Jan 20 2014
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Compassion and a Coffee Cup

Mia R. Keeys, BA, is a 2008 graduate of Cheyney University of Pennsylvania. Keeys has worked with loveLife, the HIV/AIDS prevention youth campaign of South Africa. She served as a U.S. Fulbright Fellowship in East Nusa Tenggara, Timor, Indonesia and is today a first-year doctoral student in sociology at Vanderbilt University and a Robert Wood Johnson Foundation Health Policy Fellow (2013).

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“'Scuse me, can I sit here?” she asked me.

I could have moved away. But, in a sea of patrons, it would have signified more than discomfort. What was I implying by staying seated? Was it a statement—a sit-in, if you will—to prove to myself she is no less valuable in our shared humanity? Was it to quell the guilt that I felt because I wanted to move and, furthermore, failed to ask her name? Her tawny hoodie reeked of the cold of black nights she likely endured in the last week, while I was home wrestling with my white feather-down comforter. From my seat and hers on a faux-leather brown couch—the brown of both our faces—the flames perform within the fireplace in front of us, as I perform indifference for those around me. I am not prejudice. I cross one leg sophisticatedly over the other. I am not prejudice.

A furtive leftward glance at my cell phone (albeit an archaic flip phone) exposed in my open bag—the only object separating our arms from touching. I am not prejudice. A chill in the air tickles my nose, but I resist a sneeze or even a nose-crinkle, lest the gesture of an otherwise trivial facial contortion suggest any discomfort associated with the stench of her clothes. 

Signs of her mental state abound as she fidgets with an invisible orchestra baton, perhaps. A cacophony of unintelligible conversation she has with herself is interrupted only by an incessant cough curdling from her chest.

She toted the latest issues of The Contributor, and I ponder how many she sold; how she could afford the tall cup of coffee purchased across the street from such a prestigious academic institution; why so many homeless "live’"around universities. Her pages rustle and I relax a bit as her incoherent ramblings turn to discernable complaints about something or other she was reading. She was reading. Her discourse with the voices in her head begins anew. A song drifts languidly over the coffee shop sound system—The Beatles, maybe—and she interrupts herself to hum along. She was humming.

True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring.

Dr. Martin Luther King, Jr.

It felt strange to imagine that her life was once very different. To look at her, one may not perceive the "content of her character," or the awe of mountaintops, or the pristine of hamlets. Of what moment in time did this song remind her? Was that memory from a good day? Was she diagnosed then? Will she remember me? Will I remember her on the other 364 days that do not commemorate Dr. Martin Luther King, Jr.?

The song ends as she removes a rainbow of Splenda packets from a pocket in her sweatshirt and, with surprisingly delicate fingers (because I do not naturally associate gentle movements with people who are homeless) she opens each to flavor her black coffee. I wonder if a diagnosis of chronic condition informed her choice of the sugar-substitute over the crystals of brown sugar the café offers ...

Recent statistics tell us that more than 600,000 persons are homeless in the United States. Almost 50 percent are considered chronically homeless, meaning, one suffers from a disabling condition, such as a mental illness, and has been homeless for at least one year. The "invisibility" of mental illness renders it less discernable than race, but it is fallacious to believe that mental illness has no color. According to a 2001 U.S. Surgeon General Report, people of color suffer disproportionately from lack of access to consistent mental health care, receive poorer quality of care, and are underrepresented in mental health research—all of which are exacerbated by the realities of homelessness.

It takes shared work to dismantle disparity. It takes self-work to unlearn prejudice, the predecessor of disparity. Personally confronting one’s own preconceived judgments of mental instability is paramount, even if it is a disconcerting process. Realize, too, that silence and taboo have no home in remedying mental health disparity. Having conversations with loved ones, colleagues, and decision-makers is important.

Sagaciously, Dr. King stated, "True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring." Compassion. One cannot write a prescription for it; health policy cannot legislate it; President Johnson did not sign it into civil rights law; my compassionate comportment will not receive standing ovation at the Lincoln Memorial.

As a medical sociologist and aspiring health policy expert, I carry compassion within me—particularly in my approach to health disparities research. Compassion also guides my hands as I wipe the debris—from my croissant and from my ego—off of the small coffee table we share, so that she may have more room for her newspapers, her cup, and her dignity. 

Tags: Health Disparities, Health Policy Fellows, Social Determinants of Health, Voices from the Field