Abram Nunn approaches a trash-strewn homeless camp with caution, stepping gingerly between still-warm cook stoves, heaps of tattered blankets and makeshift teepees. A few lounging pit bulls snap to attention as the young physician assistant gives his usual greeting: “Medical team’s here! Anybody sick?”
The answer is yes for most residents of the tarp-covered shantytown, but no one peeks out from their burrows, at least at first. Nunn and the rest of the Elica Health street medicine team are used to it. They’ve been working for months to earn the trust of Sacramento’s outer-edge dwellers.
Finally a stout woman in a wool hat trots up the hill, ushering the team toward a dazed-looking blonde in a camping chair. Nunn drops his military-style backpack, full of first-aid basics, and kneels in the dirt next to his first patient. Anna Darzins, the team’s caseworker, hands out intake forms and a pamphlet with her clinic’s phone number on it.
Elica, which has three brick-and-mortar locations dedicated to serving Sacramento’s low-income population, recently created two medical teams that canvass the city looking for the homeless, often on their own time. As the battle against Sacramento’s anti-camping ordinance rages on at City Hall, the nonprofit clinic is putting more resources toward ensuring that those who do live outside, whether by choice or not, can survive another day in the elements.
In cities such as San Francisco and Austin, Texas, housing agencies and nonprofit groups are experimenting with options such as subsidized hotel rooms and communities built for the homeless. Sacramento, however, is still short on housing options following the 2009 recession, when the county cut funding for a shelter and other homeless services.
Roughly 5,000 homeless people live in Sacramento in a given year, according to estimates from homeless advocates. The county, city and nonprofit groups provide about 1,000 beds, and those who don’t find shelter have to curl up in alleys, under bridges and in tents along the city’s two rivers.
Hundreds more of the homeless have been stationed outside City Hall since December to protest a longstanding anti-camping ordinance that forbids people from sleeping in public spaces.
“What happens is you get a citation, and then it goes to a warrant, and then the next time you’re approached you go to jail,” said Bob Erlenbusch, executive director of the Sacramento Regional Coalition to End Homelessness. “It’s a downward spiral. When you go to jail, that makes it difficult to get a license, find employment, access housing.”
A growing body of national research on homelessness suggests that “housing first” is the best approach to improve the health of those on the street. Give people four walls and a roof overhead and they’ll be in a better position to apply for work and reintegrate into society, according to the advocacy group National Alliance to End Homelessness.
State Senate President Pro Tem Kevin de León and other Democratic leaders are pushing for $2 billion of budget funds to be put toward housing for homeless people, particularly those who are mentally ill. The measure would be funded by Proposition 63, which instituted a 1 percent income tax on Californians earning $1 million or more per year to pay for mental health services.
Until those wider problems are solved though, Dorzin and Nunn will continue practicing “backpack medicine” in places where Sacramento’s homeless cluster. On a recent rainy Thursday on a West Sacramento street, the team was inundated with people in need of care and worked well past sundown to see them all. Many of those who didn’t get an “appointment” still received some type of aid, be it a couple of bandages, a zip-close bag of toiletries or a few days worth of aspirin.
The Elica teams have been going out twice a week for about six months now. They also hike through the woods along the Sacramento River, which they say is the only way to provide somewhat regular care for the city’s most vulnerable population.
While some people turn away when they pass a homeless person on the street, the Elica team makes a point of connecting to patients face to face and building relationships, CEO Elizabeth Cassin said. She started doing that five years ago at her favorite pastry shop in West Sacramento, where she struck up a conversation with a man living on the nearby river. She’d buy him a coffee and doughnut and encourage him to visit the Elica clinic in town to get the sores on his hands treated.
Eventually, the man led her down to his camp with a five-gallon bucket of doughnuts, and she’d deliver the breakfast to others living there while asking about their medical problems.
“These people don’t trust us and they don’t like us,” Cassin said. “They’ve been burned by us, and they don’t want anything to do with us and what we’re a part of. … While many people will come to the edge of society and talk to us, there are some very frightened, off-the-ledge people who will hide. And that’s really who we’re trying to reach.”
When visiting the camps, the team often finds commonplace, preventable ailments that go untreated for far too long, such as high blood pressure, dental problems, rashes and infections, and respiratory illnesses.
A 10-year analysis of homeless deaths in Sacramento County, released by the regional coalition in 2014, found that their mortality rate is two to three times higher than that of the general population.
Living outdoors also perpetuates widespread mental illness, said Steve Kruse, an Elica street team member who was homeless for many years and now helps the nonprofit build relationships with people living in camps.
“PTSD runs harder and deeper out here than it does in a combat zone,” Kruse said. “Living is a thing of the past. Today is survival – finding something to eat, drink and a way to stay warm and dry.”
Homeless people may not seek treatment soon enough because they don’t have transportation to get to a clinic or hesitate to leave pets and belongings unattended. They also may lack a cellphone to make doctor’s appointments with.
That’s how Michael Batts, 56, ended up with a swollen foot, poor vision and a pins-and-needles pain in his toes that keeps him up at night – symptoms of neuropathy, a nerve-related side effect of diabetes.
When the Elica team flagged him down on a recent Thursday and offered him a flu shot, he parked his bike without protest. Nunn checked Batts’ vitals, wrote out a prescription for desperately needed medication and convinced him to make an appointment at the clinic the next week.
“They brought it to me, so I figured I might as well,” Batts said while hauling his pack of essentials onto his shoulders. “I’m going to go in this time and get myself together. I’ve got to get off this river. I’m tired of it.”
Kari Lyon, a 51-year-old homeless woman who uses a wheelchair due to chronic knee and ankle issues, said her health conditions have worsened during her close to 20 years on the streets. She’s tried multiple times to get into affordable or disabled housing – but the waiting lists are too long. Taking care of her medical needs has been impossible without reliable transportation, and getting insurance paperwork in order has been difficult without a mailbox.
Wrapped in a damp sleeping bag with her Chihuahua, Destiny, during a recent street team visit, Lyon made a desperate plea to officials and passers-by to help her find somewhere to stay. Just four walls would change everything for her and a lot of other people, she said.
“I would take a cardboard box if it would keep the police from harassing me and if I could get up and take care of my appointments,” she said. “I would love to do that. Whatever steps it takes, however long it takes, I’m going to get in somewhere.”