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Homeless being trained to help the sick

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ASHEVILLE — Jane Doe 246, as she is called in a police report, was found Oct. 23 just after 4 p.m. She was still in her sleeping bag near the banks of the French Broad River.

Temperatures had dropped that Sunday morning to as low as 35 degrees. A walker discovered her body in the River Arts District just across the waterway from New Belgium's brewery.

The night before dozens reveled at the newly opened craft beer hot spot while a homeless encampment nearby escaped sight.

It would take police five days to confirm the identity of Janett Marie Jones. A corner determined the 53-year-old died of environmental hypothermia. Being outside in the cold killed her.

Despite record job growth, homelessness persists in Buncombe County, where 509 people were counted as homeless on one given night last year.

Those who live on the streets or inside temporary shelters face significant health risks, dying on average 25 years earlier than people who have a place to live.

Around 20 people impacted by homelessness in the area die from preventable causes every year, said Ameena Batada, an associate professor in the Health and Wellness Department at the UNC Asheville.

It has become a public health emergency, she said.

The death of Jones and others have caused some of Asheville's homeless community to want to do more. Partnering with UNCA and BeLoved Asheville, 10 homeless or formerly homeless people are being trained by an emergency medical technician as “street medics.”

To survive, they say, they must take care of each other.

The group so far has studied how to spot signs of stroke, what to do if someone is having a seizure or going into diabetic shock, how to recognize extreme allergic reactions or overdoses, how to take vital signs, collect medical history and assess an emergency medical scene to know when to call 911.

They will also learn about long-term foot care, illnesses caused by extreme hot or cold weather and how to control bleeding. The goal is to get the participants to be CPR and first-aid certified and earn as many other professional accreditations as is feasible.

Homeless people disproportionately suffer from health complications and are more likely to face challenges such as alcohol dependency, food insufficiency or insecurity, and mental health issues, said Batada, who holds a doctorate in public health from the Johns Hopkins Bloomberg School.

Students in her Health Parity: Domestic and Global Contexts course have partnered on the street medic project with BeLoved Asheville, an affordable housing provider and homeless advocacy nonprofit.

“It's a big issue for us as a wider society because it costs a lot to support people who are homeless, who are not sheltered, and people are dying totally unnecessarily because of conditions like cold weather,” Batada said.

The office of U.S. Housing and Urban Development estimates a homeless person costs taxpayers $40,000 a year. In Buncombe County, that amounts to more than $20 million annually.

Things like shelter, emergency room visits, mental health services, hospitalization, police, fire and court resources add up, Batada said. And, while the number of chronically homeless people has decreased in the last decade, acute homelessness is on the rise.

Chronic homelessness is defined by HUD as when a person has experienced homelessness for one year or more or at least four episodes of homelessness in the past three years. Acute homelessness involves cases that are short-lived.

“Every death on the street is heartbreaking and reminds us that in our system people are expendable,” said the Rev. Amy Cantrell, who runs BeLoved Asheville.

The minister received a call from Jones' family after news of her death. “We cried on the phone together,” she said.

The street medics

The idea for the street medic team came up as part of BeLoved Asheville's Homeless Voice Project. The initiative aims to empower people living on the streets to speak up about injustices they face and change their own lives.

The group had been grappling with Jones' death and a news report calling homelessness one of the nation's most fatal conditions.

“We began asking, 'What can we do about that?'” said Cantrell. “We began to talk about the medical crises people face, the daily struggles of homelessness, the difficulty of getting health care.”

The group realized they could change someone's life if they had medical training. Since many of them also live on the streets, they easily could be the first responder in an emergency.

They created their own curriculum based on their experiences. They came up with a list of supplies they needed and sent the UNCA students to solicit donations.

BeLoved Asheville volunteer and local emergency medical technician Dave Pike agreed to teach them. The group began training with Pike once a month in January for two to three hours at a time. They will train for about a year.

“Health is a basic human right,” Pike said. “Most of the people are ready to contribute to the discussion and share personal experiences of difficult health conditions, which really makes the topics grounded in reality.”

Pike likens the training the homeless community is getting to wilderness first-aid.

“Folks seem to openly enjoy being treated as equally capable to learn these skills as any other student,” Pike said.

Homeless people face barriers to traditional health care that other people don't, Cantrell said. They struggle with insurance, transportation and trust in the system. They also can't easily access things that help people stay healthy, such as shelter, food, refrigeration, hygiene products, first aid supplies or medicine.

“The streets break down our bodies,” said Cantrell, who slept on the courthouse steps beside the homeless recently to participate in the National Day of Action for Housing.

“After one night out on the streets, I was exhausted,” she said. “My knees, back and whole body ached. It took me a couple of days to feel better. Imagine that compounded in your body every night for years.”

The new street medics will be able to help in ways that others have not, she said.

“It is our hope that through the deep trust that they have already built in the community that they will create more access and be able to prevent deaths by being able to help as first on the scene in a medical crisis,” Cantrell said.

Asheville's homeless

Street medics in training last week led a yoga session in Pritchard Park. They were checking people's blood pressure and vital signs. A host of other providers came to the health fair they organized to expand their outreach.

Organizations distributed feminine hygiene packets for women living on the streets. There were needle exchange kits and naloxone medication, often sold as the brand Narcan, used to prevent death in heroin overdoses. There were free condoms and balance screenings. Soap, toothpaste, water bottles and sunglasses were available for the taking.

Tyrone Wise, 55, kept his eyes on a man dressed in dirt-covered clothes sitting beneath a tree while taking a break from his street medic duties.

Wise said he was worried the man was dehydrated and said his glucose levels were too high. He told him to take some water and sit in the shade.

Wise said he moved to Asheville from Cincinnati to help a friend with a drug problem but ended up on the streets himself. BeLoved Asheville recently found him a place to live.

He was robbed and beaten while homeless in Asheville and left to fend for himself, Wise said.

“I wish I had somebody that was out there that saw me and was able to say, 'Hey, you're going to be all right,' and check if I had a concussion or what not,” he said.

That incident is what drove Wise to become a street medic. “It's uplifting,” he said. “I know some of what to do now for another person in distress. Instead of just being an onlooker, I can help them.”

Life on the streets isn't always kind, he said.

And, for many, there is no end in sight.

Jobs not always a cure

“Looking Homeward: Asheville-Buncombe's 10-Year Plan to End Homelessness” failed to meet its benchmark in 2016 when 509 people were counted as homeless in a one-day tally. That's a higher number of people than were counted in 2005, the year the plan was written.

Over the past decade, homelessness has averaged in Buncombe County at 647 people, despite expanded programming and an improving economy.

Unemployment rates dropped in every Western North Carolina county in February, according to figures released in April by the state Department of Commerce.

At 3.9 percent last month, Buncombe County's unemployment rate was once again the lowest in North Carolina. It was 4.3 percent in January and 4.4 percent a year ago.

“Our economy needs cheap labor to function,” said Cantrell, who also works as a community organizer for Just Economics. “Most of the people in the 28801 zip code make $15,000 or less a year.

“So, most of our folks have jobs. The jobs do not pay a living wage, so they cannot afford housing in Asheville. Thus, they live in precarity on the streets.”

Jobs alone are not going to cure homelessness, said Michael Woods, who runs Western Carolina Rescue Ministries, the city's largest overnight shelter.

During the coldest months in 2016, the Rescue Mission housed 171 people and distributed as many as 750 meals a day.

Seventy-seven percent of the people staying at the Rescue Mission are working or in school, he said. The problem is they aren't making enough to truly change their lives.

There is also a significant population of mentally ill people experiencing homelessness, he said. Some 56 percent of people coming to the Rescue Mission self-report a mental health diagnoses.

People like Jones have a right to decline shelter, Woods said.

“It wasn't that anybody turned her away or anything like that,” he said. “The (shelter) resources are there, but there are some people for whatever reason, whether it's mental illness, fear, or trauma they have experienced in the past, they are not going to come inside.”

Cantrell said family members told her Jones suffered from mental illness and they had lost touch before her death.

“They were heartbroken and did not know where she was,” Cantrell said.

“We collectively failed her as a community,” she said. “We have housing, economic and mental health systems that are failing the very people that they were created to support. We should never lose somebody like that. Her death was completely preventable.”

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