Earlier this week, I looked around in the vendor office. Of the six vendors who were at tables, drinking coffee and chatting, three had wheelchairs; two used walkers. In fact, people frequently use walkers to unload the newspaper truck on Friday, ferrying bundles on the padded seats to pitch in to the collective effort. Street Roots vendors are infinitely resourceful.
Street Roots is now grappling with our crowded office space, strategizing over the looming need to renovate or move. At the center is the realization that we will continue to make room for more wheelchairs and walkers. That’s the reality we see. That’s the reality we plan for.
And you probably see this frequently too: the wheelchairs parked at camps all over the city.
This is the context I considered when Dr. Margot Kushel described how unhoused people present health conditions of a person 2 1/2 decades older.
“Fifty is the new 75,” the University of San Francisco researcher said in her May 30 lecture on homelessness, health and aging. The event was hosted by Portland State University Homelessness Research and Action Collaborative and the Oregon Health and Science University-PSU School of Public Health.
Geriatric medicine needs to focus its skills on a much younger population among people who are unhoused. Sickness can be the force that propels people onto the streets, where aging speeds up. It’s a cruel fact: people whose bodies need the most comfort have the least.
FURTHER READING: Life on the Streets: Sick with nowhere to go
In the early morning hours last week on Broadway Avenue, only days after Starlight parade floats drifted by, a person slept completely tucked under a blanket except for their feet covered in hospital slippers. Perhaps you sometimes also notice the hospital bracelet strapped around the wrists of people surviving outdoors. There are a lot of sick people out there.
Some organizations try to stitch it all together. The heroic Portland Street Medicine, for example, is composed entirely of volunteer physicians, social workers, and other health care practitioners. I rode along with them recently when two emergency room doctors, a social worker and a mental health practitioner volunteered. We wandered through squats, tending to an infected swollen elbow, providing follow-up care for amputated limbs, tending to high blood pressure, rashes, cuts and ailments that untreated and exposed can become much worse.
A barrier to care is camp sweeps. When people disappear, Portland Street Medicine teams search for them, sometimes locating them a few blocks away from where weather-worn paper signs announcing pending sweeps are stapled to telephone poles. Follow-up care is central to Portland Street Medicine.
Street Roots maintains an emergency health fund so we can be nimble and responsible in small ways, such as getting someone hot with fever into a motel for the night, or purchasing a wheelchair recharger for a vendor who was desperately finding other people on the streets in motorized chairs, recharging off the kindness of strangers.
One of our vendors is now sick with an infection that started on his foot. Now he’s walking on crutches. He used to be loquacious, someone who quoted poems through the centuries – from Edmund Spenser to Robert Creeley – and who could swerve from critiquing capitalism to telling humorous lore about his uncle, the New York police officer. Quite suddenly, his face is worn by the pain, his body stooped over.
Homelessness has swiftly taken its toll.
And this past winter, another of our Street Roots vendors became very ill. By night, she used to take care of other unhoused people, tucking blankets over them, sliding cardboard beneath them. By day, she bestowed nicknames, read books, cracked witty jokes and tucked treasures around the Street Roots office: a small bird perched on the door jam, scrabble letters tucked inside brick ruts.
When she got sicker and sicker, another vendor shuttled her to the ICU. She nearly died, her body filled with infection – sepsis. ICU doctors spoke gravely of her systemic illness, and how little chance she had. It’s very hard if the body’s whole system is failing at once.
But she is our miracle, alive and healing in a tiny house. Everyone at Street Root is filled with gratitude.
When I look out on our streets, I imagine this as a societal sepsis, that systemic failure. People are sick on our streets from centuries of racism. People are sick on our streets from disregard of people in poverty. It is glaring in cities with great wealth up and down the West Coast: Vancouver, Seattle, Portland, San Francisco, Los Angeles.
Homelessness is not a separate problem; it is central to who we are. It is the septic shock of our system, one where a wealthy society has left behind huge swaths of people.
And because it is about the whole system, the poorest of our residents should be central to our decisions. It’s not just about dealing with homelessness as a separate problem. Homelessness at this scale, in a wealthy society, means our whole society is sick. What people who are unhoused lack, our whole society should provide. Hygiene services, for example, are about the fact that health should be a public right.
FURTHER READING: Proposed portable toilets would foster dignity and public health (Director's Desk)
When we close down park facilities, that’s symptomatic of our larger sickness – public spaces recede while privatized spaces for wealthy consumption proliferate. And each victory – the Oregon Legislature providing better school funding last month; students filling the Ninth Appellate Court in Portland this week demanding that policies stop driving climate change – is a victory for the health of us all.
Despite the disregard, despite the deprivation, I am amazed how unhoused people survive, building communities and creative structures. They survive at the margins, but they should be central to how all of us conceive of a better future.
Kaia Sand is the executive director of Street Roots. You can reach her at kaia@streetroots.org. Follow her on Twitter @mkaiasand.