Many homeless people on-Island and elsewhere are either homeless because of health issues, or have health issues because they are homeless.
When someone is poor and living in a space that is not fit for human habitation, many of the things we think of as modern-day necessities, such as clean running water, nutritious food, and heat are out of reach.
Doreen Anderson, community health worker on Martha’s Vineyard, said many people have a flawed view of why people are homeless. She said health issues can create situations where people cannot pay their bills because they are unable to work for extended periods of time.
“Most of these people are either too poor and can’t work because of a mental or physical illness, or they can’t find housing,” Anderson said. “It really could happen to anyone.”
Anderson said she is not speaking on behalf of the hospital, but wanted to illustrate this issue through her personal accounts with homeless people on the Island.
In one case, Anderson knows of a person who had complicated medical issues who returned from a medical facility to their small tent in the woods with no running water, cell phone service, or access to wound treatment or sanitary care.
“How can someone who is living in those sort of conditions be expected to recover properly after a major operation? Just imagine,” Anderson said.
Although programs such as the Visiting Nurse Association and Elder Services are provided to aid in recovery, the sanitary conditions involved with being homeless are a huge problem, according to Anderson.
“If you don’t have access to running water, how can you shower? How can you clean a wound and replace a dressing? It’s just not possible,” Anderson said.
About 100 people are chronically homeless or living in substandard conditions year-round on Martha’s Vineyard, according to the Dukes County associate commissioner for homeless prevention, Karen Tewhey.
Another overarching issue of homelessness is a lack of nutritious food (and often a lack of food in general). The Island Food Pantry is an important resource for the Island’s homeless, but Anderson said stigma or distance often prevent people from accessing it.
“If someone is homeless and doesn’t have access to a car, they can take the bus. But that costs money too,” Anderson said. “It’s often difficult for homeless people to get access to these resources because they have no consistent means of transportation.”
Apart from the physical distance from valuable Vineyard resources, homeless people may also feel distanced from society or ashamed of their situation.
“There is a huge stigma surrounding homelessness. What we need to learn to do is treat people with respect and dignity, and try to help whenever we can,” Anderson said. “We want to sensitize people in a positive way to this issue.”
Offering a homeless person a ride to a shelter or food pantry helps alleviate the stigma surrounding homelessness, and could mean the difference between someone eating or not eating on that particular day.
A homeless person without a physical address also has no place to send or receive mail, and no landline where they can be easily contacted. For these folks, a cell phone is often their only lifeline.
“If you can’t afford a place to live, you probably can’t afford a phone, a computer, or a personal mailbox,” Anderson said. “At best, your cellphone is your lifeline to the doctor and all other essential services.”
But people who are homeless often have no readily available means of charging a cell phone, a lack of cell service, or cell phone plans with limited call minutes.
“How can someone call and schedule an appointment with a social service agency when they have no minutes left on a prepaid phone? I know at least 10 or 12 people that only text because they can’t afford a phone plan with enough minutes,” Anderson said.
Although the VNA usually provides follow-up care to patients after they are discharged from the hospital, if a living environment isn’t conducive to the nurse’s care, that essential service could be lost.
Anderson said one homeless patient she knew of was discharged from a Boston-area hospital after injuring themselves, and needed follow-up physical therapy. A homecare nurse visited the patient where they were staying at the time — in a small shed a property owner had rented out.
Because the shed was so small and cluttered, there was no room for the patient to walk, stretch, or perform recovery exercises without the possibility of falling.
“The nurse didn’t want to hurt the patient or themselves. It was a very difficult situation, and it happens quite frequently,” Anderson said.
Recently, homelessness was cited as a priority in a community needs assessment conducted by MVH, according to Tewhey. “Homelessness jeopardizes your health in every way,” Tewhey said.
She said people with weakened or compromised immune systems are particularly susceptible to serious health issues. Someone may have a disease that weakens their immune system, or a lack of nutritious food may diminish their ability to fight sickness and infection.
Tewhey gave an example of a pregnant woman without access to proper prenatal care who could be experiencing a high-risk pregnancy.
“A pregnant woman might be living in dirty and substandard conditions, they might not have access to the proper nutrition, they might be cold — there are many things necessary for a healthy pregnancy that are out of reach for homeless people,” Tewhey said.
Having limited access to electricity is another prominent issue within the homeless community.
Besides not being able to heat up and prepare food or use a portable space heater, having limited access to electricity is cause for other concerns. If someone is using portable oxygen, they need electricity for the device to function. “That is just one example of how having access to electricity is so important,” Tewhey said.
The biggest health risk for homeless people, according to Tewhey, is hypothermia.
During the winter months, homeless shelters like the Houses of Grace offer anyone seeking respite from the cold a place to stay. But these shelters often aren’t equipped to deal with a medically fragile person, according to Tewhey.
“If someone is dealing with a substance addiction, or is sick or injured, the Island shelters may not have all the proper tools to help them,” Tewhey said. And despite monumental efforts by Island clergy and dedicated community volunteers, the winter shelters can’t accommodate everyone in need of a warm and safe space for the entire cold season.
Tewhey circled back to the stigma surrounding homelessness, and how it can sometimes lead to misdiagnosis.
In one case, Tewhey said, a chronically homeless person was being treated for alcoholism, and their symptoms began to worsen dramatically and in a short timespan.
“The person wasn’t able to speak, they were getting dizzy, and were having intense bouts of nausea,” Tewhey said. “Everyone assumed it was just symptoms of alcohol addiction, but it turns out this patient had a toxoplasmosis in his brain caused by a parasite.”
Toxoplasmosis is caused by eating undercooked, contaminated meat, or being exposed to animal feces. Although most people with a healthy immune system never show symptoms of this infection, homeless people that may have a weakened immune system can experience serious complications, according to the Mayo Clinic.
By understanding how closely homelessness and health issues are related, Tewhey said, she hopes people will relate to the struggles experienced by those without a safe and warm place to live, and will want to help.
“People can always help by donating to one of the shelters on-Island or the Island Food Pantry — every bit helps,” Tewhey said.