A reflection on our Albert Schweitzer Fellowship Project

By Sarah Jabour and Ruth Bishop

Our project centers on the belief that people experiencing homelessness are our best teachers and should be included in addressing the health disparities and root causes of housing insecurity, including unaffordable housing, racial inequity, stagnant wages, and lack of access to substance use and mental health services. We proposed a narrative storytelling project among people experiencing homelessness in southeast Michigan with multiple synergistic aims: to improve mental health and access to mental healthcare services; build community and trust; and provide an advocacy outlet by elevating these experiences, in the form of digital and printed published stories and other narrative pieces, written by community members experiencing homelessness.

We believe that engaging in storytelling, through writing and video, with people experiencing homelessness could reduce symptoms of depression and build feelings of resilience, self-esteem, and community connectedness (Armstrong 2017; Bornat 1989; Hallford and Mellor 2013). This aim is directed at addressing the disproportionate number of people experiencing homelessness with mental illness and substance use disorders who are not in treatment (Center for Substance Abuse Treatment 2013). Additionally, as has been described in the literature, we would serve as a sounding board for our participants and would serve to connect our patients to the health or social services they may need (Walsh, Rutherford, and Kuzmak 2009).

As we continue to chip away at this work, we have been thinking a lot about fragility – the precipice that people in marginalized positions, including housing insecurity, teeter on. A couple of months ago, we worked with one of our friends to help troubleshoot some medical needs. He was in a catch-22 situation, where he wanted to work but was unable to due to his health condition. Not being able to work also contributed to his mental health, as he was eager to contribute and find his ikigai (happiness in living). In addition, based on his background and experience with the incarceration system, he did not have an identification card. It was nearly a full-time job to figure out how to secure a new identification card (in a pandemic era no less), which was needed to file for unemployment benefits to help pay his bills.

Later in the month, we went to Detroit with our Wolverine Street Medicine team following the heavy rains and flooding. The folks who were unhoused at our community partner site (St. John’s shelter) had flooding in their basement. This is the email we got the next day from our preceptor, leader, and role model:

Good morning!!  Thank you all for your support in yesterday’s clinic!!  As you can imagine, finding oneself in waist-deep water in the middle of the night, having much of your personal belongings lost or water-logged, and being moved to a new shelter, in a new area is traumatic. Your presence and socializing with our friends at the Kemeny Center were as important and healing as was the direct medical care that was given by you. Your unconditional regard was greatly appreciated by all -thank you!!

Listening to some of these stories firsthand was gut-wrenching. Why we continue to be so surprised that folks experiencing homelessness are often an “afterthought” in any sort of public health or governmental planning still baffles us. How we let these dysfunctional systems continue also leaves us flabbergasted. We hope we never lose that sense of anger/shock/bafflement because if we do, we fear, it will mean we have become complacent or part of a system that accepts the way things are.

Sarah Jabour and Ruth Bishop are Albert Schweitzer Fellows at Authority Health. To commemorate World Humanitarian Day, August 19, Schweitzer Fellows are publishing blogs about their work this week.