of home for them. They then are invited to write or draw the word or phase on a strip of paper, the strips are then added to the blue trap tapestry wallhanging weaving.
  • The connection between sleep and trust and hope was inspired by my current research for the Soul Stories project on the role of narrative in health and healing in the context of homeless. Specifically, this concept comes from anthropologist Hirokazu Miyazaki’s essay/chapter, “Hope in the Gift–Hope in Sleep” in Anthropology and Philosophy: Dialogues in Trust and Hope, edited by Sune Liisberg, Esther Oluffa Pedersen, and Anne Line Dalsgard, (New York: Berghahn Books, 2015).
  • I want to acknowledge the generous support of the University of Washington Simpson Center for the Humanities and the National Endowment for the Humanities for funding support for my Soul Stories public scholarship digital humanities project.

Homelessness Visible: A Photo Essay

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House not for sale. Photo credit: Josephine Ensign, 2015.

The story of homelessness, visible, in my hometown of Seattle, told through photographs and a few accompanying words.

Here, on my daily walk in my neighborhood. Derelict housing, seemingly deserted, unless you know what to look for. Scattered clothing. A tattered backpack.

And this, a most unusual lawn ornament. The 700 metric ton glacial erratic ‘Lone Rock’ now known as the ‘Wedgewood Erratic.’ According to the City of Seattle, it is illegal to climb this rock. But I don’t think it is illegal to camp near it. Hence, this recent living room armchair. And a tent (removed during the day). In the background (the boxy building to the far right), note the supremely ugly new construction ‘single family home’ on the market for a mere $1.4 million dollars. In one of Seattle’s ‘working class’ neighborhoods.

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‘Lone Rock’ and Lone Chair, Seattle. Photo credit: Josephine Ensign, 2016

Yesterday, during a fierce windstorm, there was this homeless encampment in the doorway of an empty store at a busy intersection near my home. A man and a woman were working hard to keep their belongings from blowing away. Note the new (upscale) apartment buildings and the large crane in the hole that will be the new Roosevelt Light Rail Station.

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Homeless in a Seattle Doorway. Photo credit: Josephine Ensign, 2016

And then there are the numerous unofficial ‘tent cities’ and other temporary shelters that all combine to make homelessness in Seattle very, very visible. In follow-up posts I’ll critique the current ‘state of emergency’ of homelessness declared by Seattle Mayor Ed Murray four months ago.

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Man asleep in chair by Seattle city park. Photo credit: Josephine Ensign, 2015
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Homeless encampment on Seattle sidewalk. Photo credit: Josephine Ensign, 2015