‘A place of love’: Making the rounds on the frontlines of Sacramento’s homeless health crisis
Street clinicians practice medicine in the alleys, under the bridges and on ‘the Island’
John Buck has lived by the river for two years. In that time, he’s seen four people die. He said his uncle, J.J., passed away after falling into a coma while in a hospital waiting for the amputation of an infected arm. He said another man, Capone, who had been living with AIDS, died after contracting pneumonia during the drought-ending rains last winter.
“You don’t see them really get sick,” Buck said. “They disappear. And they don’t ever come back.”
According to estimates by the Sacramento Regional Coalition to End Homelessness, a person experiencing homelessness dies nearly each week and has a life expectancy 25 years shorter than a housed person.
Buck has witnessed the statistical disparities firsthand. About the two other people who died, he said one was murdered and the other hit by a car. Now, Buck’s worried about a man he calls his “street pops,” who Buck said took him in when he was a teenager but has recently developed stage four liver failure.
Buck wasn’t sure how he could help his adopted father. Anna Darzins offered a solution.
The Elica Health Centers clinician had trudged out to this homeless encampment by the American River in search of a man with chest pains. Along with a handful of other health care providers, Darzins makes her daily rounds through the alleys, under the bridges and into the woods where Sacramento’s homeless residents try to survive out of sight. Official estimates put this population anywhere from 3,600 to north of 13,000 people.
Obviously, many lack health insurance. Yet the varied and layered medical issues of people experiencing homelessness are exacerbated by living in unsanitary places without easy access to bathrooms, clean water and trash disposal. Fairly common infections can become lethal.
Still, there’s a reluctance to seek out medical treatment because, as UC Davis medical student Crister Brady put it, “docs and cops are seen as the same thing.”
According to Buck, “Pops” despises hospitals because “that’s where all his friends go to die.” He said the older man once promised to go to the hospital. Just as Buck planned to pay him a visit there, he instead discovered that he was living in a tent in the backyard of a friend.
“I told him, ’Pops, I’m gonna give you a kisser to the chin, throw you in a trailer and then drive you to the hospital,’” Buck recalled.
Darzins assured him such measures wouldn’t be necessary. She and Brady have found that the most effective way to treat those experiencing homelessness is to come to them. They represent a new generation of medical professionals that wants to lower stigma and customize care for those experiencing homelessness.
They’ve found an ally and a liaison in Dee Chavez, a formerly homeless Navy veteran who managed to win Brady access to a large, secret homeless encampment known as “the Island.” Together, they’re trying to save as many lives as they can in the face of a public health crisis that they fear will grow worse as politicians and police step up enforcement along the river.
As Darzins assured Buck she’d return to care for his de facto dad, Buck’s wife elbowed him in the ribs. It seemed there was another patient who needed Darzins’s help.
Making house calls to the homeless
While outside of the Union Gospel Mission on June 8, Darzins turned the corner and discovered a woman screaming—alternately at imagined voices and a man she called her boyfriend. When Darzins came near, the woman remembered her, but only that in their prior meeting, she couldn’t provide prednisone, a multipurpose, anti-inflammatory steroid.
Darzins said she didn’t have any at the moment, but promised that she could potentially write a prescription if the woman engaged with her street team of clinicians, which enrolled 1,011 patients into Elica’s system over the last year. But the woman returned to her state of agitation and repeatedly told Darzins to go away, which she eventually did, but not before promising to return and check up on her.
“It’s never perfect, but we just try to go with it and do the best that we can,” Darzins said. “I wanted to make sure to check on the lady because the biggest thing is keeping your word. Because if we don’t have that, then we don’t really have their trust.”
To bridge the divide between clinics and the diverse homeless community, Elica Health Centers started its street team in 2014. Similar programs that started later include Sacramento Street Medicine and the Street Nurse Program sponsored by Sutter Health. Darzins leads Elica’s street team.
For each patient they see, Elica employees fill out an admittedly cumbersome amount of paperwork that’s a prerequisite for their federal funding, but also helps establish a patient history that’s invaluable for future treatment, wherever it may take place. Darzins said it’s critical to manage health conditions of this population before a relatively straightforward malady turns deadly.
She offered the example of diabetes. Without proper medication, cuts on diabetics require much more time to heal properly, increasing the risk of infection. Beyond that, limited food options may mean a person’s diet can worsen their condition, leading to neuropathy (extreme pain in the limbs) that makes getting to a doctor or even administering self-care borderline impossible.
Darzins said that Elica operates under a “no wrong way in” model, meaning the street team will come to a person and provide them with care no matter what. She said they also work with the Sacramento Police Department’s Impact Team, which refers prospective patients to Elica and alerts them to new encampments (sometimes before officers close the sites down).
When Darzins makes her visits, she announces her presence with loud greetings so she doesn’t take anybody by surprise.
Darzins and Brady point out that people experiencing homelessness often suffer from mental and/or physical illnesses exacerbated by drug use and inhospitable living conditions. Most homeless individuals experienced trauma earlier in their lives, Brady said, and continue to be victimized by predators. Darzins added that many of the women she’s spoken with as part of Elica’s street team are victims of sexual assault.
Although Darzins said residents regarded her hesitantly in the beginning, they’ve grown to trust and rely on her team. To maintain this trust, she must be honest when Elica can’t provide something for a patient.
Another man at the Mission, who introduced himself as Mickey, explained he recently became homeless after an employee at his gym, who used to let him spend nights there, told him he had to find somewhere else to go.
When Mickey asked Darzins for shoe inserts to help him recover from plantar fasciitis surgery, she said Elica will never have them, primarily because effective ones can cost hundreds and require customization. Mickey nodded and seemed a little hesitant to enter the Mission, but thanked Darzins when she handed him her card and promised he could call her “anytime.”
Elica’s team acts as primary health care providers to many experiencing homelessness, writing them prescriptions for necessary medications that often get covered by Medi-Cal, a program that could lose much of its federal funding as the Trump administration mulls cuts to weaken the stability of the Affordable Care Act. But when survival is a daily struggle, asking a person to do everything that’s medically recommended is a big ask.
“If you’re worried about getting food or where you’re going to sleep, then you’re not going to be like, ’Oh, I got to take my meds,’” explained Sachiko Kageyama, a street team nurse practitioner. “If you’re high blood pressure, you don’t feel any of the symptoms. You don’t think about it at all. But if you don’t manage your blood pressure, you can have a stroke, then you’ll be out here paralyzed.”
Kageyama added that many people experiencing homelessness can’t get the benefits that a housed person would. Many of her patients suffer from congestive heart failure, a condition that can warrant palliative care, including a care provider to help the afflicted with cooking, cleaning and going to appointments.
“But because they’re homeless, they don’t have all of the access to those resources,” she said. “And so their health just kind of deteriorates until they’re at a point where it’s really horrible.”
In a January point-in-time survey of 2,052 unsheltered people, 34 percent reported a medical condition; 46 percent said they suffered from PTSD; 56 percent admitted to abusing substances; and 57 percent claimed a form of mental illness, according to a report from Sacramento State University and Sacramento Steps Forward.
Some use drugs to cope with the fallout from trauma or to remain artificially alert, Darzins said, “self-medicating with something that’s not in their best interest, while it may help them feel better for a minute.”
Most serious drug addictions begin after a person has fallen into homelessness, Brady added.
Dee Chavez, the formely homeless Navy vet who has become a trusted resource on the Island, testifies to the fact that methamphetamine and other drugs can lead to psychosis and paranoia that further destabilize a person’s mental health.
“Those voices are real,” she said. “Don’t think they’re just talking to themselves. It is very, very real to them. And I tell them, ’I know, I’ve lost my mind too.’”
Journey to the Island
High on methamphetamine, Chavez rode her bike through Sacramento on the night of October 27, 2015. She had been up for two days, gathering recyclables and dodging danger—the predators who target women living on the street, the drug-induced delusions that rustled in the bushes and the police officers who had arrested her for possession of narcotics in the past.
While pedaling, she closed her eyes for what seemed like a moment. The next time she opened them, she lay at the bottom of a hill. She closed her eyes again and awoke in a bed at the UC Davis Medical Center. Bright lights glared in her face, the taste of blood sat in her mouth and she couldn’t move her head.
“I fell asleep on my bike and broke my neck,” she said recently. “And that’s why I gave up meth.”
After cycling in and out drug programs for “longer than [she] could remember,” Chavez said, she never used meth again. Once her neck healed, she decided to dedicate herself to caring for the health needs of members of the Island, an encampment where she lived with between 30 and 50 people depending on displacement by weather and law enforcement.
In another example of the “institutional trauma” that Brady said occurs to a fair portion of people experiencing homelessness, Chavez said she and her husband lost the van they lived in before moving to the Island after a visit to the Veterans Affairs Northern California Health Care System in Rancho Cordova. In the medical center’s parking lot, she said, a VA police officer stopped them, searched their car and found knives, most of which, Chavez said, were for eating or whittling, her husband’s hobby.
Federal court records show that Chavez was arrested at the Mather Field facility on June 9, 2006, and later charged with misdemeanor possession of a controlled substance. Chavez pleaded not guilty and a federal judge later dismissed the charge. But Chavez said the repossessed van was never returned.
Shortly afterward, Chavez moved to the Island, where, she said, she never felt “homeless” because, like many others, that community became her home.
Citing tall trees and river views, Chavez called the Island a “beautiful” place and said it got its name because water will surround it during the rainy season. She said dozens live in tents covered by tarps to obscure their presence and supplement weatherproofing. She said they use gasoline-powered generators for electricity and propane stoves to cook, often dining together in a set-aside kitchen area. They make the site feel like home with furniture, appliances, chunks of carpet and other odds and ends that they pick up on nighttime recycling rides.
For many, she said, the exposure to the elements and illegality of the living situation is offset by the freedom, natural beauty and lack of judgment from outsiders that the Island offers. Many of those living on the Island were there when she first arrived.
Upon hearing news of the county’s recently approved $5 million plan to rid the American River parkway of encampments, Chavez said law enforcement has dispersed the encampment in the past, but the Island’s residents almost unfailingly return.
Tensions between the homeless community and law enforcement have been widely documented, and this mistrust has been transferred to health care professionals. Some have heard that a medical team attracted attention to a San Jose encampment nicknamed “the Jungle,” which prompted the city to shut down the site.
Stories like this are why Chavez and others are hesitant about bringing in outsiders or extra attention to their living situation.
“People know we’re there,” she said. “But don’t bring the attention. Because once there’s attention, they got to do something. They have to respond. And once they respond, it may not be what you want.”
Chavez first got involved with health care through a needle exchange at Harm Reduction Services. She said she took more than 30 needles three days in a row to provide clean injection materials for community members. Soon, administrators learned the details of her unique living situation and guided her to securing other medical supplies and services.
Brady originally came to Sacramento to discover why people experiencing homelessness didn’t avail themselves of conventional health services. But after visiting the Island several times, he refocused his research on the network of care that Chavez created outside of formal systems.
He saw how Chavez kept stores of clean needles, bandages, blankets and CalFresh credits. Beyond tangible items, he recognized her status as a leader helping community members through pregnancies and mental health crises, and connecting them to drug recovery programs. Chavez said she’ll soon help bring training for residents to care for wounds, administer CPR and inject nalaxone, a drug that can halt opioid overdoses.
After Chavez introduced Brady to the residents of the Island, they gradually allowed him to begin providing medical treatment and interviewing them for a thesis project at UC Berkeley.
Chavez, who helped present that thesis, also sits on the board of Joshua’s House, a proposed hospice center for terminally ill people experiencing homelessness. It aims to open in the River District by the end of 2018.
“[This work] gave me a purpose,” Chavez said. “It made me feel important. I finally found somewhere that I can be useful.”
Down on emergency street
Robby Medibles slung his arm around Darzins and explained that his toe fracture wouldn’t have happened had he been a bit more “limber” from a little drinking. Outside the Union Gospel Mission, Darzins reminded him not to mix alcohol with his medications. Mendibles rolled his eyes, but later explained why he appreciated this nagging.
“She tells me to take better care of myself because I’m not always doing that right,” he said. “And well, it’s like this, we can’t go to them, so they come to us. And they must really care to be out here.”
Darzins hands out her personal cellphone number to almost every person that she meets on her rounds. She said one woman, Julie Boggs, who suffers from seizures and anxiety, will text her up to 20 times a day for everything from alerting her to a crisis to complaining about her relationship.
“I could say, ’Forget it,’” Darzins said. “But if she’s frustrated with her boyfriend and she texts me, who knows? Maybe that means they’re not arguing and no one’s getting hurt. Sometimes, it’s like being a big sister.”
Darzins said this personal connection with her “friends” is essential to providing them medical care. Otherwise, she thinks that she wouldn’t be able to tell Mendibles not to drink with his medication or remind Boggs that she shouldn’t pick at her scabs. And her come-one-come-all approach to medical treatment provides a welcome change for a population that often must meet a variety of requirements to get aid.
“Nobody feels like I’m judging them,” she said. “I’m coming from a place of love. It doesn’t matter if you’re high. We’ll still see you. We’ll maybe say, ’You shouldn’t use if you don’t want your heart to hurt.’ But nobody’s gonna say they’re not coming.”
That sense of urgency has meant that death is not a stranger on the street triage beat. Several patients have died, Darzins said. She hopes it’s a sign she’s getting to the places she’s needed most.
Darzins has seen displays of gratitude from the community, from hugs to simple gifts like a little bouquet of purple wildflowers left on the Elica van.
“Nobody took credit,” she said, misting up a bit. “Somebody who has nothing found a way to give something. My mood and my everything is at its highest when I’m out with the people we serve. That’s where my heart is.”
As she talked with John Buck and his wife, three members of Elica’s street team examined Pops and filled out medical information on a laptop while a little girl belly-rubbed a pit bull puppy. Next to Buck sat a small Dia de Los Muertos-esque shrine dedicated to “Mrs. Huckleberry,” adorned with liquor bottles and a glass piece for consuming dabs of cannabis wax.
With a little prodding from his wife, Buck said he was born with chronic obstructive pulmonary disease, and admitted that he is aware that it can eventually turn into emphysema. His mother smoked while she was pregnant, Buck said, and he’s supposed to get his “lungs drained” every month. It’s been at least two years, according to him. His wife said it’s actually been three and the last time they checked Buck’s lungs, they were functioning at 40 percent strength.
“So next time we come out here, we’re going to want to check you out,” Darzins said. “Just to listen to your lungs and start paperwork. There’s no sense in not checking. The providers that come out here are really good and really care about what’s going on with you. They’re gonna help you make a plan that makes sense for you.”
Buck noted that he doesn’t have health insurance.
Darzins responded that “doesn’t matter,” but said Buck needs to provide an example for his adopted father if he ever hopes to see him get medical treatment for his heart and liver.
Buck mulled it over, then took Darzins’ card and agreed to start working with Elica the next time its team came out. His wife leaned on him and smiled as he shook hands with Darzins, who looked at him and said, “I’m gonna keep after you.”