This brief is offered as a contribution to current deliberations regarding Medicaid expansion and healthcare reform in the Idaho state legislature. Idaho, like many other “blue” states, did not accept the Affordable Care Act’s Medicaid expansion. As a consequence, Medicaid in Idaho, at this time, is only available to children, pregnant women, parents of children under the age of 19, disabled people and the elderly. Even within those categories not many meet the Idaho Medicaid criteria: A family of 4 must earn less than $650 / month to qualify.

Research Findings

In 2003 I conducted in-depth interviews with uninsured individuals and families in northern Idaho, south-central Illinois, Texas, Mississippi and Massachusetts. All 37 Idahoans – at the time – were in the work force, though many were struggling to maintain a level of health sufficient to allow them to continue working and caring for their families. As I wrote in Uninsured in America: Life and Death in the Land of Opportunity (University of California Press, 2015), I was struck by the “rugged Idahoans” who shared with me stories of swallowing handfuls of Ibuprofen each day in order to manage pain, using a pocketknife to shave off bone spurs from their feet, turning to friends who worked as aides at nursing homes for help bandaging wounds, and confronting medical bills of $100,000 or more in the wake of an accident or health crisis.

In 2015 I returned to Idaho and the other four states in which I had carried out research in 2003.

  • In Idaho I looked for 37 people and was able to re-interview 20 of the 37.
  • Five of the 37 were dead: all five had passed away prematurely (in their 40s, 50s or early 60s).

One of the dead, who passed away at the age of 58, had worked in the mines his entire life. He left behind a wife and children.

  • Five are now recipients of SSI or SSDI by virtue of having become too disabled to continue working.

Jane used to work at three jobs: cleaning houses, doing laundry in a nursing home, and waitressing at a café. “Eventually I cut back to just the café job because it was my social life,” she explained, “but finally I couldn’t do it anymore. I even kept working through double pneumonia because I had to pay my bills, but eventually I had to stop because of my legs – you see my feet and ankles hurt and then turned black.” When she was finally diagnosed with diabetes at a free clinic she was told that she most likely already had diabetes for seven to ten years, but it had never been diagnosed or controlled. The staff at the free clinic would give her free samples of her medication whenever they had it available, but that was not a consistent source. At age 57 Jane was granted Disability (SSDI), but then had to wait two more years to become eligible for Medicare. By 2015 was able to access care through Medicare and Medicaid, but it was too late. She now is housebound.

  • Five now receive insurance through their employers and none of the five are able to cover their dependents through their employers. According to the Idaho Department of Labor, approximately 95% of Idaho businesses employ less than 50 workers, exempting the businesses from the ACA mandate to provide health insurance.

Marla and Peter, parents of three young children, were uninsured when I met them in 2003 and remained uninsured until a year or so ago. This was challenging because Peter has a blood disorder, ulcerative colitis and glaucoma. Throughout his adult life he has worked steadily for a company that he likes and likes him, but does not provide health insurance. When their kids reached school age Marla took an office job, but it did not provide health insurance. To take care of her family’s health needs, Marla drove them to doctors all over the northern part of the state – sometimes putting hundreds of miles on the car. At each office she would accumulate a manageable bill that they tried to pay off over time. Typically, the doctor would not see them again until they fully paid the bill. Knowing they needed healthcare coverage, Marla began to work for another small business owner who agreed to pay half of their monthly health insurance premium. But the remaining half was so high that after it was deducted from her salary she ended up taking home about $5 / hour. In 2015 she moved to a job with somewhat better insurance. Her premium now is $250 / month, but the deductible is $3000 per person and there are hefty co-pays and co-insurance.

Al, a farmer in his early 60s, was embarrassed to admit to liking “Obamacare.” But he certainly has benefitted from expanded healthcare access. Diagnosed with lung cancer a number of years ago, he had not been able to obtain health insurance before the ACA because of his pre-existing condition. During those years, hospital bills were as high as $300,000 annually, leaving him in horrendous debt. Now he pays $12 / month for insurance through the Exchange and his doctor is satisfied that “there are no new tumors.”

  • Four had moved out of state, primarily in order to access healthcare in Washington or other states that have expanded Medicaid under the ACA. No one in Idaho was receiving Medicaid in 2015.

Chris and Brittany, a vivacious couple in their thirties, moved from Idaho to Washington several years ago after Chris injured his leg on a construction job and the workers compensation ran out before the surgeries he needed were completed. While Chris was out of work Brittany took a job at a restaurant in order to tide them over. With her salary they earned too much for Chris to qualify for Medicaid and get his leg fixed. But without that salary they couldn’t survive. Today, they both are healthy and productively employed in the state of Washington, where they are raising their children and waiting for the day when it will be possible for them to return home to Idaho.

 Policy Recommendations

  • Senate Bill No. 1204, an act that proposes expanding Medicaid eligibility to persons under age 65 whose modified adjusted gross income is one hundred thirty-three percent (133%) of the federal poverty level or below, is an excellent first step towards allowing all Idahoans access to appropriate healthcare services and thus the ability to maintain better health.
    • Those with incomes below 133% of the federal poverty level cannot afford to pay for appropriate medical services. As a consequence, their health deteriorates and/or they amass medical bills that eventually are passed on to the counties or the state.
    • Idaho hospitals and clinics, for the most part, already accept Medicaid payments. Thus, the infrastructure is in place and implementation of this expansion should not involve additional costs or bureaucratic complications.
  • The proposed Primary Care Access Program (PCAP) is unlikely to substantially improve access to healthcare for Idaho’s low income residents.
    • While primary care is the core of any healthcare system, the reality of today’s complex medical world is that primary care visits alone are rarely sufficient for diagnosing or treating serious illness. For primary care providers it is frustrating not to have the capacity to send patients for tests, procedures or specialist care. Patients will find themselves in the frightening position of being told by a primary care provider that they need certain treatments but that the primary care program does not cover them.
    • There is no evidence that access to primary care alone, without parallel access to other medical services, improves the health of populations.
    • According to the published description, “The program requires payment for services on a sliding scale fee, which encourages greater personal responsibility for the patient’s own health.” Given that this program is aimed at people with very low incomes, it is more likely that fees will function as deterrents to care rather than as encouragement of personal responsibility.
    • In my research in Idaho I have never spoken with a single individual who can afford healthcare but irresponsibly chooses not to seek it. The most common reasons for not seeking care are: lack of insurance, deductibles that are too high to meet, lack of transportation to healthcare centers, inability to take off time from work during clinic hours.
    • By limiting access to healthcare to specific health centers, this proposal fails to address the needs of many Idahoans who do not live near any of the specified health centers.

 

************************************

Acknowledgments: In addition to the uninsured and formerly uninsured individuals whom I interviewed, I spoke with Terri Sterling, ICAN; Charlotte Ash, Snake River Community Clinic; Ken Whitney, Jr., Mayor of Troy; Dr. Richard Thurston, St Maries Volunteer Clinic; Donald Duffy, Panhandle Health District; Moriah Nelson, Idaho Primary Care Association; Pam McBride, Clearwater Valley Hospital, Orofino; Ashley Piaskowski, Heritage Health, Coeur d’Alene; Dr. Ted Epperly, Idaho Healthcare Coalition and Family Medicine Residency of Idaho; Stephen Weeg, Board Chair, Idaho Health Insurance Exchange. I thank all of these people for taking the time to share their expertise with me. All opinions and errors are my own.

 

Contact Information: Susan Sered, PhD; Department of Sociology, Suffolk University; 73 Tremont Street, Boston MA 02108

Email: ssered@suffolk.edu

For more on this research see Health is Where the Home Is   Health Insurance Roulette: The House Always Wins   The State(s) of the Affordable Care Act     

Courtesy of Independent 1.23.16

The emergence and spread of the Zika virus is worrisome on many levels: the impact of global warming on the spread of infectious and mosquito-borne diseases (see “Getting Dumped On: Snowmaggedon, Women’s Health and Human Rights“); indiscriminate aerial spraying of poisonous chemicals — especially in poor regions — whether well-intended or not; and the reality that the poorest families in Brazil and other countries disproportionately bear the burdens of global warming and are disproportionately exposed  to Zika virus due to living in crowded neighborhoods, reliance on public water pumps that often are surrounded by pools of standing water, and lack of adequate public health resources.

A related set of worries are products of structural gender inequalities: prohibitions on abortion in countries and US states at the same time as women are being warned not to become pregnant because of the presence of the Zika virus (see “Pregnant Bodies as Public Property“); the power of ‘rape cultures’ in which women may not be able to control access to their own sexuality and fertility (see “Fighting Rape Culture: Real Tips“); and a problematic history of public responses to viruses (such as HIV-AIDS) that may be spread through sexual contact, especially when the virus initially impacts disenfranchised or stigmatized groups.

In addition to alarm regarding the vectors of spread of the virus, there is cause for concern for the well-being of families affected by Zika virus. Here in the United States, Zika virus-bearing mosquitoes have shown up in Florida and other southern US states where many people are unable to access appropriate medical care because their state governments have refused to expand Medicaid under the Affordable Care Act (see “The State(s) of the Affordable Care Act“). Shocked and saddened by the pictures we are seeing in the press of babies born with microcephaly, the US’s continued refusal to sign the International Convention on the Rights of Peoples with Disabilities (see “Disabled Rights“) seems particularly indefensible at this time.

I’d like to share and support this statement put out by the Women’s Global Network for Reproductive Rights:

A Feminist Approach in Responding to the Zika Virus

Posted on February 5, 2016

In light of the recent outbreak of the Zika virus in Latin America and the Caribbean, the Women’s Global Network for Reproductive Rights (WGNRR) and the Latin American and Caribbean Women’s Health Network (LACWHN) join the voices of our feminist and women’s rights partners[1] in admonishing regional governments’ limited public health advisories for women. In particular we denounce the calls of countries such as Colombia, Jamaica, Ecuador, and El Salvador, advising women to delay pregnancy until the virus is eradicated, and particularly the call of El Salvador for women to avoid becoming pregnant for a full two years.[2]

Governments must recognize that when combatting the Zika virus, any public health strategy that does not have human rights, including sexual and reproductive health and rights (SRHR) at its core, will be limited in its impact and sustainability, while also creating massive grounds for human rights violations.

As a region, Latin America and the Caribbean is characterized by: high rates of unplanned pregnancy, where upwards of 56% of pregnancies are unintended;[3] high levels of sexual violence; limited access to contraceptives and sexual and reproductive health services; and restrictive laws on abortion, where in some cases such as El Salvador, abortion is prohibited under any circumstances and women are routinely persecuted and even criminalized on suspicion of having abortion.[4] Moreover, women who are young, from remote or low-income communities, and/or living in other vulnerable situations, disproportionately face multiple barriers when it comes to exercising meaningful decision-making power and control over their sexual and reproductive lives. In such a context, calls for women to simply delay or avoid pregnancy are not only unrealistic but irresponsible and negligent.

The rapid spread of the Zika virus and its strong association with marked increases in microcephaly and other neurological abnormalities is in many ways new terrain, with new elements continually coming to light, demonstrating a clear need for more research. This uncertainty makes it all the more imperative for governments to undertake from the beginning a holistic, sustainable, and rights-based approach to eradicating the virus and mitigating its effects. Anything less is careless and counter to governments’ human rights commitments under regional and international human rights law.

We thus urge the governments of affected countries both in Latin America and the Caribbean as well as other regions worldwide to undertake a rights-based, reproductive justice, and sustainable development approach towards the Zika virus and any other emerging health issue. Such an approach must be holistic, while recognizing gender equality and women and girls’ empowerment as a cross-cutting priority, in keeping with governments’ agreements and commitments under the 2030 Agenda.[5]

In practice, this approach to combatting the Zika virus must include:

  • Ensuring universal access to a full range of high-quality, voluntary, and user-friendly contraceptive methods, including barrier methods such as female and male condoms, and emergency contraception, as well as comprehensive SRH information and services, including antenatal services to enable early detection of microcephaly.
  • Targeting both men and women in public health awareness campaigns, especially in light of recent evidence that Zika may be sexually transmitted,[6] recognizing that the responsibility for safer sex methods falls on both men and women and cannot be shouldered by women alone.
  • Decriminalizing abortion, and removing all legal and implementation barriers to expand and ensure access to safe, comprehensive, free and high-quality procedures for pregnancy termination, free of requirements for marital or parental consent. As has been flagged by partners,[7] in the context of the many uncertainties and increasing public fears surrounding the Zika virus, calling on women to simply not become pregnant when access to safe abortion is limited or even completely criminalized will inevitably risk driving up rates of unsafe abortion, and ensuing maternal mortality and morbidity. Moreover, restrictive and punitive abortion laws that force a woman to carry an unwanted pregnancy violate women’s right to be free from inhuman and cruel treatment, as noted by Human Rights Bodies.[8]
  • Supporting pregnant women in Zika-affected countries who decide to remain pregnant to be able to carry the pregnancy safely to term, including access to comprehensive pregnancy, safe delivery, pre- and post-partum care and neo-natal care services; as well as the provision of special needs therapy, health and educational services as needed for children with microcephaly.
  • Systemic policy and programme changes that account for the intersections between climate change and SRHR.[9]
  • Immediate implementation of related recommendations under the Montevideo Consensus as well as targets under the Sustainable Development Goals of the 2030 Agenda, particularly those related to health and gender equality, in order undertake effective and holistic protection measures and help curb the spread of the virus.

Click here and here  and here for previous updates.

The last few months have brought some changes to the women of Can’t Catch a Break. Not all are of the life-changing sort, but I still marvel at the pace in which new crises arise in the women’s lives. Illness, death and disappointment in and of themselves are not extraordinary – they are the stuff of real life that all of us experience at one time or another. Rather, it’s the relentlessness. Some of the women don’t have time to catch their breath and assimilate one set of challenges and changes before the next set erupts.

Andrea is still unemployed and lonely. “I had a poor Christmas,” she told me. On the positive side, she is still securely housed in a well-located studio apartment.

 

Ashley is a gloriously happy stay-at-home Mom. I personally can vouch for the cuteness of her children. She posts daily photos of their antics and they keep me in stitches. Her husband is doing very well at work, they had a lovely Christmas, and both extended families are great sources of support and company.

 

Carly has had a busy few months. She remains fully engaged in her spiritual life – fighting Satan and trusting God — though she has not yet found a church that suits her perfectly. She quit the last church she’d been part of when the pastor “made white supremacist comments.” Having spent years living with a wonderful Black foster family, Carly will not tolerate racist comments in her presence.

Her big news is that she is pregnant! With a baby on the way she enrolled in a job training program which she graduated with a certificate that should pave the way for an entry level healthcare job. She still dreams of being a nurse in the future.

In the meantime, she remains stuck in an apartment that is saturated with mold and covered in rodent droppings. She desperately wants to move out but has not been able to find a landlord who will accept a tenant with a “voucher.” (Typically through the federal ‘Section VIII’ program, these vouchers cover rent according to a specific scale for low-income people. In tight housing markets like Massachusetts it is very difficult for voucher-holders to find apartments, even though the voucher guarantees rent; that is, the government agency pays rent directly to the landlord.) Because her living conditions trigger severe asthma, she has spent a great deal of time in the hospital.

For more on her housing struggles click here.

Elizabeth: See “Eulogy for Elizabeth, Update

Francesca is (still) a survivor. She is happy living part-time with the man she met last year. He is a stable, family man living in a semi-rural community at some distance from Boston. He works very long hours so she often comes back to Boston and stays for a few days with friends or with one of her sons. She has many close girlfriends of various ages and generations, and she enjoys being an “auntie” almost as much as she enjoys being a grandmother to her two lovely grandchildren.

She has had some serious health problems over the past months. She lost over one hundred pounds and spent a few stints in the hospital. She has been diagnosed with Crohns and Colitis, and then developed a C.difficile infection in the wake of antibiotics she was given for back-to-back kidney infections. She felt miserable with all of this, but is thrilled with her new svelte body!

Ginger moved back from Florida. She had moved there to be with a man she had met but that fell apart after a day or two. She called to tell me that, “I came to Fort Myers [and ended up] homeless. Last night I had a stomach virus. I threw up all over the bus. I had to go to the hospital. I was there all night. I’d been eating out of the trash. I have nowhere to in Florida.”

She called me from a local sheriff’s office next to the bus station. We figured out how to arrange to purchase a bus ticket for her. The next bus would leave in 12 hours and the trip would take two days. She had no money for food.

I spoke with the sheriff to see if there would be a way to help her out so that she wouldn’t risk being arrested for panhandling or soliciting sex for money. He said no. I wrote in my notes: “The irony that we’ll pay for a night sick in the hospital from eating in the trash, but we won’t pay for someone to get food.”

We spoke briefly when she returned to Boston, but since November I have not heard from her. I’ve tried every phone number and every friend and relative I can think of. I did catch a quick glimpse of her hanging out in the Boston Common with a small group of people whom I know to be homeless. It’s hard to know what to think. For many years Ginger has called me regularly at least once each week.

Isabella has had a horrid few months. She, her husband and her husband’s teenage son had been staying in the small living room of a one bedroom flat rented by a friend of hers. Both she and her husband were doing quite well on a methadone protocol that required them to come to the methadone clinic daily. In the Fall, after many months of applications, she landed a wonderful job. The new company sent her to a training seminar and she began to work in an office setting that she loved. Then, two things happened just about simultaneously. One, a more extensive background check carried out by her employer revealed her history of incarceration and she was let go. Two, her husband picked up heroin use (again), suffered what she considered a “psychotic break” that landed him in the emergency room and then the psych ward, and he destroyed all of their possessions.

Several weeks later he died of a heroin overdose.

Two weeks after that her roommate was given notice to move out; the landlord planned to empty out and renovate the apartment. She is now couch-surfing with a friend who lives in a town quite a distance from the methadone clinic that she needs to attend each morning. Isabella does not have a car.

Kahtia has been having a rough time. She still has not received her children back from state custody and she pines for them, as they do for her. After a few months in a sub-standard foster care situation they now are living with a foster family that Kahtia (who is not allowed to meet the family) believes is good to her kids based on how they are dressed and what they say when she sees them once a week in a supervised visit at the DCF office. I asked what she has to do to get them back. She said she’s already done everything she has to do — parenting classes, therapy, clean urines — and now is waiting on the next court date which is in February (two months off at the time). I asked her why the date is so far off and she said, “that’s just how it is.” Part of the problem is that she’s had at least three different DCF workers and two different DCF supervisors which “prolongs the case” (her words) because each time the new worker has to do a new assessment. She has gone to Court repeatedly and each time things are put on hold because of the new worker.

In the meantime she is struggling with serious health challenges and now needs to keep a portable oxygen tank with her wherever she goes. She has gained a great deal of weight and struggles getting up and down the stairs to her fourth floor apartment. She says it is highly unlikely that she will be able to move to another apartment on a lower floor.

The good news is that her husband is really coming through for her and the kids. He’s been working steadily and bringing all of his income home, coming to all the supervised visits, and staying by Kahtia’s side through the many medical problems and emergencies. He has sat with her in the hospital, stayed up with her at night, and done whatever he can to make her comfortable.

Melanie has long been one of the few women who has been steadily employed, securely housed, on good terms with her family, and in a stable relationship with a very decent man. I hadn’t heard from her in quite a while until she called this Fall, somewhat out of the blue. Distraught, she told me that she has an enlarged spleen. The doctors don’t know why though they have done many tests. Her concern is that her employer (a social service agency) is going to put her on short term disability which means that she’ll be paid only 70% of her salary and she knows that she can’t pay her bills on that. “If I have to go down to 70% of my salary I will get in my check $352 / every 2 weeks.” We went through her budget together dollar by dollar, and her calculation is absolutely correct. “I’ve used up all of my sick time and vacation time with going to doctors and then just being too sick to go into work.” She went on to say, “My job is the best thing. My Aunt said it’s my calling [to help people].”

Her asthma and depression are also acting up and “I am crying a lot” (my note: which is rare for her). She can’t stand on her feet or sleep on her left side. “I’m literally in pain.” The doctors offered her narcotics but she refused because she is an addict (that is how she defines herself though she has not used drugs at all in ten years.) She’s lost 16 pounds – “I can’t eat and I feel overwhelmed.” She also has gall stones in her digestive system, pain in her shoulder and a broken toe. She said the doctors do not know if these problems are related to one another.

Continuing updates will be posted so check back!

Christmas House Decorations wallpapers

Maybe it’s because of the bitterly cold temperatures at night this week, or maybe it’s my own visceral response to overdosing on television shows with happy family Christmas scenes and neighborhood holiday lighting competitions, but I’ve been giving a lot of thought recently to how housing and homes impact health.

About a decade ago I traveled to the Mississippi Delta, Texas’s Rio Grande Valley, south-central Illinois, the mountains of northern Idaho and the cities of eastern Massachusetts to speak with individuals and families scraping by without health insurance. Most of these people worked in construction, retail, agricultural or service jobs. The details varied, but across the country I heard about spiraling poor health, declining employability and growing poverty. In 2015 I made return trips to check in with the people I’d met ten years earlier.[i] While I was able to locate nearly all of the original interviewees who owned their homes (including very modest homes of immigrants in colonias in the Rio Grande Valley), I only located a minority of the renters. Typically, their original phone numbers were disconnected and original addresses belonged to subsequent tenants. When I knocked on neighbors’ doors the most common response was, “I don’t know [so-and-so]. I’ve only lived here for a few months myself.”

In previous posts I’ve written about marginalized Boston-area women who cycle through shelters, jails and the streets. In those contexts the “problem of homelessness” is relatively easy to see and define – all I had to do was visit shelters or walk through the public parks in which people without homes congregate during the day. But for me, it took weeks of trudging through muddy housing developments on the outskirts of Mississippi towns and knocking on doors in public housing complexes in a central Illinois cities to get a glimpse of the lives of those less visible Americans who generally manage to rent housing of some sort for periods of time but teeter on a financial edge that keeps them moving from place to place.

Unfinished housing project at 47-04 198th St. in Auburndale stands abandoned for several years.

On my 2015 reprise tour I looked for a total of 145 people in five states and was able to locate 98 of them. The missing people were not evenly distributed either geographically or by race. In Mississippi, the state that consistently has the poorest health profile in the country, I managed to locate only 11 of the 28 people whom I sought. The utter disappearance of 17 of 28 people did not surprise one local healthcare advocate (he asked to remain anonymous): “People move away to Birmingham or Tupelo to look for work. There is very little home ownership in Mississippi. The common thing is ‘lease to own’ in which a developer arranges for people to ‘lease’ (pay rent) and after 20 years they have an option to buy – to switch the rent to a mortgage. But people almost never make it to the 20 years so the developers keep leasing the same houses over.” Many of these houses would not pass even the most cursory safety inspection in other states.

I was able to locate 70 out of 88 white people I’d originally interviewed and 21 of 28 Latinos / Latinas (mostly in the Rio Grande Valley), but I only found 10 of 29 African Americans. This is consistent with national patterns. According to the US Census, the homeownership rate for the fourth quarter 2014 for non-Hispanic White householders was highest at 72 percent. The rate for All Other Races householders was 55 percent. And for Black householders it was only 42 percent. According to researchers Gregory Sharp and Matthew Hall, “The 1968 passage of the Fair Housing Act outlawed housing market discrimination based on race. …  However, emerging racial disparities over the next three decades resulted in black owners who bought their homes in the 2000s being 50 percent more likely to lose their homeowner status than similar white owners.” Even after adjusting for socio-economic characteristics, debt loads, education, and life-cycle traits like divorce or job loss, blacks were more likely to lose their homes than whites.”

Shanice’s Story

I first met Shanice in 2003 at one of the larger Black churches in Decatur, IL – a church known for its strong fellowship and advocacy on behalf of the community. She was happy to share her story with me:

“When I was 18 I worked a job, it was right after coming out of high school. No insurance and they said I wasn’t eligible for Medicaid. My doctor said that I needed to get my tonsils taken out cause they were so swollen it was almost causing me not to be able to breathe. … And so I had to go on like a payment plan with the doctor. … The whole surgery, the surgeon, the day at the hospital and then I had a setback and had to go back into the hospital cost $15,000. During the following year collection agencies called day and night, often making threats. They’d [especially] call on Sunday nights. Said that I would be going to jail if I didn’t pay them.” At age 20, Shanice filed for bankruptcy.

A few years later Shanice gave birth to her daughter. By this time Shanice was working for a storefront loan company that provided health insurance for her, but not for her daughter (she would have had to pay a premium that she could not afford on her salary.) A few years later their statuses reversed: When Illinois expanded Medicaid for children (Kid Care) her daughter became covered but Shanice, having made the decision to go back to school and learn a skill, became uninsured. Shanice was well aware of the risk she was taking was determined to build a better future for herself and her daughter. “It wasn’t just me living this carefree don’t worry about tomorrow life. Now I have someone that was dependent on me so I had to make decisions for the future. … We moved into a nice apartment, we got power, cable, phone and I got a new car.” During that time Shanice began to eat healthier meals and lost over one hundred pounds. In order to pay tuition, “I got Pell grants and student loans.” I asked Shanice how she was able to get credit to buy a car so soon after declaring bankruptcy. “Oh, they go after bankruptcy people like crazy [to sell them stuff]. I was getting credit cards in the mail every night.”

In 2003, after spending time with Shanice and her daughter at the church where they sang in the choirs, participated in groups and clubs that helped them focus on making good decisions, and volunteered helping out the poor in their community, I described Shanice in my notes as “a young woman on the way up.” She was working part-time at her church with youth and looking for her first professional job. “I just completed 1540 hours of cosmetology school and I just graduated last Friday.”

When Shanice and I walked out of the small room where the church choir stored its robes, I asked her if as a cosmetologist she would get health insurance. She answered, “I can get a job but in this field they don’t give insurance. You have to arrange that yourself.”

….

A year or so later I spoke with Shanice again. With a sense of resignation, she told me that medical and credit card debt had piled up and she was preparing to declare bankruptcy a second time.

….

Fast forward twelve years. I returned to the address at which Shanice was living when I initially met her. She had moved on and none of the current neighbors even knew her name. On USSearch I found six other addresses for her and visited each one of them. Two of the addresses did not exist. One was in a decrepit housing project that had been shut down for several years, though some people continued to squat in the apartments. (I was warned that mostly gang members were there and that it wouldn’t be safe for me to go poking around.) One address was in a middle-class, white neighborhood – none of the neighbors whom I could find knew of anyone named Shanice. Two were inhabited by other Black families who had moved in recently. Stopping by her church, I was told that, “Shanice is no longer a member of this church. She’s moved.” No one at the church knew where.

Health and Housing

It’s not hard to understand the devastating health consequences of homelessness. Living on the streets exposes people to cold, rain and assault. Without a home it’s a challenge to eat proper meals, get enough sleep and keep oneself and one’s clothing clean. The stress of not knowing where one can lay one’s head contributes to misuse of drugs and alcohol. And infections of various sorts tend to spread quickly in crowded homeless shelters. Like the people in the shelters, these health consequences are easily identified and counted.

The health consequences of moving around are less immediately visible to the casual eye. But at a community health center in Decatur Illinois, nurse administrators Karen Schneller and Tanya Andricks elaborated on ways in which churn in housing is related to churn in healthcare. Different states and even different counties and towns have different healthcare resources available to residents. Different providers have different medication preferences and treatment protocols so people stop and start treatments. Even with dedicated staff efforts, it is impossible to provide follow-up care for patients who can’t be reached – whose phones are turned off and whose mail is returned “addressee unknown.”

Jenny Trimmell, public health administrator and Melissa Rome, community liaison at the Vermilion County (Illinois) Health Department explained that children like Shanice’s daughter particularly suffer from frequent moves. “When the Cabrini Green housing project in Chicago was closed to pave the way for gentrification former residents were offered vouchers by the Housing Authority and promised housing and jobs in towns in central Illinois. But there was not enough housing and not enough jobs, so people go back and forth to Chicago. There was a cultural adjustment for many moving from Chicago to more rural downstate.  People were unaware that services outside of the city of Chicago may be limited, such as access to health care providers; bus services that do not run 24/7, etc.  Everyone is frustrated. The kids are in and out of schools and medical records kept by parents are incomplete or non-existent. It is difficult for the Health Department to determine immunization status for these children and frequently immunization series have to be started over due to the unknown immunization status.” Trimmell and Rome went on to explain that without the kinds of community support children develop when they stay put in one school, “there are high drop-out rates, teen pregnancies and drug use.”

Musings

Getting to know and then losing track of Shanice and others in similar situations has made me more attuned to the health privileges of stable and secure housing. My home allows me to accumulate the material objects that anchor and enhance my life, both in immediate ways by giving me space to store medication and in less tangible ways by grounding me in the photos, books and furnishings that tie me to my past and to the people I love. My home provides a hidey-hole for times when the outside world feels overwhelming. It gives me a familiar bed and private bathroom when I am sick, and a kitchen in which I can cook the food that I want to eat when I want to eat it. My home allows me to cultivate neighbors who can lend a hand at times of need and offers me the space to nurture those special bonds with the family that looks out for my well-being. In my own home I have the power to keep out rats, roaches, mold and the dust and down that I am allergic to. I am not dependent on the vagaries of landlords or property management companies. No less important, my home gives me an address at which I receive and retain the paperwork that helps keep my financial, medical and legal life in order as well as reminders of when and where to exercise my right to vote (yes – for candidates who support legislation that makes my community healthier).

I plan to return to Decatur next week and resume my search for Shanice. Maybe she has found another supportive church community somewhere else in the area. Maybe she finally has her healthcare coverage straightened out. Maybe her daughter has escaped being one of the kids who’s been subjected to multiple rounds of vaccinations. Maybe she’s become the star of her high school marching band or debate team. I hope so.

 

 

[i] In each community I began with the contact information people had given me when we first met. Only a minority still lived at the same address or had the same phone number. Then I turned to phone books, social media, Google and other public-access online search engines, including USSearch that listed multiple address histories for many of the people. In each community, if my initial attempts to make contact failed, I then called on common acquaintances, knocked on doors of neighboring houses, and asked at local grocery stores, libraries and churches.

For more on this project:”The State(s) of the Affordable Care Act”

For more on housing struggles, take a look at this article about “Carly”

Within the next months, Massachusetts’ legislators are expected to consider an amendment mandating that “Strip searches of inmates, including the videotaping thereof, shall not be conducted by or in the immediate vicinity of a correction officer or other employee of the opposite sex, except under an emergency or otherwise urgent situation.” Massachusetts Bill H.3444, An Act relative to searches of female inmates, comes in the wake of a successful lawsuit filed in 2011 against Sheriff Michael J. Ashe and Assistant Superintendent Patricia Murphy of the Western Massachusetts Regional Correctional Center in Chicopee. This lawsuit was filed on behalf of Debra Baggett and 178 former and current women detainees at the Chicopee Jail. As Jean Troustine explains, the defendants brought evidence showing that over a period of less than two years 273 strip searches had been videotaped, all of women, mostly by men who supposedly did not look.

The proposed law is certainly a step in the right direction. However, allowing the presence of an officer or employee of the opposite sex under an (undefined) “emergency or otherwise urgent situation” leaves the door open for subjective assessments of “emergencies” (for example, the inmate appears upset – a reaction that I’d expect to be fairly common when faced with a strip search) or bureaucratically based “urgencies” (for example, no officers of the matching gender happen to be available.)

Strip searches ostensibly are carried out in order to prevent contraband from entering prisons, yet reports cast serious doubts on the effectiveness of strip searches in that matter. In fact, evidence indicates that the majority of contraband is brought into prisons by prison employees rather than by inmates. Even if a strip search uncovers a bag of heroin or cocaine hidden on the body, that bag is likely to be a drop in the bucket against the background of the larger market of drugs smuggled in by employees. In other words, even if strip searches could be justified in terms of uncovering contraband (which, in fact, strip searches rarely uncover), to the extent that I have been able to see hard data on the matter, the amount of the uncovered contraband cannot justify this practice. In fact, no one really knows how effective strip searches are at keeping contraband out of prisons which is why I urge the Commonwealth of Massachusetts (and the rest of the country, for that matter) to document every strip search: the specific reason for conducting it and what exactly – if anything – the search uncovered.

National studies have found that strip searches often are conducted to establish power more than for real expectations of finding contraband . According to Deborah L. Macgregor, in an article published in the Columbia Journal of Law and Social Problems, women are particularly targeted for these displays of power. It is not uncommon for prison guards to use children as pawns to coerce women to participate in a strip search. For example, women may be threatened with not being permitted to see their children if they fail to cooperate. “Prison and police officers are vested with the power and responsibility to do acts which, if done outside of work hours, would be crimes of sexual assault. If a person does not ‘consent’ to being stripped naked by these officers, force can lawfully be used to do it,” according to Amanda George in the Australian Institute of Criminology.  George cites women’s accounts of strip searches: “We are strip searched after every visit. We are naked, told to bend over, touch our toes, spread our cheeks. If we’ve got our period we have to take the tampon out in front of them. It’s degrading and humiliating. When we do urines it’s even worse, we piss in a bottle in front of them. If we can’t or won’t we lose visits for three weeks.”

Justice Marshall has described a strip search as “one of the most grievous offenses against personal dignity and common decency.” These searches create “feelings of ‘deep degradation and terror'” and instill psychological reactions that “can be likened to those of rape victims.” The punitive nature of strip-searching is particularly egregious in light of the fact that approximately one third of women incarcerated in Massachusetts have not been convicted of a crime. Rather, they are in jail or prison awaiting trial, typically because they are not able to pay relatively small sums of bail money.

The coercive nature of prison exacerbates the humiliation of strip searches. An estimated 70% of women drawn into the correctional system have experienced physical or sexual violence, and in many cases that includes childhood sexual abuse. Prison procedures requiring the removal of clothing and intimate touching of an inmate’s body are especially traumatizing for women who have suffered abuse in the past. Responses to perceived threats can include alienation, withdrawal, fighting back, extreme outbursts, worsening of psychiatric symptoms or physical health problems, self-injury or suicide attempts, and increased substance use. In the prison context, these behaviors can lead to further punishment, including solitary confinement, and can easily be construed as an “emergency” meriting the presence of opposite sex officers at the strip search.

According to testimony provided by Carmen Guhn-Knight (August 7, 2015) based on interviews with sixty women who were videotaped while undergoing strip searches at the Chicopee Jail in western Massachusetts, “Women with histories of sexual abuse told me of their heightened sensitivity to having their naked bodies video-recorded. They said they returned to their communities re-traumatized, and in some cases with PTSD due to being recorded during strip searches.” Guhn-Knight shares some of the reactions she heard from these women: “Do we have to have the videotape? I don’t want to be videotaped naked. I don’t want to be filmed naked… I don’t want the camera on me.” “Is this going to end up on YouTube? … I’m being filmed while everything’s off? I’m naked being filmed.” “I’m not going to get stripped in front of a camera, that’s pornography.” “[You] take someone’s dignity and then do it again with a camera.” According to Guhn-Knight, “Despite their complaints, these women had no choice in the matter; they eventually removed their clothing themselves or were restrained while an officer removed their clothing.”

While the proposed amendment addresses the gender of the person holding the camera, it does not address the broader problem of video-taping strip searches overall. The taping of strip-searches is ostensibly for the protection of the prisoner; that is, having a record may prevent or at least document abuse during the search. However, the preservation of the tapes opens the door for grievous violations of privacy. In a country in which viewing on-line pornography is widespread (and sometimes unavoidable when unrequested porn sites pop up on screens), women inmates have good reason to fear that the tapes of strip searches may be misused for pornographic entertainment. Doubling down on the harm of the practice of videotaping strip searches, research shows that men who watch pornography are more likely to voice attitudes supporting violence against women and to display dominance and aggression (including choking, gagging and insulting name-calling) toward women while engaging in sexual activity.

Based on my reading of the scholarly literature as well as on my own research with formerly incarcerated women, I believe that the proposed amendment does not go far enough to protect women or men from the pain, humiliation and human rights violations associated with strip searches. I suggest that the law be amended to (1) disallow routine strip searches (2) permit strip searches only in situations when there is clearly defined and documented reason to suspect that the inmate is hiding contraband on his or her body (3) clearly inform all prison staff that strip searches may not be used as a form of punishment or discipline, and institute sanctions against staff who order or participate in strip searches in other than situations where there is clearly defined and documented reason for the search (4) disallow all strip searches by opposite sex officers and employees (5) cease video-taping of strip searches (6) immediately discard all existing video-tapes of strip searches.

For background on Elizabeth’s murder please read Eulogy for Elizabeth.

Nearly a year after she was murdered by a man against whom she had taken out a restraining order, the newspapers have uncovered a bit more of what happened.

The day before she was murdered she called the police with a request that they get her former boyfriend out of her apartment. She told them she had taken out a restraining order against him. According to the press, “When the two officers arrived, they failed to make the simple computer check that would have confirmed the restraining order she told them she had against him, and should have led to his arrest. They took [him] to a detox facility instead.” He came back the next day (allegedly) and battered her to death.

I can’t know what was going through the minds of the officers when they ignored Elizabeth’s plea for help, when they chose not to believe that she had filed a restraining order against the man she wanted out of her apartment. I can only guess that in their minds she was one more drunk, one more loser, one more woman who doesn’t deserve respect because she has been homeless or incarcerated.

While the Boston police may have invested a great deal of time and effort into educating officers about intimate partner violence, they certainly dropped the ball this time. “Police records show [one of the two responding officers] has had 22 internal and citizen complaints filed against him for use of force, disrespectful treatment, and conduct unbecoming. … [The other officer] has three complaints on his record. … He was the subject of a 2006 lawsuit after he led a car chase that left a 15-year-old boy dead in Roslindale.” Yet according to the Patrolmen’s Association attorney, they are “outstanding officers” who, when responding to Elizabeth’s call, did “the best they could in this situation.”

I could be snarky and say that I’d hate to see the worst they could do in this situation. On second thought, that’s not being snarky – it’s simply stating the truth.

Elizabeth – I still have your picture on my desk. I still hear your classic Boston-accent voice telling me — less than a month before you were murdered in your apartment — how grateful you were for finally having a home after two decades of shelters and the streets. I don’t believe in an eye for an eye, that’s not the kind of justice I’ll seek for you. But I will seek justice.

“What Churches Don’t Get About Ministering to Marginalized Women” – By Jennifer L. Hollis

Originally published in Sojourners 10-12-2015

See the full article here:

“One of the things that most saddens me in conversations with criminalized and marginalized women is the absence of any sort of philosophy or theology — what I call cultural scripts — for making sense out of their suffering,” sociologist Dr. Susan Sered explained to my church earlier this year. …

Faith communities must address unmet needs for meaning and community in the lives of people who suffer. Too focused on the symptoms of structural social inequalities, churches set up soup kitchens or food pantries, whose irregular schedules force poor and homeless Americans to run around among a variety of different organizations in order to be able to eat and feed their families every day. This process covers up the lack of a real safety net in our public policies instead of challenging those policies. And when a church or nonprofit gives, and poor Americans receive, the relationship makes a social — and implicitly moral — distinction between the haves and the have-nots, between the people who serve, and the people who are served. …

 

Many of the classes and programs in which women participate (voluntarily or not) teach them that in order to ‘recover’ they must take responsibility for their own problems, stop blaming others, extricate themselves from ‘co-dependent relationships,’ and learn to ‘do me’ rather than giving themselves to others. “This message undermines traits such as generosity and sympathy which women may most value in themselves,” Sered told me. “It distracts attention from the social violence that sends so many women into the institutional circuit to begin with, and negates the possibility of finding meaning in suffering.”

Sered believes that faith communities, especially churches, have a radical opportunity to do something different: help these women make meaning out of their suffering. “At least as a Jewish outsider looking in, it seems to me that the power of Jesus’ preaching as well as his horrific death is that suffering has cosmic meaning, that it has identifiable causes, and that those who have suffered the most can have the most to offer other people,” said Sered.

Continue reading at: https://sojo.net/articles/what-churches-dont-get-about-ministering-marginalized-women#sthash.KEFWJpow.dpuf

pink-handcuffs

(Thank you to Lois Ahrens for bringing the pink handcuffs to my attention.)

Each October, as national breast cancer month rolls around, I find myself fluctuating between pink-nausea and pink-rage. The pink ribbon extravaganza, a month-long consumer fest that turns women’s suffering into cold hard cash makes the absence of a national commitment to identifying and eliminating the environmental causes of breast cancer seem that much worse. The sanitized cuteness of pink-ribboned teddy bears makes the slash and burn treatments of the bio-medical cancer industry feel all the more painful. And the pink-painted messages praising “strength” and “optimism” reinforce the “holistic sickening” at the core of many of the complimentary and alternative healing modalities that “explain” breast cancer in terms of poor lifestyle choices, suppressed anger, or denial of one’s true femininity.

This year I’ve collected a few of the new (or at least new to me) egregious efforts to commodify, to normalize, to exploit — and to “cutefy” — breast cancer. Click here and here for more serious analyses. And as always, to learn more about “pinkwashing” and to support the work of Breast Cancer Action, click here.


As you can see in the feature photo, the pinkwashing Olympics have their new champion: the police department of Greenfield, Massachusetts announced on Facebook that for the month of October, they’ll be using pink handcuffs. Officers will also sport pins reading “Arrest Breast Cancer.” Because there’s no problem you can’t solve that way.

The news of this very well-intentioned, probably, gesture comes via CBS Boston and also the department’s own exuberant press release:

October is National Breast Cancer Awareness month. While most people are aware of breast cancer, many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same.

Many of our community members, including some of our own friends and family members, have been affected by breast or other types of cancer.

Officers of the Greenfield Police Department have “gone pink” in order to raise awareness for the disease! All of our officers have changed their collar pins, which were blue and white state seals to pink and white pins which states “ARREST BREAST CANCER – UNLOCK THE CURE” surrounding a pink ribbon and a pair of handcuffs. Some of our officers have even replaced their on duty silver handcuffs with pink ones and will be using them during the course of their work day.

Help us ARREST BREAST CANCER by spreading the word and by making your own early detection plan.

 

Remember: when placing a suspect in a light chokehold or frisking them against a vehicle, always ask if they’ve performed a monthly breast self-exam. There’s no awareness like the kind that takes hold in the back of a squad car.

In this era of stop and frisk, rising rates of incarceration among women and continued sexual abuse of women in prison it’s hard to get excited about a pink police car. “In 2006, a Department of Justice (DOJ) study found that women in prison are at significantly greater risk for cancer than their male counterparts. Out of every 10,000 incarcerated women, 831 had cancer, compared to 108 per 10,000 men.” According to the Department of Justice there are over 1,000 incarcerated women who either have or have had breast cancer. To learn more about  the suffering of “breast cancer behind bars” click here.

Pinkwashing has also expanded in the usual commercial way:

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(Image courtesy of the Shultz Shoes Website.)

Just what every woman needs to stay healthy: Pink stilettos. Perhaps the message is: Don’t worry about dying of breast cancer when you can kill yourself running for the train in pretty pink shoes.

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(Image courtesy of the Hard Rock Hotel Website.)

This year the Hard Rock Hotels are offering “Pink Rooms” with pink bed sheets and an option to purchase pink bathrobes. The activists among us will be relieved to know that we can stop organizing, lobbying, researching and lecturing. All we need to do to eliminate breast cancer is “Get into bed” and “relax for the cause.”  And in case you’re more of a “party for the cause” than a “relax for the cause” kind of gal, Hard Rock Hotels have you covered as well. Who knew that pink margaritas prevent (or is it cure?) breast cancer?

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Pink ribbon and other cause marketing can mask conflicts of interest, like when companies promote the idea of cancer research but also manufacture ,disseminate, or sell products that contain toxic or carcinogenic ingredients. I’ve recently seen dry cleaning companies jumping on the Pinktober bandwagon:

http://i0.wp.com/susan.sered.name/wp-content/uploads/2015/10/Capture3.png?resize=651%2C443

(Image Courtesy of Westportnow.com)

What this and similar ads leave out is that PERC, the solvent used in most dry-cleaning, is a known carcinogen.

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(Image Courtesy of Glamour.com)

Recent studies also show the harmful effects of working in a nail salon surrounded by fumes from chemicals in nail polish and yet companies are selling nail polish to “promote breast cancer awareness.”

And finally, to take away the sour tastes in our mouths (whether caused by chemo or by pinkwashing): Nothing promotes the health and wellness of women quite like sugar filled candies with cute little pink ribbons all over them.

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(Image courtesy of orientaltrading.com)

 

 


We Can Do Better

While spending on breast cancer detection and treatment continues to increase, funding for prevention – for learning about the causes of breast cancer – is far less marketable. In past years my home state, the Massachusetts legislature failed to fund research on potential carcinogenic impacts of chemical exposure despite clear findings that there are specific communities in Massachusetts with particularly high rates of breast cancer.

As for me, I’ll skip the pink bathrobes, candy, nail polish and (hopefully) police cars, and spend my money on real research into breast cancer prevention. For more on the Silent Spring Institute click here.

Thank you to Robin Yang and Ashely Rose Difraia for help with this post.

Click here and here for previous updates. Click here for the 2016 New Years update.

For women who struggle with homelessness, summer can be a bit of a reprieve. Because outdoor sleeping is a realistic possibility (unlike during the long Boston winters when they are stuck in overcrowded shelters with strict bedtimes, wake-up times and a plethora of rules) they may feel a bit less constrained, a bit more free.

Low income mothers who are hard pressed to arrange activities for their kids when schools are closed and temperatures are high often find summer to be challenging. Without a car or financial resources, July and August can seem unbearably long in hot urban apartments, especially when their children beg them to take them to water parks and on other expensive and inaccessible outings.

For women who are trying to arrange housing, welfare or other services, summer is a frustrating time in which social service employees are out of the office and paperwork gets stuck in the bureaucratic mill.

Here are early September 2015 updates on the women of Can’t Catch a Break.

Andrea: She still has her apartment but she gave up her job at the beauty supply store because they only gave her 2 days / week of work and she needs something to do the other days. This decision was taken back in the spring when a friend told her that she might be able to help Andrea get a job as a personal care assistant. At the time I asked Andrea whether she needs certification and a background check for this job. (Neither is simple in light of her prison record.) She told me that she has the certification but it turned out that she meant that she has the application to apply for certification but that she hadn’t yet filled it out. She was waiting for the friend to come over and help her with it (Andrea’s literacy is limited.) Andrea was not clear on what this kind of job entails – for example, whether she’d be working in a nursing home or for private clients, but she liked the idea that it pays $15 / hour and that she can work more hours.

By mid-July she had not made any progress and was unhappily unemployed.

Later in the summer Andrea was much happier. She’d recently heard about a “ladies drop-in place” where she now goes regularly and “hangs out with the people there.” She particularly likes that the women themselves plan day trips and activities, and the people who run the place help them with transportation. In the last few weeks they’d been to the museum, zoo and a water park. The volunteers who work there serve lunch daily and “they keep the place very clean.”

When we last spoke Andrea let me know that she was still with her long-term boyfriend but is unhappy that he takes but does not give. “I want a man who will take care of me and who wants a better life and to do things.” But her biggest complaint is loneliness: “I’m alone. No one comes to see me.”

 

Ashley: Ashley’s life today is as good as it gets. She is married to a wonderful man who works steadily at a highly skilled job. They have a child (absolutely adorable) who is welcomed and loved by flocks of grandparents, aunts and uncles. Ashley stopped working to be a stay-at-home Mom, and both she and the baby are thriving.

Carly is such a pleasant and easy conversationalist. Even though she is the youngest woman in the project, when we get together I often find myself telling her my problems before we even get around to talking about her life!

Carly’s has had some ups and down over the past half year. She had a job for a few weeks at a supermarket but was fired for getting into a fight with another employee. The final straw was when the co-worker called her “the n word” (in reference to Carly’s African American friends) and then referred to a black customer as a “monkey.” Having spent her teen-age years in foster care with a black family whom she still thinks of as her family, “I won’t put up with people using the ‘n word.”

She then landed a job working at a hotel but developed severe respiratory problems, most likely from the fumes of the cleaning supplies. She spent over a week in the hospital during which time doctors performed a slew of tests. Carly was told that the hole in her heart (she was born with a heart murmur) had grown and was now causing problems. “But then at church the Holy Spirit came on me and gave me the gift of being able to see [sense] things that are hidden from most people.” And, when she went back for a check the doctor said the hole in her heart closed. In the meantime she was fired from the hotel.

Since then nearly all of Carly’s attention and conversation is about the Holy Spirit. She can “see” Satan and knows when bad spirits are in people. Carly says that she feels empowered by this, but at the same time she is worried about spiritual warfare, believing that to be the reason why there have been so many obstacles in her life and why and bad things continue to happen to her.

Daisy’s life has settled down significantly. It is a great tribute to Daisy that her children graduated college and have good, professional jobs and solid, healthy relationships. And now that her children are adults, they are able to help her hold onto some level of stability and look out for their mom while maintaining boundaries that allow them not to burn out on Daisy’s endless needs.

Daisy is still living in a room that her daughter found for her in a rooming house in a suburb outside of Boston. While the living arrangements are minimal (shared kitchen and bathroom), they are far safer and saner than the homeless shelters where Daisy had stayed for nearly a decade. Her children also arranged for her to continue in an out-patient day program that picks her up in a van four times / week and brings her to a social center for disabled adults. Though there are few activities or enrichments at the center, Daisy enjoys playing bingo and talking to other people.

When the center is closed (three days / week plus holidays) Daisy is alone and isolated. On cold, snowy winter days and on hot, humid summer days she is essentially trapped in her room – it’s quite a long walk on a steep hill to get anywhere from her house.

I recently took her out to lunch for her birthday and she cleaned herself up and dressed nicely for our date. But she seemed very sleepy, most likely, she said, because of her medication. She has been drinking less and has not been in trouble with police for drinking outside for quite a while. But on the downside, the borders of her life are very constraining and when the social center is closed she often does not exchange a word with another human being for days on end.

For more on Daisy see Outcast Island.

Elizabeth: See Eulogy for Elizabeth.

Francesca: The ups and downs continue. Last spring she ended things with Joey, went to detox (again), and moved in with a friend whom she has helped out with childcare in the past. She enjoyed the domestic scene for a while but then began to feel sick. At the hospital she was told that, “I have an inflammation around my kidneys which caused some muscles around my kidneys to tear; I have a virus and fever and need to go home on bed rest.”

A few months later she met a new man and moved in with him and his family in a somewhat rural town without easy access to Boston. She embraced the domestic life and the opportunities to cook and clean and help care for his grandchildren. Her own grandchildren came to visit several times and she loved being part of a big family.

This man treats her well – he is not an addict and not violent – but her does have a busy life with work and hobbies of his own. So, after some time Francesca started to feel restless and isolated and now circulates among her son’s apartment, her friend’s apartment and her boyfriend’s house.

Her stated goal for the summer was to confront her fears and make choices for how she wants to live her life.

For more on Francesca see The Bitch at the Welfare Office.

Ginger has been having a hard time since her mother died. She misses her all the time and feels that the center of her life is no longer there. She spent part of the winter and spring in Florida with her brother and then moved back to Boston where she stayed on the streets and with various relatives. She was involved in a volatile relationship with a man – a relationship that involved a few police interventions and quite a few break-ups and reconciliations, as well as at least one incident in which her attempt to throw something at him ended up with her injuring herself.

She knows that it’s not good for her to keep moving around (Florida to MA) because of a man and that “I need to do me.” In the late spring she rented a room in an apartment and seemed settled. But after less than two months she moved out because the person she was renting a room from brought in people who were smoking crack and one time Ginger came home and found a man in her bed. Homeless again, she spent the summer “sleeping here and there.” The last time we spoke she had moved back to Florida.

Isabella’s two big concerns are housing and her step-son who has been in and out of juvenile detention. These two concerns are intertwined: When she and her husband lost custody of his son they also lost their eligibility for family housing. The last time I spoke with her (June) the three of them were staying with a friend. Her husband and step-son were sharing a futon and she was sleeping on a love seat with her feet dangling off the end.

Isabella is capable of working: She is bright and has solid work experience. But between the demanding hours of the methadone clinic (she has to go to the clinic every morning for her dose and she has to stay for group therapy several times a week) and the endless search for a solution to their housing problems she has not even been able to look for a job.

For more, see: Failure by Design: Isabella’s Experiences with Social Services.

Joy: In the spring Joy seemed to be in good shape. Her daughter (who is in her father’s custody) was seriously ill and Joy’s parents allowed her to stay in the hospital with her daughter. Joy was up to the task and her parents were confident that she was not using drugs.

Then, “I relapsed.” With no place to live, she spent some time in an abandoned trailer and then hooked up with a young couple who owned a car and had an apartment. “They’d sit in the car and I’d go out and do my thing [prostitution] and buy drugs and we’d split everything three ways.” She understood that they were exploiting her but didn’t see any other options. In the meantime she had failed to show up in court on an old charge and a warrant was issued for her.

In the late spring she called me from the psychiatric ward of a local hospital. She had tried to kill herself. Joy told me that she was found in the woods (near where Linda was murdered) by someone she’d known many years ago. He called an ambulance and the paramedics had to work for 45 minutes to save her. She was taken to a hospital and then released her after a few days. She then went to the police and said she would kill herself again if they couldn’t place her in a treatment program. They took her to a different hospital’s psych ward where the staff would try to find a long-term bed for her. They didn’t, and in a week she was back out on the streets.

Over the summer two of her front teeth rotted out. We talked about how she always looked after her teeth and I reminded her how the first time we met she attributed her survival to always having a toothbrush and toothpaste even when she was on the streets. I asked her what changed. She said she basically has given up.

For more on Joy’s adventures in psych wards and rehab see, Alternatives to Incarceration: Be Careful What You Wish For.

Kahtia: Things have been rough for Kahtia. She’s been struggling with depression and anxiety, and spent a week on a psychiatric ward in the early spring. But Kahtia is one of the few women to have a truly helpful caseworker who assisted her in getting back on her feet. In April I met her at a soup kitchen where she helps serve lunch and clean up as well as eating her own lunch. She liked the structure this gave to her day while her children were in school. However, during her hospital stay her meds were switched to a new anti-anxiety drug and a heavy-duty anti-psychotic. As a consequence, when we talked she was struggling with intense drowsiness – literally falling asleep with her fork halfway to her mouth. She explained that both medications cause drowsiness and the interaction causes more drowsiness. For the first time in years she did not appear to be well groomed: Her nails were dirty and unkempt; her shirt was dirty; she had some crumbs around her mouth. Her children, however, were clean and appropriately dressed and Kahtia was able to pull herself together to pick them up and school and cook real dinners for them every day.

When we spoke in the spring Kahtia was particularly upset over appearing drowsy because if she “nods” at the methadone clinic they won’t give her the dose (that happened earlier this week) because they assume she is using drugs (even though they have the paperwork about her meds.) She felt (and I agreed) that she needed to talk this over with a doctor who knows her and all of her med history. She tried to call her own doctor but no appointment was available for a few weeks.

By the end of the summer things had deteriorated even more. The head counselor at the children’s day camp called DFS (child welfare services) to report that Kahtia often seemed high in the morning at 7:30 when she dropped her off. Kahtia explained to me and to DFS that she takes psychiatric medication which leaves her groggy in the morning but she is not high. Indeed, her urine is tested regularly at the methadone clinic and she has not used illicit drugs. In any case, the children were taken away and placed into foster care. Kahtia is devastated. And while she can see the children once each week and speak with them on the phone daily, they will start the school year in a different district (where the foster family lives) rather than return to their friends and teachers.

Read about Kahtia’s reflections on sex work here.

Vanessa spent most of the winter and spring in residential programs for treating substance abuse. These stints were broken up by several episodes of her leaving (and not being permitted to return) or her being kicked out for breaking rules or “relapsing.” Each time she ended up on the street in tears and frustrated at the barriers to getting back into a program. Even when she finds a placement, each time she has to “start all over” with detox and then waiting for a longer term bed in a rehab facility.

The last time I tried to call I couldn’t get in touch with Vanessa. Her cell phone number was disconnected. And, after many years of being a stalwart support, Vanessa’s mother is ill and told me that, “I don’t know where she is. I can’t deal with her. I’m too tired. I can’t deal with the aggravation.”