Report from the USA

A look inside San Francisco


Special to Shunpiking Online

SAN FRANCISCO -- THEY SCRAPE puking drunks off the street, transport ailing prisoners and help grandpa catch his train. The San Francisco paramedic is the unsung, all-purpose civil servant.

The traditional paramedic role has undergone drastic changes during our country's shift toward 'compassionate conservatism'. At the level of the state, this ideological shift to the right has gutted social programs, leaving the needy out in the cold, with no place to turn. Over-worked city paramedics, who have added social work to their evolving job description, have filled the void left by these disappearing programs.

The changes are most evident in San Francisco's tenderloin district.

The tenderloin is different, with sirens replacing trolley car bells and rich suburban kids out for a fix, replacing curious tourists.

"There are a lot of sub-sections to the TL," said 12-year San Francisco paramedic Kirt Thomason. "There's the high visibility sex industry… and also the huge halfway-house, prison population."

The tenderloin is also home to nearly a quarter of the city's 8,000 to 12,000 homeless persons, according to a December 7 San Francisco Bay Guardian article.

Life in "the loin" proceeds at a brisk pace. Peddlers of every illegal substance known to man rub elbows with financial district stiffs looking for some coke to get them through the week.

New immigrants from around the world pour out of the small residential hotels, looking for work and realizing that in America, only the streets in the nice neighborhoods are paved with gold.

Children, trying to get to school, navigate the mazes of back alleys, filled with pimps and pushers.

Ambulances responding with flashing lights and wailing sirens hardly draw a second glance.

This is home for a city paramedic. This is where people need help.

Medics have a story for almost every building in the loin, where every dreary mass of concrete houses its own ghost.

"We get a lot of alcohol and drug abuse calls in the tenderloin, … whereas in the Sunset, we get more chronic illnesses or medication complications," said firefighter-EMT Christine Williams.

Due to the heavy reliance of addicts and homeless on assistance programs, the effects of cutbacks that help the impoverished, drug addicted or mentally ill are glaringly evident in the tenderloin.

The disappearance of the services that were designed to help the needy has led medics to evolve to meet the changing needs of the tenderloin's destitute.

No longer is it enough for a medic to pick up an over-dosing addict and deposit him at the local hospital for treatment. With cutbacks eliminating programs that would help him, rehab options are almost non-existent. He will be back on the street before the end of the medic's shift, probably requiring another transport.

"A private hospital is going to do the minimum to help [an over-dosed regular], because it is going to be out of their pocket," said San Francisco paramedic Larry Bradshaw.

For this reason, these repeat patients are called "frequent flyers". Most chronically use drugs, usually have psychiatric problems and have not a glimmer of hope in their lives, or a system that will help them. The medics know them by name and medical history. The shelters know them by street alias.

They overwhelm the emergency medical system, not only costing the taxpayers millions of dollars, but also increasing EMS response times, as units are busied by assisting them.

So, rather than allow the rotating door to keep turning, medics now attempt to find a lasting solution for people that will accept their help.

By collecting the histories of frequent flyers, medics have begun to form "bios" on them and use the information to decide who can be helped with a more permanent solution.

The frequent flyer's information is relayed to a full-time caseworker, which then searches for a structured housing situation, or similar program for the patient. This help isn't only for addicts. Medics also attempt to ensure that the elderly are safely in the care of social workers.

But, recent budget cuts are creating a shortage of adequate programs and with more health care cuts in Mayor Gavin Newsom's mid-year budget revision, medics are quickly running out of programs to turn to.

Both the Central City Hospitality House Self-Help Center and the Tom Waddell Health Center's Urgent Care Clinic are slated for closure in the next few months, according to the San Francisco Bay Guardian article.

The Central City Hospitality House Self-Help Center serves the tenderloin's large homeless population by "fulfilling immediate survival needs and subsequently linking individuals to longer-term services," according to http://www.hospitalityhouse.org .

The center acts as a "safety net" for many Tenderloin homeless people, by providing a "safe-haven for people on the street, where they can be with a community and access services that they need, while making a human connection and moving toward greater stability," according to Hospitality House Executive Director Jacky Jenks.

The immediate effect of the center's closure would be hundreds more people on the street, in crises situations and an influx of patients to the emergency medical system, according to Jenks.

The Tom Waddell Health Center's Urgent Care Clinic is a community-based clinic that is part of a larger Community Health Network. Clinic fees are on a sliding scale, with those making less than $716 per month being eligible for free health care, according to San Francisco State University research. http://www.sfsu.edu/~shs/insurance .

The clinic provides an alternative to using the EMS for many in the tenderloin.

"The city is trying to save money by not providing money to these programs, but compared to how much it costs to transport patients constantly, it is cheaper to provide a program where patients get constant care," said paramedic Larry Bradshaw.

One quick fix has been the establishment of Mobile Assistance Vans to transport inebriated street people to collection centers.

But, some patients require medical care in transport. These "ambulatory inebriates" are dropped at collection centers like the Community Awareness and Treatment Center located at 39 Fell Street.

Though it is well known by city medics and police, the existence of the Community Awareness and Treatment Center slips under the radar of your average citizen.

Users line the street in front of the dimly lit assistance center. People get high on crack cocaine and shoot heroin on the sidewalk in front. A woman, propping herself on the wall, calmly lowers her dirty sweat pants and urinates on the wall, barely catching a second glimpse.

A young Asian girl who can't afford her psychiatric medications stares blankly at a wall.

A homeless World War 2 veteran wonders why he didn't die with his friends in Europe.

This is the hidden reality of government assistance cutbacks.


*Brian Frank is a journalist and contributing writer, shunpiking magazine. He participated in the Halifax International Symposium on Media and Disinformation July, 2004.


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