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.