General

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.