This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.


OBJECTIVES: (1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prospective study designed to define and determine predictors of the course of health services utilization and physical health outcomes within one vulnerable population: homeless adults. We paid particular attention to the effects of mental health, substance use, residential history, competing needs, and victimization.

PRINCIPAL FINDINGS: Homeless adults had high rates of functional vision impairment (37 percent), skin/leg/foot problems (36 percent), and TB skin test positivity (31 percent), but a rate of high blood pressure similar to that of the general population (14 percent). Utilization was high for high blood pressure (81 percent) and TB skin test positivity (78 percent), but lower for vision impairment (33 percent) and skin/leg/foot problems (44 percent). Health status for high blood pressure, vision impairment, and skin/leg/foot problems improved over time. In general, more severe homeless status, mental health problems, and substance abuse did not deter homeless individuals from obtaining care...

CONCLUSIONS: Homeless persons are willing to obtain care if they believe it is important. Our findings suggest that case identification and referral for physical health care can be successfully accomplished among homeless persons and can occur concurrently with successful efforts to help them find permanent housing, alleviate their mental illness, and abstain from substance abuse.¹

The McDonalds bathroom holds no mirrors, nothing by which to see a face covered with fine dust thrown up by the Bruckner expressway. The dust that attaches itself to bodies in smears and smudges after spinning off semi-trucks' wheels.

The air browned by particles, a pedestrian crossing the lanes of traffic later notices marks around her collar. As she passes beneath the multiple-storied roar, others sleep in its eaves, alone or with friends in their dirt beds, in crannies provided or not-so-provided by the arches of the dual-tiered road.

The dirt sleepers ready drugs there too, crouching to the ground, behind a concrete pillar, steel barrier or found-cut plywood, to place down the upturn of their heroin cap, their needle following like a hummingbird. Drugs that mistakenly fall are rescued, shot with grit-burrs.

Dust to Dirt

Dust to dirt: Hunts Point, Bronx. Courtesy of Chris Arnade.

Wounds, injection-created abscesses, stand out: puffed pink flags against skin layered by days and months of half-baths.

The hydrants existing as free showers are closing -- summer is over. Temperatures reach the 50s. People slowly become dirtier. Rumors turn from violence to men refusing to see a woman for a date, giving her half, because she smells.

Bathing when homeless

Bathing when homeless: Hunts Point, Bronx. Courtesy of Chris Arnade.

Money is harder.

There's a shelter nearby where lines are waited in, where ID is required. Where privacy is forsaken and pride is lost but showers are available. There is choice and no choice.

And so a person scrubs in the only place, to be alone and to make herself beautiful, under golden arches where the soap isn't real, just spat foam, impossible to use to wash. Where the stall doors don't lock. Where roaches and beetles crawl out of the trash cans. Where grime maintains itself and grows outward in grooves and tiles. Where paper towels are things of the imagination and toilet paper sometimes is. Where there are blank spaces over sinks.


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