A Doctor Delivers Multiple Acts of Human Kindness to Homeless Women
Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston. She is a 2010 Robert Wood Johnson Foundation Community Health Leader.
The prolonged recession of the last four years has hit many people hard. My work is taking care of homeless women, which I have done for the past 20 years. I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters. We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.
I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers. Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.
Here is a glimpse of our work.
Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.
She is hungover. She drank to escape the horror of having been attacked. She has been on and off the wagon so many times we have all lost count. She’s also been raped and stabbed more times than any of us can remember. She doesn’t go to the police any more. She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork. I give her a hug and remind her that I love her no matter what. I know that she has a library of negative and self-loathing messages in her head. Mine is the one that can break through that chatter and give her a shred of self-respect.
An elderly woman calls to me. I’ve know her for years. She has a Section 8 apartment. She has many medical conditions, and last year was treated for breast cancer. She has fought depression since her oldest son was put in jail. She needs me to listen to her woes, check her blood pressure and blood sugar, give her some encouragement.
She announced that the housing folks have threatened to evict her. This was news. In all the years I’ve known her, her housing seemed to be a stable anchor for her. Later, our nurse visited her apartment. Turns out she is a hoarder. Floor to ceiling. Unimaginably disgusting and unhygienic. It’s a common problem with formerly homeless folks—years of deprivation and mental incapacities come together in a perfect storm. They start to collect things and can’t stop. Donations from the shelters like clothes and toiletries, then trash, newspapers, magazines, plastic bags, food wrappers.
It’s a form of mental illness and the only way to stop it is to do an “intervention” where professionals go in and take everything out. If you saw this woman, you would be stunned. She is beautifully dressed, well groomed, well spoken. Able to carry on an interesting conversation. But we know that many women who are poor and homeless have this kind of public interaction down to a science. They don’t “look” homeless or crazy or unstable. They can chat with you and you think, “What an interesting person.” Or, in the case of our health care system, they can interact with the personnel in an emergency room or an outpatient clinic and seem “fine” and “put together.” But they aren’t. They just know how to get though the conversation in a way that doesn’t draw attention to themselves.
Afterwards, they can’t remember any of the instructions, what medicines they are supposed to take, how they got to the office, or how to get there again, and they lose the card that has the doctor’s name on it. Or, in the case of our elderly lady, she’ll hold court as one of the respected elders while she is having her breakfast at the shelter, but when she goes home, she walks into a trash pit smelling of old and rotting food, and crawling with rats and cockroaches.
Each person that I visit as I make my way across the dining room has her own personal story. They don’t need an introduction to me, and the conversation we have on one day is a continuation of a conversation that we had the last time they saw me.
I gave the hungover woman a hug and reassurance that I am still here for her. She refused my offer to find a bed in a safe house, but appreciated it.
I examined the woman who was secretly hoarding. She had bronchitis so I wrote a prescription for an antibiotic and told her I wanted to see her next week. During that week, our nurse will be working with the housing people, so I wanted to give her my special attention and the message that she was important to me. She would spend the next week focusing on seeing me again to check on her bronchitis and put less energy into internalizing a host of negative self images about being “bad” for hoarding.
This is a small snapshot of only one part of one day in my life. This is what my team does. “Health care” for the women in the shelter is multiple acts of human kindness and respect that improve the quality of their lives and help motivate them to take charge of their health.
Our strengths are best illustrated in the three pillars of Community, Conscience and Cost-Savings. Giving back to the most vulnerable in our community, operating a lean budget for a program that emphasizes social consciousness over high executive salaries, and providing care in a personal and compassionate way that improves health and saves money are the cornerstones of our model.