Shipping up to Boston

Tuesday morning I set off for the International Street Medicine Symposium to be held in Boston, MA. I lugged my borrowed suitcase (thanks Chris, my own are far to Mary Poppins esque for public travel) to meet my coworker who was driving. I was giddy about the days to come, to see my family, to be home and all to come at the Symposium. We had an nice ride out full of music, laughs and gas station food. I took the T into Braintree from in town. I was so grateful to see my first real association with home in it smelly, dated and cementy glory. Seeing home and getting a ride from Haley, I am sure you all have assumed I cried at this moment…its true. 
 
Wednesday I spent the morning with Haley, which was the most heart filling way I could have spent my pre-symposium time to kill. I wish I could have seen all of my beautiful friends in the short time I spent in Boston, but it will only make Christmas even sweeter. 
 
My afternoon was spent in town at the conference, being inundated with faces and personalities from around the world, all vehemently committed to the mission of Street Medicine. This afternoon was devoted to talking about the basics of street medicine, its history and how to start up a program. It was directed mostly towards budding programs, giving advice on logistics, resources and how tos. The power of medical students in this field was surprising and promising in my eyes. Many of the programs represented this week were sprouted from the dreams of medical students  or supported by medical students in its conduction. I find it exciting that medical students are considered a resource and power in the Street Medicine movement. Students are often an untapped valuable resource. Though some of this news was not new to me, being in the atmosphere was enough to energize me wholeheartedly for the days to come. 
 
I skipped out as soon as I could and hopped on the T back to Braintree to spend the night with my family. Though I have gotten used to the bus system of Pittburgh, I greatly appreciated the familiarity and simplicity of the T.  Getting a taste for home was unsurprisingly bittersweet. The comforts of my squishy bed, Patrick and watching television with the family was long overdue, but it was also a swift kick reminder that I am far away from home. 
 
The next day my wonderful father drove me into town to start the first official day of Symposium. His gesture was MUCH appreciated versus the early AM T ride but it is not lost on me that he was conveniently skipping an appointment in the process, sneaky. 
 
My days at the symposium were filled with speakers, workshops and mingling with people dedicated to street medicine. I met Dr. Jack Preger, a British man who has spent many years working in Calcutta and served as a testimony at the Vatican for Mother Teresa in her canonization process. I met medical students from all over the country volunteering time at their respective outreach programs, seeking a career rooted in social justice. I met people from Iceland, Denmark, Nigera, Czech Republic, Puerto Rico and more. 
 
The most remarkable woman I met was a medical resident from Czech Republic. She is literally pioneering the model of street medicine in Prague. Working with the Salvation Army and a non profit called Nadeje (meaning hope) she is creating a system of health care for the city’s most vulnerable ‘rough sleepers.’ Andrea Perkarkova spoke with humility, but her drive and passion for her work was palpable. I wish I could articulate the humility she expressed with justice, having spent the past four years working tirelessly to advocate for change in health care for the homeless. I spoke to her afterwards, hearing about her goals and the struggles she faces from society and the government of Prague. She said she felt herself well up at the first day because she was surrounded by people with the same passions as her. I could deeply relate, having felt that way many times throughout the week. After her 45 minute presentation, she received a well deserved standing ovation from over a hundred people who not only support her dream but appreciate the devotion she has put forth for those most in need. It is safe to say she is my new hero. Though Andrea touched my heart the most this weekend, the beautiful words of Dr. Vargas “Chaco” filled all of our hearts with inspiration. Careers in street medicine are physically, intellectually, emotionally and spiritually demanding. Gathering in one place and receiving the beautiful words of Dr. Vargas pulled us from the microscopic view of every day struggles of lacking resources, lacking time and entering into the chaos of the people we serve.  I left Saint Anselm driven to find a cause I could invest my life in, driven by people I can relate to and who value striving for social justice. 
 
“We have reached a point in which the need to grow as an international movement challenges us to seriously consider objectives and goals of long range and transcendence. It is time for us to decide if we only want to see each other every now and then to find encouragement throughout the sharing of the beautiful stories we live daily, or if, besides that important part, we want to start changing the stories of thousands of others who live on the streets by making sure the reasons that led them and still keep them on the streets are addressed in a structured and strategic way. It is time to ask ourselves, where do we want to go?” – Dr. Vargas
 
“The streets have to be our loving and eternal challenge to move in solidarity – into provocation and direct confrontation of a system that produces homeless people and misery. ” – Dr. Vargas
 
The presenters from around the world addressed the needs for the homeless in their community, whether it is adult rough sleepers, families or street children. There were a few terrible accounts of the plights of street children in developing nations. I could go on about these topics for days, as I have a nursing midterm’s amount of notes on the week, but I will spare you all from the cerebral concepts. Topics included research on suicide in males facing homelessnss in Spain, Outreach for street children of Indonesia, TB treatment in England and much more. Feel free to ask if you have interest in topics of homelessness!
 
I was also lucky enough to befriend some medical students and a bubbly young woman from Iceland! She and her mother work in a shelter for women experiencing homelessness. Mike and I (Mike works at OSN) joined Olof and her mother for dinner at Harvard Square one evening. She and I had a lot of fun chatting throughout the conference and enjoyed sharing our mutual favorite places of the city, as she worked there as an Au Pair years ago. I also joined my coworkers from OSN for a trip to the JFK Library and to Salem. Salem was a sight and very fun, but definitely solidified my preference for Christmas over Halloween. 
 
This week has evidently been eventful…and I didn’t even gush over the incredible work happening at BOSTON healthcare for the homeless. I will spare you all but their work is profound and revolutionary in the field of Street Medicine. On the ride home, I finished the book My Own Country by Abraham Verghese which ended with this line, a perfect way to sum up this experience.  
 
“I remember the acts of human kindness that illuminate our world”

Day to Day

I realize that this blog has not clearly expressed my day to day. On the days I work for OSN, I help organize outreach backpacks, do research on projects, prepare for SWES and provide high risk and street outreach to clients with the outreach workers. When I am at TLA, I spent my time assisting the case managers with medical case management of the residents. I am finding that I really love case management. I enjoy putting together the pieces of care for people, advocating for their needs and educating our residents on their care plans and medical regimens. Medical case management has given me the wholistic connection to medicine I have craved since college. I like to be able to go to appointments with clients, “case manage” their needs and connect them to the services they need. It does not matter if one goes to medical appointments if they cannot fill prescriptions, live in a safe place, feel supported and cared for and receive education on what they are going through. Successful medical intervention is contingent on many other factors than the excellence of inpatient and outpatient care. I seek to fill the gaps of peoples lives that hinder them from positive medical outcomes through gaining income, education and follow up on their care. We are lucky to have Mercy Family Health Center literally right below us to collaborate directly for the benefit of our clients! They make our jobs much easier! I know I have emphasized the physical beauty of Trail Lane apartments, due largely to the decorative passion of my supervisor Stephanie, I have not delved deeply into what really makes it beautiful, its residents. 
 
The residents are extremely diverse, ages ranging from their 20s to mid 80s. We have men and women of all races and all walks of life. The people who call Trail Lane home have faced chronic homelessness, suffer substance dependence, mental illness and commonly medical comorbidities. Every person that lives at TLA fills me with the drive to continue what I do, to advocate for others in worse situations and appreciate the strength of the human condition. I meet jovial men flourishing because of medical and emotional support for their once debilitating mental illness, elderly gentlemen finding permanent security and respite in the comforts of big screen TVs and freshly catered food each day. I see individuals still struggling with the demons of their mental illness. The atmosphere is for the most part jovial and peaceful. I hear it gets pretty rowdy on the weekends, with impromptu cookouts and movie nights instigated by staff and residents. 🙂 I think many outsiders would be surprised by the “feel” of TLA, and I would attest most of it to respect. The staff of TLA respect the residents as adults with dignity. In response, TLA is treated with respect and dignity. There are framed photos of past and present residents. One resident stated that it was the first time he had seen a picture of himself since childhood, the first time he had ever had a photo framed. 

The Rock

One of the first colder nights in Pittsburgh, I found myself on North Side rounds with Randy and a medical student. It was in the middle of Pirates Post Season hype and the Duck’s presence at Point Park. We encountered only a few clients that evening, but one of our last mad an imprint on my soul. Randy knew he was staying under a bridge, and we went to see him. We called for him with the usual mantra, “Safety Net here, you want to come see us?” He came down from the topmost spot of the embankment. We sat with him a while, talked about his daughter and his recent acquisition of housing. He was waiting on final details patiently on the streets, having spent decades as a rough sleeper in Pittsburgh. One of us expressed concern for his spot because it was literally made of jagged mini boulders. To our concerns he replied, “Listen guys, I am a rock.” Its true. That was all I could think. Everyone who endures homelessness is a rock. He is exemplary in physical survival and mental perseverance.  Regardless of one’s personal burdens of addiction, mental illness or trauma, they are rocks, impressive and stronger than I can ever imagine. I pray though for those who are most vulnerable, weakened by personal burdens and factors far beyond their control. I pray that we are able to make systemic changes to “bridge the gap” of health care institutions and those who need it most. 

Transformations

The concept of housing first and safe haven models for housing chronically street homeless has obvious impact clients in ways much broader than simply giving them a safe place to sleep. Clients enter our program especially vulnerable. When people are actively using substances or debilitated by mental illness, the chaos of their own mind is overwhelming. It becomes the center of their being. That inability to focus on even the most basic tasks of hygiene, personal safety and health is what makes our clients deeply vulnerable. Trail Lane gives people a beautiful and safe place to stay, but the social and residential support allows people to break their prior conditions on the street if they so desire.

Working with the staff I do gives me the opportunity to hear incredible stories of all the different people and stories that they encounter in this population through their various past and present positions. One gentleman entered a housing first model residence, his hair mangled with lice and grime, body infected with common infections in the population and actively powerful delusions and hallucinations. Living in a housing first model gave him the structural support he needed to take care of himself and his health. He is now thriving in his treatment, compliant with his medications and working towards physical fitness. He is a gentle soul who is genuinely interested in understanding his experiences from his illness. He is full of faith and open with his desires to seek a safe and happy life.

We see clients every day who are transforming.  Not everyone too able to get clean or become open to medical intervention, but any transformation, any feelings of acceptance matter.

Hide and Seek

Outreach is facing a set of challenges as a result of seasonal changes and recent motions by the city to gate off camps and bridges that many of our city’s homeless lay their heads each night. Because camps are getting driven out of their usual places, our clients are much more scattered throughout the city. The fall weather draws some people to shelter, but not in the droves we anticipate for SWES. (Severe Weather Emergency Shelter). This is an extremely interesting time to be involved with OSN and Pittsburgh because of the changes downtown is looking to make on the face of our city. Below is an article that touches on the topic:

http://www.pghcitypaper.com/pittsburgh/shut-out-penndot-to-spend-240000-to-fence-off-homeless-camps-under-highways/Content?oid=1701000