The Intermittent Volunteer’s Weblog

Befriending People in Dallas Who Are Homeless

Living on the Street in Los Angeles, Islamabad, Nairobi, Rio and London June 24, 2015

Wednesday, June 24, 2015

 

Living on the Street in Los Angeles, Islamabad, Nairobi, Rio and London

http://www.bbc.co.uk/programmes/p02tmcvp

What is it like to live on the streets? An estimated 100 million people are homeless around the world. And those are the ones who are counted; a similar number is not thought to be part of any official statistic. To get a sense of what their lives are like, World Have Your Say spent time on the streets of Los Angeles, Islamabad, Nairobi, Rio and London to hear a series of intimate and revealing personal stories.

Shanaz is living in a small tent in Islamabad with her husband and seven children. “We just survive,” she says. “What am I supposed to expect for the future of my children?”

“I’ve got a nice little spot on the street,” Brant explains. He has been living on Skid Row in LA for 16 years, on and off. “I appreciate what I have.”

In Nairobi, they meet a woman who went from drug user to doctor. “Growing up as a street child I saw how health was an issue. I saw it as a platform to solve some of those problems. People can be moved from the street; you can never take away their hope. ”

 

 

Bear Witness September 3, 2013

Tuesday, September 3, 2013

Bear Witness

          “Bear witness to injustices that result in poor health, and work to remove those injustices and build health equity.  This is what healers owe society.  And this is what our society desperately needs at this moment in time.”

                                     ~~  Jessie M Gaeta, M.D.,  Medical Director of Boston Health Care for the Homeless Program

                                                Commencement Address, Boston University School of Medicine Convocation, 2013

 

You Can’t… August 26, 2013

Monday, August 26, 2013

 

Wise Words From Someone Who Knows…

“You can’t preach [the Gospel] to someone who is starving.

You can’t entertain people who are dying.”

~~  Pastor Karen Dudley, Founder and Senior Pastor, Dallas International Street Church

 

Should We House Homeless Alcoholics…? January 3, 2012

Tuesday, January 3, 2012

 

Should We House Homeless Alcoholics or Make Them Get Sober First?

 

People will doubtless have strong — and differing — opinions about this, but I’ll offer this observation:  the traditional approach of making homeless alcoholics and drug addicts get clean and sober before they qualify for housing has left a large percentage of them still on the street.  The Housing First approach described in this article has some very favorable statistics in its favor.

 

Is it better, if someone is going to die of their addiction, for them to die cold and alone outdoors?  Maybe if they don’t have the ‘moral courage’ to get clean, this is what they deserve.    This Associated Press article considers some differing perspectives.  What do you think?  KS

 

http://enews.earthlink.net/article/top?guid=20120103/243cdd6f-7af9-4a07-aef4-bfe5d271fa78

 

 

Small Things With Great Love December 19, 2011

Monday, December 19, 2011

 

Small Things With Great Love

 

My son-in-law sent me this story today.  What these two people are doing is not small, but the love they express — each in her or his own way — is great indeed.  It reminds me, despite the difficulties in the world, that there are people out there quietly doing wonderful things every day.  KS

 

 

 

 

Austrian chef, Catholic nun are spirit behind Trinity Cafe

Monday, December 19, 2011 01:16:00 AM

Dec. 19–TAMPA — Alfred Astl frets a lot.

And with good reason: He’s the chef at Trinity Cafe, a restaurant that serves the homeless and working poor in downtown Tampa. He operates on a razor-thin budget, stretching pennies instead of dollars, in order to feed the growing throng of hungry people who come for a free noontime meal Monday through Friday.

“He always thinks he’s going to run out, which he never does,” confides Sister Maureen Dorr, the 81-year-old Franciscan nun who stopped in to volunteer 10 years ago and never left.

“I tell him not to worry. I happen to know another man who multiplied. He really had a way with loaves and fishes, and so does Alfred.”

That’s how it is with the Austrian chef with the serious demeanor and the fun-spirited Catholic sister who’s a bit of a flirt. They are the yin and yang of Trinity Cafe. He does the nourishing — creating innovative and well-balanced meals from soup to dessert at about $2 a serving. She does the nurturing — walking among the homeless guests to dispense hugs, give counsel and offer prayers.

“Sister Maureen is an angel on earth. And Chef Alfred is a grizzly with the heart of a teddy bear,” says Cindy Davis, program director. “They are the heart and soul of the cafe. To have them working here together is a real blessing for us and every guest who works through the door.”

Neither seeks out attention. But they got it anyway last month.

Sister Maureen was named a local hero by Bank of America, which came with a $5,000 check. Astl, 61, was chosen as a community hero by the Tampa Bay Lightning — an honor that came with a $50,000 award. Both directed their winnings to the cafe’s food account.

Davis says the windfall came at a time when the nonprofit needs it the most.

The cafe’s $455,000 annual budget — which depends on donations and grants — is being challenged by an increase in the number of people it serves. The limit was supposed to be 200 meals a day; that’s jumped to about 230. And looming in the future is a $650,000 project that will allow the cafe to relocate from its current cramped quarters at the Salvation Army to its own permanent building in the V.M. Ybor neighborhood.

When the cafe eventually moves, it will be open seven days a week. And it will keep that same “dining with dignity” tradition, using volunteers from churches and community organizations to serve patrons at tables covered in white cloths and set with silverware.

That’s a touch Astl insists upon.

Before coming to Trinity Cafe, he spent 35 years in the hotel and food industry, honing his skills as a chef in exclusive settings from Aspen to New York. He worked at a Four Seasons, country clubs, high-end inns and corporations. He owned his own continental restaurant in Tampa with wife, Sandy. He worked for the late George Steinbrenner’s Yankee Trader at Bay Harbor Inn. For four years, he served as division chef for five Rusty Pelican restaurants.

But for all the prestige and money that came with his career, Astl got burned out. He missed out on seeing his two sons grow up. Working six or seven days a week, sometimes 18 hours a day, took a toll on his health.

Then he saw the help wanted ad for a chef to work “five days a week, lunch only.” He thought it would be a nice break for a little while. That was 10 years ago.

Obviously, there are differences. He doesn’t deal in ahi tuna or Kobe beef anymore. He haggles with food proprietors on the cost of odd-shaped chicken breasts. $1.34 a pound? I’ll give you 60 cents.

Good quality food is a must, he says, “but I have to get it cheap.” And nothing is wasted. Today’s leftover braised corn is tomorrow’s corn chowder. Every meal starts with salad or soup, a healthy portion of protein, a starch, a vegetable, a dessert and a piece of fruit. That same gourmet style he developed when working in exclusive restaurants is reflected here.

“I approach this the same way I did everything else — I come in and do the best with what I have,” Astl says. “Only I know this is the only meal of the day for these guests.”

While the chef is working his magic in the kitchen, Sister Maureen is making the rounds in the waiting lines and at the tables. Some of the faces are familiar; once a week, she’s at the jail, counseling and ministering to those who ran afoul of the law. She has a special fondness for the men, and often offers herself as a dance partner in the middle of the dining room.

“Stay with God,” she whispers to a bearded man, sitting forlornly against the fence while waiting for the cafe to open. “He won’t abandon you. Don’t give up. He’s here.”

For 40 years, Sister Maureen worked in education as a teacher and administrator. She says this is just another extension of what she has done since entering religious life at age 17.

“St. Francis taught us about living out the gospel and serving the poor,” she says. “But truth is, I don’t minister to them. I minister with them. I firmly believe there are such good people who have had bad opportunities. They show me the way to God as much as I try to show them.”

She acknowledges her advanced age, but quickly dismisses any notion of retirement. “Nuns don’t retire,” she says with a laugh. “We just get recycled. As long as God gives you the health, you keep on moving.”

Yes, Astl and Sister Maureen admit, their personalities are different. He’s all business, quite serious about the balance between pinching pennies and providing a substantive meal. She’s quick to crack jokes and wrap her arms around a lost soul who needs a human’s touch. Both agree that those differences don’t matter. The bond they share — their compassion for the poor — trumps everything.

“She is marvelous,” Astl says with admiration. “Just marvelous how she connects with everyone.”

“And he is a God-centered man,” Sister Maureen says. “Though he doesn’t think he is, I know it’s true.”

 

 

Medicine That Matters October 13, 2011

Thursday, October 13, 2011

 

Medicine That Matters

by Karen Shafer

“The Boston Health Care for the Homeless Program’s mission is to provide or assure access to the highest quality health care for all homeless men, women and children in the greater Boston area.”

The lobby of Boston Health Care for the Homeless Program at Jean Yawkey Place, with Deshawn Parris, Security Officer, and Shirley Berard, Administrative Assistant

Jean Yawkey Place 

In the summer of 2011, while touring the Boston Health Care for the Homeless Program, I stepped off the third-floor elevator into Barbara McInnis House, looked around, and began to cry, (and I’m pretty sure it was what Oprah refers to as “the ugly cry”.)  Those accompanying me — my daughter, two of my grandchildren, and our tour guide, Manager of Volunteer Services Carrie Eldridge-Dickson — at first looked at me in surprise.  After all, we were viewing a beautiful, pristine environment decorated in pastels — a state-of-the-art facility which provides “medical respite care”, short-term medical and recuperative services, for homeless men and women in Boston, Massachusetts.  I felt as if I’d stepped into an ideal world.

 

My companions’ surprise turned quickly to understanding.  They shared the comprehension that my tears were in part joyful at what has been accomplished there, but that they also conveyed frustration at how few of our homeless brothers and sisters will ever experience the level of loving and dignified care expressed in the atmosphere surrounding us at that moment.

 

The 104-bed Barbara McInnis House is a medical respite care facility spread throughout three floors of Jean Yawkey Place, Boston Health Care for the Homeless Program’s central facility which opened in May of 2008.  The building also houses a primary care walk-in clinic with ten exam rooms and four meeting rooms for mental health care, a dental clinic with five operatories, a pharmacy, office space for “street” and “family” outreach teams, and the organization’s administrative offices.

 

Barbara McInnis House provides 24-hour care for homeless men and women who are too sick for life on the streets or in shelters but not sick enough to occupy acute care rooms in area hospitals.  It has a dining room that serves patients three nutritious meals a day, and a large common area and outdoor patio — all under one roof.

 

The cellar-to-roof renovation of this former city morgue and forensic research facility now addresses the unique medical needs of the city’s homeless men and women.  It was made possible through the combined generosity of private, foundation and corporate donors.  BHCHP raised $42,000,000 in the organization’s only capital campaign in its 26-year history.

 

Model of Care

Jean Yawkey Place sets the stage for the model of ‘integrated care’ practiced at BHCHP.  The organization’s web site, www.BHCHP.org, describes the complex challenge of tackling health care among the vulnerable homeless population.

“Many homeless patients struggle with at least one substance abuse problem, at least one chronic physical condition and a psychiatric illness. Each condition is often preventable and manageable… on its own. But, in combination and left untreated, such health problems become compounded and all too often fatal. Medicine, in general, and homeless medicine, in particular, have long grappled with addressing these interconnected aspects of a patient’s healthcare in a coordinated way. In the traditional care model, behavioral health care and medical care operate independently.

The integrated care model at BHCHP unites physicians, physician assistants, nurse practitioners, nurses, case managers and behavioral health professionals in a close collaboration. They follow patients together and separately in a variety of settings: on the street, at Barbara McInnis House, in outpatient clinics and, as needed, in shelter or housing.

A patient can move from street to clinic to hospital to respite care to shelter to housing, having easy and regular contact with at least one member of the medical team so that serious medical and behavioral diagnoses receive integrated attention.”

No homeless person is refused treatment at BHCHP.  The professional staff provides medical treatment to homeless men, women and children at eighty locations across the city — in adult and family shelters; in two hospital-based clinics; in emergency, transitional and permanent-supportive housing; and through home visits to formerly long-term homeless patients who are now housed through the Housing First initiatives in Boston.  They also provide care on the street, in alleyways and under bridges to those “rough sleepers” who avoid shelters.

 

BHCHP’s Beginnings

How does such an impressive result come to be?  An article from the American Journal of Public Health entitled “The Boston Health Care for the Homeless Program: A Public Health Framework” talks about its beginnings.  (O’Connell, Oppenheimer, Judge, Taube, Blanchfield, Swain, Koh: August, 2010)

 

In 1984, a community coalition consisting of eighty people representing shelters, homeless service providers, community health centers, nursing and medical schools, state and city governments, homeless persons, and advocacy groups was convened by Boston mayor Raymond Flynn and Massachusetts governor Michael Dukakis.  An extensive community needs assessment to identify gaps in existing health care services was then conducted.

 

Initial funding for the program came through a pilot grant of $300,000 annually for four years from the Robert Wood Johnson Foundation and Pew Charitable Trusts, subsequently matched by an additional $250,000 annually from the state of Massachusetts.

 

City wide cooperation and ‘buy in’ strikes me right away as a predictor of the program’s probable success, and, in particular, the inclusion of homeless people and their advocates in the planning.  All too often, critical issues of how service is to be conceived and delivered to the homeless community is decided by committees comprised of those who have never experienced homelessness, without ‘grass roots’ input.  Such a comprehensive network early on hopefully precludes the ‘fiefdom’ approach of non profit organizations that can occur in cities, resulting in duplication of services and competition for funding.

 

The Mission of BHCHP

“To provide or assure access to the highest quality health care for all homeless men, women and children in the greater Boston area.”

When the program began offering clinical services in 1985 with a staff of seven, these things stand out in terms of its mission:

“The coalition insisted that health care be embraced as a matter of social justice rather than charity, and they defined the program’s mission to ensure that the highest-quality health care would be available to all homeless men, women, and children in Boston.” (O’Connell, et al)

It also viewed  itself as a viable professional career for health professionals rather than as a volunteer opportunity and hoped to ensure thereby continuity of top-tier, accessible health care for homeless men, women and children.  This seems a radically positive, innovative notion, and would seem to insure that, by having physicians and other health care providers as salaried employees of BHCHP, not only would availability of health care be assured, but vital relationships of trust could be built between provider and patient, leading to ‘continuity of care.’

 

What is meant by ‘continuity of care’?

1.  Continuity of care from street and shelter to hospital requires an enduring and trusting relationship between the doctor or clinician and patient.

2.  Multidisciplinary teams should deliver care.

3.  BHCHP should act as a catalyst within the mainstream health care system to ensure that the special needs of homeless persons are addressed.

4.  BHCHP should serve as the “glue” linking hospitals and health centers with the community of shelters and homeless service providers.

5.  BHCHP should strive to bridge medicine and public health.

6.  BHCHP should create and implement ‘respite care.’  [now existing as Barbara McInnis House]  (O’Connell, et al)

It is also significant that BHCHP is located near two teaching hospitals, Massachusetts General and Boston Medical Center.  BHCHP has walk-in clinics on the campuses of both facilities.  Colleges and universities are now educating healthcare providers in increased sensitivity to the particular needs of various ethnic and social groups.  This is especially important as the homeless population is one which requires special care in building trust and relationships, both because of possible health issues such as mental illness or addiction, and because attitudes toward homeless people in society as a whole tend at times to be negative, and opportunities for rejection abound.

 

Who Deserves Compassionate Care?

One only has to read the comments section of newspaper articles on homelessness — where homeless people are frequently referred to as ‘bums’ or in other derogatory language — to understand the negativity which can be directed at people living on the street.  This attitude in the public at large may be a more powerful determinant of the quality and scope of the health care offered to the homeless population than one thinks.  For example, some nonprofit organizations seeking to provide health care to those living in poverty may be hesitant to include homeless individuals within their scope — even when they believe they are deserving and needful of help — because they may feel that the ‘homeless’ label will impede funding efforts.

 

So, at the heart of the mission of any program offering health care to those living in poverty must be the consideration of this question:  Are people experiencing homelessness deserving of compassionate care?  Whether or not to include homeless healthcare in programs may in part be a matter of conscience, where non profit leaders either bend to public pressure and opinion, or stand firm in the moral commitment to treat all human beings as equally deserving of inclusion in a community of care.

 

The decision at the outset by the founders of Boston Health Care for the Homeless Program to emphatically declare that individuals who are homeless are entitled to and would be provided with top tier, continuous and compassionate health care, provided in an integrated model by on-staff medical and clinical professionals, and with the assumption of the inherent worthiness of each patient to receive such care, regardless of circumstance, represents a rare commitment, but one that seems to have been met there in an extraordinarily successful manner.

 

Toward the end of our tour of the Boston Health Care for the Homeless Program, my family and I were fortunate to have a chance meeting with Dr. James O’Connell, a founding physician of the program and currently its president.  When we told him how moved we were by the beauty of the facility and the range and depth of its proffered services, he said, “Remember, it hasn’t always been like this!  It took us a while to get here.”

 

The success of the program says a great deal about an inspired vision; about the wisdom of its founders and their careful planning; about a limitless amount of dedicated work and commitment; and also, not to be underestimated, about the political and moral will of a public which supports and undergirds the idea that those who at this moment live in society’s shadows are nonetheless deserving of its best.

 

BHCHP Overview

~~ BHCHP has operated in the black for all of its 26 years and has brought medicine that matters to tens of thousands of homeless men, women and children.

~~ BHCHP employs close to 300 doctors, dentists, physician assistants, registered nurses, nurse practitioners, psychologists, psychiatrists, mental health case workers, chefs, building and maintenance staff, substance abuse counselors, case managers and dental assistants.

~~ BHCHP delivers health care to over 11,000 patients each year.

~~ BHCHP manages the medical care throughout greater Boston’s adult and family shelter system, in two hospital based clinics and at over 80 sites throughout greater Boston.

~~ Over its 26 year history BHCHP has developed a care model that makes it a leader in urban medicine throughout the world…compassionate, professional care from a full-time staff…immeasurable savings in both dignity and dollars.

Boston Health Care for the Homeless Program: www.BHCHP.org

 

Special thanks to Boston Health Care for the Homeless Program, in particular Tom McCormack andVicki Ritterband for editing, and Carrie Eldridge-Dickson;  and to Nancy Johnson, Master’s of Science Candidate with a focus on Community Health, for access to journal articles and for thoughtful discussions of and insights into public health policy.


 

This article appears in the October, 2011 issue of Street Zine, which is available from licensed street vendors across Dallas.

 

Urgent Need in the Horn of Africa July 24, 2011

Sunday, July 24, 2011

 

 

Urgent Need in the Horn of Africa, Where Children are Dying of Hunger

I often focus on local homelessness and hunger on this blog, but the tragedy unfolding in Southern Somalia, Kenya and Ethiopia is so gut-wrenching that I’m moved to pass along this information.  Night after night I listen to the BBC World Service, and, along with many of you I’m sure, weep at pictures on the nightly news of children dying in refugee camps — having arrived just a little too late to be saved from the ravages of malnutrition.

Mothers are walking for weeks to the camps, carrying their children, in order to try to survive. Many people are dying along the way.  It’s a truly desperate situation.

While it’s a fact that Somali rebels have stolen aid from agencies in the past, making some people hesitant to give, journalists are telling us that the rebels are yielding to local pressure and are letting aid through at this time.

Even a small amount helps:  for example, texting $10 to UNICEF (864233) will feed a child for 10 days.  Here is a link to organizations that are already on the ground there and need more help:

http://www.msnbc.msn.com/id/43841708/ns/nightly_news/

KS