Homeless in Hawai’i

Alyssa Helsing ‘07
Care-a-Van, Waikiki, Hawai’i

Homeless in Hawai’i

The beginning
My trip to Honolulu had one stop in Phoenix. My first flight was delayed, so when I arrived in Phoenix I was informed that I would be spending the night. I was at the hotel about to go to bed when I decided to go in the hot tub for a few minutes. There was only one other person in the hot tub, and it turns out he also had a delayed flight. When I asked where he was headed, he explained that he ran a company that went to various cities and countries around the world in order to help the homeless by giving them information and supplies, and he was returning home from one of these trips. I said that his organization sounded a lot like what I would be doing in Hawai’i, reaching out to the homeless with a program called Care-A-Van. “You won’t be the same when you get back,” he said, “You’ll be an activist and a fighter.”
1640 S. King St. is where the homeless outreach portion of the Waikiki Health Center was located. When I walked in there was a large desk separating the clients from the workers and only a small space behind the desk for the workers to move around. After the grand tour, my supervisor, Darlene, told me that I would be working in the office for the first couple of weeks, and then I would be able to go out on outreach in the van. At the office the first thing they taught me to do was to check mail. The clients would come in and we would give them their mail and the messages that we had taken for them. Providing mailboxes and a messaging service for the homeless clients was helpful and important because they could apply for help from the government, apply for insurance and for jobs. We also gave out bus passes to go to appointments, snacks, drinks, hygiene supplies, clothes, a low cost housing list, hot meals and food pantry lists, and a phone for them to use. They could also come in and see a nurse practitioner, so one of my other jobs was to check insurance and make billing slips. All of these services were free, even if the client did not have insurance.
During my time at Care-A-Van I was privileged to work with a very diverse and loving group of people. One of the things that attracts me to this type of work is that I respect people because they are people, not because of their success, or money, or any other reason. Everyone at Care-A-Van shared this quality. This gave our clients a very safe place to come, and for some of them it was the only place they had left to go. However, some of our clients were unable to come into the office, either because of a physical, mental or location problem, so we would take the vans and go to different locations all over the island. After my first two weeks of working in the office, I was allowed to go on outreach. There are specific locations that the vans go on different days of the week. Every van goes out with an outreach worker and a nurse practitioner. The vans get stocked up with hygiene supplies, clothes, food bags, toys for the kids, and the nurse’s medical supplies.
On my first day on outreach we drove from Honolulu, which is on the southern coast, up to the north shore which consists of smaller cities. The first thing I noticed was that the beaches on the north shore were full of families, unlike the clients that I’d met in the office who were predominantly single males. At the first beach we visited there were two big Hawaiian families living in tents and old cars. They called themselves Hawaiian Sovereignty, with the rights to live on their land. The matriarch of one of the families was very friendly and happy to see us. She hugged me for getting her clothes. Everyone from then on was happy to see us. Hawaiians, Samoans, Filipinos, Micronesians, Japanese and Caucasians alike did not treat me differently. They merely saw me as a kind person trying to help and my ethnicity seemed to make no difference.

Lessons out of the classroom

When I met with my mentor, Ty Tengan, we talked about Hawaiian natives, their history and how it pertained to what I was seeing on my homeless outreach. Dr. Tengan is an Ethnic Studies Professor at the University of Hawai’i, and he explained that although there is a push to give self-governance and self-determination to native Hawaiians, the most recent legislation to do this, the Akaka Bill, did not pass in the Senate. When I asked why there wasn’t a system already set up that would give native Hawaiians pieces of land, he said that people who had been waiting for land since the 1940’s were in some cases just now receiving it. During this first meeting with Ty I loved hearing all of the information that he had about Hawai’i, but when he asked me questions about the internship and how it related to my future, I didn’t have very good answers for him. However, when we met for the second time at the end of my internship it was a different story. I had so many stories to tell him and I knew that I had found the right direction and population of clients.
I saw a little of everything during my time at Care-A-Van, and I learned infinitely more just talking to my coworkers. I’ve never been around such a diverse and loving group of people. Ages ranged from early 20’s to late 70’s. One of the people I learned the most from is Debbie, who had only been with Care-A-Van for a few months when I arrived. She was a psychologist, a nurse, and a social worker, but at Care-A-Van she worked as a psychologist, talking to the clients and helping them with their problems. Her position as a mental health care worker for the homeless population was a new concept, not just for Care-A-Van, but for all programs working with the homeless. She even created her own forms to use in assessing the patients and was always making changes and showing me her progress. Before moving to Hawaii she had a private practice, had worked as a child psychologist at a school, taught at a college, and worked at a hospital as a nurse. In her words “something keeps pulling me back to this population.”
On a few occasions, when the clients gave their permission, Debbie let me sit in with her while she talked with them. Watching and listening to her talk to the clients was so much different than reading about a certain mental illness in a book, what symptoms it entails, and what is often used as therapy. A lot of times she would have to explain to me afterwards what the client had been diagnosed with, what method she was using to help the individual and how the client was progressing. One day, Debbie came back from a meeting and told me that she had been asked to determine what percentage of the clients that are seen by the nurse have a mental illness. She said that she did not have a number to tell them and asked if I would help her go through the charts to count how many of the patients had been diagnosed with an Axis I mental illness. I spent about a month working on this project when it was not busy in the office. It was astounding to see how many of the patients had both a severe mental illness and drug addiction. In the end we found that 70% of the Care-A-Van clients who had seen the nurse had an Axis I mental illness.
Sadly, Debbie was not able to stay in Hawaii for various problems, mostly having to do with money. The workers at Care-A-Van were being paid by a grant, so the wages were very low. The cost of living has dramatically, increased especially in the past year, which was not just affecting the homeless population; it was also affecting the people trying to help, the people like Debbie. Even though it was not a livable wage and the clients were the hardest to work with, she tried her hardest to stay and help.
Toward the middle of my internship, I learned how to do intakes, and it ended up being one of the best parts of both working in the office and going out in the van. Intakes involved getting down all the information and history on a new client, but it was really a chance to “talk story”. Every person that I talked to had an amazing story of where they’ve been in their life and how they ended up on the street. One of biggest lessons that I learned was that it can happen to anyone. I met an engineer who caught Hepatitis C and was unable to work for 3 years because of the treatments he was on. A twenty year old developmentally disabled young man who did not know his parents and had just lost the grandparents that had raised him. The biggest resistance I encountered from people I talked to about my job was the argument “if I can make a living and get on my feet, so can they”. It is impossible to know where a person has been and what they have gone through so there is no way of comparing one life to another.
It was also in the middle of my time in Hawaii that I began our shared reading Let Your Life Speak: Listening for the Voice of Vocation by Parker J. Palmer. It helped me to look at an issue that had been a tension point since I had come to Dartmouth. When I arrived at school I planned on being an engineering major because I was good at math and it was an impressive goal. After I spent a year not enjoying my classes I found something that sparked my interest. Psychology made sense because I had always been good with people and how they worked was my real passion.
However, I never really felt like it was as intellectually respectable as what some of my friends were doing. Some were going on to be doctors, other getting well-paying corporate jobs, and others doing research with their professors. I had tried to understand, up until this summer, why I had chosen to do community service rather than find a job working for a professor or something that would make me more financially successful. “Vocation does not mean a goal that I pursue. It means a calling that I hear. Before I can tell my life what I want to do with it, I must listen to my life telling me who I am” (Palmer, p. 4). I was passionate about the work I was doing at Care-A-Van, and when I read this passage I was able to let go of the idea that what I felt in my heart didn’t measure up as intellectual pursuit. One of my gifts is empathy. Helping these homeless and suffering individuals is not something that everyone is good at; it is something I feel I am good at. If the purpose of the journey is to know yourself, after this experience I know that I am doing the right thing.
While I was reading “Let Your Life Speak”, the portion where Parker Palmer is discussing his battle with clinical depression also resonated. Palmer explained that when visitors began with “I know exactly how you feel,” he did not listen for the rest of what they were saying because, as he put it, “no one can experience another person’s mystery” (Palmer, p. 62). A few days before reading this passage, I had used this phrase while doing an intake. The client scolded me saying that I had no idea how he felt. I was shocked. I felt horrible because my heart was going out to this man, and I only meant it as a sympathetic phrase. Palmer’s passage helped me to understand a little more about why this had angered the man at Care-A-Van. Palmer knew that his friends were trying to be empathetic, but this phrase made him feel more isolated because it was a false connection. Those who did help him during his struggle simply stood by him in a simple and healing way. I stopped feeling guilty for the interaction with the man at work and used this information to try and improve how I communicated with the suffering individuals that I met.

Worth fighting for

One of the most influential conversations I had was with one of the nurse practitioners, Valerie. Just by looking at Valerie I could tell that she would not be one of the warm fuzzy inviting types. However, it quickly became evident that she is an efficient nurse who does not mess around and has a big heart. She told me about how the mental health care system was so bad in Hawaii that the federal government had sued the Hawaii State Hospital. Starting in 1989, the Department of Justice began investigating the State Hospital and found substandard patient care, excessive medication, inadequate staffing levels, and a leaky and deteriorating physical plant. Some of these mentally ill patients were found without toiletries such as soap, toothbrushes or towels and some patients were even seen lying unattended on concrete floors. It was even reported that one patient was seen eating paint chips and another was lying in his own urine. In March 1991 the United States filed a civil lawsuit against the Hawai’i State Hospital. Progress was slow over the next few years so District Judge David Ezra had to implement additional improvements and orders spelling out about what needed to be done. In 2001, Judge Ezra appointed Magistrate Judge Kevin Chang to be the Special Master, to assess progress and devise methods to make the necessary changes. Judge Chang filed reports with the U.S. District Court and came up with a Plan for Community Mental Health Services which included community-based and hospital-based services that would meet the clinical and social needs of persons with severe mental illness. In December of 2004, Judge Ezra dismissed the civil rights case against Hawai’i and granted an extension for compliance by the Adult Mental Health Division of Hawai’i for its community plan (SMS, 2003).
Although the State Hospital may be out of legal trouble, I can say from personal experience that they are doing a less than adequate job. The hospital is the only one of its kind on the island, so it is already full. As a result, the only people who can be hospitalized are either homicidal or suicidal. One of the best examples of this is a client of Care-A-Van’s that I will call John. I met John on one of my first days at work. He was outside at a bus stop yelling at himself while pacing with no shoes on. When he came into the office he was always hyper talkative and hard to calm down. He would say he was leaving for the day and return a few minutes later because he had such a poor concept of time. My boss informed me that had a diagnosis of schizophrenia and that we always gave him extra food when he came in because the only places he got food was from us and from the garbage. On one occasion John got violent and we were forced to call the police. They took him to Queen’s Hospital on some sort of mental illness charge. At the hospital they gave him medication, and because that calmed him down they let him go. They said he promised to make it to his 8:00 AM appointment so they didn’t feel the need to keep him overnight. He refused hospitalization or other treatment so they did not make him. I’m sure if he tried to kill someone he could get some help.
Just because some of the services available to the mentally are not adequate does not mean that we are helpless. One client, that I will call Mark, was very ill around this time last year. He was diagnosed with schizophrenia 20 years ago at age 17, and when he first started coming to Care-A-Van he was living on the street and his only possessions were bags full of garbage. When he was asked why he had what looked like a 30 year old golf club that was duct taped together, he replied “to sell it, of course.” He ran across a busy five-lane street because he got excited when he saw Craig, one of the AMHD outreach workers, in the Care-A-Van parking lot. Mark was addicted to crystal methamphetamines, which is locally referred to as ‘ice’. Ice is a huge problem in Hawai’i especially among the homeless population because it is cheap and easy to come by. For Mark, the crystal meth calmed his mind down so that he was not constantly hearing the voices in his head. It was the only relief that he was getting from his illness. Craig was able to get Mark into a rehabilitation center last year where he was weaned of the crystal meth and put on medication for his schizophrenia. For the few months following the rehabilitation, he lived in housing where he had a little more freedom, but was also monitored frequently and checked by a case manager. Now Mark is living in his own apartment, he has his first full time job working at a pizza parlor and, from what Craig has told me, bares no resemblance to the person he had originally known. Mark told me that he had spent his whole life confused and for the first time he was happy and could enjoy life.
During my time at Care-A-Van I also learned a lot from a man that I will call Richard, who was developmentally disabled and had a very low IQ. We took him shopping because without us he would spend all of his disability money that he received from the government on DVD’s. Richard is a big man and people would stare at him and treat him as though he was a threat. We were invited to come to another line to check out, but when the clerk saw Richard he completely changed and acted like he didn’t want us there anymore. Richard can get very frustrated when he does not understand things, and although he had never gotten violent with us, he had been kicked out of places for throwing chairs when he was mad.
This past winter I worked at Easter Seals with mentally and physically disabled teenagers, and until I met Richard I had not completely understood the importance of that job. Although I enjoyed working with the kids, I did not feel like I was making a big difference teaching the kids how to make a baked potato or reading to them. I see now that although the little activities may not have helped every single one of them, the environment that taught these teenagers how they would need to act and work together kept them from ending up helpless and confused on the street. It kept them from ending up like Richard.

Finding my way
On one of my last days at Care-A-Van, Craig and I went out “roving” to the parks downtown in order to give out supplies and food bags and inform those who did not know us about our services. In one park there was a long bench filled with people that Craig referred to as the “heavy hitters”. They sat around and drank and looked in general like a group of angry homeless people that I would avoid under any other circumstances. We drove up in the van and I walked up with bags of food. Every single person there greeted me as a friend. There were no aggressive stares.
I knew that I had finally found a way to help. I did not have to walk by nervously and feel bad for not giving them any money; I could provide these individuals with food, clothing, medical care, and hope. I did not stare at them with fear and hatred as most people did, I asked them if there was anything else they needed, anything else they could use to get back on their feet. Most of them will never stop using drugs and living on the street, but that does not mean they should all be given up on. They are just people like everyone else, and if I were down and out, I know that I would appreciate a friendly face. In Parker Palmer’s words, “Authentic abundance does not lie in secured stockpiles of food or cash or influence or affection but in belonging to a community where we can give those goods to others who need them – and receive them from others when we are in need” (Palmer, p.108).
In “Let Your Life Speak” Palmer explains how “The Quaker teacher Douglas Steere was fond of saying that the ancient human question ‘Who am I’ leads inevitably to the equally important question ‘Whose am I’ – for there is no selfhood outside of relationship” (Palmer, p. 17). We must know ourselves, and in that process we cannot ignore the importance of relationships because we were all born into a community. We are all connected, and because of this I cannot know myself without knowing the others that I am connected to. While I was born with gifts and a purpose, I am also part of a community that is equally as important. I will be a teacher and a student in this community for my whole life. Although I must know myself and find my own path, it would be impossible to learn or pass on knowledge without interactions and relationships with other beings. It is a concept that I must remind myself of during times when I become too self absorbed and forget that I am a teacher, or when I am too self righteous and forget that I am a student.
The only attribute of the book that I did not relate to was the multiple references to God, such as “we are the children of God”, and some of his other Quaker beliefs. It did not bother me like it once might have, it just forced me to look at his meaning and not his words, what message he was trying to send through the wisdom he has gained throughout his life, and not his religious affiliation or the way he perceives God. It is a good lesson for me to not judge someone’s message based on their religion or beliefs, but look beyond that to the real knowledge they are passing on (Palmer, 2000).

Terri
The prices of homes has risen over 30% just in the past year, and it is not expected to stop rising. A survey by SMS Research and Marketing in 2003 estimated that the number of people living on Hawai’i’s public parks, beaches and streets to be 6,029, up from the count of 3,171 homeless people in 1999 (SMS, 2003). From what I saw at Care-A-Van and heard from those I work with, this number has done nothing but rise in the past three years from housing and gasoline inflation, the high cost of living, the lack of space in the AMHD State Hospital, and the lack of a good solution.
On quite a few of our days on outreach we would be forced to drive to extra locations because if the police had just come to do a sweep, the beach or park would be empty. It is not what I would call a solution, but in order to keep the homeless out of parks and beaches the police would force the homeless to pack up and leave. With the rising number of homeless on the island, there was no where else to go when people were kicked out. They could have gone to a shelter, but the only shelter on the island is full. Even the waiting list is full.
However, an emergency shelter called Next Step was set up in a warehouse that was not being used. Terri and Savina were two workers at Care-A-Van who went and worked at the shelter at night. Terri talked to me about what they did at the shelter and she thought I would really enjoy volunteering over there. I asked our boss if I could be put on the schedule.
Something was strange about work on my second to last Monday, I just couldn’t pin point it. Our boss said that we had a meeting at 9 AM. She got us all together and softly explained that Terri had passed away over the weekend. Terri was in her late 40’s and had a 16 year old son, it just didn’t seem right.
It was that week that I was put on the schedule to go to the shelter. I went over with Savina once Care-A-Van closed. Those staying at the shelter had to have somewhere else to go during the day, and then the shelter opened at 5:30 PM. The warehouse was full of large wooden dividers that separated the cubbies. The cubbies for families were larger than those made for single men and single women, but none of them could fit more than a cot or mattress. There was a kid’s corner with toys, books, tables and supplies for coloring. My first job was to do intakes for three of the six men who were looking to stay at the shelter. Every night one of the local churches or community organizations cooks dinner, so around 7:00 PM everyone had a chance to eat a hot meal. The atmosphere was very homey and laid back, and I felt very comfortable there. I was helping a man with severely swollen legs by trying to find him an available cot when a little girl on a tricycle stopped me. “Are you a doctor?” she asked. When I said no she replied, “Okay, then can you push me?” Terri was right, I loved working at the shelter.
After my last day at Care-A-Van, most of the workers drove to Terri’s funeral. When we arrived, I was surprised to see that her funeral was outside on a small grassy area right on the beach in Hawai’i Kai. There was a large poster board filled with pictures of Terri. Following with tradition, friends and family were placing flower leis around the neck of Terri’s mother. Terri’s sons were ceremoniously blowing conch shells. When the service started, friends and family were inviting to come up and share a few words about Terri. Michael, a soft spoken Hawaiian man who worked at Care-A-Van and become one of my closest friends, got up and went to the microphone. Micheal would always play his ukulele and sing Hawaiian songs when it was a slow day in the office. He said some kind words about Terri and then started playing her favorite song. The sun was warming, the water was beautiful, and the song was soothing, but it was bittersweet.
The last person to get up and talk was one of Terri’s best friends who worked at the shelter with her. She said that when she found out, her first response was anger. How could this have happened so suddenly? She went on by saying that a few days earlier she had woken up and looked out her window to see a beautiful red bird singing a peaceful song. She went out to tend to her farm and animals and she saw a striking bright orange butterfly. The butterfly followed her and then started at her feet and did what she called a little dance all the way up her body. When the butterfly flew away she knew that everything was going to be ok. She felt as if Terri had made it wherever she was going and she had sent that little message back to her friend so that she would know she was ok. Terri had reddish-orange hair.
Life, death, beauty, suffering and relief all so intertwined. One thing that remained constant was love. The hugs from the clients, the compliments from the coworkers, the tears at a funeral. People turned out to just be people. Not local Hawaiians or rich owners or helpless families, just people who appreciated my help and concern. I didn’t want to leave, I felt like there was so much more I could do. I might now call myself an activist and a fighter.

Works Cited

Palmer, Parker J. (2000). Let Your Life Speak: Listening for the Voice of Vocation. San
Francisco: Jossey-Bass.

Sohmer, David E. (2004, December). Judge Ezra dismisses fed case against Hawaii
State Hospital. Newsletter of the Hawai’i Dept. of Health’s Adult Mental Health Division, 4, 1-3.

SMS Research & Marketing Services, Inc. (2003). Homeless Point-in-Time Count
Report: 2003. Honolulu, HI: Author.