Archive for the ‘Uncategorized’ Category

Street Medicine has rapidly spread to become a global movement with over 100 programs worldwide on 6 continents. As the Street Medicine Institute prepares for the 13th Annual Street Medicine Symposium this October in Allentown, PA, it’s right to explore why this movement has taken hold and how this innovative healthcare delivery plan has inspired hundreds of overworked medical providers to put on a backpack and work more long hours for free outside the traditional medical establishment. Although the explanation I put forth is in no way comprehensive, may it serve as an offering to explain the “core” of what those associated with the movement are experiencing by going to the people.
One of the first lessons taught to medical providers in their education is not to get emotionally involved in “cases.” This means not getting too close to patients—no crying, no hugs– and not experiencing what they’re experiencing. It’s become a matter of professionalism, that’s it actually UNPROFESSIONAL to care. When people come to us in the midst of some suffering, they are reduced to becoming a “case” so that we may avoid letting emotion crowd our better medical judgement. Inevitably, we come in contact with suffering and are faced with a choice. Humans without a pathological medical condition can’t meet the face of suffering and feel nothing so the choice is to either engage and take on suffering along with the patient, or disengage as a self-protective mechanism leaving the patient to suffer alone. Since the inception of our training we are taught to be professional and this means not becoming emotionally involved, the tendency is to disengage and leave the patient suffering alone.
There is no point in engaging a suffering patient unless you are suffering with them for a reason, suffering with joy. This can’t be accomplished with the goal of social justice or to fulfill a business plan. Justice depends on giving everyone his or her rightful due. This practiced in excess, especially in certain patients, can have disastrous consequences. In order to practice street medicine correctly, we must rise above justice to give everyone MORE than he is rightfully due. This is done through charity, or love.
Approaching street medicine through the lens of charity is essential because patients experiencing homelessness suffer a lot. This suffering is not just from material poverty which we can cure for a moment by offering food. They also suffer from emotional and spiritual poverty from being discarded by society; of feeling unwanted and unloved. If we are going out to cure, which as medical providers we must, then we also must engage with them in their suffering. This means not just giving medicine to relieve bodily suffering, but to cure means relieving the spiritual and emotional suffering they also carry. To accomplish this, street medicine must be approached through charity and love, not justice.
How or why has this approach to patients experiencing homelessness caught on as a global movement? Street Medicine has caught on because it’s been spread through the joy of suffering and giving through charity. This has turned the light on in traditional healthcare institutions and practitioners. When you turn a light on in a room it doesn’t just shine on the ones you love best, not just our patients, but shines on all in the room, like our colleagues and friends in the community.
Street medicine, at its core, is the light that it gives us permission to share the sufferings of our patients with joy, through charity, with the purpose of healing spiritual, emotional and bodily suffering.

~ Brett Feldman

Advertisements

We once knew a man who was sleeping in an encampment in the woods. One day, it was discovered that he had been beat up pretty badly by a good friend of his who also resided in the woods. He was taken to the hospital and was eventually released. His physical elements didn’t hurt him as much as the psychological and emotional pain he felt . However it was not for having been beaten up by someone he considered a friend, but rather, the guilt he felt for saying such terrible things about the friend who had just assaulted him. He went on to be concerned about his friends Health and who would take care of him if they weren’t friends. While the story may sound unique, I can assure you that I can think of at least a dozen other cases where two street friends have a disagreement that turned violent only to declare their friendship as strong as ever in the days that followed. I call it the Street Code of Friendship. It’s unlike any type of friendship structure I have witnessed but the bond seems incredibly strong. This represents for me somewhat of a paradox in which I find myself teaching my own students that many relationships formed on the street are superficial in nature. Friendships in which, when push comes to shove, are often abandoned by temptation, housing, whim, and addiction. But, as I reflect back on that statement, I am left wondering about the origins of such taless I have just told. I think about a pearl of wisdom I received from Dr. Withers (again, I know) when he mentioned that communities who feel that feeding the homeless encourages them to remain homeless is like asking you to think of the best sandwich you’ve ever eaten in your entire life and then choosing to be homeless so that you could continue eating that sandwich rather than be housed and not have the sandwich. For me, it’s not a sandwich but my Grandma Stella’s pot roast. The most delicious thing I’ve ever eaten however I would not give up my house and just so that I can have her pot roast every day. It makes me wonder, what acquaintance do I have or even friend in which I would allow them to physical hurt me and then retain my friendship with them. Or further, we have had cases where one rough sleeper refused housing out of worry about what would happen to the person they share their encampment, their bench or their doorway with. I think about the stress and the trauma of living on the street. Perhaps if you find that one person who understands and who seems to have your back on most occasions, that sense of abandonment that you’ve experienced in your life starts to dissipate in a very small but very real way. Perhaps it’s like when you go away to camp for a week when you are a kid. You are away from home as a child, you’re scared and if you’re me you’re terrified of spiders crawling on your face and in your nose and mouth as your sister promised would happen (thanks Becky for those sweet dreams). The people you meet at camp or strangers to you on the first day but by day seven you are blood brothers and sisters. The bond speaks to the human nature of wanting to be protected and protective. In someway the street cultivates this amongst individuals. Perhaps the lesson for us housed people to learn is one of forgiveness. I am not condoning violence of course by maybe the lesson is one of understanding that impulses are often acted upon carelessly and harmfully but that at the end of the day the impulse represented one second of the emotion that is not able to erase days, months or years of survival on the street.

 

 

Last week, I was sitting in a leadership training about effective communication. The instructor started off with an explanation of the ladder of inference. This ladder represents stages of thinking that one goes through, often subconsciously, to determine action or inaction after observing a behavior. When we observe something, we often reflect back on the scenario to make sense of it and in doing so, may not remember all of the details (or even have all of the details). Our minds will fill in the blanks, or infer, what is missing to complete the observation so that it makes sense to us.  We determine action or inaction based on this conclusion. The example given to us was an observation of a quiet exchange between two people which concluded with one person abruptly leaving the conversation and exiting the building. We, of course, came up with a variety of colorful, and sometimes even logical, explainations for what we saw and action that should take place as a result. Sometimes this process leads to workplace drama, other times the inference ladder could be applied to whole populations resulting in dehumanizing sterotypes.

As Brett and I were talking with an old friend this week, we realized that the inference ladder had injected it’s influence on our life in a way that we did not realize until now.  I have written before about the influence of an experience Brett and I had during my PA school education at Midwestern University in which both of us spent time at Hesed House in Aurora, Il providing healthcare for the homeless. It was a meaningful experience that lead to the desire to start the DeSales Free Clinic, and eventually, LVHN Street Medicine. In our minds, Hesed House was providing comprehensive care with tons of hours of accessibility from students and volunteers. When we set out a decade ago to open the DeSales Free Clinic, we modeled it after our recollection of Hesed House. In reality, our blueprint for the vision of the DeSales Free Clinic was not Hesed House at all, but rather, the inference ladder at it’s best. A fill-in-the-blank Mad-Libs version of what we had experienced paired with what we thought was needed for the patients. Turns out inference might not always lead to poor communication or office gossip, but maybe every once in a while, a service to a population who is often dismissed as a result of the same thought process. Tricky tricky little ladder, I’m keeping my eye on you!

The last several weeks in American history will certainly be remembered. The inauguration of Donald Trump. Women’s March which attracted strong convictions for people on all seven continents. And for me personally the visit of two dear Street Medicine colleagues from Nashville Tennessee who have pioneered a street psychiatry program of formidable sophistication. Taking extraordinarily brave steps to deliver psychiatric care at Vanderbilt university to patients who are commonly deemed as untreatable, unrehabable and prone to recidivism of the use of all civil services including a prison systems, the challenge is insurmountable but the conviction of their leader isundeniable.
As I read through commentaries about the inauguration, the women’s march and their aftermath, I can’t help but think of the parallel playing out in Street medicine before my eyes. The country stands divided as to its identify identity both nationally and internationally, The healthcare system in many ways is limping along trying to find its own identity. It’s trying to determine how do we take care of all of the patients not just some. Still charge enough to keep the doors open but not too much that it seems like we are using the ability to charge for such a necessary need to get rich. Street medicine for me has represented a glimmer of hope as teams of concerned healthcare providers, outreach worker’s, case managers and citizens march every day on their streets looking for those people who are not found anywhere else in our waiting rooms or perhaps in our society. On the Women’s March Saturday, while the world was preparing to march through their streets, Brett and I along with Dr. Fleisch and Her resident, Laura (the street medicine nurse) and Bob Rapp (outreach awesomeness worker) gathered supplies and trudged through soggy debris, muddy embankments and tired worn out train trusses looking for patients that we knew were in need. When people use the phrase American ingenuity I am always reminded of a lecture that I heard from Dr. Jim Withers several years ago. He points out that if someone took our funding away tomorrow we would not need to close the doors of our programs but rather we would hustle. We would hustle to save our programs in the same way that our patients hustle every day for survival and in doing so the hustle creates the solidarity between us and our patients. Our patients know that we would hustle for them and in return they hustle for us. They put themselves out there in ways that they never would otherwise for somebody that they didn’t identify as having their back. The Vanderbilt visit concluded with a street medicine grand rounds at Lehigh Valley Hospital. The panel of speakers included Dr. Fleisch as well as a local county judge a psychiatrist family have Valley Hospital who has served the homeless. And a patient, Tim, who has survived by hustling since being since a very young age when he was put into foster care system and then lived on the streets for many years. In so many ways, Tim represents the reciprocated hustle. He has found more success in the last several months of his life by completing a life recovery program at a local shelter and graduating with a certificate of completion. He’s the kind a guy who feels so grateful for this accomplishment that he took pictures with the street medicine team holding up his certificate. He also has an ornery sense of humor and took pictures with Santa Claus this year (his first picture with Santa ever) which he also shared with the Street team. While expressing that he was nervous to sit on this panel in front of a large crowd, he persistently reiterate that he will do anything to help the street medicine team who he feels has helped him so much. So whatever your cause may be, understand that it really has three components. The March. The Trudge. The Hustle. One without the other two is an unbalanced triangle. Imperfect, incomplete and likely unsustainable. As Napoleon Bonaparte said, “The most important qualification of a soldier is fortitude under fatigue.”

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.

file-9
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.

file-11 file-10

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.

Image result for maslow's hierarchy of needs

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.