Providing Health Care to Boston’s Homeless: Reflections from Bella ’24

Earlier this year, in the dead of winter, several large, empty boxes appeared in the Commonwealth lobby. 

Built by Bella ’24 and her father, the boxes quickly filled with hand warmers and socks, as Bella organized a drive for the Boston Health Care for the Homeless Program (BHCHP). "As I thought about places where this drive might stir up interest, Commonwealth was the first place that came to mind," Bella says. She ultimately distributed the community's contributions directly to people living on the street. The impetus for Bella's collection was a Project Week spent with BHCHP, in which she not only shadowed leaders across departments—from administration to legal aid—but worked and spoke with unhoused people in Boston. 

With COVID disproportionately affecting the unhoused and looming large in BHCHP's work, Bella began her week with a conversation with Dr. Jim O'Connell, the president of BHCHP, about vaccine equity and patients' willingness to vaccinate. "He said that, contrary to the housed population, there is no racial disparity in vaccine acceptance among the homeless population, and we had an interesting discussion about why that might be," she says. "The willingness to get vaccinated among the population that we worked with is relatively low, which has proved devastating to many people. COVID spreads quickly among the homeless population and is frequently fatal or causes long-term hospitalization due to widespread immunocompromisation." Dr. O'Connell also explained BHCHP's commitment to involving unhoused people in running the organization, both in offering services and recruiting them for the board of advisors.

Bella spent the rest of her first day learning about BHCHP's initiatives for tackling substance abuse and encouraging harm reduction in its patients. On Tuesday, she worked alongside a case manager and Americorps volunteers at the Pine Street Inn—New England's largest homeless services provider--and assisted in the documentation process for services like the Supplemental Nutrition Assistance Program (SNAP). With a long-term interest in pursuing law as a career, Bella then dove into the legal issues contributing to homelessness. "I spoke with a patient who was working to resolve some outstanding misdemeanors and get his record cleared. Another patient that I helped out a bit was dealing with immigration issues and had to get in contact with ICE monthly but didn't know how to do so," she says. "This is a big issue within the homeless community. A lack of awareness in regards to the legal system can increase people's risk of becoming homeless. A woman that I spoke to later in the week became homeless because she wasn't getting paid while on COVID sick leave and didn't know this was illegal. She didn't have resources to advocate for herself, stopped being able to make rent, and became homeless." 

In later discussions with BHCHP's development department, Bella heard about the psychological toll that confronting these issues could take on staff over time. She talked to the head of the department about secondary trauma, which often affects people who support those who have lived and are living through difficult situations. Especially since the onset of COVID, staff at organizations like BHCHP have been experiencing higher than normal levels of fatigue and emotional burnout. They also discussed how "a certain level of savior syndrome" can impede workers from getting the help they need, as they "feel that they have to be strong...because the patients are dealing with much worse things, and they feel like they shouldn't speak up about what they're going through since everyone else on the staff is experiencing similar." Dr. O'Connell replied: "You have to intellectualize [the problems of people you're working with] to even function. If you really dwell on the pain and the suffering and the unfairness that exists at every juncture, you would become paralyzed." 

After working on Thursday at the Behavioral Health Department, Bella left the BHCHP offices alongside Street Team staff to connect with the unhoused population around Boston. "Friday was the hardest," she says. She spent the day visiting people on the streets and talking to them about what they need and how they're doing. "I connected instantly with one woman, who had just recently been kicked out of a hotel that she was staying in after a complicated situation with a roommate. She held my hand and cried, repeatedly saying 'I don't know' when I asked her what she was going to do for the blizzard that was going to happen that night." Bella goes on to say:

    Many homeless people don't want to go into shelters. The large warehouse type of building makes a lot of people uncomfortable. Also, since when one enters a homeless     shelter during the evening, it's often a requirement to stay until the morning. A lot of homeless people really value their independence, as it's often one of the only things they     reliably have. Shelters are also an issue for people with paranoia, which is a large portion of the homeless population, as they often feel like people are watching or listening to     them. Since substance use disorder is rampant within [the chronically unhoused], many people need to stay outside, since they can't use [substances] in a shelter. It's common     to see couples outside because shelters are always gender segregated, often not being trans-inclusive either, which brings me to my next point. People who are marginalized     otherwise (for example, on the axis of race, sexuality, or religion) within the homeless community also feel uncomfortable in shelters. 

    There is a large sense of territoriality within the homeless community because people are less likely to get kicked out of wherever they're staying if there are fewer people staying     with them. Although territoriality is real, community is too. Dr. O'Connell said "when somebody dies, everybody's paralyzed and so clearly affected by it." I saw this firsthand     when a patient died during one of my shifts. 

By the close of Project Week, "my perspective on life in general [had shifted] greatly," Bella writes. Her interactions with people in dire circumstances—including some with a record of legal offenses—and witnessing systemic neglect challenged her preconceptions about empathy and service. Despite the intensity of these experiences, Bella encourages other Commonwealth students not to shy away from similar work if they want to advocate alongside marginalized populations. 

"I'd recommend this project to anyone who's interested in social justice and ready to work. I would add that working at BHCHP was emotionally intense, and students interested should be aware that their week isn't going to be comfortable or easy. That being said, they will absolutely be supported by the staff, and there's a lot of love to go around."