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    Stopping Homelessness May Protect All from Epidemics

    Voices: Prevention to Cure All Ills


    Thursday, February 14, 2008
    By Ken Williams, co-coordinator of Project Healthy Neighbors.
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    For years, I have written that the homeless are not an entity unto themselves. None of us are. They are as much a part of our community as anyone else. We ignore them at our own peril, both spiritually and otherwise. By ignoring the tragedy of homelessness, we not only fail in our faith and spiritual beliefs, but also compound the problem until solutions become entangled and expensive. The crisis of treating the dually diagnosed is one example of this tragic outcome. We not only have to treat the mental problems of those who suffer schizophrenia, bipolar, and other diseases of the mind but their addictions; those afflicted turn to drugs and alcohol to self-medicate their symptoms when left untreated. It would have been so much more humane and less costly to treat their mental problems before drugs were overlaid. The tuberculosis scare that we are currently dealing with is another such example. But workable, cost-effective solutions are also part of this story. In this potentially scary article, a bright spot of compassion and foresight is to be found.

    Four years ago, I was having dinner with Dr. Mark Stinson. He was telling me of his experience with the victims of the tsunami that had devastated Indonesia. He also told me of MASH units that the Brazilian military had established in shantytowns to combat developing-world diseases. I told him I had often dreamed of conducting a mobile medical clinic at the homeless shelter for just such a need. It was agreed that if I organized it, he would come and offer his services. Before his tragic death last year, Mark did in fact participate in Project Healthy Neighbors I and II.

    This year, for Project Healthy Neighbors III, Dr. Andy Gersoff took the lead and was kind enough to offer doctors from the Internal Medicine Residency Program at Cottage Hospital. Under the able supervision of Dr. Lynne Jahnke, these doctors conducted medical screenings for the homeless. HIV testing was offered, as were inoculations for the flu and pneumonia, mental health care, substance abuse counseling, veteran services, social services, and others. Cottage Hospital also provided the tents and nurses.

    The Public Health Department is working vigilantly to contain what would otherwise have been a serious outbreak.

    Dana Gamble and Dr. Peter Hasler from the Public Health Department helped coordinate medical services, as did Sandra Copley, PHN, overseeing a small army of nurses. Rape crisis and domestic violence counseling were made available. The FUND families provided care/incentive packages. Direct Relief International provided the leadership skills of Dr. Bill Morten-Smith and much-needed medical supplies. Parish Nursing provided nurses. Tuberculosis screening proved to be crucial. Through the dedicated work and planning of many, a potential outbreak of this antiquated disease was detected in time. We have found that scores of people had been exposed and some have in fact been found to have the disease. All are either being treated or have been medically cleared. The Public Health Department is working vigilantly to contain what would otherwise have been a serious outbreak.

    As a society that has allowed homelessness to fester and become institutionalized, we have played Russian roulette not only with our spiritual values but our physical well-being. In my capacity as a social worker for the homeless, I have seen developing-world diseases and infections run wild on the streets. Flesh-eating bacteria and MRSA honor no boundaries, and neither does tuberculosis. Project Healthy Neighbors was successful beyond my wildest dreams. By conducting this mobile clinic — the biggest health event of the year — we were able to jump in front of a potential epidemic. This may not have only taken lives but also would have cost a lot more money to treat. Not only would the homeless have faced this potentially deadly outbreak, but Santa Barbara as a whole would have also.

    Throughout history, epidemics have cut across social lines without mercy. If, as a society, we no longer care about developing-world conditions and allow the homeless to live in those circumstances, then perhaps we should care enough about our own health and the health of our families to address this problem. We should honor the first responders whose careers are to place themselves between those infected and the rest of society. We are indebted to those who made the dream of Project Healthy Neighbors a reality.

    Project Healthy Neighbors was a model of the local government collaborating with several outside agencies and the medical community anticipating a problem and addressing it before it became a problem. So the next time you hear a cough and know it is nothing more than a cold, stop for a moment and think of homeless people who face developing-world diseases on a consistent basis. Give thanks to the foresight and hard work of the professional medical community who were successful in protecting us all. Give a thought as to how we will end homelessness before a truly horrifying epidemic comes roaring out of the streets to threaten us all.

    Comments

    Discussion Guidelines

    In "3rd/Developing" world countries, the elderly and indigent are taken care of within the family unit. There are no veterans of needless wars, and far less drug abuse than in our 1st world "enlightnend democracy" where we stash our elderly in hospitals, invade countries for our own self interest, and consume recreational drugs with the same giddiness as the rest of our self-indulgent excesses."

    lovechop (anonymous profile)
    February 14, 2008 at 8:26 a.m. (Suggest removal)

    Santa Barbara County Jail puts new inmates into general population without doing a TB test. If the inmate is there for 2 weeks, THEN a TB test is done. Wouldn't it be more cost effective, in the long run, to give each new inmate a skin test upon arrival, segregate them for the 3 days it takes to get a result and then house them in general population? Instead, someone infected not only has the potential to infect the people they're housed with but also anyone in close proximity on the bus to court, the guards at the jail and the courts, etc.
    When is the American government going to start caring more about it's citizens instead of the bottom dollar?

    faerydragon (anonymous profile)
    February 16, 2008 at 5:10 a.m. (Suggest removal)

    What is amazing is how political candidates strive for the (fill in the blank) female, business, Hispanic, student vote and try to appeal to whatever demographic that can benifit them but they will not utter one word about homeless people. (Notice I don't use the term "Families" or "children", but "people")

    This situation can affect anyone, and those of us who are not homeless are not homeless because we are LUCKY. My sister knew a guy who was a homeowner but got cancer and while he ultimately survived the disease, he lost his home in the process.

    This is a growing problem, and people had better wake up because regardless or what gender, age, or race you are, this is a scary situation.

    Once again: What were we doing in times past as a society when becoming homeless was not such a problem? Maybe our politicians running for office can actually address how to end homelessness, rather than treat the symptoms.

    billclausen (anonymous profile)
    February 16, 2008 at 2:20 p.m. (Suggest removal)

    People struggle for the most basic of staples, and yet we are more concerned with our property values, tourism, and views from our windows than we are about our world.

    Homeless people are like the miners' canaries of yore; they are the first-line red flags, warning the rest of the population that there is not enough air for a small creature to survive, let alone a large one.

    There are not enough resources for many people to survive, and gradually they fall off their perches, one by one, and all we can think of is to criminalize them or herd the fortunate few we find most attractive into programs.

    There are no real jobs being offered, no affordable housing, and no healthcare.

    The homeless are often marginal earners (many more are employed than we will ever admit exist among us), the elderly, disabled, castoff teenagers and aged-out young adults from the foster care system.

    Some have alcohol, mental illness or drug problems, and a tiny minority have kids, but since those are the ones most commonly seen and noticed, the public and social services are lulled into believing that this is the majority, and these are the only members of the homeless population we should recognize as human, and help.

    Then we act aggressively to criminalize the remaining majority, living in their RV's, working subsistence jobs, or those who dared to get old, sick, or who managed to survive combat overseas only to end up homeless and invisible here.

    Until we all collectively wake up from our minimally conscious state and realize that this is far bigger and deeper than a "homeless problem" and is a socioeconomic Hydra we all must stand together to slay, this situation will continue to rear head after deadly head, to ultimately destroy us all.

    Homeless people are "us"...not "them."

    Holly (anonymous profile)
    February 16, 2008 at 4:08 p.m. (Suggest removal)

    Homelessness and health care are two subjects we talk about endlessly in this country, and do nothing to alleviate.

    Help for some, but not everyone, is not help at all.

    Insurance for children, but not adults, does nothing to address sick adults who use emergency rooms for primary care, then can't afford to pay for it. Employers who cleverly keep all their employees at three hours a week under the time required to qualify for insurance are the norm.

    People who might be able to still work part time are instead forced on SSI just for the health insurance.

    Housing for families, and no one else, still leaves the vast majority out on the streets. Everyone is stepping on themselves to help kids...until they turn 18 and aren't cute anymore; then the kid whom everyone couldn't do enough for finds himself hiding from the cops in a drainage ditch as he tries to get some sleep and go to work at the local fast food joint the next day.

    When I drove a paratransit bus some years ago, one of my routes involved picking up homeless Santa Barbarans (no, they aren't "transients"...they live here, most for decades) and non-locals for transport to appointments. They were mostly seniors, veterans, and long-time locals, with varying numbers of aged-out former foster kids who had nowhere else to go.

    I had to be TB tested routinely, because of the occasional Mexican ag worker who might have brought the disease up here with him. A lot of these guys would end up at local shelters in the off-season, spreading the disease to the local population.

    TB is of course, treatable, but the patient has to be compliant with treatment, but this is a population that doesn't speak English or even Spanish (many speak only Mixtec), they don't understand the treatment instructions, take a dose or two, then disappear to unwittingly infect more people.

    Homeless people are often weakened by their living conditions to the degree that they are unable to fend off so much as a mild cold, let alone TB or the rampant Staph infections that plague them.

    They are also at constant risk fo MRSA, and the flesh-eating bacteria, as they often scratch themselves on the ground rolling over in their sleep, picking up bugs from soil and sidewalks.

    We live in the most technologically advanced nation on earth, yet our people do not have equal, effective, affordable access to healthcare.

    We have a high standard of living in this country, and a terrible quality of life.

    Holly (anonymous profile)
    February 16, 2008 at 4:08 p.m. (Suggest removal)

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