City Limits
February 1998
Streetside's work attracts some of the most low-key activists in the city--a real-world, traveling cast of ER without the makeup or the chance to reshoot the scene.

PIPELINE

To Minister the Sick: In the name of harm reduction, Streetside Health Project volunteers provide health care in some of city's seamiest corners. By Dylan Foley
Brendan Pearse sits in the back of the Lower East Side Needle Exchange's Avenue C storefront on a rainy November night, giving free flu shots to a steady stream of squatter kids and intravenous drug users. Pearse, a physician's assistant in his early 50s, demonstrates how to administer injections for the three New York University medical students he's supervising. "Make sure you clean the skin before you inject," he says gently to one, who clearly is nervous. A bleached blonde woman waiting nearby breaks the tension, joking about the horrible nicknames she had in high school as her sleeve is rolled up. The next woman in line is worried--she talks in hushed tones about chronic medical problems, including diarrhea that had gone on for months. Concerned she might have the symptoms of tuberculosis, Pearse examines her with his stethoscope. He decides it isn't TB after all but urges her to go to a local clinic near her home in Hartford nonetheless. Pearse is here as a member of the Streetside Health Project, a small volunteer medical program that has been serving New York's intravenous drug users in Manhattan, Brooklyn and the Bronx for six years. Their operation may be modest--it consists of a handful of medical professionals and a tiny budget--but it represents what may be the ultimate extension of "harm reduction," the HIV-prevention strategy that includes giving clean needles to addicts. Streetside's volunteers bring inoculations and quick medical exams to needle exchanges, soup kitchens and the SROs that house people with AIDS. Sometimes they make house calls to bandage abscesses or treat thrush, an oral fungus common in AIDS sufferers. Streetside was the first medical group in New York to vaccinate at the needle exchanges, and it still is the only group that provides medical care in some privately run SROs.

An Underserved Population

Harm reduction has only recently become a grudgingly accepted practice. Illegal needles exchanges appeared in New York in the late 1980s, supported by radical groups like ACT UP. But in 1992, after several years of conflict with the police and City Hall, several exchanges were given waivers by the New York State Department of Health to distribute clean syringes. That year, a group of medical residents at the Bronx's Montefiore Hospital and Sharon Stancliff, a family practice doctor volunteering for the Lower East Side Needle Exchange, formed Streetside. "Our major goal is to show people who use drugs that they can do something about their health care," Stancliff says. "We also try to introduce health-care professionals and future health-care professionals to people they would normally only see in adverse situations." The program now has a core group of eight medical professionals volunteering their time, including doctors, nurses and physician's assistants, and they actively recruit students at New York-area medical schools to lend a hand. In December, a volunteer pool that had swelled to 40 completed Streetside's fall vaccination program, dispensing 600 flu vaccinations and 200 inoculations for bacterial pneumonia, which is often fatal to people with HIV. "The fall vaccination program is our major group project. At other times, members do volunteer outreach on their own," says Dr. Toni Sturm, one of Streetside's founders who is now a medical fellow at Mt. Sinai Hospital in Manhattan. The approach has found other adherents. For example, New York Harm Reduction Educators, a needle exchange that serves the Bronx and Harlem, is visited by a medical outreach van from Bronx-Lebanon Hospital. Many of the existing exchanges have become community-based organizations that also offer support groups, drug treatment and even acupuncture to help clients. The goal is simple: Prevent the spread of HIV through clean needles and condoms, as well as education about safe sex and safer drug use. The population at the needle exchanges and SROs needs all the help it can get. Less than half of the 150 clients Streetside surveyed in 1996 had any regular health care. Another survey showed that many of the clients lodged in three Manhattan SROs were not taking the new protease inhibitors used to fight AIDS. In response, Streetside held a workshop on the drug therapy cocktails andcontinues to advocate their effectiveness to clients.

Committed Activists

Streetside's work has attracted some of the most low-key but committed harm reduction activists in the city--a real-world, traveling cast of ER without the makeup or the chance to reshoot the scene. "I joined Streetside because it was one of the few preventive programs I could find," says Pearse, who became a physician's assistant two years ago after spending the 10 years working as a paralegal. A native of Northern Ireland--his father was one of the founders of the Irish Communist Party--Pearse obtained his green card by fighting with the U.S. Marines in Vietnam, including combat at the infamous Battle of Khe Sanh in 1967. Pearse grew up in Derry, a strife-torn, impoverished Catholic city directly affected by Protestant-Catholic hatreds. When I was a kid, the only people not destroying things were doctors, nurses and teachers," he says. "I became a physician's assistant to do good, provide relief and empower with knowledge." Four years ago, Karyn London left the feminist bookstore she founded to become a physician's assistant. Today, she works at the Ryan Community Health Center on the Upper West Side and regularly visits three nearby SROs as a member of Streetside. She has a rapport with the residents that translates into an effective approach on issues like the new AIDS treatment. "I try to engage them on the subject," she says. "They trust me more than the people in white coats." On a bitterly cold Saturday, London walks through the Camden Hotel with a nurse and a pre-medical student. In the forbidding maze of hallways with musty carpets, London's style is informal and coaxing. "C'mon, open up," she cajoles, rapping on the doors of her regulars. "It's me, Karen." An intense woman with a head of gray hair, London admits she often goes to the hotels more than once a week to look in on her most worrisome cases. "There is a degree of intimacy with the flu shot--sticking someone takes time, and it is an excellent way to get to know them," she explains with a chuckle. She adds that the shots also provide an opportunity to discuss other health problems. Some of London's patients begin to emerge. Sophie, a frail woman in her mid 60s, injured her foot trying to remove a corn, and it has become badly infected. Pleased by the attention of the visit, which alleviates the loneliness of her tiny room, she chats on while London takes her temperature. Down the hall, a very sick transgender woman with long brown hair hurries to one of the bathrooms--she hasn't been to a health clinic for more than two years. "She has the same problems that people with a history of drug use have--she does not have the skills for navigating the system," London says. "People also have an additional hostility because they can't determine her ex." Health care hurdles like these might not be covered in med school, but they're not uncommon for Streetside's volunteers. As way of example, London tells of a patient named Frank, an elderly man suffering from AIDS-related dementia. The condition made him easy prey for other residents in the hotel, who would rob him when he went on drug binges. For months, she tried to get him to move into St. Mary's, a skilled nursing residence for people with AIDS. But when he finally went for an interview, he politely refused to move in, saying he didn't like the tea they served.

Insurance Barriers

Streetside's 1997 budget was a minuscule $5,000, donated by two of the group's members. The Department of Health provided the flu shots for free as part of their of vaccination program, but the bacterial pneumonia vaccinations cost $10 apiece. Some of the medical supplies, like disposable thermometers and bandages, have to be bought, others are donated. Streetside is fueled by volunteer labor, of which it seems there is never enough. "I think we'd be eligible for various grants, but before we obtain money we really need more medical volunteers first," Stancliff says. The biggest obstacle is malpractice insurance. "The insurance from their regular jobs does not usually cover volunteer medical activities," she explains. "It really is a low-risk situation, however. Studies have shown that poor people are very unlikely to sue." Still, expansions plans are moving along. "We've had requests from a soup kitchen in the Bronx to provide more basic medical care, and we are planning to set up a volunteer medical project with one of the needle exchanges on the Lower East Side. We also want to start giving Hepatitis B vaccinations," Stancliff says. Much of the work they do is simply filling the gaps left by an indifferent health care bureaucracy. At the privately-owned AIDS housing SROs, caseworkers from the city's Department of Health should be carrying much of the load, but a source familiar with the hotels says the workers aren't always dependable: "Some are conscientious, and some are appalling. The SRO owners provide the office space for the social workers, and this dependency hurts their ability to advocate for their clients." And so London says her sickest clients will often put off calling 911 for days, until she can take them to the hospital. Such is the level of trust she has built among people to whom trust comes hard. "Often their previous experiences receiving health care have been degrading and negative," she says. "They don't want to go through the system alone. Who would?"

Dylan Foley is a freelance writer in Brooklyn who had volunteered for Lower East Side Needle Exchange in the early 1990s.

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Copyright 1998 All Rights Reserved Dylan Foley
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