Nameless. Faceless. Invisible. It’s estimated that during the life of a homeless individual in the United States, many go up three months without being called by their name. The physical and social barriers between the housed and the unhouse are immense. For the homeless, it can seem to be an endless maze of closed doors. Like the old rat experiment from my Introduction to Psychology course- teach the rat what to do and what not to do by shocking it with a quick zap at deter unwanted behavior. For the homeless, they stand too long in the doorway of a business- zap! They go to a doctor’s office without insurance – zap! They ride the bus for too long- zap! Nowhere to go, nowhere to be and no where to feel safe.
But what happens when these souls pass on from this world? Most of the bodies of our friends who have lived their lives on the streets will remain in the county morgue waiting for someone to claim them. Usually no one comes. Unclaimed and unnoticed even after death. Most are cremated and buried in an unmarked grave, unceremoniously passing from the land of the living to the land of the dead. No memorial service, no sign in book, no slideshow of memories to cherish. Even the cause of death seem somewhat generic. The majority of the time the homeless who die on the street have died of “natural causes”. There’s no family to request an autopsy or discussion as to why or how someone died. They just simply die. The injustice against these souls does not end at the moment in which they take their last breath. Over the last 11 years, I’ve had the privilege of knowing many of our rough sleepers in the Lehigh Valley. Some have resided outside for more than a decade, others have floated between the streets, shelters and single room occupancies that scatter our cities. My experience has taught me their lives are anything but forgettable. Their survival to the moment in which they left this world is nothing short of remarkable. Many of our street friends have endured things that no human should ever experience. Abandonment, untreated mental illness, an astounding amount of physical and psychological trauma. And while each of us, homeless or housed, have undeniable autonomy over our choices, we cannot ignore how previous experiences affected growth, development and decision-making capacity of those who are unsheltered. They have taught me and those who have shared their lives with them the remarkable resilience of a person and how a community of strangers can grow to love one another when they share each other’s burdens. They are some of the funniest, kindest and truest souls I have even known who had a way of sharing their reality with me so I understood their wisdom.
As we ring in the beginning of winter this week, many cities across the United States remember those men and women who have died on our streets with a memorial service. So that their lives, even after death, can attempt to have some humanism attached to it. This year, a memorial wall has been erected in downtown Allentown. Located at 707 Hamilton St so that all who pass by will remember that the Lehigh Valley is not insulated from the harsh realities of homelessness and the fact that some of our own citizens die while struggling with homelessness. It is an attempt to remind us that we are all connected. The seen and unseen. The named and the nameless. So while we gather with those who we hold so dear during this holiday season let us remember those who passed in silence and offer them some compassion, some memory, and some honor.

In September 2016, Brett and I traveled to Rome for the canonization of Mother Teresa into sainthood. In an effort to save money, we booked a local flat through AirBNB and lodged just two blocks from the Vatican. On our way back one evening, we crossed St. Peter’s square and, after passing two armed guards stationed at a government building, made a turn onto a side street close to home. The area near the Vatican has become a safe space for the homeless to sleep at night without harassment from the police. The local homeless service providers who generously shared their time, experiences and solutions with us tell us that this is a result of Pope Francis declaring that these souls should be left alone and allowed to rest without disruption. And so, to some local surprise, the local police have backed off and allow for some peace and quiet. As such, it was no surprise to see a doorway inhabited by an elaborate cardboard-bag-bottle structure skillfully designed to block light, noise and provide an astonishing amount of concealment for the person who was likely residing somewhere inside the materials. What caught our eye, however, was an inscription scrawled on the marble slab to the left of this construction – LOVE NEVER DIES. We stopped and took a picture of this remarkable image wondering who wrote the message and if the inhabitant of this doorway agreed or disagreed with the statement. We continued onto our flat and retired for the evening. Each night, we saw the same cardboard-bag-bottle construction with the same refreshed inscription, and each night we wondered.

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Three days later, we were walking back from the canonization mass. Anxious to rehydrate (it was about 92 degrees fahrenheit), use a bathroom (400am -2pm is quite a long time!) and to escape humanity for a minute (a sea of 500,000 humans is enough to make anyone need a quiet (padded) room), we nearly missed him. Our doorway dweller was awake, sitting up below the inscription and working on an elaborate drawing. Bathrooms, water and silence would have to wait. We made our way through the crowd and introduced ourselves. George, a man in his 60’s, had primarily inhabited this doorway for the last 6 years. A fisherman from Sweden, he had somehow been land ridden for some ambiguous reason. His drawings were remarkable. He had two completed charcoal drawings and was half finished with another one. All of the completed pictures contained a series of objects that were rearranged or drawn from a different angle. We explained street medicine to George and he engaged us in an interesting conversation about his experiences, affirmed that he had a doctor (however we discovered an access problem- his doctor was in Sweden), and how the heat of this summer had been particularly difficult for him. But it was his explanation of his drawings that moved me the most. The wooden truck was his favorite toy as a little boy, the canoe was his first fishing boat. A child sized fishing rod and small scaling knife were important pieces of his happy place. A pot for smoking fish lead me into a detailed conversation about how to properly prepare and cook fresh fish (fascinating for me considering I generally avoid eating things that originate from under the water). He said he draws to keep himself out of trouble. But I saw something much different. His drawings simply represented the happiest time of his life. A time when he was a young boy, falling in love with fishing and providing for himself. Before he spent 45 years at sea, had broken relationships with his family and had ended up, well, here. We purchased one of George’s drawings which hangs in a place of honor for him in our home. While he never explained why he writes his message next to his doorway everyday,  he really didn’t need to. He retains a sense of hope that one day the tides will shift and he will find his way home again, perhaps to the place in the picture.
He agreed to take a picture with us (which you can see below) and thanked us for keeping him company. As we walked away, George asked us to promise not to forget him. Promise made. Promise kept.

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Four years ago, we attended our first International Street Medicine Symposium in Boston (MA). I was wide eyed, excited and in hindsight- mostly clueless about the real world of street medicine. Street medicine in the Lehigh Valley did not exist yet, I had never been on street rounds and had only read about such legends in this area of medincine such as Dr. Jim Withers and Dr. Jim O’Connell. I met like minded people and heard tales of incredible collaboration between civil services, shelters, providers and consumers. I saw demonstrations of how humility combined with leadership can change an entire city and its citizens. And I do mean all of them – the housed and unhoused, the voting and non-voting, the overachieving students and the retired sunset-riders who directly or indirectly reaped the benefit of the Boston Healthcare for the Homeless Program (BHCHP). In the subsequent years, we travelled to Dublin, Ireland then San Jose, California and most recently- Geneva, Switzerland. Each conference provided new insights, new data, new frameworks, new friendships. As Dr. Pat Perri, chair of the Street Medicine Institute said at the most recent conference in Geneva- it is like meeting aliens from the same planet.

As I sit on my flight returning from Geneva, I am struck by the lecture I had the privilege of hearing yesterday by Nick Maguire (Southampton, UK). He is a psychologist with a brilliant mind and a wicked English sense of humor who has a way of making sense of the behavior chaos that we observe on a regular basis on the streets and in the shelters. His points were so profound to me that I have hardly been able to think of much else. But as he started his lecture, he told us how much this conference means to him. As he says, it is a bucket filler when the world is so often full of bucket emptiers. We come to this conference and are renewed with our sense of purpose and inspired by the brilliant minds from all across the globe that have so committed themselves to such a worthy cause. People who have left lucrative positions in pursuit of a meaningful contribution. People who risk arrest by providing medical care on the street. People who accept that possibility that everyone you know professionally and personally might think that you are crazy for doing this type of work.
As Nick was speaking, I glanced over my right shoulder and saw Jim Withers sitting toward the back of the room as he so often does and thought about how it feels to know that your vision is being shared and LIVED by so many people. Inspiration can be a fickle thing- there one day, and then gone the next. Sometimes people act on their inspiration but, action can also be fleeting. It is inspiration that makes us come back from church camp when we were kids and throw away all of our excess toys, cd’s (back when we used such antiquated objects to listen to music) and other items we deemed unnecessary once we realized that living a simpler life for a week wasn’t so bad after all. But three months later, there we are in our rooms with piles of newly accumulated junk that we forgot we had decided we could live without. Fleeting. But to inspire and then foster inspiration that changes the trajectory of how people LIVE is something quite different. And for me, the International Street Medicine Symposium is like inspiration on Arnold Schwartzeneger dosed steroids.

Thanks Street Medicine Institute. Bucket filled. Lid applied. Pressing on.

A few weeks ago, Lehigh Valley Health Network and the Street Medicine Program hosted two events with Dr. Jim Withers, a pioneer of street medicine in the United States, to raise awareness about homelessness to different groups in the Lehigh Valley. The first night was a small gathering of donors at a local country club with Dr. Withers as the featured panelist along with Brett and Dr. Motley, chair of the Community Health Department at Lehigh Valley Hospital.  It was a fascinating discussion about how street medicine in many cities has uncovered an ugly truth; that healthcare itself is very, very sick.  Often times the Street Medicine provider straddles two worlds. A world of middle class America and a world of extreme poverty and isolation. In terms of Maslow’s hierarchy of needs, we expect all patients to be functioning at the top of the pyramid in a place that Maslow defined as self-actualization. That is the place where people are achieving or are on their way to achieving their highest potential.  Because this is the basic assumption for all of those interacting with the healthcare system, it is no wonder that conscious or unconscious bias seeps in to our everyday patient interactions.  The traditional healthcare systems gets frustrated with those patients who just don’t or can’t follow through. We label them as non-compliant and design policies that allow us to dismiss patients from our practices after two no call no shows or after being late for an appointment a few too many times. Because after all, our clinical time is important and if we allow ‘them’ to be late then we are just enabling them.

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The homeless population and their interaction with the healthcare system is an example that can be applied to many other vulnerable populations who are expected to be functioning at the tip of Maslow’s pyramid. Domestic violence, gender dysphoria, substance abuse, financial instability and recent prison release are all examples of people are struggling to have their basic needs met. It was interesting to see and talk with the attendees at the conclusion of the panel discussion. Many of them have lived in this area their entire lives and never fully understood how and why this type of human condition was lurking in their own backyards. Perhaps the best part of the evening came from the country club bartender who spoke with me, Brett and Dr. Withers after the room had mostly cleared.  He shook our hands and told us that in his job, he listens to a lot of very boring presentations (and I believe him) but he was so grateful to have listened to this panel discussion.  He felt he had learned so much and went on to tell us about the homeless people he had known in his life and how he thought they may have ended up that way. Of all the people in the room, it seemed that perhaps the unsuspecting bartender had been one of the main benefactors of the event.

The following day, Dr. Withers gave grand rounds at the Hospital. Over 200 people RSVP’d to the event and the crowd was primarily full of short and long white coats.  At the conclusion of Dr. Withers discussion, a panel of currently or formerly homeless Lehigh Valley residents shared their stories of living on the streets, surviving on the streets and in our institutions and candidly shared how things could have been better.  One panelist has been unsheltered for over 9 years and shared that the Street Medicine team are the only people he knows that are not homeless.  This spoke to me particularly as I was reminded of the isolating nature of homelessness and the sense that the world can become ‘us’ and ‘they’ with seemingly very few bridges between. As I sat and listened, I noticed how absolutely silent it was in the room.  There was not a single pager ringing, phone buzzing or hushed side-conversation. Several hundred people who usually conversate all day were hanging on every single word these brave men and women shared.  I thought about how intimidating the room must have looked from the panelist table and that for years, the patients felt like no one listened to them. And yet, here we were, begging in earnest for them to tell us their stories. The power of this paradox is in its irony. Healthcare providers have an opportunity every day to listen to our patients stories. Not just the story of their symptoms. But THEIR story. We feel pressured to rush, to ‘work lean’, to make in through but in the end, that isn’t what anyone wants. Each time I see a room full of such talent hear the message of street medicine and the stories of its patient’s, I can’t help but feel the pull of a tide. That perhaps we are closer than we think to a return to the roots of good medicine and real connections with all of our patients.

“The woman declared that she was all for the building of a drug and alcohol rehab center next to her city apartment except that the proposed height of the building would cast shade on her kale plants and ruin her plants.”

Portland, Oregon was the host of the 2016 National Healthcare for the Homeless Conference and Policy symposium.  I found it to be a fascinating mix of liberal residual hippee mentalities mixed among upscale microbreweries.  A blue city residing in a largely rural red state. The first thing that struck me about Portland was how clean the city was. It’s beautiful to look at with its detailed architecture, Mount Hood peering over you in the background and the Willamette River hugging some of the neatest reformed parts of town. Freshly potted plants sprinkle the windowsills and front door steps of many residential and commercial properties. One afternoon I watched teams of volunteers artistically arrange flowers and potted plants in fancy designs in a local square just for the viewing pleasure of the many young professionals who eat their lunches on the squares surrounding steps. In general there was a sense of calm in the city.

But there was one obvious difference that somewhat shatters the beautiful façade of Portland. Every 6 to 10 feet I encountered a person experiencing homelessness. A man, a woman, a child just sitting on the street. Some of them were clearly high, but many of them were not. One woman sat with a pad of paper and pencil in her hand but was stuck in a catatonic state of waiting for inspiration.  Some of them were panhandling, many of them were not. Children were coloring while their parents made signs displaying their person plight. Many people were laying with their pets. The thing that struck me every day was that for the size of Portland, the number of homeless is unbelievable. Most numbers estimate between 3400-3600 people sleep on the streets of Portland every night. The lack of affordable housing and the lack of enough shelter caused the governor of Oregon to declare a state of emergency which allows homeless to sleep on the street safely without being disrupted by police, business owners or residents. The city has seemed tolerant of this and understanding of the fact that there is simply no where to shelter all of these people.  It does beg the bigger question though.  Why are there so many?

It seems that no part of the city with has been spared by number of visibly a visible homeless. During our travels, we took an informal poll. People working at donut shops. our taxicabs driver, local lifetime residents etc. We simply asked “Why do you think there are so many homeless in Portland?”   Interestingly they all gave the same answer. They thought that because Portland was such an understanding and homeless friendly community, the people (particularly youth) were seeking out Portland as a counterculture experience. There is a pervasive feeling that these that the majority of the homeless in Portland wanted to be homeless for the experience. While many of those that we informally polled recognize that the legalization of recreational marijuana probably his added to the appeal of coming to Portland, none of them could say for certain the size of that effect. The locals seem particularly bothered that there were so many people with seemingly no end in sight. While they admitted that they felt ‘bad for the people’, they were relatively unsympathetic because they felt that this was a situation that has occurred by personal choice. When I attended a breakout session with people representing homelessness from all over the state of Oregon, I told them what the locals told us about the homeless problem in Portland. I asked if they felt that it was true; that there was a counterculture experience occurring and Portland happen to be the perfect place for it to occur. All of those representing Portland on the panel adamantly denied that any of what the common feeling was true. One CEO of a local if you federally qualified health center commented that while the summers are mild, the winters are very cold and rainy and no one would choose to be homeless and stay in Portland. I would say the same for people who are homeless in New England, in Pennsylvania, in Michigan. Many people endure these harsh winters and yet they don’t leave (which has puzzled me for years). There’s no migratory patterns for the homeless to fly south for the winter. While the truth likely lies somewhere in the middle of these two polarized viewpoints, this creates a particularly large problem for philanthropy. People do not donate to a cause in which they feel the misery of poverty is by choice. Frankly, the sympathy factor goes way down and when there’s no sympathy there’s no money. Perhaps some of the most important (and challenging) steps that Portland must take is changing public perception. Porland seems prime for the picking to lead the country in inovative solutions to minimize homelessness.  A combination of finances, a youthful open minded population with well-established social and healthcare services. I look forward to watching this city’s story unfold.  Press on Portland, press on.

Portland, Oregon is a fascinating city situated on the eastern bank of the Willamette River under the watchful eye of Mount Hood.  As with any city that enjoys a river running through it, the bridges that accompany the river become part of the recognizable landscape that defines its character.  Every thursday night, an army of 150 volunteers turn the space under the Burnside Bridge into a hub of activity and services for Portland’s homeless.  I first learned about NightStrike more than 6 months ago as I was interviewing a prospective PA student who was at DeSales for an interview into our 2016 incoming class.  In high school, she had spent time volunteering under the Burnside Bridge with NightStrike and had sited it as a transformational experience that allowed her to see her own city in a different and profound way.  Brett and I were accepted as speakers at the 2016 National Health Care for the Homeless Conference and Policy Symposium in Portland, Oregon and I decided that NightStrike was something I needed to see for myself.

NightStrike is a program run by Bridgetown Inc and was founded by Executive Director Marshall Snider and his wife Lesley Snider (Program Director) 13 years ago. The organization has 5 employees (including Marshall and Lesley) and in addition to NIghtStrike, have developed several programs targeting the marginalized adults and children in the Portland area. NightStrike alone mobilized over 9600 volunteers serving over 20,000 people experiencing homelessness each year. We arrived at a rented church space near the Burnside Bridge around 630pm and immediately upon entering the orientation space, Marshall and Emily (Development Director) welcomed us to the Program. Orienting over 100 volunteers each Thursday is no small task.  I was impressed by the clear and concise message delivered by Marshall to all the volunteers. The purpose of NightStrike is “Because People Matter” and the common denominator that all humans need and desereve love. He pointed out that the volunteer needs the giving experience just as much as the person needs the blanket and encouraged each volunteer to learn the names and stories of the guests being served. To take on an “Oh there you are!”attitude instead of a “Look here I am” attitude. As an organizer of many volunteers, I particularly appreciated this piece because the message of your organization can be inadvertently misrepresented by the volunteers that are so eager to serve. Another staff member performed the reading of the rules (no photography, let religion come up naturally(if at all), show respect) and safety protocols (walk away from anything that makes you feel uncomfortable, three whistle blows means evacuate calmly and immediately etc).  We then broke into smaller orientation groups for our respective jobs. I was assigned to be a hostess while Brett, Laura, Seth and two friends from Ft. Worth were assigned to the clothing cart. After getting the run down, we all walked down to the bridge where, on average, 350 guests await. The path to the bridge cuts through a green spaces with bubble fountains along the river before arriving at the concrete slabs where we would set up shop.  Rows of Home Deopt style 6 ft tables were set up with folding chairs were already occupied by weary men and women. A mobile dental clinic and a separate mobile medical van created part of the perimeter of our space. The Willamette River and four  occupied barber chairs rounded out the perimeter. A food table with hot chili, drinks and coffee was the first stop for most guests. Other services available that night was a clothing table, library table (with new and used books for exchange), pet food table, a sewing table with two sewing machines to repair clothing, sleeping bags, tents and tarps. I even saw one woman repairing a hot dog costume for a dachshund pup that accompanied his owner everywhere.  There was a bike repair stand with everything from air pumps to tire tubes and chains.  5 volunteers carefully washed the feet of travelers while two more gave manicures to the women. A resource table and veterans table provided critical support for people trying to find their way.

My job was to chit chat with guests. I was strangely appreciative of the fact that I was not the health care provider for the night. I walked around with a thermos full of coffee and poured fresh cups for those waiting in line. I struck up a conversation with a larger than life character named George. A 6’3 black man with a large white beard and a fisherman’s hat. He had fashioned a handmade wooden cart to the back of his bicycle that was packed with elaborate handmade birdhouses.  He told me many tales that evening and emphisized the important points by leaning in, raising his eyebrows and pausing dramatically before letting out the most infectious laugh. During our conversation, many ofther guests stopped by to check out the birdhouses. While George didn’t speak to them, it was clear that he took pride in their interest.

Not all guests were like George. As one would imagine, the homeless are as diverse as we are. Some clean, some not. Some with clear responses to hallcuinations, some not. Some sat quietly, some didn’t. Some preached, some didn’t. But one woman struck me. At first glance, she looked slightly out of place with a fairly new looking hot pink fleece jacket, hair styled, and make up applied. I struck up a converstaion with her and on closer look noticed the all to familiar desperate sadeness in her eyes that comes with not really knowing how you ended up here. She did not reveal any of her story to me other than to say that you do what you have to do to survive.  With that, I poured her a cup of coffee and talked to her about the different resources in the city.

Poverty and how a city assists those who are trying to crawl out from a dark place is a fascinating, and often untold tale, of that which makes up the character of a city. Organizations like NightStrike quietly do the necessary not only to empower the guests, but to remind the volunteers that caring about the homeless population is not futile. In fact, a powerful thing happens when people are guided into being part of the solution.  Well done NightStrike. Well done.

Laura, how come you never asked me about Islam?”

I smiled at him. I said because your religion isn’t a factor for me, no one’s deserves to be homeless, especially homeless and blind.

He says to me, “I have been thinking to myself, why is this white Christian woman helping a Muslim black man” he laughs. He then lowers his head and says, “when I came to America, America was asleep. It was a beautiful country, then 9/11 happened and it became so hard for me. ” We sat in silence for less than a minute he turns to me, “Thank you, you are a great communicator and I don’t know how I would ever get here myself. God bless you. ”

Our journey together is not going to be an easy one, we are making small steps every week. Until you have become homeless or ever tried to assist the homeless you will never truly appreciate simple things such as making an appointment with a specialist, getting a pair of glasses, getting unemployment, applying for an apartment….for these people it takes months to obtain any of this. The average individual simply makes a phone call…applies online…gets the information mailed to their house…where does a homeless individual get their mail? What phone number will be called? Who has an email address?

As a nurse I don’t think I have ever felt like such a patient advocate as I do right now in my current career

How did I get here?

Yesterday, I spent 2 hours with a very special individual. He is currently homeless and when the winter shelter closes he has no plans. He doesn’t know where he is going to stay at night. He asks me, will the police let me sleep on a bench here? I sadly said no. He carries with him all his belongings in 2 plastic grocery bags. He smiles at me with his toothless grin and says, that’s OK, I’ll find a place to stay. We get escorted to his appointment room. He can’t help his legs from shaking in the chair, he tells me he has to use the bathroom all the time…not knowing this is partly because his diabetes is so out of control. I kindly asked the nurse to assist him to the bathroom, because in addition to his constant urge to urinate he has also lost his eye sight due to uncontrolled diabetes. He comes back, we discuss his current medical conditions with the doctor and they leave us. He looks at me kindly, says..you know, I have had several jobs, UPS truck driver, a cab driver, and a CNA. I have traveled the world been to Europe, road tripped across America…originally from Africa, I’ve seen a lot of things and places. But no place compares to America, you have so much available to you in America. It is the greatest country in the world, but it is competitive. If you are not competitive you will lose. I was not. Oh, Laura, how did I get here?

~ Laura LaCroix

 

Today I watched a woman and her boyfriend go “shopping” in our donations room….they have been wearing the same outfits for 2 weeks. They were so grateful for everything we had to offer. I was asked several times, “can we have this?” Every time I smiled and said of course..as they sorted through the items I heard them constantly say to one another, we don’t need that, leave some of those, this is amazing…

You see this couple had a rough past, burned the bridges with their loved ones, the only bridges not burned are through current drug users. They sought out help at a rehab. When they started dating they were kicked out of rehab…tossed to the streets. All of their belongings were kept at the rehab and they have nothing.  They didn’t want to speak badly about the rehab because they felt it had truly helped them. They are now staying in a winter shelter. How do we expect people to stay clean&sober? They fought the fight of withdrawal, found support and are put to the streets. I can’t imagine how hard it would be to stay clean facing the circumstances these people have to face. It’s very sad to me…we lack support in the areas that we need it most, for the people who need it and want it..

This couple, they told me not to worry, they found love and are going to support each other through this mess. I assisted them in getting clothes, hygiene products, nail polish…just so she could feel normal again…

And thank to the person who donated the Uggs…she was ecstatic, you would have thought she won the lottery as she screamed with joy. I wish you could have seen her face.

~Laura LaCroix, R.N.

The (EM)powering media

Posted: April 22, 2016 in Uncategorized

Every time an interview is requested, a reporter calls, a camera crew is invited-it is a difficult decision to make. Media has power. Or should I say the ability to EMpower when done right. Yesterday I received an email from an acquaintance who saw a homeless man in his usually spot who looked like he had lost weight and had a mass on his abdomen and didn’t know who else to tell. Brett got a call from someone who just learned that her coworker was homeless and living out of her car and didn’t know who else to tell. Media sheds a light in places where is was dark. Or rather helps you see what you have been looking at everyday on your drive to work. And that is why sometimes we say yes. This movement is really about you and asking you to act in some way to take better care of each other. Thank you for answering the call.