DC charity tackles chronic health issues affecting the homeless


If you’ve ever been sick—really sick—or had a chronic illness, you quickly learned a basic fact: managing an illness is a full-time job. As much as you want to put it out of your mind – and maybe in those early days you tried to – it becomes a constant background to your life.

Now imagine doing this job when your home is a sleeping bag and your “job” is dealing with the daily struggle to stay alive.

“In the world of public health, you hear phrases like ‘Housing is health care,'” said Adam Rocap, deputy director of DC homeless charity Miriam’s Kitchen. “Much public health research identifies housing as one of the key social determinants of health.”

In other words, if you can move someone off the street into their own apartment, you can improve some of the health problems they’re facing now and prevent future problems from occurring.

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And these health problems are countless. Illness is something that can lead a person to homelessness as savings are depleted and housing is lost while you try to afford care. Treating an existing illness while living on the streets is difficult.

“For people diagnosed with cancer, it’s really hard to do chemotherapy and radiation if you don’t have stable housing to recover from,” Rocap said. “Other basic things like dialysis, not that you can’t do them unless you’re housed, but it’s just really hard.”

Recovering from even the most basic outpatient surgery—keeping stitches clean, for example—is challenging. And when your belongings are in bags you carry, keeping track of medications is difficult, especially medications like insulin that need to be refrigerated.

There are also dangerous conditions that are caused or worsened by the experience of homelessness.

“Homelessness in itself is a health hazard because of people’s exposure to the elements, especially when it’s so cold,” said Catherine Crosland, a physician and director of homeless development at Unity Health Care, an organization founded to provide a safety net for people living in poverty. “People die from hypothermia every year. They develop frostbite with long-term complications including amputation and chronic arthritis.

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Homelessness also takes a toll on the psyche. Homeless people, Crosland said, can experience chronic stress from the threat of violence that comes from living on the streets. Even in shelters, they can suffer from lack of sleep.

Another wrinkle: the clientele Miriam’s Kitchen serves is getting older. Many of them are over 55 years old. Rokapp said the health problems affecting a person who is homeless are usually those of someone 10 to 15 years older.

This is all sobering stuff. But Miriam’s Kitchen is trying to help. It serves nutritious meals every weekday and twice a week – on Tuesday mornings and Thursday afternoons – Unity Health Care staff come to offer their medical services to clients.

“We’ve always believed in meeting people where they are,” Crosland said. “Rather than waiting for patients to come to us, we’ve always sought to lower barriers to access to care by going to them.”

At Miriam’s, that means setting up straight from the basement dining room of the Western Presbyterian Church in Foggy Bottom.

The long-term goal of everything Miriam’s Kitchen does is to find housing for its participants. This can be a slow process. Along the way, Miriam offers food and access to Unity’s doctors and nurses. This is important not only for dealing with immediate medical problems, but also for monitoring the patient’s health.

Think about the people close to you – your family, your friends – and how they would get involved if you got sick. If you’re estranged from your family — homeless, beset by mental health issues or addiction — you may not have that support. You may not even have something very basic: a benchmark for your health.

“When we’ve known people for a while, we might notice things that are changing healthily for one of our guests that they don’t notice,” Rockap said.

It’s not being sick, it’s a full time job. I’m getting better. If you live on the streets of the area, Miriam’s Kitchen and Unity Health Care operate right next to you.

Miriam’s Kitchen is a partner in The Washington Post Helping Hand, our annual charity fundraiser. Your donation can change the lives of homeless people facing medical crises. As Dr. Crosland told me, “Even the healthiest person left homeless will develop all kinds of health problems.”

To donate online to Miriam’s Kitchen, visit posthelpinghand.com and click where it says “Donate Online Now.” To donate by check, write to Miriam’s Kitchen, Attn: Development, 2401 Virginia Ave. NW, Washington, DC 20037.

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