Speaker 1: Push it. You know, when you think about how people
Speaker 1: talk about people experiencing houselessness, it's unbelievable, the rancor, and
Speaker 1: they've never taken the time to listen or to really understand.
Speaker 1: There's a lack of imagination in addition to a lack
Speaker 1: of empathy. And how do we fight that when our
Speaker 1: society is built on this concept of inequality and for
Speaker 1: those to have, there have to be those who don't.
Speaker 1: I'm Khalil Jibrad Muhammad. I'm Ben Austin. We're two best friends,
Speaker 1: one black, one white. I'm a historian and I'm a journalist.
Speaker 1: And this is some of my best friends are some
Speaker 1: of my best friends are I'm not a blank. Some
Speaker 1: of my best friends are that thing. In this show,
Speaker 1: we wrestle with the challenges and the absurdities of a
Speaker 1: deeply divided and unequal country. And man, this episode is
Speaker 1: about inequality. Yes, yes, we're gonna talk to someone doing
Speaker 1: some of the most innovative and important work to address
Speaker 1: our poverty problem and affordable housing problem. Houseless. We're going
Speaker 1: to break that down. Let's go. Hey man, Hey, Hey, yeah, man,
Speaker 1: So I don't think I've ever told you this story. Um,
Speaker 1: It's something that was profoundly impactful on me when I
Speaker 1: first got started at the Shamberck Center. So I'm gonna
Speaker 1: tell you about it. My heart dropped for a second.
Speaker 1: I thought you were gonna tell me like the breakup story. No, no, no,
Speaker 1: And it's totally connected to what we're talking about today.
Speaker 1: All right, let's hear it. I've become director of the
Speaker 1: Schoenberg Center for Research and Black Culture, located in the
Speaker 1: heart of Heart in two eleven. This is like historic
Speaker 1: ground that all sorts of amazing people have walked on,
Speaker 1: from James Baldwin to my Angelo to Malcolm X himself.
Speaker 1: All right, so I'm doing some early programming and I'm
Speaker 1: trying to drum up interest in the place, and we
Speaker 1: have this event one night in our auditorium and a
Speaker 1: woman comes up to me and she says, you know,
Speaker 1: this event was amazing, but I think you should invite
Speaker 1: homeless people to the Schaumberg. They can have kind of
Speaker 1: like an American idol for homeless people. And we ignore
Speaker 1: homeless people constantly. So she's like, homeless people have so
Speaker 1: much talent and they just need opportunity to showcase their talent.
Speaker 1: And so just because they don't have a home doesn't
Speaker 1: mean that they don't have something to share. What's your response. Yeah,
Speaker 1: you're hearing this and you're like, let's do it. I'm thinking,
Speaker 1: I'm thinking this job is crazy, Like I'm just trying
Speaker 1: to get a paycheck and get the fuck out of here.
Speaker 1: Like I'm running a research archive. I'm supposed to be
Speaker 1: working with scholars, and here I am having a conversation
Speaker 1: about houselessness. Homelessness talent show. Yeah, so her name is
Speaker 1: a Ratha speaks and turns out that like within a week.
Speaker 1: I come back to work on a random weekday and
Speaker 1: she's out front and has built a cardboard compound. So
Speaker 1: I want to show you a couple of pictures so
Speaker 1: that you see what this looks like. All right, all right,
Speaker 1: oh man, And there's like there really is like a
Speaker 1: living room. Yeah, a bedroom. She's got a photon. You
Speaker 1: guys are like in a home. It's a house, but
Speaker 1: it's outdoors and boxes. Oh man. She put tile on
Speaker 1: the floor inside the cardboard boxes. That's right. This is incredible,
Speaker 1: Like it's part of the community. She has taken cardboard
Speaker 1: and put it together in such a way that she
Speaker 1: has a bedroom she's got an eating living room, she's
Speaker 1: got a library with book crates and books on the crate,
Speaker 1: and it's on the sidewalk. It's right in front of
Speaker 1: the building. You cannot enter this building with out almost
Speaker 1: stepping over this compound. And I'm like, holy smokes. So
Speaker 1: I talked to her and say, what's going on in Rathla.
Speaker 1: She's like, well, you know, I just wanted you to
Speaker 1: know that the issues of homelessness need more attention. And
Speaker 1: I'm gonna be here bringing attention because this is the
Speaker 1: Schaumberg Center for Research and Black Culture. And if there's
Speaker 1: any place in America where homelessness ought to be important,
Speaker 1: it is here. And I'm like, oh yeah. She's like,
Speaker 1: I know who you are. You're Elijah Mohammad's great grandson,
Speaker 1: and I know if anybody will take this issue seriously,
Speaker 1: it is you. And you know what, I think you
Speaker 1: should rename the Schaumberg Center the Elijah Mohammad Center for
Speaker 1: Nation Building. Yeah. Yeah, So it is a fascinating moment.
Speaker 1: She's like, you're the person. This is divine that I'm here.
Speaker 1: I have set up this compound. I want to draw
Speaker 1: attention to the problem of homelessness, and you're the person
Speaker 1: is going to help me do it. I'm like, oh, okay,
Speaker 1: but I can't let you keep this construction zone here
Speaker 1: of cardboard housing. I can't. I can't let this happen.
Speaker 1: And in fact, while I'm talking to her, a woman
Speaker 1: comes up and literally brates her is like, this is despicable.
Speaker 1: Get this trash out of here. This doesn't belong here.
Speaker 1: And this woman obviously lived in the neighborhood. And I
Speaker 1: went to interject. I said, hey, you know I'm the director.
Speaker 1: She said, I know who you are. I said, oh snap,
Speaker 1: She didn't care one bit who I was. So I
Speaker 1: talked to a rough and I said, listen, here's what
Speaker 1: we're gonna do. I'm gonna hire a videographer to shoot
Speaker 1: what you've done here, and I'm gonna use that video
Speaker 1: to help you tell your story. And in exchange for that,
Speaker 1: you will agree that within two weeks you will leave
Speaker 1: the Shaunberg Center and take the cause elsewhere because it
Speaker 1: was unsustainable. So here is the day when I sat
Speaker 1: down with her, because part of the deal was she
Speaker 1: wanted me to be interviewed with her so that she
Speaker 1: could tell her story. How did she feel did she
Speaker 1: feel that she was both seeing and that her cause
Speaker 1: and voice were having an effect. Absolutely. What Ratha Speaks
Speaker 1: was trying to tell us was that we don't deal
Speaker 1: with the root causes of this problem. We keep addressing
Speaker 1: it in band aid ways, and we're criminalizing poverty by
Speaker 1: treating houseless people as if they don't actually belong in
Speaker 1: our society. And she's like, no, we have a voice, man.
Speaker 1: I love that, Khalil. I love that you took the
Speaker 1: time to get to know a Ratha Speaks and to
Speaker 1: do this work. And you're right. Today's show, we are
Speaker 1: talking with Heidi Beferous. She's a doctor of internal medicine
Speaker 1: and she's the medical director of Housing for Health in
Speaker 1: Los Angeles County. Yes, and exactly what you said. Housing
Speaker 1: for Health tackles this problem in a way that's different.
Speaker 1: That's right. It looks at homelessness or houselessness as a
Speaker 1: healthcare matter as well as a housing one. And that's innovative.
Speaker 1: And what they do in La County is also massive.
Speaker 1: They house and care for nearly twenty thousand people. Yes,
Speaker 1: this is a big deal and a really innovative approach
Speaker 1: to a massive problem that spans coast to coast, from
Speaker 1: La skid Row to the streets of Harlem, USA. And
Speaker 1: I think maybe we'll find out that the solution is
Speaker 1: to get you to go from city to city across
Speaker 1: the country with a videographer and that nice suit that
Speaker 1: you were wearing in that picture, and you know, just
Speaker 1: talk to everybody and you can handle this. Let's get
Speaker 1: going with Heidi. All right, let's do it, doctor Heidi Beferus,
Speaker 1: Welcome to some of my best friends. Are Yes, We're
Speaker 1: so happy to have you, Thank you, thank you for
Speaker 1: inviting me. I'm so excited to join this conversation. Heidi.
Speaker 1: We want to know more about what you do and
Speaker 1: what Housing for Health does in Los Angeles County. So yeah, yeah,
Speaker 1: what is Housing for Health? Housing for Health is a
Speaker 1: program of Los Angeles County, the Department of Health Services,
Speaker 1: and it was started about ten years ago by Mitch
Speaker 1: Katz now at New York City Health and Hospital Corporation.
Speaker 1: It's a gorgeous vision, right, How do we, as social
Speaker 1: justice warriors in the realm of healthcare, address the obscenity
Speaker 1: that is houselessness in Los Angeles County and think about
Speaker 1: not only providing roofs over people's heads. But helping those
Speaker 1: people who've been historically traumatized and marginalized get re enfranchised
Speaker 1: and be able to pursue meaning and purpose in their
Speaker 1: lives and address all the issues that they haven't been
Speaker 1: able to address because of their dire life circumstances, which
Speaker 1: often started from childhood. Yeah, yeah, you said something just
Speaker 1: now that's really striking, and I know for some of
Speaker 1: our listeners it will be. It was striking to me
Speaker 1: the first time that my twenty year old daughter came
Speaker 1: in my home. Her name is Jordan, and she scolded
Speaker 1: my wife and I for using the word homeless. We
Speaker 1: were like, whoa, what the what? Like? What is happening here?
Speaker 1: Like what's wrong with that? Work? So so we now
Speaker 1: use houseless, But I don't really know why. And so
Speaker 1: maybe you help me and Ben and our listeners understand
Speaker 1: why houselessness is more appropriate. I think a couple of things.
Speaker 1: One one of the things that you find when you
Speaker 1: are accompanying people who are experiencing houselessness is that they
Speaker 1: create home wherever they are, whether that's on a riverbed
Speaker 1: or an encampment or an a shelter in their car.
Speaker 1: The concept of home, which is that sense of belonging
Speaker 1: community is not obviated by the lack of walls and
Speaker 1: roof And I think it also reminds us that when
Speaker 1: we commodify housing and we create circumstances in which housing
Speaker 1: is just not affordable or not available. Yes, that in
Speaker 1: just providing the housing, that's one important thing, but we
Speaker 1: also have to address the structural violence that God us
Speaker 1: there in the first place to really achieve the healing
Speaker 1: and the wellness that we want. And I think that's
Speaker 1: why we call it houselessness. So I think we want
Speaker 1: to remind ourselves of that really important human element. Right,
Speaker 1: So not having a house is not a moral judgment
Speaker 1: on the character of a person, that's right, whose home
Speaker 1: can actually be a sense of belonging in a community,
Speaker 1: even if you're on the street, as opposed to the
Speaker 1: fact that you don't actually have a brick and mortar place,
Speaker 1: which to most of us, at least in this conversation,
Speaker 1: is more an indictment of the society we live in
Speaker 1: than the individual. That's right. And unfortunately, a lot of
Speaker 1: today's rhetoric sort of criminalizes homelessness and people experiencing homelessness,
Speaker 1: and we need to realize is really a supply and
Speaker 1: demand issue as well as speaks to the structural violence
Speaker 1: and institutional racism that are allowing and well today. And
Speaker 1: maybe you could paint a picture for us of a
Speaker 1: specific case, a specific person that you met on the
Speaker 1: street and what you did and what happened next, just
Speaker 1: to give us a sense of what actually housing for
Speaker 1: health does. I always goes back to the story of James.
Speaker 1: It's not his actual name. James scold me about the
Speaker 1: story and how important it is to understand that people
Speaker 1: come to houselessness and what it takes to really restore
Speaker 1: their dignity, which at the end of the day is
Speaker 1: what we're trying to do. So James, I met him,
Speaker 1: actually was a thirty seven year old guy. I was
Speaker 1: in clinic at Martin Luther King Community Health Center in
Speaker 1: Compton and he was scheduled to see me, and I
Speaker 1: had read up on his chart before he came in,
Speaker 1: and in the chart was the usual vitriol about this
Speaker 1: black man. Okay, right, I'll tell you the words that
Speaker 1: are being used, right, so angry, defiant, conferenceational, aggressive, non compliant, difficult, challenging,
Speaker 1: And what you could tell from looking at the chart
Speaker 1: was that James was literally coming into the emergency room
Speaker 1: every nine to ten days. He would come in at
Speaker 1: night in congestive heart failure. He's a thirty seven year
Speaker 1: old black man. Why is a thirty seven year old
Speaker 1: black man having congestive heart failure? Then you could see
Speaker 1: the frustration in the notes about like, he's not adherent,
Speaker 1: he's not doing what we're telling him to do, and
Speaker 1: this sort of revolving door. And at no point did
Speaker 1: I sort of see any notation about what was going
Speaker 1: on with James, any sort of attempt at understanding what
Speaker 1: was happening with him. And one of the things that
Speaker 1: was disturbing to me, so you know, normally when your
Speaker 1: heart pumps khalil or ben. Every time your heart pumps,
Speaker 1: about seventy percent of the blood that's in one of
Speaker 1: your chambers is pushed out into your body to give
Speaker 1: it oxygen and trition, right, And James's fraction was ten
Speaker 1: ten percent, So he was only getting tablespoons of blood
Speaker 1: out with each squeeze, which means he was really sick.
Speaker 1: Right in his life expectancy is typically six to twelve months,
Speaker 1: and at one point in one of the hospitals because
Speaker 1: he was deemed sort of non compliant. He was put
Speaker 1: on hospice. Hey, you're dying, You clearly don't care about
Speaker 1: your health. So he's being ridden off as a thirty
Speaker 1: seven year old, you're basically saying. And the process is
Speaker 1: because he's not doing what we're telling him to do. Right.
Speaker 1: One of the things that we're supposed to do is
Speaker 1: put in an automatic defibrillator in their chest so that
Speaker 1: if that happens, you know, they automatically can get shocked
Speaker 1: out into a normal rhythm. But he was deemed too
Speaker 1: non compliant to be referred for the placement of the defibrillator,
Speaker 1: and instead they gave him a vest. Then in the
Speaker 1: pocket is a little defibrillator and he was told to
Speaker 1: wear that. And I was fascinated that he was coming
Speaker 1: to clinic because he hadn't been to see anybody in
Speaker 1: the outpatient clinic for years as far as I could tell.
Speaker 1: And I was waiting and I heard some screaming coming
Speaker 1: from the lobby and I went out, and of course
Speaker 1: I had been running late because I usually do, and
Speaker 1: he was quite upset about my being late. And got
Speaker 1: him into the clinic, and you started just taking a
Speaker 1: moment and just sitting with him for a little while,
Speaker 1: and he started crying and I said, James, what's going on?
Speaker 1: And he said, I just can't take it anymore. Said
Speaker 1: last night, my ten year old boy, I woke up
Speaker 1: at two in the morning and he was staring at me,
Speaker 1: and I said, why are you awake? And he said,
Speaker 1: I'm worried You're going to die. This ten year old
Speaker 1: said this to him. Yeah, and then the story came
Speaker 1: out and James grew up in the South side of Chicago, Wow,
Speaker 1: broken home, living on the streets as a ten year old.
Speaker 1: Remembers being dropped off at the emergency room by his
Speaker 1: friends because he had passed out. Didn't start into medical
Speaker 1: care at that time because life was really challenging for him.
Speaker 1: He was in and out of the juvenile justice system,
Speaker 1: got involved with his woman as he called her, started
Speaker 1: having kids, and then began this journey of sort of
Speaker 1: going from state to state, and he ended up now
Speaker 1: in LA. He was living in his pickup truck with
Speaker 1: his women and four kids, ten, seven, three and a
Speaker 1: ten month old. His pickup truck was actually parked in
Speaker 1: the community clinic parking lot at the time, and I
Speaker 1: asked him, you know, James, what makes it hard for
Speaker 1: you to stay in the hospital, because I'm really worried
Speaker 1: about you. You know, your heart is really sick and
Speaker 1: that's probably because of the years of high blood pressure
Speaker 1: weren't treated. And he said, look, my woman is slow.
Speaker 1: What did he mean by that? I think he meant
Speaker 1: that she had some developmental delay. Got it okay? And
Speaker 1: he said, the most important thing to me is that
Speaker 1: my kids get an education, because I didn't have that chance.
Speaker 1: And he said, I go in at night when my
Speaker 1: kids are asleep. I have to be back in the
Speaker 1: car at seven to make sure they get breakfast and
Speaker 1: I drive them to school. I can't afford to be
Speaker 1: admitted in the hospital and every nine to ten days,
Speaker 1: asked my tune up because that's what I can afford
Speaker 1: to do. Wow. And I said, James, what makes it
Speaker 1: hard for you to take your pills every day? And
Speaker 1: he said, where am I going to put those pills?
Speaker 1: I'm living in a car. And I said, you know,
Speaker 1: why aren't you wearing your vest and he said, well,
Speaker 1: I don't want my kids to get electrocuted if that
Speaker 1: thing goes off. We're sitting on coils with James. What
Speaker 1: we were able to do. And it was actually a
Speaker 1: beautiful story until we sort of lost contact. But we
Speaker 1: actually were able to get Department of Children and Family
Speaker 1: Services involved with his consent, which is important, and they
Speaker 1: were able to place him in an apartment, three bedroom apartment,
Speaker 1: and he was able to start taking his pills. We
Speaker 1: were able to get that defibrillator into him. Oh my goodness,
Speaker 1: that's incredible. He came off hospice. This is what we do. One.
Speaker 1: You have to listen first. Nobody was listening and understanding
Speaker 1: that his houselessness was a symptom of greater issues. But
Speaker 1: I think James is very illustrative in the sense that
Speaker 1: houselessness is just a piece of his story. Putting him
Speaker 1: in an apartment is just the beginning. And I think
Speaker 1: that's what Housing for Health is trying to do. Is, Yes,
Speaker 1: we need to give people access to roof and walls
Speaker 1: and those basic levels of protection, but then we also
Speaker 1: need to unpeel those layers of trauma and institutionalization, you know,
Speaker 1: social and fiscal disenfranchisement and figure out, like, how do
Speaker 1: we help this person get to where they want to go? Heidi,
Speaker 1: can we spell this out using James as a model
Speaker 1: to understand what you do. So, like you said, first
Speaker 1: you had to have a contact with him, he had
Speaker 1: to come in. Then you had to spend time listening
Speaker 1: to him. And then you use a kind of housing
Speaker 1: first model, which you know, as I've learned about, is
Speaker 1: before someone can be helped in any other way, they
Speaker 1: need they need a safe and you know, livable place
Speaker 1: to be. But then you're talking about also housing first.
Speaker 1: Then what comes second, third, fourth, fifth, And that seems
Speaker 1: to be like what you do is is if it's
Speaker 1: not radical, it's at least different. Can you unpack that
Speaker 1: a little bit more? It really does take a village.
Speaker 1: And so you know, what we're trying to build is, yes,
Speaker 1: there's medical staff, but there's also social workers. There's also
Speaker 1: peers what we call you know, what I call a
Speaker 1: company tours, people who company people who maybe have lived experience,
Speaker 1: who who share the journey with James. As trying to
Speaker 1: navigate the system right and get what he needs. We
Speaker 1: had to get the Department of Public Social Services involved
Speaker 1: to get him income because one of the things that
Speaker 1: we learned was James was selling his hospice meds to
Speaker 1: provide for his family, and we had to get the
Speaker 1: Department of Children and Family Services involved because they made
Speaker 1: sure those kids got to school, they got them wick,
Speaker 1: they got them closed, they got them housed, and they
Speaker 1: provided respite care for mom. We were able to get
Speaker 1: him connected to a program called Sea Beast to apply
Speaker 1: for Social Security disability payments again to augment the income.
Speaker 1: So all of that is what we call intensive care management, right,
Speaker 1: making sure that people are getting access to the resources
Speaker 1: they need to live as full of life as possible. Right.
Speaker 1: And you can't discount the fact that these people have
Speaker 1: incredible assets, right, And when you're thinking about a recovery model,
Speaker 1: how do you build on those assets to help them
Speaker 1: achieve wellness and purpose? And just to be clear, you're
Speaker 1: using assets in the sense of his moral character, his
Speaker 1: intellectual capacity and gifts, his thoughtfulness. You know, he's someone
Speaker 1: who is in control and making good decisions as with
Speaker 1: the limited resources he has. Absolutely, Heidi, I think this
Speaker 1: story of James is incredibly illustrative of how important what
Speaker 1: your organization and what your team does. And I'm curious
Speaker 1: given that this individualized, intensive engagement with individuals like James,
Speaker 1: and I'm sure their stories are as diverse and specific
Speaker 1: to their circumstances, as one could imagine, there's a huge
Speaker 1: population of homelessness. I mean, I'm out on the East
Speaker 1: coast bends in the Midwest. You're in LA. I mean,
Speaker 1: let's talk about how do you first of all, how
Speaker 1: should we understand the scale of this problem, and how
Speaker 1: you and your organization think about addressing the skill of
Speaker 1: that problem. Yeah, so you know New York in LA
Speaker 1: or I shouldn't say competing for because that would suggest
Speaker 1: that it's a good thing, but for the country's sort
Speaker 1: of worse houselessness problem. They're at last count close to
Speaker 1: seventy thousand houseless people in Los Angeles County. And how
Speaker 1: does that mean people living on the street, living in shelters? Like,
Speaker 1: what's the that's right? And the majority of people Unlike
Speaker 1: New York, where sort of the houseless individuals are somewhat
Speaker 1: hidden because it's a right to shelter state, you don't
Speaker 1: see them as much as you do in LA, the
Speaker 1: majority of people I eat, close to fifty thousand of
Speaker 1: the seventy thousand in LA County are unsheltered. Okay, so
Speaker 1: let's just talk a little bit about how you and
Speaker 1: your organization come to terms with what you're facing on
Speaker 1: the streets of Los Angeles. In terms of the scale
Speaker 1: of the operation that you oversee, I'm curious what you
Speaker 1: have right now, Like, I just want to see the operation,
Speaker 1: So tell us, like how many people, Like what what's
Speaker 1: the operation look like right now? In housing? We have
Speaker 1: about nineteen thousand individuals. Amazing, It's incredible. Yeah, Okay, we're
Speaker 1: also providing intensive case management services. Heidi. We're going to
Speaker 1: take a quick break, but I just want to say
Speaker 1: before the break that you know, you said James schooled you.
Speaker 1: You just schooled us that in a way. We asked
Speaker 1: you about about houselessness, and we wanted to hear about
Speaker 1: people on the street, and you talked about medical care,
Speaker 1: you talked about people's past. You schooled us on all
Speaker 1: that's behind it, you know, the thing we might see
Speaker 1: on the street. You're talking about the much deeper, deeper
Speaker 1: problems that you have to address. When we come back,
Speaker 1: we're going to talk to Heidi about her past and
Speaker 1: how she got into this work. So, Heidi, this is
Speaker 1: just an incredible conversation. And Ben and I are learning
Speaker 1: so much, right Ben, You're learning a lot, I am.
Speaker 1: I am. Yeah, Yeah, and listen We want to know
Speaker 1: more about you. We want to know how did you
Speaker 1: come to take on this incredibly challenging work. I was
Speaker 1: born in Iran. I lived there till after the Iranian Revolution,
Speaker 1: my family immigrated here. I think one of the things
Speaker 1: that was just a tremendous experience for me my father
Speaker 1: grew up very poor in a small dirt village near
Speaker 1: the Afhani border, and just visiting his old home and
Speaker 1: recognizing that despite what some would deem poverty, there was
Speaker 1: an incredible richness and community. And my understanding and appreciation
Speaker 1: for resilience and beauty in the face of material suffering,
Speaker 1: and recognizing that every person deserves the opportunity to create
Speaker 1: a community as they define it. And I think one
Speaker 1: of the things that has always struck me in this
Speaker 1: country is the incredible inequality. And I used to talk
Speaker 1: about this with my mentor, Paul Farmer, because I worked
Speaker 1: with partners in health from the time I was in
Speaker 1: medical school. That's huge. Okay, so let's let's just stop
Speaker 1: for a seconds. Oh yes, so we weren't talking about
Speaker 1: Paul Farmer, but our listeners won't all know, So give
Speaker 1: us a brief like boiler play, this is the guy
Speaker 1: who did X, Y and Z. All right, So, when
Speaker 1: I was in medical school in Boston, I was at
Speaker 1: Harvard Medical School. I was very interested in going back
Speaker 1: to ran and I wanted to spend a summer looking
Speaker 1: at sort of the circumstances and nomadic tribes in south
Speaker 1: central I run around Shiraz, where I grew up. And
Speaker 1: I was struggling with getting through the Ministry of Health
Speaker 1: that wanted to stick me in a chemistry lap instead.
Speaker 1: And I went to Paul Farmer because Paul was working
Speaker 1: in Haiti with a program called Partners in Health, and
Speaker 1: this is a program he helped to found in nineteen
Speaker 1: eighty seven. That's right to address HIV, the crisis of
Speaker 1: HIV happening in Haiti at the time. That's right. You
Speaker 1: know your stuff, Khalil, he does, Okay. Paul's big take
Speaker 1: was making a preferential healthcare option for the poor. I
Speaker 1: don't even want to just go there and give them
Speaker 1: band Aid care. I want to build an Ivory tower
Speaker 1: where they get as good a care, if not better
Speaker 1: care than what a Harvard Medical School teaching hospital provides.
Speaker 1: And that was Paul. I want to ask this another question,
Speaker 1: Paul Farmer related. I'm interested in this jump from this
Speaker 1: work that we imagine, like you know, doctors without borders.
Speaker 1: We can do stuff in other countries other like third
Speaker 1: world in quote countries, but we can't do things next door.
Speaker 1: Like so like this kind of philosophy where you put
Speaker 1: this in practice, I want to hear about that, like
Speaker 1: that it's right here at our doorstep and we can
Speaker 1: do the work here. That's right. One of the key differences,
Speaker 1: this is what I was getting to that I talked
Speaker 1: to Paul a lot about, is that it's different when
Speaker 1: you go into an area that has nothing and you
Speaker 1: build it, whereas you go into a place that should
Speaker 1: have everything but people can't access it or utilize it.
Speaker 1: It's a very different set of problems. That's really helpful. Distinction.
Speaker 1: In the United States, you're always near everything, is what
Speaker 1: you're saying, like right, but there are structural forces that
Speaker 1: prohibit everybody from accessing and utilizing those services. And in
Speaker 1: some ways, I think the psychology of being a poor
Speaker 1: black man in Roxbury is very different, not better or worse,
Speaker 1: but very different than being a psychology of a poor
Speaker 1: black man in that squater settlement in Haiti. And I
Speaker 1: think you have to understand that to know like, what
Speaker 1: is it that we have to help build within that
Speaker 1: one individual? But what do we have to do to
Speaker 1: sort of dismantle or confront the structural violence that's peating
Speaker 1: his utilization of resources? Not just healthcare, right, but when
Speaker 1: you think about employment discrimination, housing discrimination, mass incarceration, the
Speaker 1: exposure to violence and the lack of safety from violence
Speaker 1: even from the state, what does that do to someone?
Speaker 1: And I'll tell you. I was twenty years old. I
Speaker 1: was walking down the median of Columbus av in Eggleston Square,
Speaker 1: Khalil you know this, And I was walking with Eric,
Speaker 1: who was a teenager eighteen year old black kid, played
Speaker 1: football in high school, Beautiful Soul. And we were going
Speaker 1: down the street and we've just heard the car doors
Speaker 1: locking click click click click click, And Eric turned to
Speaker 1: me and he said, this is what I live with.
Speaker 1: What does that do to you? And realizing that the
Speaker 1: work that we were going to do in Roxbury and
Speaker 1: Worchester wasn't just about going to people and saying, hey,
Speaker 1: you should get healthcare insurance or you should go see
Speaker 1: a doctor for that, but it was like, why why
Speaker 1: are they not going? How are they treated? When they're there.
Speaker 1: And I think one of the things that we were
Speaker 1: able to bring from Haiti is this accompany term model
Speaker 1: is we needed to have like people alongside accompanying them,
Speaker 1: that act of witnessing. When you have someone by your
Speaker 1: side who's standing there, that person behind the front desk
Speaker 1: may be going to treat you a little better. Different
Speaker 1: right when you have someone in that office with you
Speaker 1: while the doctor's talking to you, maybe the doctor will
Speaker 1: listen a little better. A patient advocate, which has probably
Speaker 1: in the last twenty five year, has become a huge
Speaker 1: part of the movement for a patient bill of rights.
Speaker 1: And my mother, who's elderly. Ben's parents are elderly. You know,
Speaker 1: we're keenly aware that we sometimes have to be there
Speaker 1: for our parents when they're having conversations with doctors, because
Speaker 1: in the routinization of just like, hey, this is another
Speaker 1: old portion of my office and they're either going to
Speaker 1: follow my orders or not, you have to step up
Speaker 1: and say, hey, let's slow this down. Let's make sure
Speaker 1: that my mom understands exactly what you're saying. That's really
Speaker 1: fascinating to understand that model coming from Haiti here into
Speaker 1: the Boston area and Roxberry as a way of really
Speaker 1: addressing this crazy complex landscape of structural barriers and structural
Speaker 1: violence that you've talked about that people like Eric were experiencing. Yeah,
Speaker 1: And I think the other thing that we brought with
Speaker 1: us was accompaniment is for life. There's this concept in
Speaker 1: the United States, it's very cultural, which is, hey, you
Speaker 1: should be able to like pull yourself up by your bootstraps.
Speaker 1: We'll give you a leg up. Ah, there it is.
Speaker 1: We'll give you that little welfare check or we'll give
Speaker 1: you a general relief and then you know, you should
Speaker 1: be good. Yes. And a lot of times when I
Speaker 1: was submitting grant proposals for these accompany tours, I'd be like, well,
Speaker 1: how long how long do they have to be there?
Speaker 1: Is it like six months? And then you could dismount,
Speaker 1: taper off and when it things that you know, the
Speaker 1: accompanytors in Haiti taught us was they have AIDS or
Speaker 1: they're living in poverty, they don't have a thatch roof
Speaker 1: that doesn't leak over their heads. For life. So I'm
Speaker 1: here for life. And it's sort of that concept, which
Speaker 1: is sort of antithetical to our esthetic in the United States,
Speaker 1: that I really struggled with because everybody wanted to see
Speaker 1: what is a short term return on investment? Oh my goodness, yeah,
Speaker 1: return on investment. I mean what you do, Heidi is
Speaker 1: obviously very expensive and requires so much coordination between so
Speaker 1: many different groups, and yet there are all these savings.
Speaker 1: There is a return on investment you were talking about, James,
Speaker 1: he goes to the emergency room all the time. That's
Speaker 1: crazy expensive. They are these savings. In the end, you're saying,
Speaker 1: on the side of the status quo is wasting a
Speaker 1: ton of resources as it is as opposed to the
Speaker 1: upfront cost of a program like this, It's clear. But
Speaker 1: what happens Ben, which is really interest interesting, is when
Speaker 1: people stop feeling the pain in the short term, Right,
Speaker 1: James isn't going to the hospital in the emergency room,
Speaker 1: and we're like, okay, we're going to keep them out
Speaker 1: by keeping them housed, by keeping those services going. Then
Speaker 1: the healthcare system is like, why is it on me
Speaker 1: to house James? But I'm like, well, who else is
Speaker 1: it going to be on? Right? We keep pointing the fingers,
Speaker 1: and then meanwhile it gets dropped because it's no longer
Speaker 1: viewed as fiscally sustainable. Or as a healthcare problem. It's
Speaker 1: James's poverty problem. That's right. We want to take another break,
Speaker 1: and you touched on a raw nerve for both Ben
Speaker 1: and me, and that is this intersection of the politics
Speaker 1: of houselessness, this idea that people are responsible for themselves,
Speaker 1: that we live in a society where everyone has the
Speaker 1: opportunity to live their best lives, and if they don't,
Speaker 1: it's on them. And so there's only so much we
Speaker 1: can do to help you. And it seems to me
Speaker 1: that what Paul Farmer and Partners in Health have shown
Speaker 1: is that America's got it wrong. So after the break,
Speaker 1: let's come back and talk about how we think about
Speaker 1: this model scaling up and why it isn't happening elsewhere.
Speaker 1: We are back with Heidi Beferus of Los Angeles County,
Speaker 1: who runs Housing for Health there. And Heidi, you guys
Speaker 1: serve nearly twenty thousand people. You just told us that,
Speaker 1: which is an extraordinary number. And partly what you're telling
Speaker 1: us is that the model that you're describing housing first,
Speaker 1: but then all these other wraparound services and coordinating them,
Speaker 1: that it works. And that's powerful to hear. It's a
Speaker 1: better use of resources. So then then it begs the
Speaker 1: obvious question is like, why aren't more places doing it?
Speaker 1: Why aren't more cities and states and municipalities in the
Speaker 1: United States doing exactly what you're doing. I think they're trying.
Speaker 1: I think it fundamentally comes down to an issue of
Speaker 1: like money and politics, okay, and I think that I'm
Speaker 1: very fortunate to live in California in the sense that
Speaker 1: the public is committed to this. You know, we got
Speaker 1: Measure H, which is huge funding that has allowed us
Speaker 1: to build. Tell us what that is, because we're not Californians. Yeah. So,
Speaker 1: so Measure was passed a little bit over five years ago,
Speaker 1: and basically what it was is like the people in
Speaker 1: La County said, yeah, I'm worried about this, so I'm
Speaker 1: willing to pay a quarter cent tax to invest in
Speaker 1: our houselessness problem. And when you said this, I'm worried
Speaker 1: about this. Everyone is seeing people on the streets unavoidable.
Speaker 1: They're like, this is a crisis. We want this addressed
Speaker 1: in some way. A quarter cent tax and what's it
Speaker 1: going to do. It's one billion over like the ten years.
Speaker 1: It's a start, right, but it's not enough to build
Speaker 1: the housing and provide the services that we need given
Speaker 1: the scale of the problem. But also when you think
Speaker 1: about what has sort of prevented us from building housing,
Speaker 1: a lot of it comes back to like redlining, all
Speaker 1: of the issues around the zoning laws, the community sort
Speaker 1: of uproar about putting in housing. Those things get in
Speaker 1: the way of building housing quickly. Those are the politics
Speaker 1: that you're referring to. Those are the politics that we,
Speaker 1: you know, we have to overcome. I'm chomping at the
Speaker 1: bit to kind of put a little color on this,
Speaker 1: so I remember Mayor is it London Breed? Is that
Speaker 1: her name? In San Francisco, she opposed attacks on high
Speaker 1: revenue companies in the tech center after Salesforce CEO was
Speaker 1: proposing attacks on every company above a certain amount of
Speaker 1: revenue to say, look, you know, if we tax ourselves,
Speaker 1: we are incredibly wealthy people, we can help to solve
Speaker 1: this problem of houselessness in our city. And Mayor Breed,
Speaker 1: who's a black woman, was essentially saying, no, we shouldn't
Speaker 1: do this. And why was she saying it. She was
Speaker 1: saying it because she didn't want to create this scene
Speaker 1: of dependency where there'd be a sign at the border
Speaker 1: of San Francisco, saying you know, all poor people, welcome
Speaker 1: to San Francisco. We're going to take care of all
Speaker 1: your needs. And this like tension between a society that
Speaker 1: is built on inequality, there's no way around it. Capitalism
Speaker 1: built on inequality, there will be winners and by DeLine losers.
Speaker 1: Then has this mythology attached to it that those losers
Speaker 1: are to blame for losing in this race to the top.
Speaker 1: Some of us might be surprised to think of, like
Speaker 1: the pushback that comes when these solutions are proposed and
Speaker 1: people are willing to tax themselves to pay for them.
Speaker 1: It's outrageous, it is, it's nonsensical. You're absolutely right, Khalil,
Speaker 1: And I think like you know, when you think about
Speaker 1: how people talk about people experiencing houselessness, and I'm seeing
Speaker 1: it now where I live, where you're seeing more in
Speaker 1: more people houseless on the street. It's unbelievable. The rancor
Speaker 1: and they've never taken the time to listen or to
Speaker 1: really understand. There's a lack of imagination in addition to
Speaker 1: a lack of empathy. And how do we fight that
Speaker 1: when our society, like you said, is built on this
Speaker 1: concept of inequality and for those to have there have
Speaker 1: to be those who don't. Yeah, And I think that
Speaker 1: it's something that keeps me up at night is how
Speaker 1: do we have that conversation, how do we make this
Speaker 1: into a collective we problem as opposed to you need
Speaker 1: to fix this. They're having this conversation in New York
Speaker 1: right then? Yeah, I mean that Khalil and I are
Speaker 1: talking about that collective we all the time, I mean,
Speaker 1: and sort of thinking about our nation's problems. Maybe another
Speaker 1: way to think about this is like why don't more
Speaker 1: municipalities do this? Is to ask about what's going on
Speaker 1: in New York now? And so in December, the mayor there,
Speaker 1: Eric Adams, said it was a priority to clear the
Speaker 1: homeless from the streets and even to remove people and
Speaker 1: hospitalize them even if they don't want to go. What's
Speaker 1: wrong or right about that approach school us a little
Speaker 1: bit more? Well, I think the first thing I would
Speaker 1: say is confronting it. Even if the tool you're you're
Speaker 1: using isn't the right one, is good. So I have
Speaker 1: to give them props for that, right, as opposed to
Speaker 1: saying like, hey, we got this. The problem is that
Speaker 1: this isn't a hospital problem houselessness? Isn't it something that
Speaker 1: the going to the emergency room is going to fix? Yeah,
Speaker 1: here we are sending people who are houseless, traumatized, may
Speaker 1: have comorbid mental health substance use issues, and saying to
Speaker 1: the emergency room do something. Just we got to get
Speaker 1: them off the street. What is the emergency room staff
Speaker 1: supposed to do? Are they supposed to miraculously be able
Speaker 1: to find permanent housing or they just like stabilize them
Speaker 1: And what does that mean? And then put them into
Speaker 1: a shelter? And then what that shelter keeps them and
Speaker 1: they don't end up back on the street. Right, So
Speaker 1: it's sort of like it's not the right approach. It
Speaker 1: makes you feel like you're doing something, but you're really
Speaker 1: re traumatizing not only the people who are experiencing houselessness,
Speaker 1: but also like that emergency room staff. What does that
Speaker 1: feel like? Yeah? So I just want to get this straight.
Speaker 1: So is it just shuffling people to somewhere else that
Speaker 1: they're eventually going to shuffle back? Meaning if you say
Speaker 1: we're going to send it to the emergency room, but
Speaker 1: if there's no larger systemic solution and like an organization
Speaker 1: like yours that is thinking about how all these different
Speaker 1: pieces work together, and there's sort of these long term
Speaker 1: holistic solutions. It's just moving someone away for a little
Speaker 1: while until they go back. Yeah, And I think there
Speaker 1: are plenty of great organizations in New York that are
Speaker 1: doing similar work to housing for health. I think the
Speaker 1: issue there is the stock of housing again. Right, So
Speaker 1: if the fundamental solution to addressing homelessness or houselessness is
Speaker 1: having housing stock housing first, you do need that first step.
Speaker 1: You do second, third, fourth, fifth, but you need that
Speaker 1: first step. You need that first, and then you have
Speaker 1: the resources to provide those supportive services in that intensive
Speaker 1: care management, in that trauma informed way to keep people
Speaker 1: housed and support them towards achieving wellness. And that's what
Speaker 1: needs to sort of be invested in. Then I've been
Speaker 1: thinking about your question about New York, and obviously I'm
Speaker 1: in the media bubble of the city and so I
Speaker 1: hear these stories a lot. And one of the things
Speaker 1: I'm struck by, which connects with Heidi's sort of story
Speaker 1: about the notes in James's file, about his lack of appreciation,
Speaker 1: his aggression, his defiance, you know, James was being criminalized
Speaker 1: in a way. He was made to be undeserving of
Speaker 1: the attention that he was getting. That was not that
Speaker 1: was failing to meet his needs. And it strikes me
Speaker 1: that that Eric Adams is doing two things. He is
Speaker 1: calling for greater hospitalization and he is calling for some
Speaker 1: of the vacant office buildings downtown to be converted to
Speaker 1: either temporary or permanent housing four houseless people. I think
Speaker 1: that's a good thing because COVID has created vacancy rates
Speaker 1: in office buildings downtown, which means there's just a lot
Speaker 1: of empty space currently and the city is trying to
Speaker 1: figure out a way to use some of that space.
Speaker 1: And maybe to a surprise to a lot of people,
Speaker 1: New York has long used hotels. They've rented entire floors
Speaker 1: of hotels for the purposes of housing people. So I
Speaker 1: think Heidi's right about that there is a spirit of
Speaker 1: goodwill and there are effective ways in which people do
Speaker 1: get help, But there's a spirit of meanness right now
Speaker 1: that is being articulated in the Adam's plan, and that
Speaker 1: is it's attached to this concern about the mentally ill
Speaker 1: being on the street and the crime problem, and so
Speaker 1: I just keep thinking about Heidi, the way in which
Speaker 1: there's a broad culture of punitiveness directed towards houseless people,
Speaker 1: and they're essentially blamed for everything. They're blamed for disorder,
Speaker 1: they're blamed for uncleanliness. In this case, they're blamed for
Speaker 1: contributing to New York's rise in crime, which is not
Speaker 1: really evident other than in these high profile news stories
Speaker 1: where you know, someone pushes someone tragically onto the subway
Speaker 1: track and a person dies. I get that that's not
Speaker 1: anything to belittle, but to use those moments to then
Speaker 1: say we're gon we're gonna sweep the streets of the
Speaker 1: mentally ill who who are homeless, which is essentially collapsing
Speaker 1: those two categories into one, strikes me as another version
Speaker 1: of the story that you told about James Yep, that
Speaker 1: only a crazy person could refuse, you know, could refuse
Speaker 1: our services, when in fact we're not actually dealing with
Speaker 1: the broader circumstances. It brought this person to our attention
Speaker 1: in the first place, that's right, and very few people
Speaker 1: who are experiencing houselessness have that sort of high level
Speaker 1: psychotic illness, and so you sweep up a lot of
Speaker 1: people who's to say who is mentally ill right, and
Speaker 1: that the hospital system if you don't have an understanding
Speaker 1: of that person. Let's say we do determine that they
Speaker 1: have an acute psychosis that should be handled, Like where
Speaker 1: are we going to put them? Do we have enough
Speaker 1: psychiatric treatment facilities? Do we have interim housing that can
Speaker 1: support them after their discharge from the hospital. Do we
Speaker 1: have the supportive housing that they move into that can
Speaker 1: continue to support their thriving as someone who's living with
Speaker 1: mental illness. You have to build all those pieces. I
Speaker 1: think if you're going to say we're doing this as
Speaker 1: an act of beneficence, otherwise you're right. It is sort
Speaker 1: of like very punitive in the end, very traumatizing, because
Speaker 1: what happens is if you don't have those other pieces,
Speaker 1: people end back up right out on the street, and
Speaker 1: it just creates the circle of a violence. I mean,
Speaker 1: hearing all these echoes of things like the criminal justice
Speaker 1: system and the need just to show a response which
Speaker 1: isn't actually solving the larger systemic problems, and all the
Speaker 1: ways that we think about collective responsibility, and you know,
Speaker 1: the problem of houselessness is often also this idea of
Speaker 1: like making the city more livable. But when we say that,
Speaker 1: we mean for whom, and we mean for people who
Speaker 1: are not forced to sort of pass individuals who around
Speaker 1: the street and so on, Heidi, Just as a way
Speaker 1: to wrap up, what do you say to make people
Speaker 1: know that this is we need to all invest in
Speaker 1: this and sort of get behind this work. I think
Speaker 1: it's for me. It's really important that it's a message
Speaker 1: of hope and optimism. People feel these problems are intractable,
Speaker 1: and it's really important to say we can solve this,
Speaker 1: we know how to solve this, we just need to
Speaker 1: do it, and people get stuck with that in that
Speaker 1: paralysis of it's too big, it's too hard, And I'm like,
Speaker 1: let's just start with changing the tenor of our conversation,
Speaker 1: which is we can do this, we know how to
Speaker 1: do this. We just need to make that commitment. That's
Speaker 1: the most important thing to me. And it's so interesting.
Speaker 1: The other day I was with my daughter and she
Speaker 1: was with a friend and her parent and a person
Speaker 1: experiencing houselessness that I've learned to know in my neighborhood,
Speaker 1: who's this incredibly sweet, funny trans woman who has these
Speaker 1: like outrageous outfits, and my daughter was wearing these like
Speaker 1: platform rainbow converse shoes and Tatiana came up to her
Speaker 1: and was like, oh girl, I love your shoes. And
Speaker 1: you know, Layla was engaging with her, and I saw
Speaker 1: the other parents sort of recoil and she texted me
Speaker 1: and said, sorry, I had to leave, you know, I
Speaker 1: just didn't feel safe. Oh wow. And I texted her
Speaker 1: back and I said, Tatiana is such a lovely person.
Speaker 1: I wish you had gotten to hear her story. And
Speaker 1: she texted me back and she said, maybe next time
Speaker 1: I'll stop and listen. That for me is a win.
Speaker 1: How do we how do we amplify that? Wow, that
Speaker 1: is both inspiring and depressing because he said maybe, But
Speaker 1: you know, it's a start. We got to take that Khalil,
Speaker 1: Oh my goodness, we know how to solve this. That's
Speaker 1: that's the place to start, Like, that's the conversation. Yeah,
Speaker 1: like and then and then to show people how m Yeah. Well,
Speaker 1: we're very inspired by what you do. We are grateful
Speaker 1: for the time you took to be with us today,
Speaker 1: and we'll do our part to share the good news
Speaker 1: about the work that's going on in Los Angeles. And
Speaker 1: hopefully it can spread across the nation. Thank you so much,
Speaker 1: and we'll continue in La Luja. Thank you, Hidie, thank
Speaker 1: you Okay, thank you Hidie. Take care. Wow, Khalil, I'm
Speaker 1: thinking about the story you told me at the beginning
Speaker 1: about a Ratha speaks outside the shan Burg Center and
Speaker 1: horror them, and about the story that Heidi told us
Speaker 1: at the end of the conversation about her interactions with Tatiana,
Speaker 1: the trans woman in her neighborhood. That's right, And both
Speaker 1: of those stories they seem so connected about taking this
Speaker 1: leap of getting to know somebody, of humanizing somebody who
Speaker 1: is houseless as we've learned to call it, that's right,
Speaker 1: and then allowing them to tell their deeper story that
Speaker 1: if we're going to think about any solutions, it has
Speaker 1: to involve those people and their histories. That's right. It
Speaker 1: can't just be something on the surface. Yeah, those feel
Speaker 1: so connected, of like as book ends to this conversation.
Speaker 1: Now they totally are. And I love you bringing up
Speaker 1: Tatiana in the experience that Heidi shared with us, because
Speaker 1: partly what she was saying is that we have to
Speaker 1: connect with our own humanity by seeing the people who
Speaker 1: are struggling in our mits, not because they have failed themselves,
Speaker 1: but because we have failed them. That is the story
Speaker 1: that Heidi shared with us about the people she works with,
Speaker 1: the work that she's doing. And I gotta say, like,
Speaker 1: that's a lesson that a taught me. But I also
Speaker 1: have to say it's really hard because at the end
Speaker 1: of the day, in the case of Arafa, I mean,
Speaker 1: I consider her a friend to this day. But it
Speaker 1: didn't end well. Oh you mean it didn't Andy, even
Speaker 1: in that moment outside the Schaumburg. No, it didn't end
Speaker 1: well because while she did leave, she came back and
Speaker 1: she set up again, like several weeks later, and I
Speaker 1: said to her, I was like, a Rafa, this isn't
Speaker 1: the deal, and she's like, but I got nowhere else
Speaker 1: to go. Yeah, And so I just want to acknowledge,
Speaker 1: like we have to solve this problem in the deeply
Speaker 1: systemic way in which we created the problem. And as
Speaker 1: much as we want folks to lead with their own
Speaker 1: voices and they should be at the table to do it,
Speaker 1: it's not going to be solved one Tatiana and one
Speaker 1: a rough at a time. Yeah, because your deal meant
Speaker 1: nothing about where she was going to sleep that night
Speaker 1: or those problems. That's correct, yeah, man, well love you,
Speaker 1: love you too, man. Some of My Best Friends Are
Speaker 1: is a production of Pushkin Industries. The show is written
Speaker 1: and hosted by me Khalil, Gibron Muhammad and my best
Speaker 1: friend sometimes Ben Austin. It's produced by Jonasanti and Lucy Sullivan.
Speaker 1: Our editor is Sarah Knicks, our engineer is Amanda Kawang,
Speaker 1: and our managing producer is Cottonstanza Gallardo. At Pushkin thanks
Speaker 1: to Lee Tall, Mulad, Julia Barton, Heather Faine, Carly Migliori,
Speaker 1: John Schnars, Greta Khne, and Jacob Weisberg. Our theme song,
Speaker 1: Lil Lily is by fellow chicagoan the brilliant Avery R. Young.
Speaker 1: It is from his album Tubman Okay. You definitely want
Speaker 1: to check out more of his music at his website
Speaker 1: Avery R. Young dot com. You can find Pushkin on
Speaker 1: all social platforms at pushkin Pods, and you can sign
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Speaker 1: review it, and please tell all of your best friends
Speaker 1: about it. Thank you so much,