Homeless people – let us give them dignity

by Denise Nanni and Milena Rampoldi, ProMosaik. In the following, our interview with Jim of the Operation Safety Net in Pittsburgh. The organisation is part of the Operation Safety Net, part of the Pittsburgh Mercy Health System and Trinity Health, sponsored by the Sisters of Mercy. It touches the lives of hundreds of men and women living on the streets in Pittsburgh annually by providing them with access to health care, hope, and dignity. What impressed us was exactly the word dignity. People who are homeless first of all need dignity. All the rest is something additional.
 Jim wrote us: „I have to also say that I admire your mission very much.  The core of what I believe is inclusion and social justice.  I also feel that if we can act strategically and symbolically in ways that demonstrate our values then our ideas will gain momentum.  My prior work has been with domestic violence and I see this as the doorway that led me to seek connection with those who are excluded and whose reality is not appreciated by mainstream society.   Let me try to answer your questions.“ We would like to thank Jim again for the important impulses.
What are the main problems and needs that homeless people need to face?
I have worked to create street medicine programs throughout the world and I see a commonality in that those who sleep on the streets are seen as “the other”.  Exclusion is both the mechanism and the experience of people sleeping on the streets.   In many parts of the world, the rough sleeping population are either immigrants or native people who have experienced historical trauma.  Associated with poverty and trauma are a wide range of medical, mental and addictive conditions which, in the US result in an average death ago of 47-52.   The stigma and violence they experience is terrible and universal.   As with domestic violence, victims find themselves in a complex cycle of injury and a reality for which services are not effective.  Blame is turned inward and mere survival becomes the focus.  
Once on the streets, the mental and physical health of the street homeless rapidly declines. The longer a person is homeless the more difficult it is to recover.  People suffer from severe weather and violence, but also die at a much higher rate from preventable conditions poorly treated.  It is nearly impossible to navigate the bureaucratic maze out of homelessness when you are sleeping on the streets.  Medical care is fragmented or non-existent due to barriers to care.  Depression and suicide are common as are the resultant addictions that complicate the unsheltered homeless experience.  Discouragement and a loss of hope may be the most deadly forces leading to ultimate death.
What are the most important services offered by your organization?
My local program, Operation Safety Net (www.operationsafetynet.net), brings medical care directly to people living under bridges, along river banks and in the abandoned buildings of Pittsburgh in the USA.   Teams provide immediate medical care from backpacks as well as material support to survive the weather.  From that point we work with the street homeless to get them to the services they desire.  These include primary medical care, housing, legal and recovery services.  As people move into housing and other arenas our staff is able to accompany them to support and advocate for their rights.  I call this advocacy process “in reach” (collaborate, advocate, innovate, integrate and celebrate).   We have housed over 1400 people from the streets in their own apartments.   We also coordinate medical care for the street homeless throughout the various clinics, hospitals and emergency departments of our city to improve care and reduce costs.  Our program includes medical education as an important part of our mission.  I believe a “classroom of the streets” is vital to transforming the consciousness of our future leaders – many of whom have gone on to start their own programs or devote themselves to social justice.
I am also a founder of an international organization that is responsible for promoting and developing street medicine as a global movement.  The Street Medicine Institute (www.streetmedicine.orghas partners in over 100 communities on six continents and hosts an annual International Street Medicine Symposium at a different location each year.  Although the Street Medicine Institute does not provide direct care, it serves as the home of a growing movement that is bringing direct medical and social care to people sleeping on the streets wherever they may be found.  The Institute provides direct consultation to communities seeking to create their own programs and facilitates improvement of street medicine best practices.
Do you cooperate with local authorities and institutions? If yes, at which level?
All street medicine programs like mine have to work over the years to build relationships with all the other relevant agencies and community entities like the city government.  It is an ongoing struggle complicated by politics and prejudice. Key members of our organization devote a significant amount of time to meeting those stakeholders and develop positive solutions.  We sit on a variety of committees reflecting the range of political perspective.  Our credibility from working on the streets is both an advantage and a moral obligation to uphold.  When possible we include the street homeless.  Within the “in reach” process mentioned above, we work to reconnect the street population with the rest of the community by humanizing each group to the other in the process of creating solutions that serve both their different realities.  We work at all levels from individuals to the mayor who has joined us on street rounds to deliver care.  The media can be an important resource as street medicine tends to attract the interest of the public in whatever location it is practiced.
Do you think that institutions and policy makers could act in order to prevent this issue? If yes, how?
I think that institutions and policy makers must look at the forces that lead to street homelessness and create solutions such as affordable housing, reality based support systems for those at risk of homelessness, and better coordination of resources.  Street medicine is a witness to the failure of such systems.  As with most issues, prevention would be far better than a late response to this chronic disaster.