By Nick Brunner
Joe Smith is the director of outreach and engagement for Hope Cooperative, and Anna Darzins is the director at the Meadowview Navigation Center, which is operated by Volunteers of America Northern California. Smith and Darzins recently met for the first time at the VOA offices to talk about a more compassionate view of the unhoused community.
The conversation was recorded for the podcast Housing in the Capital.
Smith: I’m a board member for Sacramento Street Medicine, and you were working in Street Medicine. In fact, Street Medicine is at the [Outreach and Engagement] Center right now working with the folks.
Darzins: Well, you know what happened. I was working at the clinic as a case manager, and there was a doctor that was going out on the street, and he would send me a fax … [like] “Mary needs a pap smear. She hangs out at McDonald’s on Richards Boulevard, her date of birth is blah, blah, blah, go find her and set an appointment.” This was back in the day, this is what it was like. And I’d walk around and I’d stop every woman: “Are you Mary So-And-So? Are you Mary So-And-So?” And nobody wanted to talk to the lady. Because they were like, Who is this lady? And what does she want from us? So it was not trusted regardless of my badge.
So I went to the doctor and I said, “Sir, surely if they met me when they met you, this would be a lot easier, right?” And it took a while. But we really got to that point where half of my time was going out into the street going, hey, we’re bringing doctors tomorrow, and the rest of the time was just kind of trying to get it all. But it’s a very hard thing to do. Because I think this community is really frightened of getting that new diagnosis. They know about the COPD and the stroke and the liver failure. But they’re really worried about that next thing that they go to the hospital for because every time you go it’s just a horrible diagnosis.
Smith: I’m a person with lived experience of chronic unsheltered homelessness. I came off the streets and [had] numerous stays with VOA, and then found my way into a temporary housing solution and onward to a more permanent kind of solution. And I started working in homelessness services with Loaves and Fishes in 2016. I left there about a year ago to come to Hope Cooperative to run the Outreach and Engagement Center and the Homeless Outreach Program.
Darzins: I grew up here in Sacramento, I’ve been a servant of the city for about 10 years is the way I see it. I had a traumatic childhood and young adulthood. So I just had a lot of the same type of experiences many of our friends in the shelters and out on the street have had. I didn’t know what I was going to do until someone gave me access to education. I just finished my master’s at USC. After graduating, I started the first Street Medicine Program here in Sacramento, bringing doctors out to homeless camps, doing primary care and mental health out on the street in riverbanks. After a few years, it was really exhausting because it was really hard to see any sort of progress. … When I was invited into shelter here at VOA in 2017 I was really excited and thrilled to see how giving someone a place to — I call it — “defrost.”
It’s like two weeks after coming indoors where you’re doing maybe a little less of whatever drug you’re doing and resting and sleeping and kind of coming off of the adrenaline you’ve been living off of and in people would have like heart attacks … strokes and come in really sick … but there, we would have someone who was stable enough and ready enough to actually work on housing and recovery.
Smith: That’s kind of my story a little bit, going from living out on the streets and getting that opportunity, which was through a VOA program at the time, back in 2011. But to have that place to come as you are, have someone welcome you, have a warm place to sleep, hot food, and the shower, gives that opportunity to kind of reignite that spark and start working on solutions that are going to keep a roof over your head for even longer. With me, working at Loaves and Fishes, for all the incredible work they do, it was always really hard to shut that gate at the end of the day, and see people walk away.
Ours is a 24-hour respite center [at] Hope Cooperative. Just to have a place to know that the folks we’re serving are going to be saved for the night, it’s a big deal. Because we see what that does for them. We’d see that kind of spark go on. And people who were unwilling maybe to even talk about different avenues of transitional living, or housing or anything like that, or they start to soften up and they start to want that for themselves. It’s really pretty miraculous.
Darzins: What’s really striking to me is folks that live in doorways downtown, and the number of people that walk past them. These individuals may have been assaulted, are hungry, hurt, and kind of invisible to everyone who walks past. In my time of working with this population, I’ve learned that the first thing you can do is recognize their humanity. Maybe say hello. Doesn’t mean you have to put yourself out or make yourself vulnerable. But recognizing someone who may feel ignored by people is really an important thing. I think that it is frightening because there’s so much that’s not known about the homeless community, that it’s easy to wonder if some of the problems in neighborhoods are brought on by this population or will increase if they come in. What do you think?
Smith: Everyone wants to be seen and heard — all of us do. People living outside are no different in that way than any other human being. However, they’re probably going through some of the most difficult times of their life. And they have no place to grieve what’s going on in private, they’re doing it right there on the street. I can’t think of too many more horrible things that can happen than to be invisible in the moment when you’re in so much pain.
I think that you’re right to stop and acknowledge the person, to smile at them every once in a while, to say hello or good morning. It starts to let them know that they’re not alone and it keeps reminding us that they’re there. And they’re just as human as we are.
One of the things about the Outreach and Engagement Center is the staff is really personable and how much we have in common, in every way, to people [that] are living outside; except that great divide — we have a home and they don’t — so we try to make it a home for them and and the grief starts to come out, and suffering maybe gets a little easier. But for the average person out on the street, they either feel shunned or just completely invisible.
Darzins: Folks that are living outside, especially, feel really frightened about addressing their healthcare needs, because of the fact that when they go and interact with doctors or providers, the doctor and provider may have a lot of frustration because this person hasn’t taken the medication you have prescribed and hasn’t gotten their labs drawn, and isn’t engaging their health. Then the person who’s receiving the care feels super judged and doesn’t want to make the changes, because they’re just trying to live.
Smith: Yeah, the day-to-day. “I have to eat tomorrow, I have to stay safe tomorrow, I have to feed my dog tomorrow, I have all these things to do tomorrow, today and tomorrow.” Sometimes some of the things I ran into with the folks in the encampments around Loaves and Fishes [were]: “So you want me to leave my encampment, and go get labs drawn, or an x-ray done, or even want me to go to the pharmacy — and leave my stuff? Alright, how do I know my stuff’s going to be safe? This is all I have in the world, I can’t leave my stuff.” Someone would barely break away long enough to go eat lunch at Loaves and Fishes. So I think the idea of street medicine is so important.
Darzins: It is.
Smith: [Also]: “Who are these people? And why would we trust you?” They’ve actually been doing weekend outreaches that are just survival supplies, human contact, and things like that to build trust. Now they’re building up the doctor providers behind that, who are just so welcomed into the environment, because the relationships are already built, but what an uphill time to get them to reveal those things. …
Darzins: It’s really powerful to go and meet people where they are, recognize their humanity and ask if you could help. A lot of times I would be met with a lot of reluctance and it wasn’t until I started taking someone’s vitals and preparing them for the doctor that they’re like, “Oh, wait a minute, I do have something.” Because until then they’re just thinking you just … want their information.
There were days that I couldn’t get anything done and all I did was change some band-aids or wash feet … just because people would keep shoes on for so long. But just some relief in having an ability to wash feet was amazing. Folks would remember that and so the next time they saw you, they might be a little more ready. … Also, I think, sometimes one of the biggest barriers I see is individuals don’t speak the same language providers do. … One day, I remember I went to this camp and this man, he says, “Anna, you lied.” And I said, “Oh, my gosh, what did I lie about?” And he says, “You said my prescriptions would be there. And they weren’t.” So I’m calling the pharmacy, and they’re like, oh, yeah, the prescriptions here, but we don’t have his insurance information. … They said, “no,” and [he] just left. … For someone who’s used to hearing no, they don’t know to ask any further and they walk away. …
Smith: In that instance, if you were to start asking more questions or feel comfortable or feel heard or seen he might have stepped up and advocated for himself more, but people get so used to just being invisible. And, you’re right, “no” is the most common answer to any question they hear. The street medicine doctors are amazing. The whole staff that goes out, they’re using a lot of medical students. Second-year medical students along with licensed providers go out and the [doctors] kneel down in front of the tent, you know, seeing the person, is speaking plainly to them, asking thoughtful questions and really taking the time to listen. It’s just transformative, watching them work. It’s amazing work.
Darzins: I remember we had one young lady who was pregnant, and it was just incredible. She had delivered on the riverbed. So she delivered on the street. … [She had] preeclampsia. So she had a condition, in addition to being pregnant, that made it dangerous. And following her and then getting her to go into the hospital where that doctor was able then to be part of her delivery was just incredible. … It was one of the most meaningful things I’ve ever done in my life.
Smith: Heroes. During COVID, they didn’t stop at all. They realized early on that when you say you’re going to be somewhere —like, I’m going to my next visit to this camp in two weeks in the morning. And then two weeks from then in the morning they were there, they were the most consistent-like people in their lives throughout that whole epidemic. It’s amazing.
Darzins: You said something that really resonated with me, and that is this idea of having a place to feel safe, and be at home. But, I think, as human beings we’re much more than that. We also need to have a sense of community and meaningful activities, things that we can participate in, that bring us joy in order to truly kind of feel whole in that sense and find meaning in our lives. But that’s really difficult when you have experienced some of the extreme trauma that you have out on the street because people are assaulted, sexually assaulted, robbed. They worry about whether or not they’re going to survive. They watch others go through these same attacks.
As a community, we haven’t done enough to recognize, what are the effects of that? And how can we wrap services around you regarding that part of your recovery? … I think that it is stable housing, and it’s meaningful activities, just a sense of community and a sense of self-pride. But I also think about how people have been affected by what’s happened to them.
Smith: Yeah, when I came off the street into the first place I had, it was a single room [in a house] for other people who had had a similar situation to me. I can remember how difficult it was just to sleep in that room. Just I don’t think people are aware of exactly how difficult it is to be out there for so long, like you’re saying, and come inside and be successful.
And then all the pitfalls of living with people who have had [similar] circumstances, I swear it was six weeks before I could even resist the urge to just jump out the window. It was an incredibly difficult time. I completely agree with you: We need to think about … what do we do to help them be successful? How do we bring them back into community and really put them on a path of success and happiness for whatever they want in their lives? Without that, people are going to end up right back out on the street. I can tell you that … I’ve been off the streets for over 10 years, and that’s still my greatest fear is that one day I might have to go back in. I couldn’t imagine that.
Darzins: That’s a very common fear for a lot of individuals. I’m thinking of one gentleman that we had at the triage shelter that had been homeless for about 40 years — Vietnam veteran. And I remember when we housed him at first everyone was like, success, this is wonderful. And by 5 p.m. he called me and he says, “This is the worst thing that’s ever happened to me. I wish I were dead.”
What we had forgot about was by removing him from his community, we just essentially placed him in a box and he lost his identity and his meaning system was gone. So I think that services are incredible, but restoring individuals to some sort of recovery and stabilization also means finding ways to re-invite them back into the community and give them their place at the table and not just kind of set them away in an apartment and think that it’s fine. …
The environment has changed and who’s homeless has changed, and because of that, we have to learn more about what it’s going to take to serve that population.
Smith: A couple of really kind of disturbing trends that I’m noticing lately — and they’ve been there all along — but I think with Sacramento bringing online the Coordinated Access System, [that] has really kind of pulled the sheets back on on the real numbers that are out there. I think it will continue to be very revealing, as the system ramps up more and more, the amount of families with children that are on the streets right now. I’ve been in this work for not quite 10 years, but I never assumed it was as large of an amount of families as there are.
When I was at Loaves and Fishes, there was an alarming amount of parents who were bringing their children to the Mustard Seed School who had once been students of the Mustard Seed School. We’re kind of perpetuating our own situation by not figuring out what’s going on and finding ways to stop it. …
Darzins: I’m interested in asking you something. I’m just curious about your perception. Who are all the people downtown, living on the W-X corridor? And on Alhambra? How is it that that area has just exploded with mega camps? I’m stunned … and I don’t remember seeing them until COVID hit. An encampment that we would have normally [seen] at a creek bed is now in the middle of downtown.
Smith: It was quite a phenomenon that happened in this population when COVID first struck. I was working at Loaves and Fishes at the time, and we had to go out into the surrounding areas to let people know we were still open and providing services. I mean, we obviously modified a lot of things, but we didn’t stop. But a lot of smaller organizations did — a lot of organizations that provide aid to people living outside. …
So people started to come out of the creek beds. People who were really reliant on the services that were being brought to them, the services weren’t happening anymore. So they went … into downtown. … [Additionally,] as COVID alleviated, they started to do enforcement activities on those areas to remediate whatever was going on there. Those people were displaced … and the only thing they could do is migrate more to the core [closer to services within walking distance]. …
Darzins: So if you don’t mind my asking, just because I’m curious of your opinion. We’re always talking about shelter beds, and I think they’re really important, but do you think that’s the answer?
Smith: That’s the prevention piece — appropriate shelter beds, and then housing options that will work for the person accepting them and keep them successful. It’s a three-legged stool. And without an adequate amount of each leg, it’s going to fall over and not be as successful. But shelter beds are expensive, and not everyone wants to go into them. And not all of them are appropriate for a number of people. So I think there has to be a variety. The tiny home solution is kind of intriguing, as a kind of bridge between emergency shelter and transitional kind of living arrangement. It’s a little more private and secure. …
Darzins: I don’t know if you’ve seen this, but I definitely have seen this — as individuals who’ve been there so long that on the day that they’re intended to move, they’re really resistant, just because even though living in the shelter is not ideal, they know they’re safe. …
What I hear a lot is individuals talking about others coming to Sacramento to be homeless. I don’t know about you, but I haven’t really found that to be the case. Most of the time, I’ve found individuals going back to the community that they grew up in, to be homeless versus traveling to another city or state. What have you found?
Smith: My personal experience is I made it about a quarter-mile away from where I was living to set-up my first encampment. … This is homegrown homelessness. … I think I’m seeing more of an uptick of people who came here from somewhere else, warehoused, had a job and fell victim to all the different things that can lead a person in homelessness, but no one no one’s catching the bus to Sacramento to be homeless. That’s not what’s happening. No one’s pushing them out of a nearby municipality to come here. …
I think one of the challenges I have right now, at the Outreach and Engagement Center is people want their own housing. It’s been years and years and years of people living on the street, living in shelters, not living in shelters, and they don’t really want to keep doing that. They want to have the things that we all want for ourselves. They want their own door, clothes, and heat and air conditioning, and showers, and a place to make food, and to have their life. …
I think the barriers to getting people into housing right now are incredible. They’re incredible for any of us living in Sacramento right now — but take a person who doesn’t have rental history, doesn’t have income, doesn’t have a credit history. Even if they may have a job that’s somewhat affordable, or maybe a Social Security benefit … affordable housing places start to open up like in South Sacramento with Mutual Housing and Mercy Housing, those are all great targets for them. But they’re still barriers. … The other things that are holding them back, they have kind of lost hope. They just resigned themselves to the way it is. And what do we do about that here in Sacramento?
If people want to get involved, we’re heading into an election cycle and I’m not one to get anywhere near politics, but I know that there are a lot of conversations happening in a lot of circles. Something I would hope to see, it’s already starting to become a trend and really expand, is more people getting involved in conversations about solutions. … I hope as we move into this next cycle of elections, where we bring in new people and new energy into our climate, that more people are willing to have that conversation to talk about these things in their congregations, in [their] community groups, in their workplaces and their families. To say, “Well, maybe we can sit down and listen and see what we can work out,” instead of just meeting these things with a solid “No, not here” mentality.
This conversation has been edited for length, flow and clarity.
This story is part of the Solving Sacramento journalism collaborative. Solving Sacramento is supported by funding from the James Irvine Foundation and Solutions Journalism Network. Our partners include California Groundbreakers, Capital Public Radio, Outword, Russian America Media, Sacramento Business Journal, Sacramento News & Review, Sacramento Observer and Univision 19.