Their medical rounds brought them weekly to a northwest Atlanta enclave where homeless men and women camp.
But sheer persistence kept Matthew Reed and Joy Fernandez de Narayan coming back to the navy blue tent.
Perched on the edge of the Bridge to Nowhere, a partially demolished overpass, it was the last in a line of makeshift shelters, past the tiki torches, orange cones and piles of garbage.
Toting backpacks with food, water and medical supplies, Reed and de Narayan knew there was a man sweltering inside the nylon shelter.
They also knew there was a good chance that the man — Ronald Bussey, a sometimes employed construction worker who had lived on the streets for nearly 25 years — would balk, yet again, at their offers to help.
Talking to him through the closed flaps of the tent, as they had for several weeks, the social worker and the nurse tried to assess his condition.
“Just checking if you need anything.”
“I’m fine. I don’t need anything.”
As unlikely as that was, Reed and de Narayan had no choice but to move on and hope for a breakthrough the next week, or the week after that, with a man they had never seen but, in many ways, knew all too well.
Bussey was, in government parlance, chronically unsheltered. He wasn’t in between apartments, or temporarily unemployed or waiting for a room to open up at a shelter. He was one of the people who had spent at least a year, and often much longer, sleeping on bridges, in abandoned buildings, on city sidewalks.
While poverty and a lack of affordable housing play a role in chronic homelessness, so do a constellation of other factors — drug addiction, mental illness, physical ailments and an inability to get through the cumbersome process of finding permanent housing.
» PHOTOS: The Mercy Care Street Medicine team
Reed and de Narayan work on the frontlines to overcome those challenges with a holistic approach. As a part of Mercy Care’s small but determined Street Medicine team, they venture into some of Atlanta’s grittiest environs, to engage with the homeless men and women least likely to seek help.
They apply antibiotic ointment to cuts, wrap up sprains and treat chronic conditions like high blood pressure. While they’re there, they also provide referrals and assistance with the not-so-simple first steps of finding housing and employment, like securing birth certificates and Social Security cards and getting identification with no permanent address.
Their hope is that some of those they encounter will be in a position to take advantage of programs like the one supported by Atlanta Mayor Keisha Lance Bottoms. The mayor, who has made affordable housing one of her platforms, said last month the city has raised $50 million to provide housing for 550 homeless people in Atlanta.
Though that would put only a dent in the problem, Protip Biswas, who concentrates on homelessness initiatives for the United Way of Greater Atlanta, is optimistic. He said there is positive momentum building for tackling homelessness in the city – estimated in January’s “Point in Time Count” to be 3,217. A study by the U.S. Department of Housing and Urban Development says the homeless population has dropped by close to 50% since 2011, when it stood at 5,987.
There’s debate about whether these numbers truly reflect the state of homelessness. Critics say the count can miss people sleeping in their cars and those drifting between transitional housing and extended stay hotels. Even so, several homeless advocates agree that better coordination between agencies is yielding better results.
Biswas praised Mercy Care’s team for helping to move the needle by reaching out to those living in especially desperate conditions.
“The Street Medicine team helps the most difficult population to help,” he said.
“The ones who feel like no one cares”
The so-called Bridge to Nowhere is located just north of Atlanta’s shiny new, billion-dollar Mercedes-Benz stadium.
Once a part of Bankhead Avenue, it carried traffic over the railroad tracks for years but was closed in the early 1990s and partially demolished when a parking lot was built. Now, the concrete comes to an abrupt end and there’s a steep drop-off.
It was there, on the edge, that Bussey decided to make camp a few years ago.
Decades on the streets had taught the Atlanta native how to stay out of the way of trouble. This location made the most sense to him: No one could approach him from behind. Everyone had to come to his tent from the front.
And like clockwork, every Wednesday evening, the Street Medicine team came.
Even sitting inside his tent, he knew when they were around, just from the chatter of others outside. He grew familiar with their soft voices, with their footsteps. But he couldn’t figure out what they wanted or why they wouldn’t just leave him alone. Over and over again, he said he was just fine. Now in his late 60s, and homeless since his divorce, what could they do, other than judge him?
He was convinced they would look down on him because of his appearance, the way he smelled, his drug use, which he said started after he became homeless and led to several run-ins with the law.
The years had also taught him this much — nobody does anything for you without an angle.
It isn’t unusual for Reed and de Narayan to encounter such wariness. But they say it also doesn’t deter them.
Their team goes out on the streets four days a week, often accompanied by a psychiatrist and Emory and Morehouse medical students. With their bandages, antibiotic cream, inhalers and blood pressure monitors, they provide whatever medical treatment they can on the spot. Oftentimes, they provide counseling and psychiatric care for conditions such as bipolar and post-traumatic stress disorder.
Three core members make up the team. De Narayan, who is married and in her late 20s, knew she wanted to be a nurse and serve the poor after working at a clinic in Honduras following her freshman year at Kennesaw State University. A nurse practitioner, she recently obtained a doctorate in nursing.
Reed, who is 45 and single, said he grew up a “troubled young suburbanite” who partied a lot and barely graduated from high school. In his early 20s he was drawn to the church, and his faith strengthened. He eventually got his degree at Georgia State University and spent years at Grady Memorial Hospital as a social worker.
Stephanie Dotson, a licensed practical nurse, recently moved to Atlanta from a small town in Michigan and was immediately struck by the number of homeless people she saw. The married mother of three adult children felt compelled to try to help.
» PHOTOS: Mercy Care free dental clinic in Atlanta
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Though other organizations, such as Intown Collaborative Ministries and Grady Memorial Hospital, offer mental health counseling and other supportive services, the three were drawn to Mercy Care’s unique approach of combining medical care with other services.
“I look for patients in need, the ones who feel like no one cares, or feel unworthy of care,” Dotson said.
Mercy Care operates six clinics throughout Atlanta, primarily serving the poor. The Street Medicine team was created nearly six years ago. It is an outgrowth of work started by the Sisters of Mercy, a Catholic religious congregation.
Sisters of Mercy also opened the first hospital in metro Atlanta, which would later become Saint Joseph’s Hospital. Saint Joseph’s is now part of the Emory network. Mercy Care, meanwhile, is now an independent non-profit.
The total annual budget for the Street Medicine team is $910,000, with a third coming from federal funding and the rest raised through private donations. Soon, Mercy Care intends to go even further in its work to aid the poor, by building 280 units of affordable housing.
“They treat you like a person”
Right now, the wait for housing — even once approved — can be a year.
In the meantime, Mercy Care tends to the physical needs of those living on the streets.
Homeless people suffer diseases such as HIV/AIDS, hepatitis C, cancer and heart disease at rates three to six times higher than the general population, according to National Health Care for the Homeless Council. About a third of homeless people in Atlanta have a serious mental illness. A third have a substance abuse disorder. Many have both.
On average, homeless people die 12 years sooner than the general population.
On a recent evening, before starting their rounds, Street Medicine workers bowed their heads inside a white Mercy Care van equipped with a table and leather chairs. De Narayan read a passage from the book “Souls in the Hands of a Tender God.”
“The first act of mercy is to be present, to hold and share in the woundedness of our brother or sister. We are called to be compassionate, to understand rather than to judge.”
Their first stop was along Northside Drive under the I-20 bridge. Michelle Williams, 32, smiled as the group approached. A slight breeze rustled through her khaki tent while she reclined on large pillows.
She told them she was glad she had taken their advice to go to the hospital a couple months ago. She had been reeling in pain and couldn’t keep food down. It turned out, she needed her gallbladder removed immediately.
“I’m feeling better — so much better,” she said.
Williams said she’s been living on the streets for more than a year. She became homeless after something “traumatic” happened, although she didn’t want to elaborate. She’s grateful for the Street Medicine team. “They treat you like a person, that you matter, and you can feel it.”
They left her with a hygiene kit, water and food packet – a can of soup, crackers, canned tuna, a fruit cup.
Over a span of three hours, the group traveled to five locations, stopping under bridges, at church steps, an abandoned gym, all within a couple miles of the Georgia State Capitol. They engaged with nearly two dozen people, changing a wound dressing for a toe injury, checking vitals, doling out ibuprofen for aches, offering mental health counseling, and referring those who might need further treatment to Mercy Care clinics.
At the corner of Martin Luther King Jr. Drive and Washington Street, the team spotted Dathan McMullen, wearing eyeglasses with one lens missing.
Reed introduced himself and asked McMullen how he felt. Questioned about how long he’d been living on the streets, the soft-spoken 45-year-old paused, unsure.
“Almost forever,” he responded.
After he was written a referral to a clinic, where he could get glasses, the team decided to dig deeper.
“What’s important to you?” Reed asked.
“I would like to have my own apartment,” said McMullen, without hesitation.
They talked a bit more before Reed said, “I think you are a good candidate for housing.” The social worker offered to help him begin the process of obtaining the necessary documents, which includes a copy of a birth certificate, a letter verifying homelessness, a Social Security card and a Georgia state ID.
Helping people get off the streets can be full of starts and stops.
Reed remembers the case of an older man who had finally reached the top of the housing waiting list. But, when an apartment became available, he was out of town and couldn’t be reached. And then there was a disabled man, who couldn’t walk. He didn’t qualify for available housing; his disabilities were deemed too severe to be accommodated.
“I remember we had to bring him back to the bridge,” recalled Dotson. “We cleaned his mat, and we set up blankets around him. And I started bawling.”
They got lucky, though. Within a few months, a spot for the man became available at a nursing home.
“They gave me a spark”
Bussey’s decision to hear what street team members had to say can be attributed to two factors: curiosity and the heat. It was just too hot to hide inside his tent.
So, in July of last year, after eight months of ignoring them, he came out of his shelter to listen.
He waited for the questions about how he became addicted to drugs, how he got into this situation, but they never came.
Reed and de Narayan asked about his physical health, whether he was in pain. They just talked to him, like he was anybody else.
The next week, he came out of his tent again. And the next week again. They were gentle, kind, and “talked to me like a human being,” said Bussey, who suffers from depression. Members of the team brought him blankets and food.
He let de Narayan check his vitals, and she started bringing him blood pressure medication.
Gradually, they began asking him what he wanted to do with the rest of his life, if he wanted help trying to find housing. He did.
“They gave me a spark to have some hope,” said Bussey. “And I just didn’t want it to stop.”
He said the team motivated him to take charge of his life. He got his documents together and asked Reed to provide him with a list of possible housing options.
Bussey also made another decision: Before completing the process, he had to get sober. He no longer wanted to be on the bridge, going nowhere.
The Street Medicine team helped him find and get into a facility — CaringWorks Hope House, a residential rehab facility that specializes in working with homeless men. He went on to complete a five-month drug rehabilitation program.
A few months ago, Bussey, who is now 68, moved into a room at O’Hern House, a converted factory in the Old Fourth Ward. It offers supportive housing for about 75 people who were formerly homeless.
He works part time in a warehouse. Street team members continue to visit him every week, to check in, as they have for some 30 others they’ve helped get into housing over the past year.
Bussey recently bought himself a TV and said he didn’t know what to watch. The last time he had a TV, “Full House” and “The Fresh Prince of Bel-Air” were popular.
He credits the Street Medicine team with changing his life, especially Reed, who he says “co-created this.”
With tears in his eyes, Reed gave the credit right back to him.
“I feel like there was some real insight and honesty on your part,” said Reed, “and you wanted to get sober before making the move.”
Later, the social worker said he and other members of the Street Medicine team never know when people are going to be open to their help. It’s rarely a straight line to success.
“People feel so dehumanized and invisible,” said Reed, “and that beautiful spark in anyone can get buried in trauma and disappointment. We pull that junk out, little by little. There’s a lot of physical and mental healing that goes on.”
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