When Renee Ali lived alone in a Sacramento homeless encampment last fall, she was often in pain. Her ankles were swollen from constant travel on foot. She was anxious about the men around her, and said the stress spurred headaches and cramps.
And she could never seem to find a place to pee.
“Being a woman, it’s a miracle if you can find a sane, safe quiet place to take a tinkle,” she said.
But Ali was able to get some pain medication from the bus that rolls up to North B and Ahern streets each week. It’s a mobile clinic run by Elica Health Centers, a Sacramento nonprofit that brings health services to homeless people.
This population often has trouble getting medical care, because they can’t find transportation, or don’t want to be separated from their pets. “Situations like this, when the stress is causing me problems with my stomach, the pharmacy delivers right around the corner and they come right in front of my tent,” Ali said after an October appointment. “So, what more can you ask for?”
Right now, Elica has one bus that makes weekly visits to homeless shelters and low-income schools. Later this summer, they plan to add a second clinic-on-wheels with mental and dental services, and a room for OB-GYN care.
Nurse practitioner Sachi Kageyama said women on the streets are skittish about their reproductive health. Many are worried about hygiene, and might even decline a gynecological exam because they haven’t showered.
“So, we do lots of reassuring, we’re not worried about things like that,” she said. “I try and encourage everybody when was your last pap smear, when was your last breast exam, is that something you’re interested in? Can we do those things today?”
And if she doesn’t catch them right away, she’s not likely to find them again. When I checked back in on Ali a few months after that appointment, she and Penny had moved.
“I have their attention right this second, but are they going to be as worried about their women’s health, their mammogram when they leave my mobile unit?” Kageyama said.
Kageyama also does “backpack medicine”’ — a model where medical providers travel to homeless encampments carrying just the basic equipment. She does whatever reproductive exams she can, and if she senses a problem, she refers women back to the bus.
“If they have a tent, and they’re comfortable undressing in the tent, we can do a check,” she said. “Even in the field, we’re still trying to push women’s health.”
That’s because high rates of sexual violence in the homeless community put these women at additional risk for cervical cancer, genital injuries and other gynecological complications.
Nicole Bergeron is a social worker at Women’s Empowerment, a nonprofit that guides homeless women into jobs. She said safety net clinics, and their mobile units, are some of the only places women can find medical care.
“It’s harder and harder to find a doctor,” she said. “And it’s pretty easy to start giving up when you can’t find a doctor.”
Plus, women who sleep on the pavement night after night just don’t have a lot of faith in the system. They report being turned down from shelter beds that are designated for men, recovering addicts or families.
“If you’re single, and you don’t have children, and if you have been fortunate enough not to have an alcohol and drug issue or a serious mental health issue, everyone assumes why are you homeless?” Bergeron said. “Getting services can be next to impossible.”
The latest homeless count from the federal Department of Housing and Urban Development shows the number of single, childless women without shelter is rising at a faster pace than men in the same category.
Cindy Reece said that’s how she felt when she was homeless in Sacramento — like there was nowhere for her to go. She eventually moved into a trailer and started working in the kitchen at the Loaves and Fishes homeless resource center north of downtown. She was a patient on the Elica bus for a few years.
“Women are constantly being raped, they’re constantly being beat up, they’re constantly having things took away from them,’ she said. “Because they’re by themselves. When a women is out here homeless, she’s vulnerable.”
She said seeing Elica providers made her feel safe, and gave her hope
“Finally I had somebody that would listen to what was going on, somebody that would actually pay attention to what I’m telling them,” she said
The street medicine movement is growing in Sacramento as advocates learn more about the health needs of the homeless population. The Sacramento Homeless Deaths Report, which sources more than a decade of data, found that the average lifespan for people without shelter is roughly 30 years shorter than it is for the general population.
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