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.
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
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.
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
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.
Copyright 1998 All Rights Reserved Dylan Foley
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