As of this month, I have been a public health nurse for forty-two years. Public Health nursing rocks. It requires compassion and a heart for advocacy and activism, as its foremothers and founders demonstrated. Here are images of a younger me at the 1993 March on Washington for Lesbian, Gay, and Bi Equal Rights and Liberation when I was working as a nurse practitioner at Baltimore’s Chase-Brexton Clinic. And me in 1982 in my first job as Hypertension Control Nurse with the Richmond Health Department and the Richmond Urban League. Taking the blood pressure of then mayor of Richmond, Dr. Roy West and shaking the hand of then governor of Virginia, Charles Robb when he declared a hypertension awareness month.
I love public health nursing and everywhere in this world it has taken me. No regrets on my career choice.
This past week, I had the pleasure of sitting down with public health nurse Jody Rauch to talk about her work as a direct-service public health nurse and a policy/systems change advocate for people experiencing (or, as she says, “surviving”) homelessness. She talks about the path that led her to her current work as Senior Program Manager for the Seattle/King County Coalition on Homelessness. I love how she stated that she didn’t listen to nursing instructors when she was in her BSN program who told her she couldn’t go directly into public health nursing upon graduation. She credits the wise mentoring she received about this from Dr. Maggie Baker (a trusted friend and former colleague of mine). Nursing students whose heart is in community/public health nursing should absolutely consider going directly into jobs in that field upon graduation. Please don’t listen to the nay-sayers you may encounter!
Jody stated, “I really think homelessness is just where the failures of systems, and either good or bad public policy impacts, really converge. And I wanted to be able to work and participate in trying to shift systems.” She talked about what is going on in Burien, where she lives. “Right now the Burien City Council in particular has chosen to criminalize homelessness.” She speaks up at City Council meetings and advocates against the cruel effects of sweeps and other bans on people surviving homelessness. It’s important to note here that places like Burien that criminalize homelessness cause more pain and suffering, prolong homelessness, and lead directly to an uptick in hate crimes against people “appearing” to be homeless. Unfortunately, this includes verbal and even physical attacks on official outreach workers (and public health nurses) in the field who are connecting people with needed health and social services, including behavioral health and housing options.
Finally, Jody spoke of success stories, positive programs, and public health/social service interventions, especially ones we learned locally due to the COVID-19 pandemic response impacting people living homeless. It is important to emphasize, celebrate, and support evidence-based programs, including multidisciplinary outreach teams like REACH (Evergreen Treatment Services) and the U Heights Vehicle Outreach Team.
In honor of National Nurses Week, I want to highlight interviews I’ve done with some amazing nurses working on health and homelessness issues in the Seattle area. I had the pleasure of working with Eric Seitz, RN, when he was completing his BSN nursing degree at the University of Washington. He was the class president. I interviewed him right after graduation. He spoke of his own journey through homelessness and heroin addiction on the streets of Seattle when he was a teen and young adult. About how he almost died on the streets from a “flesh-eating” bacterial infection in his leg. About his two-month stay at Harborview Medical Center and the role of nurses and others there who provided quality and compassionate care. About his decision to turn his life around with the help of friends and family members–to become a nurse to help other people living in addiction and homelessness. And to work as a street medic to provide first aid at protests and to help “spread calm.”
Almost ten years after graduating, Eric has worked as a public/community health nurse in the Seattle area. He worked for a while at Harborview Medical Center, a place he credits with saving his life. He worked as a “HOTT Nurse,” (Housing Health Outreach Team). And he has worked as the head admissions RN at one of our too few low-barrier substance use detox and intensive inpatient facilities. He is doing amazing work. As he says, he can “empathize with all the suffering.”
On June 24, 2022, I sat down with Noah Fey, director of the Downtown Emergency Service Center (DESC) Housing Programs, at the DESC building in Pioneer Square. We discussed his work, first as a volunteer at DESC, then as an outreach worker, and now in DESC administration overseeing all of their varied housing programs. That morning, I had walked past tent encampments on the sidewalk just north of DESC. Noah talked about his nuanced views of encampment clearances (sweeps), encampments that grew exponentially in Seattle during the COVID-19 pandemic. Noah said, “I am not a fan of sweeps, but I am not a fan of simply saying, ‘We need to leave people where they are and leave them be.’ Neither of those are good alternatives and neither of those are informed by what we know works for people. Sweeps on their own are highly disruptive for people. (…) There’s already such a feeling of insecurity when you don’t have a place to live. Losing it time and time again is inherently pretty traumatic. (…) But I also think we’re shortsighted (…) if we are just adamantly saying, ‘No sweeps,’ and not saying what should come instead.”
Various cities around the country, including the Seattle area Burien, enforce stricter “anti-camping” bans, allowing more encampment sweeps and legal fines for unsheltered people. Many people and advocacy groups, including the National Health Care for the Homeless Council, point to the mounting evidence that sweeps harm people experiencing homelessness. Other groups like the National Homelessness Law Center have the campaign, “housing not handcuffs,” highlighting the fact that encampment sweeps are a form of criminalizing homelessness and poverty.
This past Monday, April 22, I conducted a workshop on homelessness in a large medium-security correctional facility in a rural area of Washington. The forty-five men who attended wanted to discuss the just-opened Supreme Court case, City of Grants Pass, Oregon v. Johnson, which will decide whether laws regulating camping on public property constitute ‘cruel and unusual punishment’ prohibited by the Eighth Amendment. Many of the men had experienced homelessness and had family members still living on the streets. Obviously, they were in prison for other crimes, but homelessness had complicated their lives. They asked me for resources on re-entry programs for when they are released from prison to reduce their chances of becoming homeless and churning through the homelessness, jail, and prison pipeline. Through the librarians at the facility, I was able to provide some of these resources. The Central Library of Seattle Public Library has a list of re-entry services, as does the Emerald City Resource Guide from Real Change. Seattle University’s Homeless Rights Advocacy Project, which advocates for legal and policy changes to prevent homeless people from entering the criminal justice system, also has a list of sources. My experience with the men at the prison made me even more grateful for the dedicated work of people like Noah Fey in providing compassionate, evidence-based housing and support services in our region.
Social worker Krystal Koop talked with me about her lived experience of homelessness as a young teenager, her work in homelessness, harm reduction, and criminal justice. Krystal helped start the University District Street Medicine Project (UDSM), a University of Washington interprofessional student-run organization that still operates today (and for which I am a huge fan and faculty preceptor). This conversation occurred in the summer of 2015. Today, Krystal Koop works as a grief counselor. She talks about her first-hand experiences trying to work within broken systems, including child protective services, behavioral health, and the carceral system (and our continued and increasing criminalization of homelessness). She speaks to the importance of working with people currently or formally experiencing various forms of homelessness, with community-based frontline service providers, and providing interprofessional “learning by doing” opportunities for our health science students. This interview mentions the nurse-led Housing Health Outreach Team (HHOT) and the Downtown Emergency Service Center’s housing first 1811 Eastlake, among other Seattle service providers.
Dr. Michael Copass, Seattle native, neurologist, Vietnam Army veteran/physician, and long-time head of the Harborview Medical Center’s Emergency Department, is a living legend in the Seattle area and in emergency medicine in our country. On July 26, 2015, I traveled to Sequim, Washington, to the home of Dr. Copass. Harborview physician Dr. David Carlbom and his wife, Dr. Judith Rayl (a retired physician and abstract photographer), accompanied me. I recorded this interview with Dr. Copass and his wife, Lucy, at their kitchen table. He spoke about his philosophy of care (“everyone is a gold coin”; about how the Seattle of the 1970s (as, perhaps, now) had “no organized plan for dealing with sadness”; about the creation of Harborview’s pioneering sexual assault center in 1972 by social worker Lucy Berliner, saying she did this by “churning through masculine indifference”; about the creation of King County’s stellar Medic One system of pre-hospital emergency care; about many other aspects of his long professional medical career.
I first worked with Casey Trupin soon after I moved to Seattle almost thirty-two years ago. At the time, I was working on applied policy research on improving access to health care for teens and young adults experiencing homelessness (while working as a nurse practitioner providing primary health care at a Seattle clinic specifically for our houseless young people). Along with Seattle and King County Department of Health Health Care for the Homeless, Casey and I worked on a project to clearly interpret Washington State laws impacting what types of health care could be provided to teenagers without necessitating the legal consent of parents/guardians–a source of confusion for teens and healthcare providers and a major barrier to care. I think this was when Casey was a recent law school graduate. I’ve followed his amazing work over the decades and was glad to talk with him recently about his work.
As he points out in this conversation, preventing youth homelessness is one of the best ways to prevent adult and chronic homelessness. A recent report from the Office of Homeless Youth for Washington shows that a concerted effort by multiple agencies and people (including young people with the lived experience of homelessness) reduced homelessness among young people ages 12-24 in Washington by 40% (between 2016 and 2022). Proving that it can be done.
On March 8, 2024, I sat down with Tamara Bauman to discuss her work, experiences, and perspectives on homelessness, domestic violence, and frontline staff burnout.
This project received funding support from a 4Culture Heritage Award, a Jack Straw Cultural Center Artist Award, and a Humanities Washington Stories Fund award. I want to thank these important arts and culture agencies and all the people who have talked with me about their work.
Yesterday, at a community homelessness resource and health fair where I was faculty preceptor for a footcare clinic with some of our medical and nursing students, I was reminded of the powerful role of libraries in the lives of people experiencing homelessness. Among the tables and tents offering warm winter coats, gloves, hats, behavioral health resources, pizza, bagels, coffee, haircuts, youth shelter and women’s day shelter services, and our footcare, the University Branch of the Seattle Public Library table was quite popular. Amidst the absurdity of a return to backward-looking book bans throughout our country and in a season of thanksgiving, let us remember that public libraries literally save lives.
It is not hyperbole to say that public libraries save lives, especially for people experiencing homelessness. Libraries give sanctuary and shelter, both emotionally and physically. Libraries yield quiet, peacefulness, community, heat, and, hopefully, air conditioning when it’s hot and smokey outside. Libraries have public restrooms, which are surprisingly scarce in Seattle as in most US cities. Harried parents can find respite in libraries with their bright, colorful children’s book sections, free access to the internet and computers, and children’s story hours. Children, teens, adults, and older adults, no matter their race, ethnicity, gender, sexual identity, differing abilities, socio-economic and housing situations, can all find stories of people like them who deal with challenges they face and who find ways to not only survive, but endure, resist, and thrive.
If you are fortunate enough to be comfortably and stably housed, please remember that not all of our community members have these basic necessities. When visiting public libraries, try to practice tolerance for all people who seem different to you. That extends to people who ‘appear’ to be experiencing homelessness.
A growing number of public libraries throughout our country and internationally are hiring social workers to assist library patrons from all walks of life to access needed health and social support. Whole Person Librarianship is a library-social work collaboration hub with resources and a map of social work-supported libraries. A recent and excellent book is Libraries and Homelessness: An Action Guide by the librarian and homelessness advocate Julie Ann Winkelstein–available, of course, in many public libraries.
