Report Drop Offs

All the font's really small but here's what the data looks like.

With my time in Seattle quickly drawing to a close- I fly back east tomorrow for a good friend's Vermont wedding- I wanted to pull together some loose ends. All of the information the women have shared with me has now been collected into a glorious, overflowing Excel spreadsheet. And over the past week, I've been writing an initial report with key findings, anecdotes, and data concerning demographics.

When I conducted the interviews, I promised the women that I'd drop off copies of the report so they could see the findings. I swung by both Angeline's and Tent City 3, at its newest location, yesterday to hand over copies.

This is TC3's new location, up in Northern Seattle at Haller Lake Methodist Church. Folks at TC3 shared that they are almost completely set up now (the move was on Saturday and yesterday was Tuesday). It's certainly an awe-inspiring move that occurs every 60-90 days. They'll get to stay at this site through October, which is a great thing since the move is so labor intensive and emotionally draining. However, it takes at least an hour (which can include a 20 minute walk) to get to and from the site from downtown Seattle. And while it's roomy and the neighborhood seems especially friendly, that's a long way to travel for a job or a doctor's appointment. Plus, if King County bus cuts are made, it will be even more of a trip as the two buses that go there- the 41 and 358- are both slated to be reduced. 

While I'm definitely nervous to see what interviewees' reactions to the initial report might be- I left my email for any feedback- I hope that the general conclusions I've been able to draw represent their thoughts. And hopefully, this analysis can serve as a way to hear the needs and feelings of homeless women directly. Often times, and I know I've been guilty of this, assumptions are made about others' needs without appropriate direct consultation with the impacted communities.

I'll post some key take-aways shortly as well.

Just as an FYI, while I'm headed back to school shortly, this project will most likely turn into my thesis work so the policy ideas and examinations of other cities health care for the homeless will continue. Plus, any excuse to come back and visit Seattle is quite appealing!

Moving Day... Every 60 Days

Tent City 3 is sponsored by host churches, per the city's consent decree. And TC3 can stay at a particular host site for up to 90 days. However, lately, it seems like they've been moving every 60 days. Today was moving day, wherein everything is packed up and loaded into massive trucks and then set up all over again in a new location. Everyone is required to help with the move, otherwise you can be banned. It's a massive effort and a phenomenal glance into just how TC3 works as a self-governed entity. The take-down and set-up happens all within one day, which is really a herculean effort considering it's 100 people's belongings as well as communal spaces.

TC3's new location is praised in many ways, with an emphasis on the larger amount of space it affords residents. However, it's in Northern Seattle, requiring a lengthy bus ride with a transfer to get downtown, which, unsurprisingly, is where most health care and job related resources are. 

We went over to help with the loading this morning. Here's a few photos:

Here's just one of the moving trucks used today. You can see one of the many piles of wooden pallets and baseboards used to as the ground for individuals' tents to help keep out moisture and the cold. 

Just a glance of what 100 peoples' belongings look like. Residents say the move every 60-90 days is completely exhausting, unsurprisingly.

Another shot of people's belongings.

Where's the Empirical Evidence?

Seattle policy debates are heating up! And attending hearings, meetings, and pulling together my research reminds me that I made the right choice to earn a masters in Public Policy. A public meeting last week provided additional confirmation.

The room wasn't as full as The Chamber expected but it
was surely full of heated debate. You can kind of
see me sitting behind the camera on the right side.

The Seattle Chamber of Commerce hosted a 'forum' (term used very loosely since it turned into a bit more of an open mic, which isn't necessarily a bad thing, just different than what it may have been marketed as) with six panelists to discuss the details and respond to questions about the proposed paid sick leave ordinance for all city employees. Seattle would be following in the path of San Francisco, the state of Connecticut, Washington D.C. and Milwaukee. As both a public health and a social justice issue, paid sick leave is the right thing for the city to mandate.

The panel featured three ardent supporters of the policy (all women) who each offered compelling stories about why the legislation is necessary: a school nurse, the owner of Cupcake Royale and the Policy Director from the Economic Opportunity Institute. However, there were certainly some angry voices from the other side of the issue including the director from the Washington Policy Center's Center for Small Business (as the Center states, they 'promote sound public policy based on free-market solutions), a representative from the Seattle Society for Human Resource Management and spokesman from the REAL coalition (which you would hope would advocate for strong benefits packages for workers which include paid sick leave...) and a small business owner who operates several H and R Block franchises.

From an observer's standpoint (granted, as an observer with a very strong alliance to mandated paid sick leave policies), there was one overarching pattern that delineated the speakers and their allegiances. Those in favor of the legislation shared stories, personal anecdotes, and appealed to a call for social justice and public health. Those opposed said there simply wasn't enough data. They wanted the empirical evidence. And this was repeated over and over and over again without citing exactly why they were insisting on time-consuming economic analyses when they have been done on cities with policies already in place.

To be honest, it felt like a stalling tactic and one that didn't have the teeth to compete against the woman who stood up and shared that she couldn't take time off when her child is sick. She very simply explained that this jeopardizes her job and results in the loss of a full day's income. Data is important but I believe it really does make a difference to hear personal anecdotes about how a policy will impact an individual family. It's why I'm making sure to have both numbers and stories to back up what women have told me throughout the summer.

On a slightly different note, after the panel, I chatted briefly with the school nurse who had shared such powerful anecdotes from her time in the school system. She spoke about children who would come to her sick but beg her not to call their parent, knowing they couldn't leave work to come pick them up.

Not only was she a compelling speaker, but her public health background marks her an expert who understands human needs. I told her how strong a panelist she was and that she should consider running for office. Knowing how few women think they 'can' or 'should' become involved in electoral politics, I've decided to make sure I tell someone when they strike me as such. After all, wasn't it that recent NYT's article where research suggested that women run for office to 'accomplish something' and because someone else tells them they'd be good at it?

Increased Bus Intensity

The Women's Commission is working incredibly quickly to make the case that the proposed bus cuts will disproportionately impact low-income and homeless women's access to health care. They sent off a letter to the King County Council yesterday citing the information gathered from interviews with women at TC3 and Angeline's and it was featured in Publicola, Seattle's online news source this morning.I can't help but read the comments that people post below- feel free to peruse at your leisure despite this warning that some suggest 'typical comment obnoxiousness.'

What the situation boils down to is that the council members have a vote on their hands to enact a temporary $20 vehicle license fee to cover the additional budget lapses for the bus system. They need six votes to pass the fee and it sounds like citizens who rely on public transportation have been working very hard over the last few weeks to make their concerns known about the reduction in bus service.

Here's a bit more about the situation:
An article in The Stranger
A clip on chanel 5

In the end, I firmly believe that limiting access to health care services will only make more women avoid them. And it's low income women who don't have the choice or the ability to seek out other service providers closer to home; I surely wouldn't make an appointment that would take two hours and three bus transfers to get to. And if this means women are avoiding preventative care, I can't help but worry that much more serious health care issues that might have been avoidable will arise down the road, damaging women's health and costing the city far more.

Seattle Buses: The Wheels Go Round With Not As Much Frequency

While Seattle weather would indicate that summer hasn't really even begun yet, my time here is beginning to wind down. I've now completed all of my interviews with the women- 34 in total, and am set to begin an overall analysis.The first part of this analysis includes a look at bus routes and health care provider proximity.


More specifically, due to budget cuts, many Seattle bus lines are slated to be severely reduced, if not cut entirely. I'm curious to see if these impending reductions would indeed impact access to the current health care providers they frequent. In short, it seems like the answer is 'yes.'

A total of at least six bus lines that are used for women to access particular medical clinics, hospitals, Department of Social and Human Services and SSI offices are on the chopping block. At least another 23 bus lines necessary for accessing these sites are checked for reduced schedules/stops, meaning it will take even longer to get to an appointment or visit a clinic for an emergency.

I have to wonder if this reduction in public transportation will provoke more people to take an ambulance to the ER.  As of now, many of the women I spoke with who cited the ER as their primary care provider take the bus there. But, if it's going to require three transfers and an hour ride just to go two miles, an ambulance surely sounds more appealing if you don't have the money for a cab...

Just a few of the amazingly strong women I've met

I thought it might help personalize some of what I'm sharing by telling you a bit more about some of the women I'm meeting from both Tent City 3 and Angeline's. And since my interviews are now complete, I'm beginning to analyze and share these stories. No names, locations or ages are shared to protect confidentiality and safety of the interviewees.

Each interviewee has been gracious enough to share her stories with honesty, detail and beyond all else, enormous strength.

-A 20-something year old with dentures who has finally found the medicine that can best support her mental health needs yet can't get it covered by her current insurance.

-A woman who is badly injured from an on-the-job injury and knows that physical therapy is the only way to treat it so that she can eventually get off of disability. The irony is that her disability insurance won't cover physical therapy; it only covers medication, which doesn't work for her.

-A woman who is not allowed to see her son and every time she goes to the doctor, is asked about how her family is. And her response is often that she is stuck in a cycle of depression as the separation from her child leads her to feelings of deep sadness.

-A woman who feels extremely grateful for all of the services she is afforded as she is trying to earn a vocational degree and get back on her feet after fleeing a domestic violence situation.

-A woman who has been married for four years yet only spent two of them with her husband because of homelessness and the lack of any shelters for couples to live together. 

-A woman who has been waiting for weeks and weeks to learn if her SSI application was approved and in the meantime, cannot get the medication for her mental health needs.

-A woman who is a cancer survivor but does not know where to go to seek follow-up specialty care to ensure her remission continues.

-A woman who is diabetic who is consciously trying to take control of her illness yet faces numerous challenges because of how hard it is to eat healthy when you're homeless.

-Several women who lie about their addresses when they go to the doctor or the hospital, knowing that if they put down a relative's or former personal address, they will be treated better. As some shared, this can mean a shorter wait time and a more compassionate provider rather than treatment under the assumption that they are simply there to abuse the system or get a new dose of narcotics.

-And one woman who paid me the best compliment I may have ever heard. After we completed the interview, she thanked me for taking the time and then shared that speaking with me made her feel special.

Chaka Kahn

I entered Angeline's this morning, ready to embark on another five interviews. While I sat waiting for my 10 am meeting, laugher and some serious music started pouring out from the main sitting room. After a stroll over with the Center's volunteer coordinator, we found a group of about five women having the most fantastic Chaka Khan dance party. Other women, those not so into dancing, were sitting in their chairs, clapping along, laughing hysterically. It was the best possible way to begin a Monday morning. If I could dance, I would have joined them in a second!


And if I was blog savvy enough, I'd find a way to make it play some Chaka for you as you read. I promise, it'd lift your spirits immediatley and you'd start humming, "Ain't nobody. Love me better..." It's ok, you can blame me for getting it stuck in your head now.

When speaking with the Center's director later, she shared that music and dancing is one of the easiest, and sometimes the only way, for some women to interact and communicate with eachother. In fact, one of the women dancing had, only moments early, been pretty visibly angry during a questioning by the police.

While I continued waiting for my interviewee to show up, a man delivered a bouquet of roses. With the handover of the fresh flowers, he took out the haggard-looking ones from the previous week. Apparantly, the urban legend of the flower delivery is that a woman who was a former Angeline's client now pays to send the Center fresh flowers every week.

While the flower myth may or may not be true, and a local florist may, in fact, be the benevolent donor, women do stop by to share their accomplishments and progress. This past afternoon, while waiting for a different interviewee, a former client swung by Angeline's just to show the staff how well she is currently doing on her own. It's clear that many women who use Angeline's services develop a friendship and a trust with the staff and are eager to earn their bragging rights.

Heading to Angeline's

One of the reasons many women cited choosing Tent City 3 over a shelter revolved around having a space for her belongings, a sense of privacy, and while not quite a Virginia Woolf-ian Room of One’s Own, a place to belong throughout the day and night without being kicked out. As a result, shelters were often unappealing specifically because many do not offer privacy or a space to stay during the daytime. Rather, they are most often a sleeping-only safe space, asking the homeless to rise at 6 or 7 in the morning, head off for the day with their belongings, and then return at 7 or 8 at night to line up for a bed for the night. As a result, many are left without daytime spaces.

Angeline's, located in downtown Seattle in a recently renovated building.

There are, however, spaces to serve those intermediary needs. One is Angeline's.

My next round of interviews will be with women who reside or use the day facilities at Angeline’s, a YWCA-run center for homeless women. Here’s a terrific article explaining some of Angeline’s work and the relentless cyclical shuffling one living in poverty encounters on a daily basis. It's old (2002) but I think captures many of the sentiments I heard expressed by TC3 women.

I’ll be curious, more specifically, to learn about how access to health care differs for these women compared to TC3 residents. Angeline’s has public health nurses, health care professionals and resources regularly available.I'm headed there tomorrow for a tour and then will hopefully begin round 2 of interviews shortly thereafter.

Dropping off some resources

I strolled over to TC3 yesterday to drop off the completed Health Care Resource guides. Hopefully, they'll be a somewhat helpful tool for the residents. Here's the finished products if you're curious:

Photo Credit: Kate Reeder

I created both regular sized comprehensive guides and then wallet-sized
resource cards, which were modeled after a similar sized card the
city created to provide a resource of numerous services. The city cards, however,
only included two health care resources for general/primary care so hopefully,
these can fill a few of the needs expressed by residents.

Stigmatized or Less Urgent: Where Do STDs fall?

I'm in the process of gaining approval for the next step in my interviews, in which I'll be interviewing women who live in a shelter to see how resources and referrals compare to those provided to or identified by TC3 residents. I'm interested, in particular, to find out if there is a difference regarding what needs are expressed as unfulfilled. Women at TC3, when asked "How do you think female residents hear about health care services?" most often shared that it was simply through word of mouth. Many female residents share information with others, several longtime residents are considered the camp sages and several women stick entirely to themselves, leaving sans 'health care gossip.'

If, though, word of mouth is the means for awareness raising and resource referring, and no one has an idea about where to get a free pap smear or mammogram, then the chain of communication hits a road block. It would be incredibly interesting to see if a shelter- one which is also receiving funding from the city- has that same communication method and consequential breakdown as well. Or, perhaps, a shelter has a case worker onsite or management employees who keep resource handouts stocked and up-to-date. It should be pretty interesting to find out.

But what I really wanted to write this post about is sexually transmitted infections. No, not about challenges finding free testing and treatment- they're there, you just have to dig a bit. What I really want to talk about is a continuation of a conversation I had with my friend Lauren who works with a policy organization that specifically advocates for homeless people with HIV/AIDS and HIV/AIDS people who become homeless. The question: Are sexually transmitted infections still of such a stigmatized nature that we cannot or do not talk about them in the same way as other diseases, illnesses or health-related needs?

The gut reaction might likely me an resolute 'yes.' No one seems too willing to publicly share their recent bout of herpes or gonorrhea. But then, I had thought that menopause, yeast infections, abortion and mental illness often faced similar stigmas in our society as well. Commercials never actually call a yeast infection by its name, women are shamed for choosing to terminate a pregnancy, we speak of menopause in hushed tones, and mental illness is still looked upon with grave negativity in many circles.

What struck me throughout the interviews with TC3 women is that these otherwise stigmatized actions/changes/illnesses/infections were mentioned repeatedly, openly, honestly, and without any shame (not that there should be any shame attached to any of them). There were a few euphemistic references to having some changes "going on down there," but it was mentioned as part of a litany of health related needs and concerns. They were mentioned without being specifically asked but rather with a probing, "Are your reproductive health care needs met?" or "Are your mental health care needs met?" I never asked any interviewee specifically if she had chosen to have an abortion, if she had any particular mental health needs, if she was undergoing menopause but these bodily changes and challenges were all mentioned and discussed repeatedly.

Just one of the numerous pro-protection advertisments from the past
that places blame squarely on the woman. I'm actually headed to a movie
showing tonight showcasing old sex-ed videos.
 I'll be eager to share, I'm sure.

However, not a single interviewee mentioned any sexually transmitted infection in her listing of current or recent health needs or challenges. I can offer a few hypotheses for why this might be the case, per recent conversations with friends in the reproductive health world: 1) None of the women have an STI/STD; 2) STI/STDs are so common that they don't seem worth mentioning, placing them at the level of a common cold (which was in fact mentioned several times); 3) There are more pressing health care needs that put an STI/STD at the bottom of the list; or 4) STI/STDs still retain such a stigma and are linked with such blame and fault that they just aren't mentioned. (In fact, a quick google search returned the Facebook group, I can proudly say I've never had an STD).

There could surely be additional reasons, or thoughts about why one woman didn't share something compared to another. And my data set isn't nearly large enough to run any kind of quantitative, causal analysis but it's surely something to think about. And in a positive light, to be glad that those health care changes or challenges that were mentioned aren't facing a stigma that keeps someone from talking about them to a grad school interviewer without any medical training.

A study to be cited for years to come...

And yet another timely article in the Times, reporting on a study that finds when low-income have access to health insurance, they have better health. Indeed, it does seem obvious, and certainly echoed in the thoughts of the women at TC3. However, what's different about this particular study is its random selection of those on and off Medicaid, significantly minimzing other variables.

Here's just a tiny excerpt:

Women with insurance were 60 percent more likely to have mammograms, and those with insurance were 20 percent more likely to have their cholesterol checked. They were 70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.

Vancouver

It seemed like I would be remiss to be in Seattle and not visit Vancouver, the city people glow about. So, last weekend, we took the Cascades Amtrak up to Vancouver. Here's a few photos from the 48 hours spent exploring:

Yup, Vancouver had a one-room Jimi Hendrix shrine. It was well worth the five minutes we spent inside.

This is me making John lift up the house on stilts.

We strolled through Chinatown and found the usual assortment of bins full of spices, fish, and mushrooms. However, I've never before seen a bin full of lizard skins on sticks. They were not expensive either.

Vancouver likes to knit things for their bike racks. I think we should probably do something similar for the ones at school- it gets cold in Cambridge in the winter.

There were fantastic sculptures all around, many added to the city for the 2010 Olympics.  I especially liked this one- there was a circle of red squatting men, all identical to this one. The artist is Wang Shugang.

Stanley Park has a collection of beautiful totem poles that were created in the late 1980s.

And what trip to Vancouver would be complete without people watching- there were tour buses full of high schoolers decked out for the prom. The dresses were definitely a bit more elaborate than what I'm accustomed to.

Just part of Vancouver's beautiful skyline.

Ok, this is Rory. We hung out with him on Whidbey Island a few weekends ago but I thought he deserved to be included in a blog photo posting.

A Success!

Just a quickie but today was a good one. I think I've finally finding some services to share with people over at TC3!

I have now located free vision care (eye exams and glasses), free dental care, including dentures, and free prenatal care. It may have taken calling at least 20 different so-called 'low-income dental clinics' but free dentures exists. The resource manual is coming along quite nicely and I should be able to bring it over to TC3 within the next week.

More coming soon detailing the next step of the project!

18 Interviews Down

Hi Blog Readers,
This is an entry of disparate thoughts:

1. First of all, many thanks to everyone who's shared their encouragement and interest in my project. Your praise for the blog and support for the challenges that this summer's work proposes has been enormously appreciated. And if you have ideas, thoughts, etc. please don't hesitate to leave me a comment note.

2. I've now completed 18 interviews with women at TC3. Each story has been so very different and yet, the frustrations with the limits and failures of health care provisions continue to resonate. In addition to the often-mentioned vision and dental care barriers, mental health care needs continue to arise. Not only is there limited access for diagnoses and support but the costs of filling prescriptions often seem to feel insurmountable. I'm going to move into the next stage of the project shortly so stay tuned for details!

3.  For each of these 18 interviews, I've sat at the Tully's coffee shop directly across the street. The staff have been fantastic and most patrons seem to have no idea what's going on- it's just me scribbling furiously to catch every word the woman sitting across from me says. However, earlier this week, there was an older man sitting, drinking his coffee and working on a crossword puzzle, who kept giving me the dirtiest looks. I don't know what it was about- I was sitting with a woman who looked more 'homeless' than some of the others I've interviewed. I do believe the majority of these women would 'pass' and those of us with sustainable incomes would never guess them to be tent city residents. I just smiled back at him, despite his continued glares. Eventually he got up and left, not without shooting me one last glare. I hope my interviewee didn't notice.

Today, though, after completing one particular interview, the interviewee and I chatted a bit about what it's like for her to live in a tent city. She had already shared how she believes her interactions with medical care providers to be different because of her housing and lack of insurance coverage. She then stated that when she had stayed at a Tent City 4 location previously, she had been part of a panel of residents who spoke with community members at a new tent city location. She stated that a woman in the audience of this panel stood up and asked the tent city residents if they would be using the park a few blocks away. One panelist responded, "Well, yes, it's a public park and people in the tent city do like parks."

The audience member then probed further and said, "Well, what are we supposed to do with our children?" My interviewee shared that she had been holding the mic at this point, and had no idea what to say, so she responded, "I'm not really sure what you mean."

The woman, rather than catching onto the idea that her question might have been offensive, just repeated it verbatim. "What are we supposed to do with our children?"

Dumbfounded that someone would speak with such presumption and prejudice, the panelists were all silent. Finally, one non-tent city resident who was also speaking on the panel, vouching for the community's credibility, shared, "Well, some tent city residents have children and have raised children so I assume they'd be happy to meet your kids."

The woman I was interviewing shared this story with grace and with sadness. But not with any hint of anger or frustration or anger. In fact, she admitted that before she ended up in a tent city, she had dismissed homeless people, and probably would have shared some concerns similar to this particular accuser.

So timely!

I just came across this article in today's NYT. The Obama administration is launching a 'secret shopper' survey to find out how long it takes to receive care as a new patient trying to make an appointment with a doctor. They're tracking discrepancies between the access to care for someone on Medicaid versus holding private insurance. The results should be pretty interesting.

Trudging Through the System

I know, I know, I just posted, but there's some serious frustrations that I think need to be expressed. It's hard for me to talk with folks who need services and not do anything to try to help them find them. I've set about trying to compile some referrals that will be provided to TC3 so that they have an up-to-date resource. Don't worry, it won't be shared until my TC3 interviews are complete on Monday so as to retain my methodological credibility.

As someone with access to a cell phone, a desk phone with unlimited minutes, and 24 hour/day internet, I cannot even begin to imagine the frustrations TC3 folks feel in trying to find resources for medical care. Again, it becomes ever more obvious why someone would choose the ER over a phone-transferring run around. Moreover, TC3 folks are limited to three minutes on the camp phone so any time spent on hold eats up alloted minutes.

Here's my prime example trying to find pre-natal care:

1. Call Medicaid. Wait on hold for 15 minutes. Robot voice says I have at least another 30 minutes of wait time. Give up on this referral option.
2. Call Planned Parenthood for a referral idea instead. They offer free birth control and yearly exams (Hooray!) but suggest I call Medicaid. I share that it puts me on hold for an hour.
3. I search on the Department of Health website for referral numbers. I call a Downtown Seattle clinic which says they have a home visiting nurse and explain the situation and needs. They say I need to speak with WIC.
4. This clinic transfers me to Kent County WIC HQ. I've now left Seattle services behind for some reason.
5. I tell Kent County WIC person what I'm looking for. She asks for address, wonders why I'm calling Kent, and then tells me phone number for a clinic-based WIC office near TC3.
6. I call the suggested number for this clinic WIC office, only to find a recording telling me that the number has been changed.
7. I call the new number and hear a voicemail message saying that the WIC office isn't open on Fridays.
8. More than 30 minutes since beginning this process, I leave a voicemail at the local WIC office. Hopefully they'll call me back on Monday.

I'd be ready to head over to the ER just about now too.



Some Emerging Patterns

I've now had the opportunity to interview ten women who currently live at Tent City 3. All have been incredibly kind and open, which is especially noteworthy since they're speaking with a stranger about personal health needs. And while each person's story differs- how they've ended up in TC3 and what their personal health care needs are- there have been some emerging patterns.
To maintain confidentiality, I don't want to share any of the personal stories for fear of such an experience being tied to one of the ten women but I can share some general themes that aren't necessarily surprising but are wholeheartedly saddening.

1. No income means waiting for months:  While there are numerous clinics that provide sliding scale fees, often going as low as $15 for a visit, this amount, if you're someone without SSI, Medicaid or GA-U, and you have an annual income of $0, the nominal $15 co-pay is too much. There are a handful of clinics that will not refuse treatment regardless of one's ability to pay, or they use Charity Care funding, bringing a bill down to nothing. But, these are the clinics where you frequently encounter a waiting list for new clients or a several month waiting period for an appointment.When faced with these two challenges, I can imagine why it's often far more appealing to head straight to the ER, where you couldn't be refused treatment.

This is not meant, in any way, to disparage the work being done at each of Seattle's clinics for the low-income. Rather, this work sounds tremendous and should be replicated. Rather, I believe that such an occurance further clarifies the barriers the homeless face and how dire the need actually is.
2. The ER provides primary care: I remember talking to voters throughout the 2007-2008 campaign cycle, trying to get folks onboard with a vague plan for universal healthcare as proposed by then Senator Obama.  For those ardently opposed, the talking points would always involve the token, "Because we don't have coverage for all Americans right now, folks are using hospital emergency rooms as their primary care resources, and you, as a tax payer, are footing the bill." 

I assumed this to be true- the Talking Points Masters wouldn't lie- but with 10 interviews now accomplished, there hasn't been a single woman who hasn't mentioned the ER as her resource when faced with illness. Most avoid any kind of health care due to lack of insurance or income, but when they have some type of ailment that they believe needs treating, some type of ailment that I would definitely pop into my regular doctor for, they take a bus ride over to one of the area's hospitals. They simply have no other option and they haven't had access to enough preventative care to prevent such a need in the first place.

3. Walgreens Glasses: There is a desperate need for vision care yet no one seems to have been able to find it for little to no cost. Instead, many women shared that they've just purchased $1 reading glasses at Walgreens, which may help slightly but do very little to conquer the constant headaches or need to squint.

4. Dentures: There's a dental van that comes to TC3 about once a month and is able to pull out people's problem teeth or complete fillings as needed. It's a great service but it leaves folks in the lurch for other much-needed dental care.  More specifically, I continued to hear about dentures; there's several women in their mid-40s and 50s who wear dentures and need repairs. But no one seems to offer denture work for low income individuals.



Thanks Congressman Ryan but your budget proposal
is just going to result in more preventable visits to the ER

It might have been the cycle of Indigo Girls songs on my Ipod this morning that put me in a more frustrated-than-usual by social inequities and injustices mood, but the unmet needs just don't seem like what folks should have to encounter in the United States in 2011. There's a lot of great services in existence, and noble attempts at alleviating suffering and limiting the reach of poverty, but I can't help but grow more and more frustrated about the continuing political debate regarding PPACA funding. No, the ACA isn't a panacea but it's surely a start.  Those holding up the legislation's enactment with cost concerns should really have to go and speak to these women. They should have to tell them personally, "I'm sorry you can't chew your food because of an infected absess in your mouth but we just can't afford to help you."

First interviews begin today

I'll be heading over to TC3 this afternoon to begin speaking with female residents. In preliminary conversations with a few women last Thursday, I'm heading into these interviews with a hypothesis that the services for health care needs exist, by and large, but there's a disconnect in making sure those services are accessible and that patients know of them. One woman shared, "I'm 44 and I've never had a mammogram. I know there are places that have sliding scale fees but even $28 is too much for me to pay."

Another resident shared that she hasn't had a pap smear in several years and knows she's due for one but just doesn't know where to go. I also met a woman who's pregnant and another who was recently diagnosed with cancer. I'm not sure what prenatal care and treatment options exist and are being accessed for these residents but I'm hopeful that if they're not currently what they need, we can identify the shortfalls.

I was honored to present these brief conversations and the project at-large to the Seattle Women's Commission at their June meeting last night. In addition to being asked some incredibly thoughtful questions and hearing some helpful brainstorms about directions the project could take, the Commissioners shared the work each of their sub-committees have accomplished. One committee is working to see how current city sex education programs can include education about prostitution. As the Commission's 2011 Work Plan explains,

• It is estimated that between 300 and 500 underage girls are prostituted in King County. SWC will promote education of sexual exploitation/youth prostitution issue to educators and parents. It will also research Seattle School District's violence prevention curriculum and advocate for inclusion of teen dating violence and prostituted youth education for middle and high school students. SWC also seeks to explore building stronger connection between Youth & Families Initiative and youth prostitution issue.
• Additionally, SWC will analyze areas of influence in legislative arena and make policy recommendations; advocate for changing law around arresting underage girls for prostitution.

Additionally, while the idea of paid sick leave seems like a pretty solid 'no-brainer' to me, the majority of cities in the nation don't mandate any policy like this from their employers. While Connecticut just passed state-wide legislation mandating paid sick leave, Seattle is following in the footsteps of San Francisco and looking at it on a city-level. The Seattle City Council is considering a plan that would mandate paid sick leave for all workers, regardless of the size of the business. The Women's Commission has been at the forefront of the effort, speaking with individual council members to help convey the need. It would pretty monumental to be here when such a bill passes. Check out more details from this morning's story!

Completely Unrelated...

Nothing to do with TC3 but today, while out asking for gift card donations to local drugstores to help incentivize interview participation, I saw not one, but two different people with ferrets on leashes. Seattle loves ferrets?

I'm Approved!

Tonight was a night of good/need to share things:
1. My project has been approved by the residents of TC3 and I'm invited to come in and interview interested women! This is the biggest hurdle I was worried about regarding project implementation so it's great news.

I was actually over there tonight for the host-church 'Welcome TC3 Ice cream Social." I took a mini tour of the community and got to speak to a handful of women. Maybe they were being polite but they seemed really interested in speaking to me. Several made note of the fact that shelter and food are regularly spoken about and addressed but that healthcare (and women's healthcare, in particular) is frequently given secondary consideration, if any at all.

2. I also had an opportunity to speak to several male residents. One man explained which Seattle neighborhoods were most welcoming of the tent city (Capital Hill ranks highly, apparently). He shared that in some neighborhoods, permanent residents will see someone from the Tent City with a backpack and immediately assume they're homeless. His language was quite deliberate and it presented an eye-opening realization. He doesn't see himself as homeless- the tent city is his home. He views himself and his peers differently from the homeless folks he sees downtown every day.

This notion proved even more salient when, during the tour, one non-tent city woman yelled out, emphasizing her support for their system, "You can tell the city that you'll stop living in tents when they give you homes." The tour guide- a longtime tent city resident- paused for a long while before responding. I don't know if he felt like TC3 is his home and that her suggesting otherwise was a possible affront, but the language was surely interesting.

Socks and Dignity

Two years ago in D.C., I was walking home one evening post work, passing by the homeless people who I had passed by every day before. It was winter and as I approached the CVS, I walked past the man who was regulary there, perched on his plastic milk crate. As I walked up and past him, I watched as he rubbed his very swollen-looking feet and put them back into his grimy shoes. He had no socks and it was cold. Very cold. While watching this, the only thing I could think about was how much I hate putting my feet into shoes or socks with dirt in them, that gritty, sandy feeling that just feels so unpleasant. And so, while I normally never give money to folks who ask on the street, I decided, at that moment, that I would run into CVS and buy this guy some new socks so he wouldn't have to continue experience that gritty feeling that I have such a personal aversion to.

I purchased the socks, and came back out, eager to present my offering, so pleased with myself for thinking of being kind. I approached him and shared, earnestly, "Here, I thought your feet might be cold so I bought you some socks."

The guy looked at me in return and said, "Do you have any money?"

Shocked that he wasn't excited to have clean socks, I repeated my offer, "Well no, but I bought you socks."

The man took them after I insisted another time, and then went right back to rattling his cup of change at passer-bys. I felt defeated and frustrated. I had gone out of my way and spent my money and time to buy him socks. And when he didn't want them, I had had to convince him that I knew what he needed to get him to agree to accept them. I wanted other passer-bys to see my generousity.

The total action had been entirely about me- my hate for toe grit and cold feet and my need to be seen and recognized for my supposed kindness.

I've thought about and retold this story quite a bit since it happened and each time, am more aware of my problematic assumptions and paternalism. I haven't tried to buy socks for someone again. But I've mostly ignored the pleas for money while walking down the street as well, meaning I pretty much ignore the people making the pleas too. It's often easier to pretend you just don't see them or hear them, to offer a quick "Sorry," and walk on.

However, I had the opportunity to engage in a meeting yesterday that has since changed my thoughts. I was lucky to catch Mimi, a Seattle-based artist, before she heads out to Mt. Rainier for three months, to pick her brain about her three month project where she lived as a Tent City 3. I had initially hoped to learn about how best to advertise the interviews, recruit women to participate, and present myself (a serious question of what to wear!- jeans or businessy). But I took away some incredibly helpful reflections from my conversation with Mimi as well. Most of all, she reminded me of who the people living in TC3 and on the streets of Seattle are. Mimi shared that two female residents of TC3 were pregnant, one couple had gotten married and numerous others had life stories full of impressive accomplishments such as violinists with globally-performing orchestras, aspiring poets, and idea-laden entrepeneurs.

She also shared that TC3 has even stricter rules that I had thought (not just zero tolerance policies for substance abuse or failing to perform your assigned security shift). As a resident, Mimi was not allowed to be seen loitering in the neighborhood- which meant no sitting on a bench on the church property and no requesting a local bookstore host a bookclub for residents. And when the residents embarked on their regular, silent meditation walk around the neighborhood (a past site) on Christmas morning, a woman wearing a Santa cap trotted onto her front lawn and yelled at the folks walking by, "I pay to live here."

A city ordinance which allows TC3 to reside in neighborhoods brings with it a challenging contrast: how much dignity should be sacrificed to create this living space? How do you balance the needs of community members with the needs of new, temporary community members? And what sacrifices are ok?

And so Mimi's suggestion, when passing folks on the street, is simply to smile and exchange a hello. A recognition of someone as an individual, while not enabling them to purchase material goods, helps reaffirm that they're there, that they're part of this city too.

A Staggering View

When I described this project to friends, the response was typically one of two things. People either expressed enthusiasm coupled with a recognition of the potential challenges I might encounter or folks expressed shock and dismay that in 2011, the United States has tent cities, communities suggestive of the 1930s and 1940s 'shantytowns.'

St. Joseph Parish, the host church

Before embarking on this summer's work, I had heard a bit, here and there, about tent cities popping up throughout the nation, mostly in response to the current economic climate. The general pattern seems to be that many families, once solidly middle class, employed and paying down household mortgages, now face unemployment and homelessness, having had their homes foreclosed upon. I'm not sure yet if that particular scenario applies to Tent City 3 here in Seattle, but it seems to be a general truth with regards to other tent cities, including those that have sprung up in Sacramento, and St. Petersburg, Florida.

I thought that I had had enough time to digest the project before getting to Seattle, that I wouldn't be shocked to see TC3 in-person. And yet, today, as I walked over to TC3's new location in Capital Hill, what I found was indeed, staggering. Staggering because of its size and capacity. Staggering because it (and its residents) must move every three months. Staggering because of its ability to be reconstructed in a matter of hours to ensure people a place to sleep that night.

Houses in the neighborhood

TC3's new location- on the beautiful property owned by St. Joseph's Parish- has actually been its old location twice before and it seems like congregants and neighbors know the drill. But it's tough to ignore the juxtaposition of the tent city in this neighborhood. The houses are large and beautiful (I walked past one with its own, private basketball court), the sidewalks have colorful mosaics cemented into them, and poppies are blooming on well-groomed lawns. Then there's the tent city. I took a few photos but didn't want to encroach on the community's request for privacy so they're from afar.

The tent city is surrounded by fencing to offer a bit of privacy

You can just see the tops of the tents down below

I'm eager to hear TC3 residents' thoughts about the community and am sure I'll continue to be impressed and challenged. Hopefully, some interviews can begin next week to learn more about health care access specifically. Tomorrow, I'm meeting with Seattle artist Mimi Allin who spent three months living in TC3 (check out her blog).

Only two posts so far and too many words. Here's just a few photos, instead, of a hike I went on yesterday to Mt. Rainier. Most of the trails were still unpassable because of snow (sorry friends in D.C. sweltering in the 100 degrees plus humidity) but we did spot two amazing banana slugs...

Seattle so far

I've been in the city for just about five days and it's been a whirlwind of getting acquainted with my neighborhood (the fantastic Capital Hill with its abundance of restaurants, hills, and bookstores) and the project. I had a meeting with two members of the Women's Commission on Thursday to map out some details and figure out a likely time line. I'll be joining the Commission's monthly meetings and presenting the project at the all-Commission gathering in late June.

For the duration of the summer, I'll be housed in the Seattle Office of Civil Rights; they're being kind enough to allow me to use their space as a home base for the project. The SOCR actually sponsors several other city-wide commissions so it should be really interesting to have an eye into how these bodies work with local government. It seems, at least from an outsider's view, that Seattle's city government is quite committed to ensuring and engaging citizen participation and that citizens return the goal by volunteering to be involved.

As far as my project with TentCity 3 goes, I'm still in the prep work phase. I want to make sure that I'm not only eliciting information and thoughts from women who live in the tent city about their access to health care, but that the project also provides a tool for empowerment and self-determination for such services. I'm hoping to learn more about how TC3 works on a daily basis to best figure out how to advertise for the interviews, determine where will be best to conduct them, and figure out the best way to frame the project and myself. Apparently, mentioning the 'H-bomb' in Seattle (the ubiquitous Harvard name-drop) is a sure way to lose friends out here so I'll just identify myself as Emily, the graduate student working with the Women's Commission. In fact, I've been working on learning various Seattle-isms and was told that out here, someone going to Harvard doesn't even pull the typical east-coast "Oh, I go to school in Cambridge" line- it's more of a vague "I go to school on the east coast." I'm more than happy to oblige (no offense HKS buddies).

Anyway, as part of the project's prep work, I've been working at securing gift card donations from area drug stores to help incentivize interview participation. It's harder than I had hoped. But there's a good number of stores near to where the tent city just moved to yesterday. It's being hosted for the summer by St. Joseph Parish at 18th and Aloha, in the northern part of Capital Hill. The church is hosting a welcome ice cream social this Thursday so hopefully, I can attend as well and begin to introduce myself to community members. It's not a far move from its previous location, but I don't doubt the amount of work that has to go into such a migration. Here's a few pictures from SHARE/WHEEL's website of former tent city sites (these are actually at Tent City 4 in Mercer Island) so you can get an idea of just how large-scale such a movement is every three months:





I'll head over to visit the new site tomorrow so stay tuned.

Getting Ready for the West Coast

I land in Seattle this coming Monday at midnight and am eager to finally get to the city of flying fish, trolls, amazing summer weather, 1990s grunge, the best public library I've ever seen, complete with a book-return conveyor belt. Packing's going well and currently includes what I think should be appropriate for the dress code: several flannel shirts, hiking gear and a rusty pair of Dr. Martens not worn since 9th grade (ok, I wasn't cool enough to own Dr. Martens but if I did have them, they'd be dumped into my summer suitcase as well).

For all of the amazing attractions that Seattle holds, it also is one of the few cities in the nation with an ordinance allowing the existence of a rotating tent city. TentCity 3, in existence since 2002, routinely houses approximately 100 homeless individuals and is hosted most often by a community church for a period of three months. All residents have their own tent and the community is self-patrolled, meaning residents can leave their belongings in their homes while working or looking for work. The tent city emerged as a temporary solution to the limited space available in the city's temporary or transitional shelters. Additionally, we know some residents elect to live there over a shelter in order to remain with a partner, which may not be possible in a traditional shelter. Currently, the TentCity 3 is located at St. Mark's Episcopal Cathedral and sponsored by SHARE/WHEEL, a city non-profit that supports that initiative.

In a city like Seattle, where social service programs are strong and to be modeled, we're hoping to hear female tent city residents' stories and opinions about what works well and where there are gaps to be filled, specifically when it comes to access to health care. While dental and primary care clinics routinely visit the residents of the tent city, we're not sure what services might be lacking, if any. And the best way to learn about the program's strengths and weaknesses is by listening to the residents. This summer, I'll be working with Seattle Women's Commission to interview female residents of TentCity 3- those who currently live there and who have lived there previously. From these conversations, we're hoping to draft policy recommendations to the city to support greater access to health care, including reproductive health care, for all of its female-identified residents.

This experience is made possible by the Harvard Women and Public Policy Program and Roy Family Fellowship. I'm tremendously grateful to have this opportunity.