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Clean Start
Joanne Goldblum saw poor people reusing disposable diapers and had to do something. Her nonprofit, The Diaper Bank, now gives 150,000 diapers a month to people in need.
Printed in Miller-McCune Magazine, September 2008
View article on Miller-McCune web site
Shakespeare: Engaging portraits, enduring works of art
Printed in Arts! magazine, July/August 2006
View PDF (400K)
Miss Jackie
Printed in Liguorian magazine, April 2004
Miss Jackie was the tallest woman I ever saw, and she looked taller still because of the nest of matted hair on her head and the three or four wool caps she wore. Most of the homeless, at least the ones who’ve been on the streets for a long time, carry a world of old clothes and plastic bags on their persons. But Jackie was extraordinary. Layer on layer — almost all men’s old clothes because of her size. Snow boots in July. She carried 20 pounds of wardrobe on her body and pushed a shopping cart jammed with everything she could beg or steal. She never seemed to stoop under all that weight, but carried it with grace.
She was the most memorable of the folks we served at the soup kitchen, a place of suffering and joy. The cinderblocks were painted baby blue and bounced the noise around like heavy artillery. The rows of tables stretched back to the piano and the statue of the Sacred Heart. Jesus was missing a few toes. The ceilings were low and the room was dark, like most basements.
The huge wooden door at the back opened to a winding stair up to the hallway that took you to the church and the rectory. The glass doors to the sanctuary were usually locked. I used to stand there sometimes just to see the light by the tabernacle.
We had a rule at the soup kitchen: no guests inside until 11:30 a.m. There was so much work to do preparing for the noon meal. But we always let in Jackie because she had nowhere else. She wouldn’t sleep in a shelter. “They’ll cut you while you sleep. Love. Don’t you never go there.” And she was afraid to sleep on the street. “There’s crazy people set you on fire.” So she snuck in every morning with the day-old bread, stretched out on a pew and slept. There were a few old pews lining the sides of the room. People too tired to stand and wait for their tray rested there. The pew by the coffee urns was Jackie’s. She’d pretend to hide, and we’d pretend not to see her.
Jackie was formidable, which enhanced her reputation for violence. There were all sorts of stories about Miss Jackie. That she caught her husband in bed with her sister, cut them both, walked away from the house with nothing but a bloody knife and never looked back. That when some toughs tried to knock over her shopping cart, she broke one of the boy’s necks with her bare hands. I suspect that Miss Jackie invented these stories to keep people from messing with her. Because to look at her, she was just a crazy old lady with no walls to protect her.
Miss Jackie was dirty. Other homeless people did not want to touch Miss Jackie. She had chronic diarrhea. “The health van’s right outside, Sweetie,” I’d say. “C’mon and lets see if the doc can give you something.” She’d smile, promise to walk out with me, then disappear. Jackie didn’t like doctors, or cops, or social workers, but by the grace of God, she liked me.
I always set down a doughnut and a glass of juice next to her for when she woke up. Juice was a scarce commodity. We usually cut it with sugar water. But I was concerned about the diarrhea and wanted Jackie to have the real thing.
Homeless people sleep like new mothers, still aware of everything around them. So Jackie half knew that I was the one who made her breakfast appear like magic every morning, and she came to love me for it. She told people that I was not a regular person, but an angel who came to her in dreams and covered her with quilts that smelled like her momma and made her good whiskey and tea like they used to have by the stove. She called me “The White Lady From God.”
I was deeply shamed by this nickname. You see, I left Jackie’s food beside her in part so that I wouldn’t have to risk touching her, as I might have if I’d actually served her when she was awake. She was so dirty. I knew that Christ was in the poor, but confess I’d never actually seen him there. If I had, I wouldn’t have much cared how dirty they were.
Jackie began to follow me around, offering to reach cans from high shelves. Chasing away all the men who wanted to flirt with the white girl. “You get away, you trash. God gonna strike you dead if I don’t first.” Her smell was with me every second of the day now, but I came to recognize what gentility she had. She was always stealing our latex gloves because “gloves shows you a lady.” And she insisted on thanking “the chef” after every meal. I started calling her “First Lady.” She loved that.
Jackie did “her laundry” in the ladies room. She’d wash her dirty underwear in our sinks, which did the underwear very little good and did the sinks a whole lot of bad. The director asked me to talk to her. (I’d become everybody’s ambassador to Miss Jackie.) I did, and of course Miss Jackie swore she’d find another place to do the laundry. But we both knew she wouldn’t; we were Jackie’s only place.
That’s why my heart sank when my boss said he was going to ban Jackie from the kitchen. Her diarrhea was getting worse and worse. She was doing a real job on the ladies room, and he was afraid she’d pass something along to the other guests. I didn’t sleep that night, but close to morning I came up with an idea. I volunteered to go in with a bottle of bleach and clean up immediately every time she used the bathroom. And so Miss Jackie was allowed to stay.
Around this time, I got pregnant. The soup kitchen tended to bring on morning sickness. It was the odor, the combination of odors. The place always smelted of strong, strong chicken stock, urine and Kool-Aid. I ran up to the rectory bathroom once or twice a day because I generally tried to avoid the soup kitchen bathroom. But cleaning up after Miss Jackie didn’t bother me, though I’d expected it to. It was just feces. One, unadulterated smell. And I knew I was keeping her off the street. I felt I’d failed a lot at the kitchen. Cathy was still living with that guy who beat her and gambled away her check every month. Malcolm was still getting thinner and sadder. Ronnie still got full of pills and booze and pushed everybody’s buttons, a habit that would get him shot eventually. But for Jackie, at least I’d preserved a safe place to sleep. It was something.
My mother has a tremendous brand loyalty, so she saves packaging for me to use as a model when I go to the store for her. “See. It’s the Lady Gillette, with two refill cartridges. In the blue wrapper.” Jackie was the same, only she pulled her packages out of garbage cans. “My angel, can you get old Jackie some of these little round Band-Aids?” It was usually first aid supplies, especially hydrogen peroxide. The most unsanitary person you ever met, and she went through bottles and bottles of hydrogen peroxide.
One week, I kept having trouble getting to the store. Every day, poor Jackie was so disappointed that I didn’t have any hydrogen peroxide for her. Finally, I bought her five bottles of it to atone.
Jackie looked at her hydrogen peroxide and then she looked at me. She spread her tremendous arms wide as the earth and her face lit up with joy beyond measure. It was getting on toward lunchtime, a time of chaotic orders and clanging dishes that seemed to always pass in a blur. But nothing moved for me. There was no sound for me. There was no sight for me but Jackie. We had left the world and were in a place where the air was light and sweet.
How can I describe it? Nothing had changed; everything had changed. I finally saw what faith had always told me was hidden beneath the grime and insanity. I did not see Christ the way da Vinci painted him, golden and wan with holiness. Jackie in all her particulars was still Jackie. But she was divine. She was — in her cast off sweatsuits and oily trench coats — radiant, beautiful.
I rushed to her, and we held each other. Her long, strong arms enveloped me, but I could not encompass her. It did not matter. I was as joined to her as to the child inside me. She rested her head on top of mine, and it was warm.
For city residents with limited access to medical services,
Yale’s
mobile clinic fills a critical void
Printed in Yale Medicine magazine, spring 2004 issue
The Community Health Care Van parks in front of an apartment house with
plywood nailed over the windows. Orange spray paint on the Congress Avenue
tenement demands, “Whose Livable City Is This?” — a reference
to New Haven’s anti-blight initiative. It is cold and rainy, the
kind of weather that discourages patients from venturing out to the mobile
clinic. But enough people show up to make for tight quarters.
Joel stoops to walk inside.
“It’s a good day because we’re alive to see it,” the lanky man says with a grin as he brushes raindrops from his jacket.
This is an optimistic time in Joel’s life; with the assistance of the van staff, he has just signed up for substance abuse treatment. But first he needs a physical and a tuberculosis test, and the van takes walk-ins. Waiting weeks or even days for an appointment at a clinic would be difficult and risky for a man who says he is “just trying to find the strength one day at a time.”
Entering its 10th year of service to New Haven, the van has always emphasized free, immediate and dignified care, says Frederick L. Altice, M.D., HS ’89, associate professor of medicine (AIDS Program) and director of the Community Health Care Van initiative. Altice got the idea for a mobile clinic a decade ago while working with New Haven’s needle exchange program. He saw people come in with abscesses that went untreated until they were acute enough to land the client in the emergency room.
With a small van borrowed from Yale-New Haven Hospital’s Primary Care Center, Altice began following the needle exchange van once a week. Along with a social worker and HIV counselor, Altice provided primary care, mostly to injecting drug users. Today, a newer, 36-foot van serves patients 11 hours a day, five days a week throughout the city. The rotating staff includes senior physicians, residents, HIV specialists, a nurse practitioner, a physician associate, an HIV counselor, a drug treatment coordinator, a case manager, outreach workers and a number of volunteers. Usually four staff members ride on most trips. Many others are immediately available by cellular telephone.
The van’s impact on the community is well-documented: a 41 percent reduction in emergency department visits for clients who are injecting drug users, a 66 percent success rate in getting drug users to complete all three shots in the hepatitis B series, and promising results using buprenorphine to reduce heroin cravings. For clients who do not qualify for entitlements, the van may be their only treatment option. Where possible, the aim is to move the patient toward a community health center or some other fixed source of primary care. In 41 percent of the cases, that transition is successfully made. The van has done promising work on TB screening with undocumented residents, says Altice, which he expects to publish soon. Similar work is going on with the homeless.
About half of the 500 to 600 patients who visit the van each month arrive with issues unrelated to drugs. On the same morning that Joel needs a physical to get into treatment, a teenage girl with seashells braided into her hair, powder-blue tennis shoes and a handbag that says “Princess” takes a seat in the van. “I’m here for two reasons,” she announces with studied nonchalance, “a pregnancy test and an HIV test.”
Within minutes, she has seen a mental health counselor, a physician and an HIV counselor. She is relieved to get test results quickly and without a lecture. As she leaves with condoms she smiles and says, “I’ll be seeing you.”
“Everybody I meet on the van is always nice,” says Michael, 28, who takes his daily HIV medications here. “This gets my morning going.”
Much of the ongoing care the van provides also is the basis for research that might help patients far beyond New Haven. Some clients take their HIV medications in the van as part of an effort to increase adherence. Data collected so far show that the directly observed medication program works, according to Robert Douglas Bruce, M.D., clinical instructor of medicine. Some patients, he says, have seen their viral loads fall and their T cells rise substantially. The research project is funded by the National Institute on Drug Abuse.
Research funding has largely sustained the van, says Altice. The mobile clinic is an ideal setting for many other investigations. For example, he is eager to monitor HIV therapy for inmates released from prison. HIV tends to be well-managed in prison, but viral loads often rise after release.
Aside from research grants, fund-raising efforts have been difficult, Altice says, in part because the clientele arouses little public sympathy. It is precisely that lack of sympathy that the van staff is determined to combat. For example, many patients say they have been treated terribly by other health care providers, which makes them reluctant to seek treatment. Charly began coming to the van for primary care after her release from prison. Though she found work immediately after returning to New Haven, her job provides no health benefits. Charly says that on the van she gets a measure of respect she rarely finds elsewhere: “You don’t have to be afraid to tell them about nothing,” she says. Perhaps that’s the secret of the van’s success.
Public relations
Diabetes Doesn’t Need to Disable African Americans,
Yale School of Nursing Researcher Finds
Yale University News Release 9.24.1998
New Haven, Conn. — Gail D’Eramo Melkus is fighting
a vicious and subtle epidemic.
Melkus, an associate professor at the Yale School of Nursing, studies diabetes in African-American women along with co-investigator Geralyn Spollett, assistant professor. Their work is funded by the Donaghue Foundation.
Both black men and women are more prone than whites to Type 2 diabetes, also called “adult onset diabetes.” An estimated 9,000–12,000 African-Americans in New Haven alone have the disease. The problem is truly epidemic among African-American women, with one in four over the age of 55 affected. Blacks also suffer more serious consequences than whites do: blindness, renal failure and amputations are much more common as a result of diabetes in African-Americans than in whites.
Although diabetes can be managed through lifestyle changes, sometimes coupled with medication, the disease does not have striking symptoms in its earliest phases when it is most easily controlled. By offering diabetic black women strategies for healthier eating and information about their disease, Melkus is working to attack diabetes before its more serious effects take hold.
“They are very motivated to improve their health,” Melkus says of the women in her current study. “They know they are needed by others, because they are caregivers and gatekeepers.”
Despite that motivation, Melkus realizes that many people of color are reluctant to participate in health studies. They are scared off by a history of exploitation, most notoriously epitomized by the Tuskegee syphilis study, and are put off by a primarily white healthcare system that is rife with barriers both cultural and economic.
“This program would never have worked without the support of the New Haven black community,” said Melkus. She and Delorise Simmons, recruitment coordinator for the study, established an advisory board of African-American community and church leaders who do everything from helping her recruit study participants after Sunday services to previewing educational videos for cultural appropriateness.
Women in Melkus’s study meet in small groups facilitated by
a nurse practitioner and student assistants to talk about diabetes,
healthy eating and exercise habits, and the warning signs of its
more serious consequences. Once a month, they are examined by a
diabetes nurse practitioner, with the understanding that they will
also continue to see their own primary care providers on a regular
basis. The School of Nursing study also provides them with a glucose
monitoring meter and testing strips donated by Boerrhinger Mannheim
so that they can get an immediate reading of their blood sugar levels,
something Melkus has found is helpful in getting the women to make
healthy food choices.
Obesity and diabetes are closely related in adults, so diet is a
major concern. “Every provider tells them to lose weight,”
says Melkus. “Nobody was telling them how to do it.”
Education sessions tend to focus on eating a healthy diet rather than on losing weight. Topics include reading labels of prepared foods, culturally appropriate recipes and strategies for working an exercise routine into an already full day. Melkus notes that the women in her study all work and many care for children and grandchildren as well, all with limited resources. Through these small group sessions, the researchers and the women with diabetes work together to arrive at a sensible balance between health needs and the demands of job and family.
“It’s a partnership,” says Melkus. It’s a partnership that pays off, she notes. With an approximate 15 pound weight loss, blood pressure, blood sugar and cholesterol all improve significantly.
Access to health care has historically been a big issue for many of the women in the study. Even some with private insurance do not see their providers as often as they need to because they cannot afford the co-payment or deductible, says Melkus. She has tried to remove as many barriers as possible for the women in the study, scheduling evening and weekend sessions, providing bus fare or parking fees and babysitting. Melkus has also made herself available by telephone around the clock. “I never wore a beeper until this study,” she said.
Even when African-American women do have good access to care, their diabetes may go unaddressed. In a previous study, Melkus found that middle-class black women who saw their providers regularly had appropriate cancer screenings 95 percent of the time, but only half were properly screened for diabetes complications. Gender, race and weight discrimination all play into the lack of attention to diabetes risk, according to Melkus.
Melkus’s pilot study is drawing to an end. She hopes to recruit more area black women for a much larger project, in which some of the participants in the current program will act as facilitators. The cost of this intervention is steep up front, says Melkus, but she hopes to convince policy makers that it is worth the investment.
“If you can educate people in self-management skills, you can minimize the incidence of complications,” she says. “When people end up on dialysis, become blind or require amputations, that’s tremendously costly to the community. Women who were caregivers and heads of households require hours and days of care every week from their families. We know we can prevent that.”
African-American women interested in participating in Melkus’s diabetes program may call her at [phone number omitted].