Framing Homelessness

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Rough sleeping in the U-District. Photo credit: Josephine Ensign/2016

Homelessness is in the news almost every day here in my hometown of Seattle. Unless you happen to live in a gated community and never go outside your protected home, there is scarcely a city block you walk without distinct signs of people living rough outside or in cars or RVs. It is no surprise then that our One Night Count of homelessness by the Seattle/King County Coalition on Homelessness last week found 4,505 people homeless/without shelter, a 19% increase from the One Night Count in January 2015. And this is despite the fact that the One Night Count volunteers (including a group of our UW Seattle nursing students) being unable to enter and count homeless people in ‘The Jungle,’ a longtime homeless encampment area in an I-5 greenbelt area of Seattle–and the location of our impressive Depression Era Hooverville. There had been a mass shooting in The Jungle the night before, resulting in the death of two homeless people and the hospitalization of three others.

Just two months ago, in November 2015, Seattle Mayor Ed Murray declared a state of emergency over homelessness, saying this in the official notice: “The City of Seattle, like many other cities across the country, is facing a homelessness crisis. The region’s current needs outweigh shelter capacity, leaving too many seniors, families and individuals sleeping on the street. More than 45 individuals have died while homeless on Seattle streets in 2015 alone.” His declaration of a state of emergency supposedly helps “deploy critical resources more quickly to those in need.”

Suddenly it begins to feel like we’ve entered a 1980s time-warp, with so many people weighing in with competing viewpoints, priorities, and proposed ‘fixes’ for our homelessness problem. I, of course, could add my own voice to the rising cacophony surrounding this latest round of the homelessness crisis. Instead, I offer these words of wisdom and perspective from some of my favorite deep and critical thinkers on the topic of the ‘first wave’ of modern homelessness in the 1980s:

  • “The scandal of homelessness looked as though it could harness a new politics of compassion and shame–compassion for the plight of the dispossessed and shame at the inhumanity of national and local policies toward them. Homelessness, in sum, had political appeal.” pp 132-133, in Donald Schon and Martin Rein’s excellent book, Frame Reflection: Toward the Resolution of Intractable Policy Controversies. Basic Books, 1994.
  • Put plainly, the opposite of homelessness is not shelter, but home. Understood culturally, ‘home’ must entail some claim to inclusion. The principled question underlying homelessness policy, then, is not, what does charity demand? but rather, what does solidarity require? And so it no longer suffices (if it ever did) to ask what it is about the homeless poor that accounts for their dispossession. One must also ask what it is about ‘the rest of us’ that has learned to ignore, then tolerate, only to grow weary of, and now seeks to banish from sight the ugly evidence of a social order gone badly awry.” p. 214 of Kim Hopper’s now classic book, Reckoning With Homelessness. Cornell UP, 2003.

Nurse Practitioners: An American Invention

Josephine Ensign (Bowdler then) at Cross-Over Clinic. From The Bon Secours Courier/St. Mary's Hospital June 1987.
Josephine Ensign (Bowdler then) at Cross-Over Clinic. From The Bon Secours Courier/St. Mary’s Hospital June 1987.

In celebration of the 50th Anniversary of the establishment of the role of nurse practitioners, I want to share an excerpt from my forthcoming book, Catching Homelessness (She Writes Press, August 9, 2016 publication date). Young people contemplating careers in nursing often ask me if I am happy I ‘became’ a nurse practitioner back in the early 1980s. My answer is always a qualified and honest, “yes, but it has not always been an easy role to work within–mainly due to the rigid medical hierarchy.” Yet of all the health care roles in existence today, if I had the chance to do it all again, I would–without any hesitation–become a nurse practitioner. We are a tough breed, willing to work on the medical margins, and we are here to stay.

Here is the excerpt from my book, in a chapter titled “Confederate Chess”:

“Nurse practitioners are an American invention, and specifically they are an invention of the American West. The nurse practitioner role was started by a Colorado nurse in the mid-1960s during President Johnson’s War on Poverty, when Medicaid and Medicare were established to extend health care to the poor and elderly. Even before this expansion of health care, there was a shortage of primary care physicians. At the same time there were many seasoned, capable nurses who were already providing basic health care to poor and underserved populations. A nurse-physician team developed the nurse practitioner role, adding additional course work and clinical training for nurses. With this, states began allowing nurse practitioners to diagnose and treat patients, including prescribing medications for common health problems.

Not surprisingly, the emergence of the nurse practitioner role met with the most resistance in states with higher physician to population ratios, and in states with more powerful and politically conservative physician lobbying groups. The nurse practitioner role was protested both within the medical and the nursing establishments. Physicians didn’t want nurses taking jobs from them, and nurses didn’t want other nurses having a more direct treatment role—more power and prestige—than they did. But the role caught on and spread throughout the country. Nurse practitioners didn’t get firmly established in Virginia until the mid-1980s when I completed my training.

Why nursing? I often asked myself, and people continued to ask me even after I became a nurse practitioner. It was as if any sane, intelligent, modern woman could not want to be a nurse. I had stumbled into nursing while a master’s student at Harvard University, studying medical ethics and taking courses in the School of Public Health. I was gravitating toward a public health degree, but was advised by one of my professors to go to either medical or nursing school first in order to get direct health care experience. I didn’t like the approach of mainline medicine, but also had a negative stereotype of nursing. The only nurses I knew worked in my rural family doctor’s office. They were stout, dull-witted, and wore silly starched white caps, overly-tight white polyester uniforms, and white support stockings that swished as their fleshy thighs rubbed together. But in graduate school at Harvard I sprained my ankle, and went to the student health clinic. I was seen by a kind and competent provider who spent time explaining what I should do to help my ankle recover. I was impressed and thought she was the best doctor I’d ever seen. Then she told me she was a nurse practitioner and explained what that was. My negative stereotype of nurses was challenged.”

In Boom or Bust: Standing in Solidarity

Version 2Seattle is a boom or bust town. Boom times: The timber/logging industry of its early days. The jumping off point for people drawn to the Klondike Gold Rush in the Yukon. The Boeing surge during WWII. And, since the 1990s and accelerating over the past four or so years, the technology boom with Microsoft and now Amazon leading the way. The bust times in between, including the Boeing Bust of the early 1970s, spurring the famous billboard near the Sea-Tac airport reading, “Will the last person leaving Seattle turn out the lights.”

Since its early days Seattle has been a socially progressive place. King County, which includes the City of Seattle, was formed by the Oregon Territorial legislature in 1852. From the beginning, the King County Commissioners were responsible for such things as constructing and maintaining public buildings, collecting taxes, and supporting ‘indigents, paupers, ill, insane, and homeless people living in the county.’ Today, while there is a robust safety net in our community, it is not strong enough. Homelessness in the Seattle area is increasing, with tent cities sprouting up wherever they can, including along the original Skid Road (Yesler Way) in the shadows of Harborview Medical Center as shown in this photo taken late last fall.

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Homeless encampment near Harborview in downtown Seattle. Photo credit: Josephine Ensign/2014.

As the bumperstickers at the beginning of this post proclaim: Healthcare is a human right; housing is health care. They were produced by the National Health Care for the Homeless Council, of which I am a member. The Council recently issued this timely and hopefully provocative-in-a-good way justice statement entitled Standing in Solidarity: In Support of the Movement for Social Justice. It reads:

“The National Health Care for the Homeless Council recognizes that the significant health disparities associated with homelessness are part of a much larger pattern of injustice in the United States. Poverty and structural racism too often are perpetuated and upheld by poor public policies and narrow social opinion, leaving millions of men, women, children, and youth unable to achieve their potential for well-being and success. We stand in solidarity with the growing social movements and supportive jurisdictions that seek to correct underlying social and economic inequities. We understand that our work as health care providers is part of a much larger struggle to attain human and civil rights, to include the rights to housing and health care.

Numerous recent events involving police violence and community responses have reawakened the national consciousness around the failures of our public systems. Rather than focusing on sensationalized moments and ignoring the daily traumatic violence experienced by those living in poverty, we ask that media outlets instead continue to highlight the root causes of these incidents—social disinvestment, racism, and the ongoing, profound inequities in opportunities, as evidenced by the following:

Public policies created current conditions, but the policy-making process can also promote a robust and inclusive society. We call for measures to establish for everyone in our country the rights to health care, housing, and livable incomes. We also call for those in the Health Care for the Homeless community—and others allied with this cause—to continue our work toward public policies that achieve social justice.”

Apolitical Intellectuals Teaching Health Policy?

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Collection of health politics and policy teaching materials on my desk at work.

Is it desirable, indeed, is it even possible to teach health policy without also teaching politics? What would it mean to be an apolitical intellectual teaching health policy to future health care professional students?

As a lyrical definition of ‘apolitical intellectual,’ here are the first stanzas of  a poem by the Guatemalan poet and revolutionary Otto Renee Castillo, translated by Francisco X Alarcón. The full text of poem is available here and a powerful ‘spoken word’ version using a slightly different translation is available here .

APOLITICAL INTELLECTUALS
One day
the apolitical
intellectuals
of my country
will be interrogated
by the humblest
of our people.

They will be asked
what they did
when their country was slowly
dying out,
like a sweet campfire,
small and abandoned.

Basically, as I would interpret it, apolitical intellectuals have a lot of book knowledge and an escapist ‘life of the mind’ sort of attitude, but no practical, down-to-earth working knowledge of power and privilege. I do not aspire to be an apolitical intellectual teaching health policy to future health care professionals.

But I do aspire to be balanced and fair in my approach to teaching health policy. That is one of my prime duties as a teacher. Since I lean towards the Progressive side of politics, especially as politics relates to health and social justice issues, I bring that lens to the teaching of health policy. Many of my health policy current events articles come from the NYT or the (non-partisan but still left-leaning) Kaiser Family Foundation, and many of my videos (as in the photo above) are produced by PBS. I have tried, with limited success, to bring in more Conservative-leaning course readings, videos, and guest speakers. I find that it is difficult to find credible, intelligent, research/data-backed Conservative sources.

If I were teaching health policy at a university in close proximity to Washington, DC, I would probably have better luck finding good Conservative-leaning guest speakers. For instance, the DC-based Heritage Foundation has much different politics from my own, but they are credible, intelligent, and thought-provoking. They currently have an interesting section on their website: “Stop Obamacare Now.”

Since I am about to go on a year-long sabbatical in order to focus on my Skid Road and Soul Stories research and writing projects, I get to put away my health policy teaching materials. Both projects are public scholarship focusing on health policy for homeless and marginalized populations. As such, they are taking me even further away from being an apolitical intellectual. I consider that a good thing, but I do wonder how it will affect my teaching of health policy once I return to the university.

New Orleans Bottle Djinn: Stealing Stories?

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New Orleans, Louisiana, French Quarter, May 2014. Part II.

How do people deal with and bear witness to trauma? How have the people of New Orleans collectively chosen to remember Hurricane Katrina?

As I wrote in my previous post “Collective Sites of Memory: New Orleans” (3-28-15), those were some of the questions I was pondering last May as I returned to New Orleans for the first time since Katrina. Having visited–and been disappointed by–the Katrina National Memorial Park in New Orleans, I decided to visit the permanent exhibit “Living with hurricanes: Katrina and beyond” located at the Presbytere Louisiana State Museum in the heart of the French Quarter.

Greeting me in a wildly disorienting way as I entered the main door of the museum building, was the art installation shown in the photos above. Hundreds of ‘floating’ glass bottles with messages curled up inside them, all hanging from the ceiling. Interspersed among the bottles are ghostly blue glass hands, reaching down–or wait! are they reaching up out of the deluge, the person attached to the hand drowning and asking to be rescued? I stood in the middle of the foyer gazing up at the display as the lights surrounding them gyrated from blue to purple to pink to red and back again–trying to figure out which way was up and which was down in this display. Who are the rescuers and the rescued? It felt as if I was simultaneously the rescuer and the rescued—floating in the midst of the primordial sea of life.

The brightly-colored bottle display also reminded me of that uniquely Southern folk art of bottle trees, shown here in a classic black and white photograph by the venerable writer (and WPA photographer) Eudora Welty. The folk belief is that placing bottles on trees away from the main entrance to the house will help to capture and repel ‘bottle genies’/djinn/or ‘haints’—spirits that haunt a place. The bottle trees are thought to protect people and their homes from calamities. Maybe all the pent-up bottle djinn in the New Orleans area had been released by Katrina.

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House with bottle-trees/Simpson County/1941/ Eudora Welty. From Eudora Welty Photographs, University Press of Mississippi, Jackson, 1989.

I have the habit of always looking at a piece of art before reading the accompanying information placard, which often ‘explains’ or interprets what the artist is aiming for. I like to experience the art before being told what it is I am looking at (or hearing), and how it should make me feel. But after several minutes of standing in the museum’s foyer gazing at the bottles and light show, I read the placard below:

IMG_2173The “Message of Remembrances”  (notice the singular ‘message’ in the title) was next to the official entrance to the Katrina exhibit, with a large sign stating “Resilience.” Oh no,  here we go with the official scripted, up-with-people resilience narrative, I thought, as I entered the darkened room.

‘Resilience’ is an oft-used and ill-used term. ‘Bad things happen to good people, but what doesn’t break you makes you stronger.’ I am highly suspicious of resilience and any context within which resilience is mentioned. I put it in the same category with all those ‘redemptive’ novels according to Oprah: catharsis equals a nauseatingly Hallmark Moment.

But, okay, I will attempt to suspend my critical stance and give this museum exhibit on Katrina an honest chance,  I told myself.

As I snaked my way through the rooms of the exhibit, I found quite a lot to admire in how the curators had chosen to ‘tell the story’ of Katrina. The first few rooms were dark and immersive, showing billowing smoke from one New Orleans building, next to a display of an ax stored in the attic of a ‘mock’ house (an essential home safety precaution that I didn’t know about–many people in Katrina got trapped inside their attics in the rising water and drowned because they couldn’t cut an escape route through their roofs).

Then I entered the second room of the exhibit, filled with separate displays on ‘ordinary heroes’ (what is an extraordinary hero–Wonder Woman?), hospitals, First Responders, seats from the Superdome (fiasco), samples of emergency cans of water from the Red Cross, and MREs (Meals, Ready to Eat that included little bottles of Tabasco hot-sauce). There was a brief and somewhat sanitized display labeled “Race, Class, and Inequality” with a heavily edited quote from then President George W. Bush. This second room was filled with random flashing lights of red, yellow, and that freaky blue again, echoing the bottle display.

There was quite a lot of content on the effects of climate change, environmental degradation, and engineering mistakes that all compounded the devastation of Hurricane Katrina. Audio-recordings of Katrina survivors played on an endless loop. An African American man, a former resident of the most severely affected Ninth Ward had this to say: “The water in the vast area matched the speed of a second hand of a clock—that was the amount of time it took for that water to rise. I don’t remember hearing it before: a sound like a freight train.” I found his first person testimony both eloquent and haunting, and I listened to the loop several times to make sure I wrote down his exact words.

But one section of the Katrina exhibit has continued to bother me. It takes up the most space in the middle-part of the exhibit, being eight or nine panels, sections of the actual walls in a central New Orleans housing project apartment. The walls preserve the ‘wall diary’ of Tommie Elton Mabry, a 53 year old man (shown in photo below in front of his wall diary/ ‘ledger or graffiti’ as he called it–written with a black Sharpie.) Mabry, who had been homeless ‘since Regan was president,’ stayed in a first-floor apartment in the deserted high-rise B.W. Cooper public housing development in downtown New Orleans. Starting the day before Hurricane Katrina hit New Orleans until two months later when he was forced to leave by the housing authority officials (the building has been torn down).

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Tommie Elton Mabry in front of his diary of Katrina written on wall of New Orleans Housing Authority building. Photo: Thomas Neff, November 2005.

What bothers me about this part of the exhibit is the unacknowledged ethical issues, power dynamics, and inherent racism and classism. Mabry’s diary entries are written in about a fourth or fifth grade level, include frequent f-bombs, and many of the entries focus on him getting drunk or nursing a hangover. These all highlight negative stereotypes of homeless people, and especially of African American poor people.

In the photo and in several local newspaper articles (see below), Mabry appears to be proud of the fact that his diary is now on permanent display in a museum. But did anyone bother to ask his permission before they preserved his ‘wall diaries?’ Did anyone consider setting up some sort of appropriate payment–or housing fund– for use of his words?

Tommie Elton Mabry died of a heart attack in 2013, at the age of 58. He was still homeless and couch-surfing at the time of his death.

_______________________________

Resources/related articles and videos:

“After Hurricane Katrina struck, Elton Mabry used writing as a way to survive the storm” by Maria C. Montoya. The Times-Picayune, August 23, 2008.

“The diary of Tommie Elton Mabry” (video). The Times-Picayune, September 1, 2010.

“Hurricane Katrina survivor and chronicler Tommie Mabry dies at 58” by Elizabeth Mullener. The Times-Picayune, February 1, 2013.

“Jungleland: The Lower Ninth Ward in New Orleans gives new meaning to ‘urban growth,” by Nathanial Rich. NYT, March 21, 2012.

 

Falling Off the Funding Cliff of Good Health

cliff-475661_640Words, and especially metaphors, fascinate me. They are powerful and oftentimes unexamined. Take cliff for example. The OED definition of cliff is: “a perpendicular or steep face of rock of considerable height.” Cliffs are both dangerous and exhilarating-seductive. Think of the aptly named Heathcliff (Emily Bronte’s in Wuthering Heights that is, not the rather insipid comic-strip cat). Cliffs represent the edge of the known and comfortable world. Cliffs are good places to gain some perspective.

Cliff, as a metaphor in the health policy world, is used in various ways. First, there is the ‘funding cliff,’ and specifically the current ‘primary care funding cliff,’ also called the ‘community health center funding cliff.’ Community Health Centers across the U.S. are facing a potential federal funding cut of up to %70 this coming fall (for a good and brief article on it, see the Commonwealth Fund’s Washington Health Week in Review, “Health Centers Push for Remedy to Avoid the Funding ‘Cliff,” by John Reichard, 11-3-14). The National Association of Community Health Centers has a policy issues website on the primary care funding cliff with more information and links to policy advocacy that individuals and groups can get involved in. Funding-Cliff-Infographic-1And here is the RCHN Community Health Foundation’s infographic on the primary care funding cliff.

 

 

 

 

 

 

 

 

 

 

I am a big fan of community health centers (CHCs)  and have worked at three different CHCs in the Seattle area over a period of fifteen years. They typically have very passionate, social-justice oriented people working for them, and they emphasize the use of interdisciplinary teams. CHCs provide comprehensive community-based health care for over 25 million people living in poverty, people who are homeless, as well as immigrant/refugee, and migrant farm workers in urban and rural areas throughout the U.S. CHCs are far from the ‘perfect’ model of care–they are high professional burnout workplaces and they often have much more ‘heart’ than ‘head’ (as in sometimes struggling with good leadership/administration). But they are as close to perfect that I’ve experienced in our country. Not surprising to me is the fact that one of our earliest models of CHCs was the Frontier Nursing Service, started by nurse midwife Mary Breckinridge in 1925 (and still in existence) to provide primary health care in an impoverished rural area of Kentucky.

But to return to the cliff metaphor, a second and important use of ‘cliff’ in the health policy arena is Dr. Camara Jones‘ ‘Cliff Analogy’ framework for levels of health prevention at a population level. Dr. Jones is a family physician and epidemiologist, and currently Research Director on social determinants of health and equity at the Centers for Disease Control. She distills down and illustrates complex health policy/health systems issues through the use of stories and metaphor–the Gardener’s Tale for levels of racism, and the Cliff Analogy for the social determinants of health and of health equity.

In a recent journal article/commentary, Dr. Jones states, “The social determinants of health equity differ from the social determinants of health. While the social determinants of health are the conditions in which people are born, grow, live, work, and age, the social determinants of equity are systems of power. (…) The social determinants of equity govern the distribution of resources and populations through decision-making structures, practices, norms, and values, and too often operate as social determinants of in-equity by differentially distributing resources and populations.” (“Systems of Power, Axes of Inequity” in Medical Care, October 2014, 52(10): S71-S75). In a graphic depiction of these concepts included in her ‘Cliff Analogy,” she shows that the cliff is not a flat, 2-dimensional cliff (as in the infographic above), but is 3-dimensional–differing in how resources, populations, (and, I would add, even the cliff’s physical contours/environment) are distributed.

So on this official President’s Day in the U.S., or Washington’s Birthday for all federal workers, take some time away from the shoe and cars sales and school holiday to consider what actions you can take to make our communities healthier and more equitable places.

A Photo Ode to Harborview

This week I have been immersed in both the history and present state of the health care safety net in my home town of Seattle, especially as it is ’embodied’ (or ’em-building-bodied’) by Harborview Hospital/Medical Center.

Harborview is the largest hospital provider of charity care in Washington State. It serves as the only Level 1 adult and pediatric trauma and burn center, not only for Washington State, but also for Alaska, Montana, and Idaho, a landmass close to 250,000 square kilometers with a total population of ten million people. In addition, Harborview provides free, professional medical interpreter services in over 80 languages, and has the innovative Community House Calls Program, a nurse-run program providing cultural mediation and advocacy for the area’s growing refugee and immigrant populations.

Here is my photo–simple ode–to Harborview and its adjacent Harbor View Park:

Behold, the shining beacon on the hill,

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Rising from marshland’s King County Poor Farm,

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Stalwart Sisters of Providence did till,

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Shielding paupers, ill and homeless from harm;

Then, to separate church from state, we care,

‘Above the brightness of the sun: Service,’

Proclaimed the poster on opening day;

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Now, our common humanity declare

Responsibility to resurface,

Embrace compassion for all, we say.

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What is Public Scholarship?

IMG_3174My irreverent answer: work done by nerdy, bookish, abstruse (yes, abstruse), people with way too much formal education who can get over themselves enough to care about the ‘real’ world, what’s going on in it, what they might have to offer it on a more practical level, and what they can learn from that big, scary ‘real world.’

Here is one of the more reverent official answers:

“Publicly engaged academic work is scholarly or creative activity integral to a faculty member’s academic area. It encompasses different forms of making knowledge ‘about, for, and with’ diverse publics and communities. Through a coherent, purposeful sequence of activities, it contributes to the public good and yields artifacts of public and intellectual value.” (From: Ellison, J., and T. K. Eatman. 2008. Scholarship in Public: Knowledge Creation and Tenure Policy in the Engaged University. Syracuse, NY: Imagining America.)

The photo above is of me looking very happy yesterday at the University of Washington Odegaard Library (first floor) in front of my public scholarship multimedia exhibition Soul Stories: Homeless Journeys Told Through Feet.
This is a collection of poetry, prose, photographs, and digital storytelling videos about my work as a nurse providing health care to people marginalized by poverty and homelessness. I understand homelessness at a visceral level, having lived through it myself as a young adult. I also readily acknowledge that just because I ‘made it out of homelessness’ doesn’t mean everyone can, nor that it is an easy thing to do, especially within our society.

The Soul Stories exhibition will be at Odegaard Library (opposite Suzzallo Library on ‘Red Square’) through March 20, 2015. Odegaard Library is open to the public during regular library hours. Many thanks to the wonderful librarians at Odegaard who opened this space for me, and thanks to 4Culture for helping to fund part of this project. I was looking happy in this photograph because this has been the most challenging, fun, and soul-satisfying scholarly project so far in my career.

Public or community-engaged scholarship has never been valued by ‘high brow’ university types, especially not at research-intensive universities. It generally doesn’t ‘count’ as a valid activity for those pursuing graduate degrees. It generally doesn’t get you tenure. But that all seems to be changing, albeit at the achingly slow speed of any change within higher education. The catalyst for this change seems to be less from sudden altruistic enlightenment on the part of the academy, and more from public pressure for universities to show tangible positive impact at the local, national, and international levels. Within medical science scholarship, you can see this outside pressure manifested in the embrace of ‘translational research.’ Research within the realm of public scholarship doesn’t need to be translated.

Within the area of health-related public scholarship, a terrific resource I have used throughout my career is the Community-Campus Partnerships for Health (CCPH).  Check out the free, no membership required resources on their website, especially CES4Health, for peer-reviewed products of community-engaged scholarship.

Be Very Afraid

IMG_3124Or be at least a little bit afraid: not so afraid that you become paralyzed with fear and not so little afraid that you don’t do practical things to better prepare yourself (and your family) in case of disaster/emergency. Aim for being ‘just right’ afraid.

Public health messaging about ‘appropriate’ disaster preparedness has been a topic of fascination for me since teaching my community health course in New Zealand this past winter. (See my previous ‘New Zealand Postcards’ blog series, especially ‘Disaster Tourism; All Right?’ and ‘Disaster Preparedness: Lions and Tigers and Zombies and Earthquakes, Oh My!’) When I returned to Seattle in April I had resolved to practice what I preached in this regard and make a disaster preparedness kit for our home. Seven months later I’ve finally put one together.

This cute little red ‘lunchbox’ disaster/emergency preparedness pack in the photo is one that got delivered to my university office this past week. A one-person 72-hour survival kit. Inside it has pouches of water, high-energy food bars, a mini first aid kit, a whistle, a flashlight/extra batteries, hand sanitizer, an emergency survival blanket, maxi pads, hand warmers, and a poncho (this is Seattle after all and we like our rain gear). The CDC Emergency Preparedness and Response website and FEMA’s ‘Ready’ website  recommend having smaller grab-and-go personal disaster preparedness kits like this one at work/school, in your car, or other places where you spend a lot of time. They recommend having a larger ‘family-sized’ disaster preparedness kit at home and they provide lists of recommended items for the kits. Some of the recommended items on the two lists are the same (like water and food), but many of the items on the lists differ. An interesting but largely unsurprising fact. I prefer the CDC list. The American Red Cross survival kit list on their website seems to follow the CDC list and both seem to have taken health literacy factors into account.

Through the process of researching and putting together a household disaster/emergency preparedness kit, I’ve realized the health and safety advantages of having camping and hiking as hobbies. Swiss Army knife. Check. Tent. Check. Portable water filtration kit plus iodine water purification tablets. Check. Sleeping bags. Check. Portable first aid kit with hand sanitizer. Check. Toilet paper and small plastic shovel for digging a latrine. Check. Rain poncho. Check. Hand-cranked and solar-powered flashlight and NOAA weather radio. Check.  All stored in one easily-accessible place at home. Check. The only items I needed to add to my preexisting camping supplies were cans of food and water jugs. I now having a home disaster preparedness kit. In Seattle, if you could chose an ideal place to be when disaster strikes, I think it would be inside REI’s flagship store downtown.

I’ve realized that even basic home disaster/emergency preparedness is not an equal opportunity endeavor–it is mainly available to people with the resources to: 1) research and figure out what a disaster kit should include, 2) purchase the items (or purchase a ready-made kit), and 3) have a home in which to store the disaster/emergency preparedness kit.

 

 

Simple (and Not So Simple) Ways to Help the Homeless

  • IMG_1230 - Version 2Respond with a smile and kind words—even if it is “no—sorry” when you’re asked for a handout for coffee, a meal, or spare change. There’s nothing worse than for a person to be ignored–unless it is for them to be ridiculed, called names, told to ‘just get a job,’ or to become the victim of physical violence. Speak up if you witness someone harassing or demeaning someone who appears to be experiencing homelessness. (See ‘hate crimes and homelessness’ below.)
  • Carry fast food restaurant certificates to give to the homeless when they ask for food.
  • Support and buy Real Change or whatever your local poverty and homelessness newspaper is. Take the time to talk with and get to know the vendor.
  • Support an agency that provides direct services to the homeless, especially agencies that also work on upstream solutions to preventing homelessness, such as low income housing or job training programs. An example of upstream services is Habitat for Humanity whose vision ‘is a world where everyone has a decent place to live.’ Not a shabby vision to have and to support.
  • Become informed and become an advocate for local community solutions to homelessness and poverty, as well as state, national, and international ones. Consider joining advocacy organizations such as the excellent National Low Income Housing Coalition.

Hate Crimes and Homelessness: There is a well-documented relationship between criminalizing homelessness (such as municipal laws against camping or panhandling) and ‘hate crimes’/violence against homeless people. Although homeless status is not currently a protected class under federal hate crime laws, there are local, state, and federal efforts to increase protection of homeless people from being victims of bias and opportunity hate crimes. People experiencing literal homelessness are very visible and vulnerable to being victims of targeted crime.

The National Coalition for the Homeless collects data on violence against homeless people. In their latest report (June 2014), Vulnerable to Hate: A Survey of Hate Crimes Against Homeless People in 2013, they found that documented cases are rising (perhaps partially–but not completely–due to better surveillance and recording efforts. Such crimes remain significantly under-reported.) This is an excellent, balanced, and disturbing report. It includes detailed case studies of victims of targeted violent hate crimes.

Last year there were 109 documented attacks on homeless people, resulting in 18 deaths. There were five documented cases of police brutality of homeless people. Over half of all cases of violence against the homeless were in California and Florida. Nationally, the vast majority of perpetrators were teenage and young adult men. In the report, they call for federal Homeless Hate Crime legislation, better reporting of homeless hate crimes, as well as education/prevention efforts such as education (enlightenment) in high schools and police departments.

Resources to Learn More About Homelessness Issues

Note: This series of blog posts on health and homelessness is based on my unpublished* book manuscript Catching Homelessness. It is the story of my experiences with homelessness, both as a nurse practitioner working with homeless people, and as a homeless person. The stories in Catching Homelessness are about events that have happened to me through my work with homeless people. The stories are all factual in that they actually happened. My perception of them at the time of the events and my memories of them inform the stories. Many of my interactions with people in these stories were within an ongoing professional relationship. Since I recount stories of specific patients I worked with, out of ethical and legal obligations, I have altered some biographical details and changed names in order to protect their identities. I have not changed the names of co-workers and friends except where indicated as such in the text.

I have kept detailed journals, both personal and work-related, throughout my life. These were invaluable resources for writing this book. Because I have a background and training in anthropology, my work-related journals were written as expanded field notes. In my journals I recorded patient stories, direct quotes, profiles and personality quirks of co-workers, my reflections on my actions and on events with which I was involved. I kept copies of my detailed monthly and year-end clinic statistics, narrative reports, and letters that I submitted to the Cross-Over Clinic Board of Directors, for whom I worked; these became sources of information for sections of this book. I also drew upon archived newspaper articles, mainly from The Richmond Times-Dispatch, the leading newspaper in Richmond at the time, and currently the city’s only major newspaper. For some chapters, I relied on interviews with people working with homeless people in Richmond, site visits, and reports (past and present) on homelessness in Richmond, in Virginia, as well as nationally.

The following books and articles were the ones that I referred to the most, or which most influenced my thinking as I wrote Catching Homelessness.

  • Zygmunt Bauman. Wasted Lives: Modernity and Its Outcasts. (Polity Press: Cambridge), 2004.
  • Ted Conover. Rolling Nowhere: Riding the Rails with America’s Hoboes. (Vintage Press: New York), 2001.
  • Kim Hopper. “Homelessness Old and New: The Matter of Definition.” In, Understanding Homelessness: new Policy and Research Perspectives, Dennis P. Culhane and Steven P. Hornburg eds., (Fannie Mae Foundation, 1997).
  • Kim Hopper. Reckoning With Homelessness. (Cornell University Press: Ithaca), 2003.
  • Joseph B. Ingle Last Rights: 13 Fatal Encounters with the State’s Justice. (Abingdon Press: Nashville). 1990.
  • Jonathan Kozol. Rachel and Her Children: Homeless Families in America. (Three Rivers Press: New York), 1988.
  • Elliot Liebow. Tell Them Who I Am: The Lives of Homeless Women. (Penguin: New York), 1993.
  • Elliot Liebow. Tally’s Corner: A Study of Negro Streetcorner Men. (Rowman and Littlefield Publishers: Lanham, MD), 2003.
  • Paul A. Lombard. Three Generations, No Imbeciles: Eugenics, the Supreme Court, and Buck vs Bell. (JHU Press, Baltimore), 2008.
  • George Orwell. Down and Out in Paris and London. (Harcourt: New York), 1933.
  • Janet Poppendieck. Sweet Charity?: Emergency Food and the End of Entitlement. (Viking: New York), 1998.
  • Christopher Silver, Twentieth-Century Richmond: Planning, Politics, and Race. (The University of Tennessee Press: Knoxville). 1984.

Thanks to the organizations that supported my four years of research and writing of Catching Homelessness: 4Culture, Jack Straw Writers Program, and Squaw Valley Community of Writers. I extend my thanks to the wonderfully supportive librarians in my life, Lisa Oberg and Joanne Rich, of the University of Washington Health Science Library in Seattle. Many thanks to Wendy Call, Waverly Fitzgerald, George Estreich, Drs. Barbara McGrath, Stephen Bezruchka, and Sheila Crowley for reading and providing constructive feedback on earlier drafts. Thanks also to the members of my writing group, The Shipping Group, and to Karen Maeda Allman of the Elliott Bay Book Company in Seattle, for providing writing space and encouragement. A special thanks goes to my husband, Peter Kahn, my son, Jonathan Bowdler, and my daughter, Margaret Kahn, for all their love and support throughout the process of bringing this writing to life.

*Most all of Catching Homelessness has appeared in print in various forms and venues (including in this blog series):

 Some books are meant to be written, but not necessarily to be published. Catching Homelessness is such a book. I’ve moved on to writing my next book, Soul Stories: Health and Healing Through Homelessness. I thank Hedgebrook for the opportunity (starting this next week) for the ‘radical hospitality’ of protected time, space (my own hobbit-house/ ‘Owl’ cottage), food!, and nurturing community of women writers necessary to forge ahead with writing Soul Stories.