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"bio": "\u003ca href=\"http://www.MarkFiore.com\">MarkFiore.com\u003c/a> | \u003ca href=\"https://twitter.com/markfiore\">Follow on Twitter\u003c/a> | \u003ca href=\"https://www.facebook.com/pages/Mark-Fiore-Animated-Political-Cartoons/94451707396?ref=bookmarks\">Facebook\u003c/a> | \u003ca href=\"mailto:mark@markfiore.com\">email\u003c/a>\r\n\r\nPulitzer Prize-winner, Mark Fiore, who the Wall Street Journal has called “the undisputed guru of the form,” creates animated political cartoons in San Francisco, where his work has been featured regularly on the San Francisco Chronicle’s web site, SFGate.com. His work has appeared on Newsweek.com, Slate.com, CBSNews.com, MotherJones.com, DailyKos.com and NPR’s web site. Fiore’s political animation has appeared on CNN, Frontline, Bill Moyers Journal, Salon.com and cable and broadcast outlets across the globe.\r\n\r\nBeginning his professional life by drawing traditional political cartoons for newspapers, Fiore’s work appeared in publications ranging from the Washington Post to the Los Angeles Times. In the late 1990s, he began to experiment with animating political cartoons and, after a short stint at the San Jose Mercury News as their staff cartoonist, Fiore devoted all his energies to animation.\r\nGrowing up in California, Fiore also spent a good portion of his life in the backwoods of Idaho. It was this combination that shaped him politically. Mark majored in political science at Colorado College, where, in a perfect send-off for a cartoonist, he received his diploma in 1991 as commencement speaker Dick Cheney smiled approvingly.\r\nMark Fiore was awarded the Pulitzer Prize for political cartooning in 2010, a Robert F. Kennedy Journalism Award in 2004 and has twice received an Online Journalism Award for commentary from the Online News Association (2002, 2008). Fiore has received two awards for his work in new media from the National Cartoonists Society (2001, 2002), and in 2006 received The James Madison Freedom of Information Award from The Society of Professional Journalists.",
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"content": "\u003cp>Mayor London Breed has tapped Matt Dorsey, the openly gay director of strategic communications for the San Francisco Police Department who has also struggled with addiction to drugs and alcohol, to fill the Board of Supervisors District 6 seat left vacant by the election of Matt Haney to the state Assembly.\u003c/p>\n\u003cp>“As a longtime public servant, Matt Dorsey knows how the city works, and as a member of the recovery community, he can bring new energy and commitment to the crisis of addiction that is fueling our overdose crisis and impacting neighborhoods throughout this city,” the mayor said in a written statement.\u003c/p>\n\u003cp>In choosing the relatively moderate Dorsey, the mayor will likely get a more reliable ally on the board than Haney, who often criticized Breed’s management of the city. But she also runs the risk of alienating constituents who will see Dorsey’s relationship with the SFPD as a liability.\u003c/p>\n\u003cp>Others, including Assemblymember Haney, were hoping Breed would appoint Honey Mahogany to lead District 6. Mahogany served as Haney’s chief of staff and would have been the first transgender member of the San Francisco Board of Supervisors.\u003c/p>\n\u003cp>\u003cb>“\u003c/b>I do understand why she would want to appoint someone maybe that was closer to her,” Mahogany told KQED. “But I think that the residents of District 6 actually need someone who knows what they’re doing, who has experience\u003ci>.” \u003c/i>She cited her work in Haney’s office on behalf of issues including public safety and homelessness.\u003c/p>\n\u003cp>The appointment of Dorsey sets up an electoral conflict for November with Mahogany. But as some have noted, \u003ca href=\"https://missionlocal.org/2022/05/sources-mayor-to-tap-matt-dorsey-for-d6-supervisor-triggering-high-stakes-political-brawl/\">it may also serve as a proxy battle\u003c/a> between Mayor Breed and the newly elected Haney, backing Dorsey and Mahogany, respectively, at a time when Breed is gearing up for her own election. Breed appears to be banking on the electorate’s mood shifting to favor a candidate with strong ties to the police, like Dorsey.\u003c/p>\n\u003cp>Dorsey, who has experienced decades of substance use disorder and recovery, hopes to use that experience in his new position.[pullquote size=\"medium\" align=\"right\" citation=\"Honey Mahogany, District 6 supervisor candidate\"]‘I think that the residents of District 6 actually need someone who knows what they’re doing, who has experience.’[/pullquote]“I’ve been open about being in recovery before, but I never thought to be this open about it,” Dorsey told KQED. “But at this moment with the public health crisis that we have, I hope I can make a difference,” he said, referring to the relentless numbers of overdose deaths on city streets.\u003c/p>\n\u003cp>San Francisco recorded 640 accidental overdose deaths in 2021, \u003ca href=\"https://sf.gov/sites/default/files/2021-05/2021%2005_OCME%20Overdose%20Report.pdf\">according to the Office of the Chief Medical Examiner\u003c/a>. Roughly 20% of those deaths were in the South of Market neighborhood, which Dorsey will now represent.\u003c/p>\n\u003cp>Dorsey sees a direct connection between rampant open-air drug dealing, addiction and overdose deaths in San Francisco and some of its other most vexing challenges.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I think when you consider things like homelessness and street conditions and theft and recent auto burglaries, a lot of this stuff, if we can make progress on drug use, getting more people into recovery, I think we’ll see progress on a lot of things. I’m optimistic about what we can do,” Dorsey said.\u003c/p>\n\u003cp>While not well known to the general public, Dorsey has been a fixture in San Francisco politics, campaigns and government for decades. He spent four years on the San Francisco Democratic Party board. After 14 years as press secretary to City Attorney Dennis Herrera, Dorsey became a partner in a local communications company. He returned to the public sector in 2020 to head the SFPD’s strategic communications.\u003c/p>\n\u003cp>The appointment of a former SFPD staffer comes at a time of \u003ca href=\"https://www.kqed.org/news/11906253/violent-crime-soared-during-the-pandemic-but-does-the-political-debate-reflect-the-data\">rising fear of crime in San Francisco\u003c/a>, leading to contentious debates over whether increased policing is needed in the city. And from \u003ca href=\"https://www.kqed.org/news/11897148/rash-of-organized-weekend-robberies-target-luxury-stores-across-the-bay-area\">smash-and-grab robberies at luxury stores in Union Square\u003c/a> \u003ca href=\"https://www.cbsnews.com/sanfrancisco/news/elderly-asian-woman-beats-up-man-attacking-her-in-san-francisco/\">to high-profile attacks against members of the Asian American community\u003c/a>, that debate is taking place in neighborhoods Dorsey will represent, including downtown, South of Market and Mission Bay.[aside tag=\"politics\" label=\"Related Coverage\"]“There’s obviously some concern around Mr. Dorsey and some of his work for the police,” said former San Francisco Police Commissioner John Hamasaki. Hamasaki referred specifically to a public relations campaign to discredit District Attorney Chesa Boudin while Boudin’s office was prosecuting a police officer for excessive use of force. The SFPD alleged that Boudin’s office had violated a memorandum of understanding between the police and the DA.\u003c/p>\n\u003cp>Hamasaki, who is a critic of the SFPD, said “it created this aura that the district attorney was cheating in this case. But the facts that it was based on were misrepresented. It called into question, you know, what the police were doing with their taxpayer money and the resources in the media unit, and then also how that ultimately affected the trial.”\u003c/p>\n\u003cp>Among those who worked with Dorsey in the City Attorney’s office is state Sen. Scott Wiener, who called Dorsey “a rock-solid choice” for the job. Wiener, who like Dorsey went to the Board of Supervisors from the City Attorney’s office, said it’s useful experience for a supervisor to have.\u003c/p>\n\u003cp>“I can say that being in the City Attorney’s Office, you see how city government works and how it’s not working,” Wiener said. “You’re involved in every aspect of city government, and you truly see the good, the bad and the ugly. So Matt is not going to need a huge education in terms of how the different departments are functioning and what needs to be done better.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dorsey, who said San Francisco must do more to address the lack of affordable housing in the city, said he’ll bring his own experiences as a resident to help prioritize the issues he’ll emphasize. “I choose not to own a car. I commute generally by Bikeshare. I am a renter, so I think transportation will be important,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dorsey, who also is HIV-positive, sees a resemblance to the city’s drug problems with the AIDS epidemic in the 1980s and ’90s. “The stigma of who is dying is masking the horror of how many are dying,” Dorsey said. “And as somebody who remembers what those days were like, I just keep thinking that this is where a voice from this recovery community is needed.”\u003c/span>\u003c/p>\n\u003cp>As expected, Dorsey is a staunch defender of the SFPD, saying that under Chief Bill Scott the police department has made tremendous strides implementing reforms that have reduced unlawful use of force and policies and practices that landed the previous police chief in hot water.\u003c/p>\n\u003cp>“I\u003cspan style=\"font-weight: 400\">t is a better police department than people think it is,” Dorsey said, adding that the rank-and-file officers don’t get the credit other first responders have gotten during the pandemic. “They were making a lot of the same sacrifices that nurses and firefighters and EMTs and others were — just not being appreciated.”\u003c/span>\u003c/p>\n\u003cp>But just last week, Dorsey’s future colleagues, led by Supervisor Dean Preston, criticized the media relations job Dorsey’s office is doing, saying the SFPD was highlighting information that made the police look good with the goal of getting more city funding, while underplaying persistent problems.\u003c/p>\n\u003cp>“We need to understand to what extent taxpayer funds are being used to help shape media and public narrative on these controversial issues,” Preston said.\u003c/p>\n\u003cp>Preston’s comment came at a meeting of the Government Audit and Oversight Committee that he called to explore issues related to the SFPD’s communications operation.\u003c/p>\n\u003cp>Police Chief Bill Scott has often sparred with District Attorney Chesa Boudin, \u003ca href=\"https://www.kqed.org/news/11913102\">who is facing a recall election\u003c/a>. Asked whether he supports Proposition H, the June 7 measure to recall Boudin, Dorsey hedged, saying he is “authentically undecided,” adding that “\u003cspan style=\"font-weight: 400\">I have some complicated issues around my [SFPD] department’s relationship with the district attorney. And, we’ll see.”\u003c/span>\u003c/p>\n\u003cp>“I’m going to give some thought to it and pray on it and talk to the DA and talk to some others and hear from my residents,” he added.\u003c/p>\n\u003cp>In the meantime, Dorsey’s opponents are already gearing up to face him in his first election.\u003c/p>\n\u003cp>Haney, who said “I have nothing bad to say about Matt,” noted that Mahogany was better suited to represent the district given her experience dealing with issues like affordable housing, homelessness and public safety.\u003c/p>\n\u003cp>https://twitter.com/MattHaneySF/status/1523544352949039106\u003c/p>\n\u003cp>“He [Dorsey] writes press releases for the police and for a lobbying firm,” he said. “That’s very different than someone who has been in the trenches working to keep a community safe, to build housing. I think that’s the kind of person that we need in office.”\u003c/p>\n\u003cp>Mahogany, who is transgender, will run for the seat in November, setting up a lively debate over who can best represent the district. She seemed to take Breed’s decision in stride.\u003c/p>\n\u003cp>“I think that [the voters] are going to definitely see the depth of my experience. And you know, I think they’ll make the right decision in November,” she added.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Mayor London Breed has tapped Matt Dorsey, the openly gay director of strategic communications for the San Francisco Police Department who has also struggled with addiction to drugs and alcohol, to fill the Board of Supervisors District 6 seat left vacant by the election of Matt Haney to the state Assembly.\u003c/p>\n\u003cp>“As a longtime public servant, Matt Dorsey knows how the city works, and as a member of the recovery community, he can bring new energy and commitment to the crisis of addiction that is fueling our overdose crisis and impacting neighborhoods throughout this city,” the mayor said in a written statement.\u003c/p>\n\u003cp>In choosing the relatively moderate Dorsey, the mayor will likely get a more reliable ally on the board than Haney, who often criticized Breed’s management of the city. But she also runs the risk of alienating constituents who will see Dorsey’s relationship with the SFPD as a liability.\u003c/p>\n\u003cp>Others, including Assemblymember Haney, were hoping Breed would appoint Honey Mahogany to lead District 6. Mahogany served as Haney’s chief of staff and would have been the first transgender member of the San Francisco Board of Supervisors.\u003c/p>\n\u003cp>\u003cb>“\u003c/b>I do understand why she would want to appoint someone maybe that was closer to her,” Mahogany told KQED. “But I think that the residents of District 6 actually need someone who knows what they’re doing, who has experience\u003ci>.” \u003c/i>She cited her work in Haney’s office on behalf of issues including public safety and homelessness.\u003c/p>\n\u003cp>The appointment of Dorsey sets up an electoral conflict for November with Mahogany. But as some have noted, \u003ca href=\"https://missionlocal.org/2022/05/sources-mayor-to-tap-matt-dorsey-for-d6-supervisor-triggering-high-stakes-political-brawl/\">it may also serve as a proxy battle\u003c/a> between Mayor Breed and the newly elected Haney, backing Dorsey and Mahogany, respectively, at a time when Breed is gearing up for her own election. Breed appears to be banking on the electorate’s mood shifting to favor a candidate with strong ties to the police, like Dorsey.\u003c/p>\n\u003cp>Dorsey, who has experienced decades of substance use disorder and recovery, hopes to use that experience in his new position.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I’ve been open about being in recovery before, but I never thought to be this open about it,” Dorsey told KQED. “But at this moment with the public health crisis that we have, I hope I can make a difference,” he said, referring to the relentless numbers of overdose deaths on city streets.\u003c/p>\n\u003cp>San Francisco recorded 640 accidental overdose deaths in 2021, \u003ca href=\"https://sf.gov/sites/default/files/2021-05/2021%2005_OCME%20Overdose%20Report.pdf\">according to the Office of the Chief Medical Examiner\u003c/a>. Roughly 20% of those deaths were in the South of Market neighborhood, which Dorsey will now represent.\u003c/p>\n\u003cp>Dorsey sees a direct connection between rampant open-air drug dealing, addiction and overdose deaths in San Francisco and some of its other most vexing challenges.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think when you consider things like homelessness and street conditions and theft and recent auto burglaries, a lot of this stuff, if we can make progress on drug use, getting more people into recovery, I think we’ll see progress on a lot of things. I’m optimistic about what we can do,” Dorsey said.\u003c/p>\n\u003cp>While not well known to the general public, Dorsey has been a fixture in San Francisco politics, campaigns and government for decades. He spent four years on the San Francisco Democratic Party board. After 14 years as press secretary to City Attorney Dennis Herrera, Dorsey became a partner in a local communications company. He returned to the public sector in 2020 to head the SFPD’s strategic communications.\u003c/p>\n\u003cp>The appointment of a former SFPD staffer comes at a time of \u003ca href=\"https://www.kqed.org/news/11906253/violent-crime-soared-during-the-pandemic-but-does-the-political-debate-reflect-the-data\">rising fear of crime in San Francisco\u003c/a>, leading to contentious debates over whether increased policing is needed in the city. And from \u003ca href=\"https://www.kqed.org/news/11897148/rash-of-organized-weekend-robberies-target-luxury-stores-across-the-bay-area\">smash-and-grab robberies at luxury stores in Union Square\u003c/a> \u003ca href=\"https://www.cbsnews.com/sanfrancisco/news/elderly-asian-woman-beats-up-man-attacking-her-in-san-francisco/\">to high-profile attacks against members of the Asian American community\u003c/a>, that debate is taking place in neighborhoods Dorsey will represent, including downtown, South of Market and Mission Bay.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“There’s obviously some concern around Mr. Dorsey and some of his work for the police,” said former San Francisco Police Commissioner John Hamasaki. Hamasaki referred specifically to a public relations campaign to discredit District Attorney Chesa Boudin while Boudin’s office was prosecuting a police officer for excessive use of force. The SFPD alleged that Boudin’s office had violated a memorandum of understanding between the police and the DA.\u003c/p>\n\u003cp>Hamasaki, who is a critic of the SFPD, said “it created this aura that the district attorney was cheating in this case. But the facts that it was based on were misrepresented. It called into question, you know, what the police were doing with their taxpayer money and the resources in the media unit, and then also how that ultimately affected the trial.”\u003c/p>\n\u003cp>Among those who worked with Dorsey in the City Attorney’s office is state Sen. Scott Wiener, who called Dorsey “a rock-solid choice” for the job. Wiener, who like Dorsey went to the Board of Supervisors from the City Attorney’s office, said it’s useful experience for a supervisor to have.\u003c/p>\n\u003cp>“I can say that being in the City Attorney’s Office, you see how city government works and how it’s not working,” Wiener said. “You’re involved in every aspect of city government, and you truly see the good, the bad and the ugly. So Matt is not going to need a huge education in terms of how the different departments are functioning and what needs to be done better.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dorsey, who said San Francisco must do more to address the lack of affordable housing in the city, said he’ll bring his own experiences as a resident to help prioritize the issues he’ll emphasize. “I choose not to own a car. I commute generally by Bikeshare. I am a renter, so I think transportation will be important,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dorsey, who also is HIV-positive, sees a resemblance to the city’s drug problems with the AIDS epidemic in the 1980s and ’90s. “The stigma of who is dying is masking the horror of how many are dying,” Dorsey said. “And as somebody who remembers what those days were like, I just keep thinking that this is where a voice from this recovery community is needed.”\u003c/span>\u003c/p>\n\u003cp>As expected, Dorsey is a staunch defender of the SFPD, saying that under Chief Bill Scott the police department has made tremendous strides implementing reforms that have reduced unlawful use of force and policies and practices that landed the previous police chief in hot water.\u003c/p>\n\u003cp>“I\u003cspan style=\"font-weight: 400\">t is a better police department than people think it is,” Dorsey said, adding that the rank-and-file officers don’t get the credit other first responders have gotten during the pandemic. “They were making a lot of the same sacrifices that nurses and firefighters and EMTs and others were — just not being appreciated.”\u003c/span>\u003c/p>\n\u003cp>But just last week, Dorsey’s future colleagues, led by Supervisor Dean Preston, criticized the media relations job Dorsey’s office is doing, saying the SFPD was highlighting information that made the police look good with the goal of getting more city funding, while underplaying persistent problems.\u003c/p>\n\u003cp>“We need to understand to what extent taxpayer funds are being used to help shape media and public narrative on these controversial issues,” Preston said.\u003c/p>\n\u003cp>Preston’s comment came at a meeting of the Government Audit and Oversight Committee that he called to explore issues related to the SFPD’s communications operation.\u003c/p>\n\u003cp>Police Chief Bill Scott has often sparred with District Attorney Chesa Boudin, \u003ca href=\"https://www.kqed.org/news/11913102\">who is facing a recall election\u003c/a>. Asked whether he supports Proposition H, the June 7 measure to recall Boudin, Dorsey hedged, saying he is “authentically undecided,” adding that “\u003cspan style=\"font-weight: 400\">I have some complicated issues around my [SFPD] department’s relationship with the district attorney. And, we’ll see.”\u003c/span>\u003c/p>\n\u003cp>“I’m going to give some thought to it and pray on it and talk to the DA and talk to some others and hear from my residents,” he added.\u003c/p>\n\u003cp>In the meantime, Dorsey’s opponents are already gearing up to face him in his first election.\u003c/p>\n\u003cp>Haney, who said “I have nothing bad to say about Matt,” noted that Mahogany was better suited to represent the district given her experience dealing with issues like affordable housing, homelessness and public safety.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>“He [Dorsey] writes press releases for the police and for a lobbying firm,” he said. “That’s very different than someone who has been in the trenches working to keep a community safe, to build housing. I think that’s the kind of person that we need in office.”\u003c/p>\n\u003cp>Mahogany, who is transgender, will run for the seat in November, setting up a lively debate over who can best represent the district. She seemed to take Breed’s decision in stride.\u003c/p>\n\u003cp>“I think that [the voters] are going to definitely see the depth of my experience. And you know, I think they’ll make the right decision in November,” she added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Stanford Nurses Approve New Contracts, Ending Weeklong Strike",
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"content": "\u003cp>Nearly 5,000 striking nurses at Stanford and Lucile Packard Children’s hospitals plan to return to work Tuesday after overwhelmingly approving new three-year contracts.\u003c/p>\n\u003cp>The new agreements, which cover nurses at both hospitals, include yearly wage increases of 7% this year and 5% for each of the following two years, along with more generous retirement benefits and additional vacation time.\u003c/p>\n\u003cp>In an effort to address severe staffing shortages and high rates of burnout in the profession, the contracts also offer better access to mental health support and new pay incentives for recruiting and retaining nurses in hard-to-staff sectors, like critical care.\u003c/p>\n\u003cp>“We are very proud of the advances we have made with these contracts,” Colleen Borges, president of the Committee for Recognition of Nursing Achievement (CRONA), the union representing nurses, told reporters Monday. “They addressed the goals we set out at the outset of negotiations, and we hope will lead the way to improve nursing as an overall profession.”\u003c/p>\n\u003cp>https://twitter.com/CRONAnurses/status/1521176731083706368\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11912231/stanford-nurses-strike-over-staffing-shortages-lack-of-mental-health-support\">Nurses went on strike last Monday\u003c/a>, April 25, in an action that more than 90% of the union’s rank-and-file supported after their previous contracts expired in March. Union officials argued that the two hospitals were not adequately reinvesting in staffing, even after receiving hundreds of millions of dollars in federal pandemic relief funding. Revenue for the two hospitals grew 16%, to a combined $8.3 billion, according to Stanford Health Care’s financial disclosure for the 2021 fiscal year.\u003c/p>\n\u003cp>Kathy Stormberg, CRONA’s vice president, said management finally got the message that the nursing profession needs to be more sustainable and appealing.\u003c/p>\n\u003cp>“Amid a nationwide shortage of nurses driven by high levels of burnout, moral injury, exhaustion and trauma, hospitals need to step up their support for the nursing profession,” she told reporters on Monday. “Creating better and safer working conditions for nurses is directly connected to ensuring the best care conditions for the patients who are in our charge.”\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"stanford-hospital\"]A 2021 UCSF study estimated a \u003ca href=\"https://www.ucsf.edu/news/2021/09/421366/california-faces-short-term-nursing-shortage-covid-19-retirements\">shortage of more than 40,000 full-time registered nurses in California\u003c/a>, part of what it identified as a longer-term trend that has been accelerated during the COVID-19 pandemic.\u003c/p>\n\u003cp>Meanwhile, a survey conducted by CRONA in November found that 45% of Stanford nurses had considered leaving their jobs due to a lack of resources, training and support staff.\u003c/p>\n\u003cp>Kimberley Reed, a union representative who has worked for roughly 18 years as a nurse in Stanford Hospital’s cardiac intensive care unit, said many nurses simply have been pushed to the brink.\u003c/p>\n\u003cp>“There’s been high turnover, an increased amount of overtime that we’re using, decreased resources available to us,” she said. “And there’s really no time for us to rest and recharge. All of this is not sustainable.”\u003c/p>\n\u003cp>Reed said she’s particularly encouraged that the new contract includes better mental health support and pay incentives for nurses working with severely ill patients in emergency departments, intensive care units and critical care transport teams.\u003c/p>\n\u003cp>“The reason that is so important is because it’s been really, really hard for the institution to be able to get nurses in those areas,” she said. “So this incentive program will hopefully retain the nurses who have been here through the pandemic. And it will also incentivize experienced nurses who want to come to Stanford to work in those areas.”\u003c/p>\n\u003cp>Pressure mounted against hospital management heading into the strike, with nurses receiving strong support from elected officials across the Peninsula and South Bay. \u003ca href=\"https://twitter.com/SenAlexPadilla/status/1520202366049562626\">U.S. Sen. Alex Padilla also visited the picket line Friday\u003c/a>, calling nurses “real-life superheroes.”\u003c/p>\n\u003cp>In a statement, Stanford said it was pleased to reach a deal that reflects “shared priorities and enhances existing benefits supporting our nurses’ health, well-being, and ongoing professional development.”\u003c/p>\n\u003cp>CRONA officials agreed Monday that both sides had shared goals, but suggested that they approached the negotiations in notably different ways.\u003c/p>\n\u003cp>“Sticking points really had to do with sort of a philosophical difference in how we approach things,” Stormberg said. “It wasn’t so much that there was a specific issue, rather that it was a complete package of changes that we were working on.”\u003c/p>\n\u003cp>\u003cem>This story includes reporting from KQED’s Sara Hossaini and Eli Walsh of Bay City News.\u003c/em>\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "The new contracts, which cover some 5,000 nurses at both hospitals, include yearly wage increases, better retirement benefits and additional vacation time. The package also comes with new pay incentives for critical care nurses and better mental health support.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nearly 5,000 striking nurses at Stanford and Lucile Packard Children’s hospitals plan to return to work Tuesday after overwhelmingly approving new three-year contracts.\u003c/p>\n\u003cp>The new agreements, which cover nurses at both hospitals, include yearly wage increases of 7% this year and 5% for each of the following two years, along with more generous retirement benefits and additional vacation time.\u003c/p>\n\u003cp>In an effort to address severe staffing shortages and high rates of burnout in the profession, the contracts also offer better access to mental health support and new pay incentives for recruiting and retaining nurses in hard-to-staff sectors, like critical care.\u003c/p>\n\u003cp>“We are very proud of the advances we have made with these contracts,” Colleen Borges, president of the Committee for Recognition of Nursing Achievement (CRONA), the union representing nurses, told reporters Monday. “They addressed the goals we set out at the outset of negotiations, and we hope will lead the way to improve nursing as an overall profession.”\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>A 2021 UCSF study estimated a \u003ca href=\"https://www.ucsf.edu/news/2021/09/421366/california-faces-short-term-nursing-shortage-covid-19-retirements\">shortage of more than 40,000 full-time registered nurses in California\u003c/a>, part of what it identified as a longer-term trend that has been accelerated during the COVID-19 pandemic.\u003c/p>\n\u003cp>Meanwhile, a survey conducted by CRONA in November found that 45% of Stanford nurses had considered leaving their jobs due to a lack of resources, training and support staff.\u003c/p>\n\u003cp>Kimberley Reed, a union representative who has worked for roughly 18 years as a nurse in Stanford Hospital’s cardiac intensive care unit, said many nurses simply have been pushed to the brink.\u003c/p>\n\u003cp>“There’s been high turnover, an increased amount of overtime that we’re using, decreased resources available to us,” she said. “And there’s really no time for us to rest and recharge. All of this is not sustainable.”\u003c/p>\n\u003cp>Reed said she’s particularly encouraged that the new contract includes better mental health support and pay incentives for nurses working with severely ill patients in emergency departments, intensive care units and critical care transport teams.\u003c/p>\n\u003cp>“The reason that is so important is because it’s been really, really hard for the institution to be able to get nurses in those areas,” she said. “So this incentive program will hopefully retain the nurses who have been here through the pandemic. And it will also incentivize experienced nurses who want to come to Stanford to work in those areas.”\u003c/p>\n\u003cp>Pressure mounted against hospital management heading into the strike, with nurses receiving strong support from elected officials across the Peninsula and South Bay. \u003ca href=\"https://twitter.com/SenAlexPadilla/status/1520202366049562626\">U.S. Sen. Alex Padilla also visited the picket line Friday\u003c/a>, calling nurses “real-life superheroes.”\u003c/p>\n\u003cp>In a statement, Stanford said it was pleased to reach a deal that reflects “shared priorities and enhances existing benefits supporting our nurses’ health, well-being, and ongoing professional development.”\u003c/p>\n\u003cp>CRONA officials agreed Monday that both sides had shared goals, but suggested that they approached the negotiations in notably different ways.\u003c/p>\n\u003cp>“Sticking points really had to do with sort of a philosophical difference in how we approach things,” Stormberg said. “It wasn’t so much that there was a specific issue, rather that it was a complete package of changes that we were working on.”\u003c/p>\n\u003cp>\u003cem>This story includes reporting from KQED’s Sara Hossaini and Eli Walsh of Bay City News.\u003c/em>\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>About 5,000 nurses at Stanford and Lucile Packard Children’s hospitals went on strike Monday, with workers calling on Stanford Health Care management to boost wages, address staffing shortages and provide workers with more mental health support, a need that’s grown during the pandemic.\u003c/p>\n\u003cp>According to the Committee for Recognition of Nursing Achievement, or CRONA, which represents the striking nurses, executives at Stanford Health Care and Luclle Packard Children’s Hospital have failed to address low staff retention and high turnover rates and have attempted to withdraw health benefits for striking nurses.\u003c/p>\n\u003cp>Stanford administrators and union leaders are set to go back to the bargaining table Tuesday as nurses enter their second day of an open-ended strike.\u003c/p>\n\u003cp>Roughly 93% of nurses represented by CRONA voted to authorize the strike earlier this month after their labor contract with Stanford expired March 31. The strike is CRONA’s first in more than two decades, according to the union.\u003c/p>\n\u003cp>“A strike has always been the last resort for CRONA nurses, but we are prepared to stand strong and make sacrifices today for the transformative changes that the nursing profession and our patients need,” said CRONA President Colleen Borges on Monday. Borges is a pediatric oncology nurse at Packard Children’s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>https://twitter.com/CRONAnurses/status/1518635587435065345?s=20&t=zWCMkNe3aGzraOscLsagKg\u003c/p>\n\u003cp>A survey conducted by CRONA in November found that 45% of Stanford nurses considered leaving due to a lack of resources, training and support staff.\u003c/p>\n\u003cp>Stanford Health Care Chief Nurse Executive Dale Beatty and Stanford Children’s Health Senior Vice President Jesus Cepero said in a joint statement that they respect the union’s right to strike, but argued that Stanford will be forced to reduce some services and reschedule elective procedures during the strike, even after securing replacement nurses for the two hospitals.\u003c/p>\n\u003cp>The two executives also argued that Stanford’s most recent contract offer to CRONA was sufficient, offering increased wages, student loan repayment assistance and incentive payments for nurses in units with high turnover rates.\u003c/p>\n\u003cp>“We continue to work toward an agreement with CRONA on a contract that our nurses can support and be proud of,” Beatty and Cepero said. “Our nurses are exceptional, and we strive to recognize and reward their enormous contributions.”\u003c/p>\n\u003cp>[aside postID=news_11911519 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/04/GettyImages-1392178871-1020x676.jpg']“Nobody wants to strike,” ICU cardiac nurse Kimberley Reed told KQED. “Because it’s not good for hospitals. It’s not good for nurses. It’s not good for our patients.”\u003c/p>\n\u003cp>But Reed said she’ll be at the bargaining table to fight for better retirement benefits and to make sure that patients get the best care — and part of that, she said, is making sure nurses also get the mental health care they need.\u003c/p>\n\u003cp>“A lot of [workers] are paying for mental health services out of their pockets,” she said. “And I think with the death of Michael Odell … that actually did something to a lot of people.” Odell was a 27-year-old traveling nurse who was working at Stanford Health Care in January when he \u003ca href=\"https://www.statnews.com/2022/03/23/nurse-warned-of-pandemic-mental-toll-health-workers/\">died by an apparent suicide\u003c/a>.\u003c/p>\n\u003cp>“We had been bringing these [mental health] issues to light even before the tragic death of one of our colleagues,” Fred Taleghani, a nurse at Lucile Packard Children’s Hospital and a member of the union’s negotiation team, told KQED before the strike began.\u003c/p>\n\u003cp>The hospitals’ existing employee assistance program, Taleghani said, “was taking upwards [of] four to six weeks to even get an appointment with a therapist. And [for] anyone experiencing a mental health crisis, you need help immediately. A month from now, a month and a half from now — it doesn’t work.”\u003c/p>\n\u003cp>Taleghani said the union is asking for creative workarounds to get the hospitals to improve mental health care options for workers.\u003c/p>\n\u003cp>“We’re asking for $1,750 that [a] nurse can reimburse up to 80% of their outside mental health expenses with,” he said. “Mental health is a really personal issue, and you have to have a therapist that you connect with — and a randomly assigned therapist from a large company … is just not workable.”\u003c/p>\n\u003ch2>Hospitals plan to cut striking workers’ benefits\u003c/h2>\n\u003cp>Stanford Health and Packard Children’s announced earlier this month that they would cut striking workers’ health care benefits as of May 1. Stanford executives Beatty and Cepero said doing so is “standard national practice,” as health care benefits from an employer are generally only provided to those who are actively working.\u003c/p>\n\u003cp>“This standard practice is not unique to our hospitals and applies to any of our employees who are not working, are on unpaid status, and are not on an approved leave,” they said.\u003c/p>\n\u003cp>State legislators representing parts of the peninsula have called on Stanford to resolve the contract dispute.\u003c/p>\n\u003cp>In a joint letter Friday to Stanford Health Care President and CEO David Entwistle and Packard Children’s President and CEO Paul King, Assemblymembers Ash Kalra (D-San José) and Marc Berman (D-Palo Alto) and state Sen. Josh Becker (D-San Mateo) called it “unconscionable” that the two hospitals would cut health care benefits for striking workers and suggested it was a tactic to break the picket line.\u003c/p>\n\u003cp>The legislators and CRONA also have noted that Stanford Health Care and Packard Children’s have received hundreds of millions of dollars in federal pandemic relief funding — Stanford Health Care’s financial disclosure for the end of the 2021 fiscal year reported that revenue for the two hospitals grew 16% to a combined $8.3 billion.\u003c/p>\n\u003cp>“Cutting off the health care for these frontline health care workers and their families after they have carried us through a pandemic is not only unnecessary — it is cruel and out of step with the values Stanford and Packard publicly advertise,” Kalra, Berman and Becker said. “Having received generous federal funding the last two years, Stanford and Packard health care should not be playing games with nurses’ health care benefits.”\u003c/p>\n\u003cp>CRONA has yet to announce an end date for the strike and plans to continue bargaining with Stanford Health executives.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story includes reporting from Eli Walsh of Bay City News, KQED’s Sukey Lewis and KQED’s April Dembosky. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>About 5,000 nurses at Stanford and Lucile Packard Children’s hospitals went on strike Monday, with workers calling on Stanford Health Care management to boost wages, address staffing shortages and provide workers with more mental health support, a need that’s grown during the pandemic.\u003c/p>\n\u003cp>According to the Committee for Recognition of Nursing Achievement, or CRONA, which represents the striking nurses, executives at Stanford Health Care and Luclle Packard Children’s Hospital have failed to address low staff retention and high turnover rates and have attempted to withdraw health benefits for striking nurses.\u003c/p>\n\u003cp>Stanford administrators and union leaders are set to go back to the bargaining table Tuesday as nurses enter their second day of an open-ended strike.\u003c/p>\n\u003cp>Roughly 93% of nurses represented by CRONA voted to authorize the strike earlier this month after their labor contract with Stanford expired March 31. The strike is CRONA’s first in more than two decades, according to the union.\u003c/p>\n\u003cp>“A strike has always been the last resort for CRONA nurses, but we are prepared to stand strong and make sacrifices today for the transformative changes that the nursing profession and our patients need,” said CRONA President Colleen Borges on Monday. Borges is a pediatric oncology nurse at Packard Children’s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>A survey conducted by CRONA in November found that 45% of Stanford nurses considered leaving due to a lack of resources, training and support staff.\u003c/p>\n\u003cp>Stanford Health Care Chief Nurse Executive Dale Beatty and Stanford Children’s Health Senior Vice President Jesus Cepero said in a joint statement that they respect the union’s right to strike, but argued that Stanford will be forced to reduce some services and reschedule elective procedures during the strike, even after securing replacement nurses for the two hospitals.\u003c/p>\n\u003cp>The two executives also argued that Stanford’s most recent contract offer to CRONA was sufficient, offering increased wages, student loan repayment assistance and incentive payments for nurses in units with high turnover rates.\u003c/p>\n\u003cp>“We continue to work toward an agreement with CRONA on a contract that our nurses can support and be proud of,” Beatty and Cepero said. “Our nurses are exceptional, and we strive to recognize and reward their enormous contributions.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Nobody wants to strike,” ICU cardiac nurse Kimberley Reed told KQED. “Because it’s not good for hospitals. It’s not good for nurses. It’s not good for our patients.”\u003c/p>\n\u003cp>But Reed said she’ll be at the bargaining table to fight for better retirement benefits and to make sure that patients get the best care — and part of that, she said, is making sure nurses also get the mental health care they need.\u003c/p>\n\u003cp>“A lot of [workers] are paying for mental health services out of their pockets,” she said. “And I think with the death of Michael Odell … that actually did something to a lot of people.” Odell was a 27-year-old traveling nurse who was working at Stanford Health Care in January when he \u003ca href=\"https://www.statnews.com/2022/03/23/nurse-warned-of-pandemic-mental-toll-health-workers/\">died by an apparent suicide\u003c/a>.\u003c/p>\n\u003cp>“We had been bringing these [mental health] issues to light even before the tragic death of one of our colleagues,” Fred Taleghani, a nurse at Lucile Packard Children’s Hospital and a member of the union’s negotiation team, told KQED before the strike began.\u003c/p>\n\u003cp>The hospitals’ existing employee assistance program, Taleghani said, “was taking upwards [of] four to six weeks to even get an appointment with a therapist. And [for] anyone experiencing a mental health crisis, you need help immediately. A month from now, a month and a half from now — it doesn’t work.”\u003c/p>\n\u003cp>Taleghani said the union is asking for creative workarounds to get the hospitals to improve mental health care options for workers.\u003c/p>\n\u003cp>“We’re asking for $1,750 that [a] nurse can reimburse up to 80% of their outside mental health expenses with,” he said. “Mental health is a really personal issue, and you have to have a therapist that you connect with — and a randomly assigned therapist from a large company … is just not workable.”\u003c/p>\n\u003ch2>Hospitals plan to cut striking workers’ benefits\u003c/h2>\n\u003cp>Stanford Health and Packard Children’s announced earlier this month that they would cut striking workers’ health care benefits as of May 1. Stanford executives Beatty and Cepero said doing so is “standard national practice,” as health care benefits from an employer are generally only provided to those who are actively working.\u003c/p>\n\u003cp>“This standard practice is not unique to our hospitals and applies to any of our employees who are not working, are on unpaid status, and are not on an approved leave,” they said.\u003c/p>\n\u003cp>State legislators representing parts of the peninsula have called on Stanford to resolve the contract dispute.\u003c/p>\n\u003cp>In a joint letter Friday to Stanford Health Care President and CEO David Entwistle and Packard Children’s President and CEO Paul King, Assemblymembers Ash Kalra (D-San José) and Marc Berman (D-Palo Alto) and state Sen. Josh Becker (D-San Mateo) called it “unconscionable” that the two hospitals would cut health care benefits for striking workers and suggested it was a tactic to break the picket line.\u003c/p>\n\u003cp>The legislators and CRONA also have noted that Stanford Health Care and Packard Children’s have received hundreds of millions of dollars in federal pandemic relief funding — Stanford Health Care’s financial disclosure for the end of the 2021 fiscal year reported that revenue for the two hospitals grew 16% to a combined $8.3 billion.\u003c/p>\n\u003cp>“Cutting off the health care for these frontline health care workers and their families after they have carried us through a pandemic is not only unnecessary — it is cruel and out of step with the values Stanford and Packard publicly advertise,” Kalra, Berman and Becker said. “Having received generous federal funding the last two years, Stanford and Packard health care should not be playing games with nurses’ health care benefits.”\u003c/p>\n\u003cp>CRONA has yet to announce an end date for the strike and plans to continue bargaining with Stanford Health executives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story includes reporting from Eli Walsh of Bay City News, KQED’s Sukey Lewis and KQED’s April Dembosky. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "from-the-underground-to-public-health-policy-a-history-of-harm-reduction-in-san-francisco",
"title": "From the Underground to Public Health Policy: A History of Harm Reduction in San Francisco",
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"headTitle": "From the Underground to Public Health Policy: A History of Harm Reduction in San Francisco | KQED",
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"content": "\u003cp>It was 1998, and San Francisco was in the midst of a heroin overdose crisis. Rachel McLean was an outreach worker in the Haight, and she says it felt like a war zone.\u003c/p>\n\u003cp>When youth in the neighborhood fatally overdosed, outreach workers would host memorials by a bench in Golden Gate Park’s Panhandle.\u003c/p>\n\u003cp>They’d order pizza, tell stories, make zines and write poetry. But then came one three-week stretch with a new overdose death each week.\u003c/p>\n\u003cp>“And by the time we got to the third memorial, no one could even talk about what they loved and remembered about that person because it was just too much,” McLean said. “And I remember a bunch of kids were like, ‘You know, ‘eff this, I’m just going to go and get high.'”\u003c/p>\n\u003cp>Heroin prices had dropped and the purity had doubled. From 1997 to 2000, 384 people died from heroin-related causes in San Francisco, making it the city’s single-largest cause of accidental death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2000, the San Francisco Health Commission made harm reduction — a philosophy that advocates for making it safer to use drugs rather than criminalizing those who do — an official public health policy. It’s an approach with roots spanning from the Summer of Love in 1967, to the beginning of the AIDS pandemic in the 1980s, to the present-day fight to open sites in San Francisco for people to use drugs safely.\u003c/p>\n\u003cfigure id=\"attachment_11911094\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911094\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vitka Eisen, president and CEO of HealthRIGHT 360, poses for a portrait at the medical clinic in San Francisco on March 9, 2022. HealthRIGHT 360 is a health care provider for lower-income and otherwise marginalized Californians. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Inside a ‘hippie’ clinic, health care was a right\u003c/h2>\n\u003cp>The Haight Ashbury Free Medical Clinic opened its doors in 1967, committed to an ethos where health care was a right, not a privilege. Tens of thousands of flower children and teenage runaways were flocking to San Francisco to “drop out” of everyday society and experiment with drugs, sex and rock ‘n’ roll.\u003c/p>\n\u003cp>The clinic offered people who used drugs health care at a time when the city’s health department worried compassion would encourage the hippies to stay. It provided a safe space for people dealing with bad trips and heroin withdrawal and, later, for veterans returning from Vietnam with post-traumatic stress disorder.\u003c/p>\n\u003cp>Founder Dr. David Smith said it was illegal for physicians to treat people with substance use disorder with prescription drugs in the 1960s. Clinic volunteers were so worried police would shut the clinic down if people used drugs inside that the door was painted to read: “No dealing!/No holding drugs/No using drugs/No alcohol/No pets/Any of these can close the clinic/We Love You.”\u003c/p>\n\u003cp>When the Summer of Love ended, many people went home, but generations of people searching for meaning stayed behind in San Francisco, where the hard drugs moved in and people’s health care needs overwhelmed the clinic.\u003c/p>\n\u003cfigure id=\"attachment_11611310\" class=\"wp-caption alignright\" style=\"max-width: 355px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11611310\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut.jpg\" alt=\"\" width=\"355\" height=\"800\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut.jpg 355w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut-160x361.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut-240x541.jpg 240w\" sizes=\"(max-width: 355px) 100vw, 355px\">\u003cfigcaption class=\"wp-caption-text\">This painted door marked the entrance to the Haight Ashbury Free Medical Clinic. \u003ccite>(Courtesy of David Smith archives)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“More than three years of life in the Haight, once the flower pot of America, now shattered into fragments of terror and despair, a ‘behavioral sink’ of pathologies feeding off the pill and the needle,” read a 1971 New York Times piece.\u003c/p>\n\u003cp>Still, the philosophy of the clinic — not only that health care is a right but also that addiction can be treated with medicine — persisted.\u003c/p>\n\u003cp>“It was harm reduction before there was such a term. It was never like, ‘When are you going to get your shit together?’ It was always, ‘Hey, can I see what’s going on?'” said Vitka Eisen, who was a patient at the Haight Ashbury Free Medical Clinic, as it was called in the 1980s.\u003c/p>\n\u003cp>The clinic smelled of patchouli, and a counselor walked around in a leather fringe jacket, Eisen recalled. She would go to the clinic before visiting her family in New York because she didn’t want to be strung out on heroin when she went to see them. She’d pick up a “kick pack” of medicine to fight stomach cramping and nausea, and to help her sleep during withdrawal.\u003c/p>\n\u003cp>“After the seventh or eighth time, I was like, ‘I can’t do this anymore,’” she said.\u003c/p>\n\u003cp>She got treatment at Walden House, an addiction and mental health treatment program in San Francisco, and said she never used drugs again. Now she runs the treatment provider HealthRIGHT 360, the umbrella organization that includes what is known today as the Haight Ashbury Free Clinics.\u003c/p>\n\u003ch2>‘Carrying bleach was like having aspirin’\u003c/h2>\n\u003cp>The philosophy of harm reduction spread internationally when activists and caregivers sought ways to reduce suffering and health risks during the AIDS crisis in the ’80s. Volunteers handed out clean needles and encouraged cleaning needles with bleach.\u003c/p>\n\u003cp>Maia Szalavitz, the author of “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,” says she was addicted to cocaine and heroin at the time. She was unaware that sharing needles put her at risk of contracting HIV until 1986, when she met Maureen Gammon with the San Francisco-based group Mid-City Consortium to Combat AIDS.\u003c/p>\n\u003cfigure id=\"attachment_11911096\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911096\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-800x846.jpeg\" alt=\"\" width=\"800\" height=\"846\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-800x846.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-1020x1079.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-160x169.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-1452x1536.jpeg 1452w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1.jpeg 1859w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maia Szalavitz, author of ‘Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,’ in the 1980s. \u003ccite>(Courtesy of Maia Szalavitz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“She told me I shouldn’t share, but if you have to share, clean the needle with bleach and then with water,” Szalavitz said. “Shooting up is a pretty compulsive thing, so I immediately incorporated this into my compulsive routine and she probably saved my life.”\u003c/p>\n\u003cp>Gammon said carrying bleach was as common as having aspirin.\u003c/p>\n\u003cp>“People just had [bleach], and it was not unusual to go into a corner store or taqueria or bar and ask for a bottle of beach and be able to get it,” Gammon said.\u003c/p>\n\u003ch2>Inside the Ambassador Hotel\u003c/h2>\n\u003cp>The AIDS crisis also forged a new generation of physicians, said Joshua Bamberger, an associate clinical professor of family and community medicine at UCSF.\u003c/p>\n\u003cp>He began his residency at San Francisco General Hospital in 1989, and said all his energy and focus went into caring for men who were dying of AIDS.\u003c/p>\n\u003cp>“Much of my work was really holding men in my arms as they died,” he said. “And as awful as that was, it also created an era of physicians and other healers who bonded over the important things in medicine, which isn’t necessarily slinging medication but providing love and care for people who are really suffering.”\u003c/p>\n\u003cp>Some hospices refused to take in people who had a history of drug use, or had clauses saying they’d only accept people on the condition they’d been sober for six months before being referred. But the people who needed to be referred often had two or three months left to live.\u003c/p>\n\u003cp>So, many people found refuge at the Ambassador Hotel, an SRO in the Tenderloin run by gay rights activist Hank Wilson beginning in 1978. It became one of the few places where AIDS patients who used drugs could live without having to die on the streets. In the 1996 documentary “Life and Death at the Ambassador Hotel,” the site is described as a model in harm-reduction housing.\u003c/p>\n\u003cp>“The Ambassador was sort of a de facto AIDS hospital,” said Bamberger, who did rounds there, providing care alongside community members and friends of those dying. “When treatment options were limited, and [people] didn’t have a home, the Ambassador was a place where they could land.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=5XiwqOu_R7I\u003c/p>\n\u003cp>Val Robb, a nurse at the Ambassador Hotel, said she had to learn the culture of the people who stayed there. Many people who used drugs were distrustful of a health care system that considered them not worth treating.\u003c/p>\n\u003cp>“I started speaking the language more, which is, ‘Let me work out a deal. You need me to do this. I want you to do that,'” Robb said. “I need you to go to the doctor. If you go to the doctor, if you let them examine you, then let’s get you some codeine. It wasn’t like, ‘I’m Nurse Nancy doing this thing for you.'”\u003c/p>\n\u003cp>There were times Robb had to go against what she knew about health, such as offering guests cigarettes if they would let her examine them. But she said she still had to draw the line.\u003c/p>\n\u003cp>“Another guy, he says, ‘Val, I’m trying to get high, and my partner couldn’t hit the vein. Can’t you?’ I said, ‘No, I’m a nurse with kids and a license, I can’t do that,'” she recalled.\u003c/p>\n\u003cp>It took years before the city approved or funded some of the harm-reduction practices happening underground. The AIDS crisis hit its peak in San Francisco in 1992, and the following year Mayor Frank Jordan declared a state of emergency and announced that San Francisco would back a program to give clean needles to people who used drugs.\u003c/p>\n\u003ch2>‘Call it Lazarus in a hypodermic’\u003c/h2>\n\u003cp>Meanwhile, naloxone, the medication used to reverse overdoses, was still only widely available in medical settings. Rachel McLean, the outreach worker, said she and others attended a conference on drug policy reform in 1999 where an Italian man gave a presentation on naloxone.\u003c/p>\n\u003cp>“None of us could even understand what he was saying because his accent was so strong. But we understood that he said that in Italy, community health workers give out naloxone on the street,” she said. “And all of us, our minds were just blown by that.”\u003c/p>\n\u003cp>At the conference, Dan Bigg with the Chicago Recovery Alliance brought a duffle bag full of naloxone.\u003c/p>\n\u003cp>“And people would just come and take it, and that’s how underground naloxone started in San Francisco,” McLean said.\u003c/p>\n\u003cfigure id=\"attachment_11911104\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911104\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-800x454.png\" alt=\"\" width=\"800\" height=\"454\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-800x454.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-1020x579.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-160x91.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10.png 1522w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Naloxone education material used in San Francisco from the Massachusetts Department of Public Health. \u003ccite>(Courtesy of Joshua Bamberger)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s a mission that’s part Che Guevara, part Mother Teresa. The guerrillas aren’t doctors. Nonphysicians, obviously, are barred by law from handing out prescription drugs — it’s a felony that can carry up to 10 years in federal prison,” reads a 2003 article from A.C. Thompson in The San Francisco Bay Guardian on a visit to a San Francisco needle exchange site where volunteers were distributing naloxone. \u003c/span>\u003c/p>\n\u003cp>Critics said providing people who used drugs with naloxone, more commonly known by the brand name Narcan, would encourage drug use. Clinicians worried about \u003ca href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=286850\">liability\u003c/a> if people had an adverse reaction to the naloxone, or if they died even after naloxone was used.\u003c/p>\n\u003cp>While studying at San Francisco State University in the same year as the conference on drug policy reform, McLean was assigned to write a paper analyzing a public health problem. She drafted some ideas based on the knowledge she had absorbed from the community, and proposed opening safe injection rooms, testing drug supplies and training people who inject drugs in administering naloxone.\u003c/p>\n\u003cp>She presented the paper to members of a so-called “heroin subcommittee” created by the city to address overdose deaths, and members included the ideas in their final recommendations.\u003c/p>\n\u003cfigure id=\"attachment_11911100\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911100\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Rachel McLean looks through her archive of flyers, zines, educational information, and research on harm reduction at her home on March 10, 2022. A photo of friend and colleague Pete Morse can be seen, as can a zine about Matty Luv, singer of the San Francisco punk band Hickey, who passed away from a heroin overdose in 2002. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Soon after turning in her paper, McLean graduated from college, quit her job as an outreach worker and went to Mexico for three months, burned out by the trauma. But she would sometimes wake up at night to scribble notes about what an overdose prevention program would look like.\u003c/p>\n\u003cp>“The fire was still there,” she said.\u003c/p>\n\u003cp class=\"p1\">Members of the heroin subcommittee ended up calling McLean. They remembered her recommendations from several years before and asked McLean if she would implement some of her ideas.\u003c/p>\n\u003cp>With a $30,000 annual budget, the Drug Overdose Prevention and Education (DOPE) Project began in a makeshift office in McLean’s kitchen in 2002. She started making phone calls to overdose prevention workers, and put together a curriculum to teach drug and alcohol treatment providers, sheriffs and deputies, the probation department, homeless shelter staff, and others how to reverse overdoses through rescue breathing. Without naloxone widely available, rescue breathing was something anyone could do to reverse overdoses, with some training.\u003c/p>\n\u003ch2>Heroin overdose deaths plummet\u003c/h2>\n\u003cp>Alex Kral, then a researcher with the Urban Health Study at UCSF, conducted a pilot study with other researchers in 2001 to 2002, training 24 people to use naloxone. There were 20 overdoses during the study. Trainees reversed all of them, 15 with naloxone, and most of those with an additional rescue method. The researchers presented the findings to the county’s public health director.\u003c/p>\n\u003cp>“We said, ‘Look … you’ve got people dying of overdoses and you’re not able to do anything about that,'” said Kral, who is now an epidemiologist with the nonprofit health research institute RTI International. “‘Why don’t you do something about it?’ And [the director] said, ‘Yeah, let’s do it.'”\u003c/p>\n\u003cp>One year later, the San Francisco Department of Public Health partnered with the DOPE Project to distribute naloxone at syringe-exchange programs, SROs, reentry programs and other sites in the community.\u003c/p>\n\u003cp>Joshua Bamberger, who oversaw the program with San Francisco’s DPH, said heroin overdose deaths dropped “unbelievably down,” plummeting from a peak of 155 in 1995 to 10 in 2010.\u003c/p>\n\u003cfigure id=\"attachment_11911101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911101\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">An altar includes a candle from a memorial for Pete Morse on the mantel of Rachel McLean’s home on March 10, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Nothing’s gonna reduce death to the extent that getting 10,000 doses of naloxone out there in San Francisco in the early 2000s will ever do,” Bamberger said.\u003c/p>\n\u003cp>McLean, who now works for the state health department, still keeps a picture on her mantel of Pete Morse, who was at the forefront of bringing naloxone to the streets of San Francisco. He died of a drug overdose in 2007.\u003c/p>\n\u003cp>“I think about him all the time. I want to make sure that his contributions are remembered,” McLean said. “I don’t want to say that it broke my heart the most because I don’t want to compare it to all of the other deaths, but it’s still with me.”\u003c/p>\n\u003ch2>The fentanyl overdose crisis\u003c/h2>\n\u003cp>Naloxone has become a key tool in reducing overdose deaths nationwide. For years, it helped stave off the worst of the opioid crisis in San Francisco. But geography also helped for a time. On the West Coast, black tar heroin was the most common type of heroin, and that black color made it more difficult to hide white-powdered fentanyl inside.\u003c/p>\n\u003cp>Still, the number of people who injected drugs in San Francisco — mostly heroin — more than doubled early in this century, from 10,158 in 2005 to 22,000 in 2012.\u003c/p>\n\u003cp>By 2017, fentanyl had crept in to begin its rampage. That year, the city reported 36 deaths linked to fentanyl. That jumped to 90 in 2018. In 2020, the number of fentanyl-related deaths skyrocketed to 518.\u003c/p>\n\u003cp>An estimated 650 people overdosed and died in San Francisco last year, a spike driven by fentanyl, according to data from the San Francisco Medical Examiner’s Office.\u003c/p>\n\u003cfigure id=\"attachment_11911293\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911293\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-800x384.png\" alt=\"\" width=\"800\" height=\"384\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-800x384.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-1020x489.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-160x77.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-1536x737.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1.png 1626w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Data on fentanyl-related and non-fentanyl-related overdose deaths from the San Francisco Department of Public Health and San Francisco Medical Examiner’s Office. \u003ccite>(Chart by Matthew Green/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I lost so many people to just fentanyl,” said Joel Webber, who goes by Turtle. He sat on a curb recently near Hotel Whitcomb, a city-run hotel on Market Street. People regularly gather nearby to use or sell drugs.\u003c/p>\n\u003cp>Webber said he received methadone treatment for 22 years, then started using fentanyl when he stopped his methadone treatment.\u003c/p>\n\u003cp>“If I could, I would blow up every f—ing fentanyl lab up with a button and end it. I’d get sick, but I’ll take it,” Webber said. “I just want it gone.”\u003c/p>\n\u003cp>Drugs like fentanyl are unlikely to disappear, and that means the city will need to try new strategies to prevent overdoses. A river of naloxone is not enough to confront the crisis, said Keith Humphreys, an addiction researcher at Stanford University School of Medicine.\u003c/p>\n\u003cp>One dose of naloxone often is not enough to reverse a fentanyl overdose.\u003c/p>\n\u003cp>“Maybe we can’t make fentanyl use safe,” he said. “Let’s say you make it twice as safe. It’s still just so deadly it just overwhelms the capacity of what we know how to do.”\u003c/p>\n\u003ch2>Community and trauma in harm-reduction work\u003c/h2>\n\u003cp>In 2021, President Joe Biden became the first president to make expanding harm reduction one of his drug-policy priorities. But people still argue that harm reduction encourages drug use. Several city leaders in San Francisco have criticized an overreliance on harm-reduction services and a lack of abstinence-based treatment options.\u003c/p>\n\u003cfigure id=\"attachment_11911102\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911102\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Marshall and the Dope Project team pose for a portrait during Overdose Awareness Day in 2020. The event gathers providers and community members to hold space for those lost and celebrate people still with them. \u003ccite>(Courtesy of Kristen Marshall)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kristen Marshall was the program manager for the DOPE Project until last winter.\u003c/p>\n\u003cp>“When you do this work, it’s your life, even if you try to fight it. It’s a lot of grief, it’s a lot of pain, it’s a lot of trauma. And that breaks a person down,” she said. “It feels really hard for me as someone who is in this position when suddenly people are like, ‘Well, this is your job. If overdose prevention is your job, what do you do? Harm reduction must not work.'”\u003c/p>\n\u003cp>Still, because of the vast supply of naloxone in the community, people are reversing more drug overdoses, many fentanyl-related, in San Francisco than ever before. The DOPE Project reported 81 overdose reversals in 2006. In the year 2021 alone, the group reported 8,985 reversals. Many of those overdoses were reversed by people who use drugs. In comparison, San Francisco police, who by then were carrying naloxone, reversed 144 overdoses in 2021.\u003c/p>\n\u003cfigure id=\"attachment_11911286\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911286\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-800x581.png\" alt=\"\" width=\"800\" height=\"581\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-800x581.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-1020x740.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-160x116.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-1536x1115.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco.png 1634w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Reporting data from the Drug Overdose Prevention and Education Project, as documented in a San Francisco Department of Public Health report. \u003ccite>(Chart by Matthew Green/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marshall said the larger question she keeps asking herself is what happens after overdoses are reversed.\u003c/p>\n\u003cp>“So they go to treatment, then what? Where’s their housing? So they go right back outside,” she said.\u003c/p>\n\u003cp>She believes overdose prevention efforts will inevitably fall short until root causes such as poverty, racism and isolation are addressed.\u003c/p>\n\u003cp>“We’re giving people Narcan and saying, ‘Live, live, live, live — you have to live,’” she said. “The question that I want to ask everyone is, ‘What are we living for? What is there for people to grasp?’”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This reporting was produced as a project for the USC Annenberg Center for Health Journalism’s 2021 Data Fellowship. KQED’s Kate Wolffe contributed to this story. \u003c/em>\u003c/p>\n\n",
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"excerpt": "The use of Narcan to reverse drug overdoses in San Francisco began as an underground movement more than two decades ago. It's part of a long history of harm reduction that stretches from the Summer of Love in 1967 to today's fentanyl crisis.",
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"title": "From the Underground to Public Health Policy: A History of Harm Reduction in San Francisco | KQED",
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"headline": "From the Underground to Public Health Policy: A History of Harm Reduction in San Francisco",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was 1998, and San Francisco was in the midst of a heroin overdose crisis. Rachel McLean was an outreach worker in the Haight, and she says it felt like a war zone.\u003c/p>\n\u003cp>When youth in the neighborhood fatally overdosed, outreach workers would host memorials by a bench in Golden Gate Park’s Panhandle.\u003c/p>\n\u003cp>They’d order pizza, tell stories, make zines and write poetry. But then came one three-week stretch with a new overdose death each week.\u003c/p>\n\u003cp>“And by the time we got to the third memorial, no one could even talk about what they loved and remembered about that person because it was just too much,” McLean said. “And I remember a bunch of kids were like, ‘You know, ‘eff this, I’m just going to go and get high.'”\u003c/p>\n\u003cp>Heroin prices had dropped and the purity had doubled. From 1997 to 2000, 384 people died from heroin-related causes in San Francisco, making it the city’s single-largest cause of accidental death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2000, the San Francisco Health Commission made harm reduction — a philosophy that advocates for making it safer to use drugs rather than criminalizing those who do — an official public health policy. It’s an approach with roots spanning from the Summer of Love in 1967, to the beginning of the AIDS pandemic in the 1980s, to the present-day fight to open sites in San Francisco for people to use drugs safely.\u003c/p>\n\u003cfigure id=\"attachment_11911094\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911094\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54198_007_KQED_VitkaEisenHealthRight360_03092022-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vitka Eisen, president and CEO of HealthRIGHT 360, poses for a portrait at the medical clinic in San Francisco on March 9, 2022. HealthRIGHT 360 is a health care provider for lower-income and otherwise marginalized Californians. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Inside a ‘hippie’ clinic, health care was a right\u003c/h2>\n\u003cp>The Haight Ashbury Free Medical Clinic opened its doors in 1967, committed to an ethos where health care was a right, not a privilege. Tens of thousands of flower children and teenage runaways were flocking to San Francisco to “drop out” of everyday society and experiment with drugs, sex and rock ‘n’ roll.\u003c/p>\n\u003cp>The clinic offered people who used drugs health care at a time when the city’s health department worried compassion would encourage the hippies to stay. It provided a safe space for people dealing with bad trips and heroin withdrawal and, later, for veterans returning from Vietnam with post-traumatic stress disorder.\u003c/p>\n\u003cp>Founder Dr. David Smith said it was illegal for physicians to treat people with substance use disorder with prescription drugs in the 1960s. Clinic volunteers were so worried police would shut the clinic down if people used drugs inside that the door was painted to read: “No dealing!/No holding drugs/No using drugs/No alcohol/No pets/Any of these can close the clinic/We Love You.”\u003c/p>\n\u003cp>When the Summer of Love ended, many people went home, but generations of people searching for meaning stayed behind in San Francisco, where the hard drugs moved in and people’s health care needs overwhelmed the clinic.\u003c/p>\n\u003cfigure id=\"attachment_11611310\" class=\"wp-caption alignright\" style=\"max-width: 355px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11611310\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut.jpg\" alt=\"\" width=\"355\" height=\"800\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut.jpg 355w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut-160x361.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/08/RS26138_Detox-Door-Trimed-2-DSC_0018-qut-240x541.jpg 240w\" sizes=\"(max-width: 355px) 100vw, 355px\">\u003cfigcaption class=\"wp-caption-text\">This painted door marked the entrance to the Haight Ashbury Free Medical Clinic. \u003ccite>(Courtesy of David Smith archives)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“More than three years of life in the Haight, once the flower pot of America, now shattered into fragments of terror and despair, a ‘behavioral sink’ of pathologies feeding off the pill and the needle,” read a 1971 New York Times piece.\u003c/p>\n\u003cp>Still, the philosophy of the clinic — not only that health care is a right but also that addiction can be treated with medicine — persisted.\u003c/p>\n\u003cp>“It was harm reduction before there was such a term. It was never like, ‘When are you going to get your shit together?’ It was always, ‘Hey, can I see what’s going on?'” said Vitka Eisen, who was a patient at the Haight Ashbury Free Medical Clinic, as it was called in the 1980s.\u003c/p>\n\u003cp>The clinic smelled of patchouli, and a counselor walked around in a leather fringe jacket, Eisen recalled. She would go to the clinic before visiting her family in New York because she didn’t want to be strung out on heroin when she went to see them. She’d pick up a “kick pack” of medicine to fight stomach cramping and nausea, and to help her sleep during withdrawal.\u003c/p>\n\u003cp>“After the seventh or eighth time, I was like, ‘I can’t do this anymore,’” she said.\u003c/p>\n\u003cp>She got treatment at Walden House, an addiction and mental health treatment program in San Francisco, and said she never used drugs again. Now she runs the treatment provider HealthRIGHT 360, the umbrella organization that includes what is known today as the Haight Ashbury Free Clinics.\u003c/p>\n\u003ch2>‘Carrying bleach was like having aspirin’\u003c/h2>\n\u003cp>The philosophy of harm reduction spread internationally when activists and caregivers sought ways to reduce suffering and health risks during the AIDS crisis in the ’80s. Volunteers handed out clean needles and encouraged cleaning needles with bleach.\u003c/p>\n\u003cp>Maia Szalavitz, the author of “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,” says she was addicted to cocaine and heroin at the time. She was unaware that sharing needles put her at risk of contracting HIV until 1986, when she met Maureen Gammon with the San Francisco-based group Mid-City Consortium to Combat AIDS.\u003c/p>\n\u003cfigure id=\"attachment_11911096\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911096\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-800x846.jpeg\" alt=\"\" width=\"800\" height=\"846\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-800x846.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-1020x1079.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-160x169.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1-1452x1536.jpeg 1452w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Maia-wig-85-or-86-1.jpeg 1859w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maia Szalavitz, author of ‘Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,’ in the 1980s. \u003ccite>(Courtesy of Maia Szalavitz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“She told me I shouldn’t share, but if you have to share, clean the needle with bleach and then with water,” Szalavitz said. “Shooting up is a pretty compulsive thing, so I immediately incorporated this into my compulsive routine and she probably saved my life.”\u003c/p>\n\u003cp>Gammon said carrying bleach was as common as having aspirin.\u003c/p>\n\u003cp>“People just had [bleach], and it was not unusual to go into a corner store or taqueria or bar and ask for a bottle of beach and be able to get it,” Gammon said.\u003c/p>\n\u003ch2>Inside the Ambassador Hotel\u003c/h2>\n\u003cp>The AIDS crisis also forged a new generation of physicians, said Joshua Bamberger, an associate clinical professor of family and community medicine at UCSF.\u003c/p>\n\u003cp>He began his residency at San Francisco General Hospital in 1989, and said all his energy and focus went into caring for men who were dying of AIDS.\u003c/p>\n\u003cp>“Much of my work was really holding men in my arms as they died,” he said. “And as awful as that was, it also created an era of physicians and other healers who bonded over the important things in medicine, which isn’t necessarily slinging medication but providing love and care for people who are really suffering.”\u003c/p>\n\u003cp>Some hospices refused to take in people who had a history of drug use, or had clauses saying they’d only accept people on the condition they’d been sober for six months before being referred. But the people who needed to be referred often had two or three months left to live.\u003c/p>\n\u003cp>So, many people found refuge at the Ambassador Hotel, an SRO in the Tenderloin run by gay rights activist Hank Wilson beginning in 1978. It became one of the few places where AIDS patients who used drugs could live without having to die on the streets. In the 1996 documentary “Life and Death at the Ambassador Hotel,” the site is described as a model in harm-reduction housing.\u003c/p>\n\u003cp>“The Ambassador was sort of a de facto AIDS hospital,” said Bamberger, who did rounds there, providing care alongside community members and friends of those dying. “When treatment options were limited, and [people] didn’t have a home, the Ambassador was a place where they could land.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/5XiwqOu_R7I'\n title='//www.youtube.com/embed/5XiwqOu_R7I'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Val Robb, a nurse at the Ambassador Hotel, said she had to learn the culture of the people who stayed there. Many people who used drugs were distrustful of a health care system that considered them not worth treating.\u003c/p>\n\u003cp>“I started speaking the language more, which is, ‘Let me work out a deal. You need me to do this. I want you to do that,'” Robb said. “I need you to go to the doctor. If you go to the doctor, if you let them examine you, then let’s get you some codeine. It wasn’t like, ‘I’m Nurse Nancy doing this thing for you.'”\u003c/p>\n\u003cp>There were times Robb had to go against what she knew about health, such as offering guests cigarettes if they would let her examine them. But she said she still had to draw the line.\u003c/p>\n\u003cp>“Another guy, he says, ‘Val, I’m trying to get high, and my partner couldn’t hit the vein. Can’t you?’ I said, ‘No, I’m a nurse with kids and a license, I can’t do that,'” she recalled.\u003c/p>\n\u003cp>It took years before the city approved or funded some of the harm-reduction practices happening underground. The AIDS crisis hit its peak in San Francisco in 1992, and the following year Mayor Frank Jordan declared a state of emergency and announced that San Francisco would back a program to give clean needles to people who used drugs.\u003c/p>\n\u003ch2>‘Call it Lazarus in a hypodermic’\u003c/h2>\n\u003cp>Meanwhile, naloxone, the medication used to reverse overdoses, was still only widely available in medical settings. Rachel McLean, the outreach worker, said she and others attended a conference on drug policy reform in 1999 where an Italian man gave a presentation on naloxone.\u003c/p>\n\u003cp>“None of us could even understand what he was saying because his accent was so strong. But we understood that he said that in Italy, community health workers give out naloxone on the street,” she said. “And all of us, our minds were just blown by that.”\u003c/p>\n\u003cp>At the conference, Dan Bigg with the Chicago Recovery Alliance brought a duffle bag full of naloxone.\u003c/p>\n\u003cp>“And people would just come and take it, and that’s how underground naloxone started in San Francisco,” McLean said.\u003c/p>\n\u003cfigure id=\"attachment_11911104\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911104\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-800x454.png\" alt=\"\" width=\"800\" height=\"454\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-800x454.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-1020x579.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10-160x91.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/Screenshot-2022-04-14-at-06.42.10.png 1522w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Naloxone education material used in San Francisco from the Massachusetts Department of Public Health. \u003ccite>(Courtesy of Joshua Bamberger)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s a mission that’s part Che Guevara, part Mother Teresa. The guerrillas aren’t doctors. Nonphysicians, obviously, are barred by law from handing out prescription drugs — it’s a felony that can carry up to 10 years in federal prison,” reads a 2003 article from A.C. Thompson in The San Francisco Bay Guardian on a visit to a San Francisco needle exchange site where volunteers were distributing naloxone. \u003c/span>\u003c/p>\n\u003cp>Critics said providing people who used drugs with naloxone, more commonly known by the brand name Narcan, would encourage drug use. Clinicians worried about \u003ca href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=286850\">liability\u003c/a> if people had an adverse reaction to the naloxone, or if they died even after naloxone was used.\u003c/p>\n\u003cp>While studying at San Francisco State University in the same year as the conference on drug policy reform, McLean was assigned to write a paper analyzing a public health problem. She drafted some ideas based on the knowledge she had absorbed from the community, and proposed opening safe injection rooms, testing drug supplies and training people who inject drugs in administering naloxone.\u003c/p>\n\u003cp>She presented the paper to members of a so-called “heroin subcommittee” created by the city to address overdose deaths, and members included the ideas in their final recommendations.\u003c/p>\n\u003cfigure id=\"attachment_11911100\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911100\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54296_009_KQED_RachelMcLeanHarmReduction_03102022-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Rachel McLean looks through her archive of flyers, zines, educational information, and research on harm reduction at her home on March 10, 2022. A photo of friend and colleague Pete Morse can be seen, as can a zine about Matty Luv, singer of the San Francisco punk band Hickey, who passed away from a heroin overdose in 2002. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Soon after turning in her paper, McLean graduated from college, quit her job as an outreach worker and went to Mexico for three months, burned out by the trauma. But she would sometimes wake up at night to scribble notes about what an overdose prevention program would look like.\u003c/p>\n\u003cp>“The fire was still there,” she said.\u003c/p>\n\u003cp class=\"p1\">Members of the heroin subcommittee ended up calling McLean. They remembered her recommendations from several years before and asked McLean if she would implement some of her ideas.\u003c/p>\n\u003cp>With a $30,000 annual budget, the Drug Overdose Prevention and Education (DOPE) Project began in a makeshift office in McLean’s kitchen in 2002. She started making phone calls to overdose prevention workers, and put together a curriculum to teach drug and alcohol treatment providers, sheriffs and deputies, the probation department, homeless shelter staff, and others how to reverse overdoses through rescue breathing. Without naloxone widely available, rescue breathing was something anyone could do to reverse overdoses, with some training.\u003c/p>\n\u003ch2>Heroin overdose deaths plummet\u003c/h2>\n\u003cp>Alex Kral, then a researcher with the Urban Health Study at UCSF, conducted a pilot study with other researchers in 2001 to 2002, training 24 people to use naloxone. There were 20 overdoses during the study. Trainees reversed all of them, 15 with naloxone, and most of those with an additional rescue method. The researchers presented the findings to the county’s public health director.\u003c/p>\n\u003cp>“We said, ‘Look … you’ve got people dying of overdoses and you’re not able to do anything about that,'” said Kral, who is now an epidemiologist with the nonprofit health research institute RTI International. “‘Why don’t you do something about it?’ And [the director] said, ‘Yeah, let’s do it.'”\u003c/p>\n\u003cp>One year later, the San Francisco Department of Public Health partnered with the DOPE Project to distribute naloxone at syringe-exchange programs, SROs, reentry programs and other sites in the community.\u003c/p>\n\u003cp>Joshua Bamberger, who oversaw the program with San Francisco’s DPH, said heroin overdose deaths dropped “unbelievably down,” plummeting from a peak of 155 in 1995 to 10 in 2010.\u003c/p>\n\u003cfigure id=\"attachment_11911101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911101\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54290_003_KQED_RachelMcLeanHarmReduction_03102022-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">An altar includes a candle from a memorial for Pete Morse on the mantel of Rachel McLean’s home on March 10, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Nothing’s gonna reduce death to the extent that getting 10,000 doses of naloxone out there in San Francisco in the early 2000s will ever do,” Bamberger said.\u003c/p>\n\u003cp>McLean, who now works for the state health department, still keeps a picture on her mantel of Pete Morse, who was at the forefront of bringing naloxone to the streets of San Francisco. He died of a drug overdose in 2007.\u003c/p>\n\u003cp>“I think about him all the time. I want to make sure that his contributions are remembered,” McLean said. “I don’t want to say that it broke my heart the most because I don’t want to compare it to all of the other deaths, but it’s still with me.”\u003c/p>\n\u003ch2>The fentanyl overdose crisis\u003c/h2>\n\u003cp>Naloxone has become a key tool in reducing overdose deaths nationwide. For years, it helped stave off the worst of the opioid crisis in San Francisco. But geography also helped for a time. On the West Coast, black tar heroin was the most common type of heroin, and that black color made it more difficult to hide white-powdered fentanyl inside.\u003c/p>\n\u003cp>Still, the number of people who injected drugs in San Francisco — mostly heroin — more than doubled early in this century, from 10,158 in 2005 to 22,000 in 2012.\u003c/p>\n\u003cp>By 2017, fentanyl had crept in to begin its rampage. That year, the city reported 36 deaths linked to fentanyl. That jumped to 90 in 2018. In 2020, the number of fentanyl-related deaths skyrocketed to 518.\u003c/p>\n\u003cp>An estimated 650 people overdosed and died in San Francisco last year, a spike driven by fentanyl, according to data from the San Francisco Medical Examiner’s Office.\u003c/p>\n\u003cfigure id=\"attachment_11911293\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911293\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-800x384.png\" alt=\"\" width=\"800\" height=\"384\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-800x384.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-1020x489.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-160x77.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1-1536x737.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/n3ivi-sf-overdose-deaths-from-fentanyl-and-other-drugs-nbsp-__2_-1.png 1626w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Data on fentanyl-related and non-fentanyl-related overdose deaths from the San Francisco Department of Public Health and San Francisco Medical Examiner’s Office. \u003ccite>(Chart by Matthew Green/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I lost so many people to just fentanyl,” said Joel Webber, who goes by Turtle. He sat on a curb recently near Hotel Whitcomb, a city-run hotel on Market Street. People regularly gather nearby to use or sell drugs.\u003c/p>\n\u003cp>Webber said he received methadone treatment for 22 years, then started using fentanyl when he stopped his methadone treatment.\u003c/p>\n\u003cp>“If I could, I would blow up every f—ing fentanyl lab up with a button and end it. I’d get sick, but I’ll take it,” Webber said. “I just want it gone.”\u003c/p>\n\u003cp>Drugs like fentanyl are unlikely to disappear, and that means the city will need to try new strategies to prevent overdoses. A river of naloxone is not enough to confront the crisis, said Keith Humphreys, an addiction researcher at Stanford University School of Medicine.\u003c/p>\n\u003cp>One dose of naloxone often is not enough to reverse a fentanyl overdose.\u003c/p>\n\u003cp>“Maybe we can’t make fentanyl use safe,” he said. “Let’s say you make it twice as safe. It’s still just so deadly it just overwhelms the capacity of what we know how to do.”\u003c/p>\n\u003ch2>Community and trauma in harm-reduction work\u003c/h2>\n\u003cp>In 2021, President Joe Biden became the first president to make expanding harm reduction one of his drug-policy priorities. But people still argue that harm reduction encourages drug use. Several city leaders in San Francisco have criticized an overreliance on harm-reduction services and a lack of abstinence-based treatment options.\u003c/p>\n\u003cfigure id=\"attachment_11911102\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911102\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54382_TheDopeProjectSF2020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Marshall and the Dope Project team pose for a portrait during Overdose Awareness Day in 2020. The event gathers providers and community members to hold space for those lost and celebrate people still with them. \u003ccite>(Courtesy of Kristen Marshall)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kristen Marshall was the program manager for the DOPE Project until last winter.\u003c/p>\n\u003cp>“When you do this work, it’s your life, even if you try to fight it. It’s a lot of grief, it’s a lot of pain, it’s a lot of trauma. And that breaks a person down,” she said. “It feels really hard for me as someone who is in this position when suddenly people are like, ‘Well, this is your job. If overdose prevention is your job, what do you do? Harm reduction must not work.'”\u003c/p>\n\u003cp>Still, because of the vast supply of naloxone in the community, people are reversing more drug overdoses, many fentanyl-related, in San Francisco than ever before. The DOPE Project reported 81 overdose reversals in 2006. In the year 2021 alone, the group reported 8,985 reversals. Many of those overdoses were reversed by people who use drugs. In comparison, San Francisco police, who by then were carrying naloxone, reversed 144 overdoses in 2021.\u003c/p>\n\u003cfigure id=\"attachment_11911286\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11911286\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-800x581.png\" alt=\"\" width=\"800\" height=\"581\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-800x581.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-1020x740.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-160x116.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco-1536x1115.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/xHw1R-narcan-refills-and-reversals-in-san-francisco.png 1634w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Reporting data from the Drug Overdose Prevention and Education Project, as documented in a San Francisco Department of Public Health report. \u003ccite>(Chart by Matthew Green/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marshall said the larger question she keeps asking herself is what happens after overdoses are reversed.\u003c/p>\n\u003cp>“So they go to treatment, then what? Where’s their housing? So they go right back outside,” she said.\u003c/p>\n\u003cp>She believes overdose prevention efforts will inevitably fall short until root causes such as poverty, racism and isolation are addressed.\u003c/p>\n\u003cp>“We’re giving people Narcan and saying, ‘Live, live, live, live — you have to live,’” she said. “The question that I want to ask everyone is, ‘What are we living for? What is there for people to grasp?’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This reporting was produced as a project for the USC Annenberg Center for Health Journalism’s 2021 Data Fellowship. KQED’s Kate Wolffe contributed to this story. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Although more than three-quarters of California adults are vaccinated against COVID-19, opinions are more divided when it comes to vaccinating children. That sentiment played out Thursday when first, the author of a bill that would have mandated vaccines for all children pulled the legislation, and then again when state health officials pushed back the date of their student vaccine mandate.\u003c/p>\n\u003cp>It was a striking shift for a state that had been \u003ca href=\"https://www.latimes.com/california/story/2021-10-01/newsom-sets-covid-vaccine-mandate-across-california-schools\">the nation’s first to announce a planned K-12 COVID-19 mandate\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB871\">Senate Bill 871\u003c/a> by Sen. Richard Pan, a Sacramento Democrat who chairs the Senate Health Committee, would have added COVID-19 vaccines to the list of inoculations California students are required to get in order to attend K-12 schools. The bill would have precluded personal belief exemptions, allowing only students with a rare medical exemption from a doctor to avoid getting the shot.\u003c/p>\n\u003cp>In sidelining his own bill, Pan said the focus needs to be on making sure families can access the vaccine for their children.\u003c/p>\n\u003cp>Within hours, the California Department of Public Health announced it would not begin the process of adding the COVID-19 vaccine to the list of mandated childhood vaccines for K-12 public and private school students because it has not yet been fully approved by the federal Food and Drug Administration. Previously the state \u003ca href=\"https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/\">had intended to require it for the upcoming 2022-23 school year\u003c/a>, but now that won’t happen until at least July 1, 2023.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The health department said in a statement that even after COVID vaccines for kids receive full approval, it would also consider the recommendations of a Centers for Disease Control and Prevention vaccine advisory committee and the American Academy of Pediatrics and American Academy of Family Physicians before issuing a school vaccine requirement.\u003c/p>\n\u003cp>Support for Pan’s bill has been wavering for several weeks. Last month, another member of the Senate Health Committee, Democratic Sen. Connie Leyva of Chino, told the group Stand Up Ontario, in the Inland Empire, that \u003ca href=\"https://www.instagram.com/tv/CbB869zFrvi/?utm_source=ig_web_button_share_sheet\">she was not going to vote for the bill\u003c/a>.\u003c/p>\n\u003cp>She said she told Pan, “I just don’t think it’s the right time. We are too divided in the community. I think this bill is too divisive.”\u003c/p>\n\u003cp>GOP political consultant Mike Madrid said legislators pull bills for many reasons, including a lack of support or because there is another way to reach the same goal.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"vaccine-mandates\"]“If a better way to solve it is access without the acrimony of mandate, that is fine,” he said. “The point isn’t to disagree, it’s to get to a point where we have public health protections.”\u003c/p>\n\u003cp>Pan’s bill was one of \u003ca href=\"https://calmatters.org/health/coronavirus/2022/03/california-vaccine-laws/\">eight aggressive COVID-19-related bills\u003c/a> introduced as part of a slate from the Legislature’s vaccine working group, made up of Democratic lawmakers. Among the bills still alive in the Legislature are proposals that would punish doctors who share misinformation, require schools to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB1479\">continue regular COVID testing\u003c/a>, and change how the state’s vaccination registry works. Also still in play: a bill that would allow 12- to 17-year-olds to get \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB866\">vaccinated without parental consent\u003c/a>.\u003c/p>\n\u003cp>In August, the COVID vaccine received full approval from the FDA for people 16 and older. Children as young as 5 also can receive it, but only under the FDA’s emergency use authorization. \u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/#age-ethnicity\">About two-thirds\u003c/a> of 12- to 17-year-olds in California have been vaccinated, but the numbers are much lower for kids 5 to 11, with only about one-third vaccinated.\u003c/p>\n\u003cp>Citing the low COVID vaccination rate among younger children, Pan said a mandate is not a priority until the state can make the vaccine more accessible. He said that in his experience, as a pediatrician, when parents ask about vaccinations they want to see their child’s doctor. But many doctor’s offices don’t offer the COVID vaccine and have instead been referring families to drug stores or vaccination sites that are often not child-centric.\u003c/p>\n\u003cp>“The challenge is that we are not getting vaccines into essentially the places where people normally get vaccines for their children,” he said, referring to pediatricians’ offices. “We still have a long way to go.”\u003c/p>\n\u003cp>A \u003ca href=\"https://escholarship.org/uc/item/0669t7s7\">Berkeley IGS poll released in late February\u003c/a> found that two-thirds of California voters supported requiring the COVID-19 vaccine for K-12 students. But there is a big split along party lines: Democrats and liberals overwhelmingly support a mandate while only about a quarter of conservatives and Republicans do.\u003c/p>\n\u003cp>Among parents, two-thirds said they felt having their kids vaccinated was essential or important, while 26% percent said it was “either not too or not at all important.” This question did not address the mandate.\u003c/p>\n\u003cp>Pan’s legislation was the second of the working group’s bills to be sidelined by its original author. A proposal to require all people who work, including contractors, to be vaccinated also was pulled.\u003c/p>\n\u003cp>Critics have been pushing back, arguing that the bills are burdensome and infringe on health and privacy rights — and no bill was more controversial than Pan’s. Many parents who opposed it said that parents should get to choose whether to vaccinate their children, especially when the vaccine does not fully prevent transmission and it’s still unclear how long it remains effective against the virus.\u003c/p>\n\u003cp>“We did not feel it was the appropriate policy for children with respect to COVID-19 at this time,” said Christina Hildebrand, head of A Voice for Choice. The group advocates for parental choice and has worked since 2015 to keep personal belief exemptions for various vaccines in place. She points to the low rate of COVID vaccination among 5- to 11-year-olds as a reason to hold off on a mandate.\u003c/p>\n\u003cp>“Those parents have had ample opportunity to get their children vaccinated, but the parents are hesitant,” she said.\u003c/p>\n\u003cp>Pan said it’s difficult to require something that two-thirds of young children have yet to receive. “Mandates are good at getting you to that final bit when we are at 80% and have to get to 90, not when you are below half,” he said. “If you are that far behind, there’s a reason. Some of it is people have questions and want to get them answered, and they want to hear from the person they have been going to for a long time to get vaccinated.”\u003c/p>\n\u003cp>Pan, though, said his bill is certainly not dead. He intends to watch vaccination rates and said it could be something he brings back later.\u003c/p>\n\u003cp>Madrid, the GOP consultant, said the bills signal the possibility of future vaccine mandates as the world becomes more globalized and pandemics happen more frequently.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“There is an appetite to have more protection for public health and not less,” he said. “You give it a year and study how you can make it work if you are going to pass legislation this broad and sweeping. You have to make sure you get it right the first time.”\u003c/p>\n\n",
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"excerpt": "State health officials said a COVID vaccine mandate for students in older grades — which was expected for the upcoming school year — wouldn't be implemented until at least the fall of 2023. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Although more than three-quarters of California adults are vaccinated against COVID-19, opinions are more divided when it comes to vaccinating children. That sentiment played out Thursday when first, the author of a bill that would have mandated vaccines for all children pulled the legislation, and then again when state health officials pushed back the date of their student vaccine mandate.\u003c/p>\n\u003cp>It was a striking shift for a state that had been \u003ca href=\"https://www.latimes.com/california/story/2021-10-01/newsom-sets-covid-vaccine-mandate-across-california-schools\">the nation’s first to announce a planned K-12 COVID-19 mandate\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB871\">Senate Bill 871\u003c/a> by Sen. Richard Pan, a Sacramento Democrat who chairs the Senate Health Committee, would have added COVID-19 vaccines to the list of inoculations California students are required to get in order to attend K-12 schools. The bill would have precluded personal belief exemptions, allowing only students with a rare medical exemption from a doctor to avoid getting the shot.\u003c/p>\n\u003cp>In sidelining his own bill, Pan said the focus needs to be on making sure families can access the vaccine for their children.\u003c/p>\n\u003cp>Within hours, the California Department of Public Health announced it would not begin the process of adding the COVID-19 vaccine to the list of mandated childhood vaccines for K-12 public and private school students because it has not yet been fully approved by the federal Food and Drug Administration. Previously the state \u003ca href=\"https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/\">had intended to require it for the upcoming 2022-23 school year\u003c/a>, but now that won’t happen until at least July 1, 2023.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The health department said in a statement that even after COVID vaccines for kids receive full approval, it would also consider the recommendations of a Centers for Disease Control and Prevention vaccine advisory committee and the American Academy of Pediatrics and American Academy of Family Physicians before issuing a school vaccine requirement.\u003c/p>\n\u003cp>Support for Pan’s bill has been wavering for several weeks. Last month, another member of the Senate Health Committee, Democratic Sen. Connie Leyva of Chino, told the group Stand Up Ontario, in the Inland Empire, that \u003ca href=\"https://www.instagram.com/tv/CbB869zFrvi/?utm_source=ig_web_button_share_sheet\">she was not going to vote for the bill\u003c/a>.\u003c/p>\n\u003cp>She said she told Pan, “I just don’t think it’s the right time. We are too divided in the community. I think this bill is too divisive.”\u003c/p>\n\u003cp>GOP political consultant Mike Madrid said legislators pull bills for many reasons, including a lack of support or because there is another way to reach the same goal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“If a better way to solve it is access without the acrimony of mandate, that is fine,” he said. “The point isn’t to disagree, it’s to get to a point where we have public health protections.”\u003c/p>\n\u003cp>Pan’s bill was one of \u003ca href=\"https://calmatters.org/health/coronavirus/2022/03/california-vaccine-laws/\">eight aggressive COVID-19-related bills\u003c/a> introduced as part of a slate from the Legislature’s vaccine working group, made up of Democratic lawmakers. Among the bills still alive in the Legislature are proposals that would punish doctors who share misinformation, require schools to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB1479\">continue regular COVID testing\u003c/a>, and change how the state’s vaccination registry works. Also still in play: a bill that would allow 12- to 17-year-olds to get \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB866\">vaccinated without parental consent\u003c/a>.\u003c/p>\n\u003cp>In August, the COVID vaccine received full approval from the FDA for people 16 and older. Children as young as 5 also can receive it, but only under the FDA’s emergency use authorization. \u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/#age-ethnicity\">About two-thirds\u003c/a> of 12- to 17-year-olds in California have been vaccinated, but the numbers are much lower for kids 5 to 11, with only about one-third vaccinated.\u003c/p>\n\u003cp>Citing the low COVID vaccination rate among younger children, Pan said a mandate is not a priority until the state can make the vaccine more accessible. He said that in his experience, as a pediatrician, when parents ask about vaccinations they want to see their child’s doctor. But many doctor’s offices don’t offer the COVID vaccine and have instead been referring families to drug stores or vaccination sites that are often not child-centric.\u003c/p>\n\u003cp>“The challenge is that we are not getting vaccines into essentially the places where people normally get vaccines for their children,” he said, referring to pediatricians’ offices. “We still have a long way to go.”\u003c/p>\n\u003cp>A \u003ca href=\"https://escholarship.org/uc/item/0669t7s7\">Berkeley IGS poll released in late February\u003c/a> found that two-thirds of California voters supported requiring the COVID-19 vaccine for K-12 students. But there is a big split along party lines: Democrats and liberals overwhelmingly support a mandate while only about a quarter of conservatives and Republicans do.\u003c/p>\n\u003cp>Among parents, two-thirds said they felt having their kids vaccinated was essential or important, while 26% percent said it was “either not too or not at all important.” This question did not address the mandate.\u003c/p>\n\u003cp>Pan’s legislation was the second of the working group’s bills to be sidelined by its original author. A proposal to require all people who work, including contractors, to be vaccinated also was pulled.\u003c/p>\n\u003cp>Critics have been pushing back, arguing that the bills are burdensome and infringe on health and privacy rights — and no bill was more controversial than Pan’s. Many parents who opposed it said that parents should get to choose whether to vaccinate their children, especially when the vaccine does not fully prevent transmission and it’s still unclear how long it remains effective against the virus.\u003c/p>\n\u003cp>“We did not feel it was the appropriate policy for children with respect to COVID-19 at this time,” said Christina Hildebrand, head of A Voice for Choice. The group advocates for parental choice and has worked since 2015 to keep personal belief exemptions for various vaccines in place. She points to the low rate of COVID vaccination among 5- to 11-year-olds as a reason to hold off on a mandate.\u003c/p>\n\u003cp>“Those parents have had ample opportunity to get their children vaccinated, but the parents are hesitant,” she said.\u003c/p>\n\u003cp>Pan said it’s difficult to require something that two-thirds of young children have yet to receive. “Mandates are good at getting you to that final bit when we are at 80% and have to get to 90, not when you are below half,” he said. “If you are that far behind, there’s a reason. Some of it is people have questions and want to get them answered, and they want to hear from the person they have been going to for a long time to get vaccinated.”\u003c/p>\n\u003cp>Pan, though, said his bill is certainly not dead. He intends to watch vaccination rates and said it could be something he brings back later.\u003c/p>\n\u003cp>Madrid, the GOP consultant, said the bills signal the possibility of future vaccine mandates as the world becomes more globalized and pandemics happen more frequently.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There is an appetite to have more protection for public health and not less,” he said. “You give it a year and study how you can make it work if you are going to pass legislation this broad and sweeping. You have to make sure you get it right the first time.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Ngûyen Pham remembers where he was on March 16, 2020.\u003c/p>\n\u003cp>He was at his house in San José when he got a call from his workplace. “I was told to stay home and work from home,” he said. Santa Clara County had just ordered all residents to shelter in place for the next few weeks.\u003c/p>\n\u003cp>Pham works with the \u003ca href=\"https://varoundtable.org/\">Vietnamese American Roundtable\u003c/a>, a group that promotes workers’ rights and cultural programs for the Vietnamese community in the South Bay — \u003ca href=\"https://en.wikipedia.org/wiki/List_of_U.S._cities_with_large_Vietnamese-American_populations#Cities_with_more_than_10,000_Vietnamese_Americans\">one of the biggest Vietnamese enclaves in the country\u003c/a>.\u003c/p>\n\u003cp>As nonprofits, churches and libraries closed their physical doors and turned online to keep operating, Pham realized that thousands in his community could potentially lose access to food and other essential services these places provided them with. And he knew elders in the Vietnamese community with limited access to the internet were especially vulnerable to losing this aid when they needed it most.\u003c/p>\n\u003cp>He started making calls. He reached out to friends and old colleagues he knew from years of being involved in social work across Santa Clara County to figure out exactly what families and elderly neighbors would need during lockdown, and how to get these services out in the spirit of mutual aid.\u003c/p>\n\u003cp>People responded.\u003c/p>\n\u003cp>Friends were delivering hot meals to the elderly and translating critical information about the coronavirus into Vietnamese. They were even collecting funds to build coffins, for those who lost their lives to COVID-19 but whose families had limited financial resources.\u003c/p>\n\u003cfigure id=\"attachment_11911164\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911164\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ngûyen Pham pictured at a desk in the Vietnamese American Service Center on March 4, 2022. \u003ccite>(Amaya Edwards/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Mutual aid, historically — it’s been there in the community,” Pham said. And in the Vietnamese community, he notes, “the mutual aid effort really started out from helping underprivileged folks here and in Vietnam.”\u003c/p>\n\u003cp>After North Vietnamese forces took control in Vietnam in 1975, the Bay Area saw an influx of Vietnamese migrants. But traditional financial institutions like banks made it difficult for recent arrivals to access credit when they needed it the most.\u003c/p>\n\u003cp>“Small groups would … put money together to fundraise,” said Pham. “They would request from members a donation monthly and would use that money for scholarships, to build houses and things like that.”\u003c/p>\n\u003cp>These strategies employed by Vietnamese families to survive tough times in the U.S. served as the blueprint for young people like Pham to organize at the start of the pandemic — a time when the Bay Area saw many mutual aid efforts spring up.\u003c/p>\n\u003cp>The jarring nature of a global pandemic, paired with an economic downturn that left millions unemployed and unable to pay for basic necessities, left many to turn to mutual aid when local, state and federal governments fell short of providing the kind of support they needed. Many of these efforts received widespread media attention and subsequent financial support throughout 2020.\u003c/p>\n\u003cp>“The pandemic really taught us a lesson that everybody really needs to rely on one another,” Pham said. “When one person is hurt, the rest of the community is in pain.”\u003c/p>\n\u003cp>As time went on, though, organizers say that mainstream coverage — and funding — slowly started to fizzle out in many ways. But those involved in mutual aid work, like Pham and his friends, haven’t stopped organizing.\u003c/p>\n\u003ch2>‘Romanticized’ vs. reality\u003c/h2>\n\u003cp>Mutual aid is work.\u003c/p>\n\u003cp>Organizers invest countless hours each week to raise funds, find food and other essential goods, and maintain an online presence to let folks know what resources are available.\u003c/p>\n\u003cfigure id=\"attachment_11911145\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911145\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Gabriela Alemán, alongside a group of volunteers, packs bread, fruit, vegetables, eggs and milk into boxes during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>No one knows that as well Gabriela Alemán, co-founder of the \u003ca href=\"https://missionmealscoalition.org/\">Mission Meals Coalition\u003c/a> (MMC), a mutual aid network created in San Francisco’s Mission District a few weeks after city officials announced its shelter-in-place order in March 2020.\u003c/p>\n\u003cp>“People see the pictures and they like to hear the updates. But the reality is mutual aid is really, really hard,” she said.\u003c/p>\n\u003cp>Alemán, along with her sister Xiomara and her friend María Castro Noboa, began MMC by connecting immigrant families and seniors across the Bay Area to free warm meals and fresh groceries.\u003c/p>\n\u003cp>They later opened up \u003ca href=\"https://www.kqed.org/news/11853703/support-is-the-force-at-family-led-mission-meals-coalition-serving-the-community-runs-deep\">a free fridge in the Mission where residents could drop off food so others could take what they needed\u003c/a> — at a time when many residents had lost their jobs, and were struggling to keep up with expenses.\u003c/p>\n\u003cp>The group started MMC while they were holding down full-time jobs. They were doing all of this in their free time.\u003c/p>\n\u003cp>Soon after the fridge opened, news outlets across the region — including KQED — were drawn to MMC. Alemán acknowledges that media coverage played a big role in spreading the word about the group, but says there’s a lot more to the story.\u003c/p>\n\u003cp>“Mutual aid was really romanticized, especially with the fridge program,” she said. “Across the country, people were covering these fridges. They had gorgeous images of the fridges.”\u003c/p>\n\u003cp>“But the reality is it’s really hard to maintain a free fridge. There’s so many safety concerns around fridges — and I like to use that kind of as a metaphor for what mutual aid is,” said Alemán.\u003c/p>\n\u003cp>While the group still operates the fridge, they’ve grown to now distribute boxes of food to hundreds of families and workers in San Francisco and the North Bay. This also includes boxes catered specifically to folks with diabetes or prediabetes; baby food for new parents; and dental kits to promote oral health.\u003c/p>\n\u003cfigure id=\"attachment_11911147\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911147\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Community members repack food boxes into bags they can carry home during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues, in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Food justice goes beyond providing a single meal, Alemán explains. While folks could signal what their food needs are by what they take from the fridge, there’s a lot groups like MMC could miss. Who doesn’t have access to a kitchen? Who doesn’t have time to cook a healthy meal because they work two or three jobs to make rent?\u003c/p>\n\u003cp>This is where the preestablished connections within the community came in. “Our community engagement comes from our señoras,” she said. “The relationships they have built across the neighborhood and WhatsApp groups is incredible. You can’t find that anywhere else.\u003c/p>\n\u003cp>That’s some of the critical work that was left out during the flurry of media coverage in 2020, says Alemán. And it hasn’t gotten better since.\u003c/p>\n\u003cp>“I feel like people have moved on from the pandemic, from talking about food equity and food work,” she said.\u003c/p>\n\u003ch2>‘An undying love for our people’\u003c/h2>\n\u003cp>Mutual aid must also be a revolutionary act.\u003c/p>\n\u003cp>That’s according to Yemi Belachew, director of operations for \u003ca href=\"https://www.peoplesprograms.com/\">People’s Programs\u003c/a> — a West Oakland-based group founded by Delency Parham and Blake Simons in 2017 that provides free meals, organizes political education workshops and organizes bail funds for detained Black protesters.\u003c/p>\n\u003cp>When many homeless shelters closed at the start of the pandemic, \u003ca href=\"https://www.kqed.org/bayareabites/137476/for-peoples-breakfast-black-liberation-food-access-and-bail-funds-intersect\">People’s Programs quickly organized to get food, shelter supplies and other goods to unhoused residents across the East Bay\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11911169\" class=\"wp-caption alignnone\" style=\"max-width: 1170px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911169\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut.jpg\" alt=\"\" width=\"1170\" height=\"1162\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut.jpg 1170w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut-800x795.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut-1020x1013.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut-160x159.jpg 160w\" sizes=\"(max-width: 1170px) 100vw, 1170px\">\u003cfigcaption class=\"wp-caption-text\">Members of the West Oakland-based mutual aid organization People’s Programs. \u003ccite>(Courtesy Yemi Belachew)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We’re organizing for independence,” Belachew said. And each of the resources offered by People’s Programs plays a role in the group’s goal of securing Black liberation in Oakland.\u003c/p>\n\u003cp>“Yes, there are people who are hungry. Yes, there are people who need these material needs,” she explained. “But we’re doing that with a political objective.”\u003c/p>\n\u003cp>The People’s Programs’ efforts to bail out Black people arrested in the summer of 2020 during protests following the murder of George Floyd by a Minneapolis police officer garnered \u003ca href=\"https://www.npr.org/local/305/2020/09/18/914028936/local-mutual-aid-groups-face-dwindling-funds-and-burnout-months-into-the-pandemic\">widespread attention across social media\u003c/a>. That visibility helped raise awareness about the food distribution work the group was doing — and folks outside of West Oakland started volunteering.\u003c/p>\n\u003cp>Volunteers and donations from outside the community have shifted in the past two years, but Belachew says that the support from within West Oakland among residents has stayed strong.\u003c/p>\n\u003cp>“When you build with us, you’re not here for one summer, one event, one moment. You’re here for the entirety of the organization,” she said. “And we’re investing in you as well.”\u003c/p>\n\u003cp>From the beginning, People’s Programs has envisioned creating permanent support networks for Black people in the Bay Area, Belachew says. And the media buzz around mutual aid efforts during 2020 — amplified by protests after George Floyd’s murder and the accompanying reckoning with racial justice in the country — did introduce this work to a wider audience.\u003c/p>\n\u003cfigure id=\"attachment_11911171\" class=\"wp-caption alignnone\" style=\"max-width: 1170px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911171\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut.jpg\" alt=\"\" width=\"1170\" height=\"1166\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut.jpg 1170w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut-800x797.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut-1020x1017.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut-160x159.jpg 160w\" sizes=\"(max-width: 1170px) 100vw, 1170px\">\u003cfigcaption class=\"wp-caption-text\">Members of the West Oakland-based mutual aid organization People’s Programs. \u003ccite>(Courtesy Yemi Belachew)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Belachew says that this profile also made it easier for institutions like governments and corporations to appropriate the term, and use it for purposes that weren’t necessarily rooted in community.\u003c/p>\n\u003cp>[aside postID=\"bayareabites_139183\" hero=\"https://ww2.kqed.org/app/uploads/sites/24/2020/10/iStock-1165146004-1020x574.jpg\"]“Mutual aid as a concept has been co-opted by the state, by the media and other organizations,” she said. “Originally, the idea of mutual aid was that we were creating systems of support outside of this genocidal government — that we were supporting each other.”\u003c/p>\n\u003cp>She says that she’s continuing to learn what mutual aid can look like from other folks doing the work on the ground around the Bay Area and the country. Ultimately, a love for one’s people is why you do this work, said Belachew.\u003c/p>\n\u003cp>“An undying love for our people and our people’s liberation. It fuels you in times where your body might not,” she said.\u003c/p>\n\u003ch2>Adapting — and partnering — to survive\u003c/h2>\n\u003cp>As inflation rapidly drives up the cost of food and \u003ca href=\"https://www.kqed.org/news/11908640\">COVID-19 public benefits like eviction protections and unemployment benefits come to an end\u003c/a>, the need for mutual aid keeps growing.\u003c/p>\n\u003cp>Many families in San Francisco are turning to Mission Meals as they once again have to decide between buying groceries or making rent. Alemán makes it clear that the collective will always find a way to fill these needs — but stresses that with limited budgets, it’s not easy keeping up with the growing needs of the community.\u003c/p>\n\u003cfigure id=\"attachment_11911146\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911146\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Volunteers help keep a long line moving during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues, in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There were times last year where the group was not sure whether they’d make it to the next week, Alemán says. Neighbors and friends would pitch in when they could, and donations would come in through social media, but it was a constant battle to stay afloat and have enough food available for everyone who needed it.\u003c/p>\n\u003cp>[aside postID=\"news_11910942\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/gettyimages-1239161116-b8a59eaa6f071f0d7d4d3c37a8b5d53b308502e9-1020x764.jpg\"]Alemán says that stress, along with all their other personal and work responsibilities, was very difficult for the group to manage. “Managing burnout in mutual aid is very real,” said Alemán.\u003c/p>\n\u003cp>So the group sought out help themselves.\u003c/p>\n\u003cp>They formed a partnership last year with \u003ca href=\"https://www.homey-sf.org/\">HOMEY, a 501(c)(3) nonprofit in the Mission that offers social services with a focus on violence prevention\u003c/a>. Thanks to this collaboration, MMC has found a much bigger base to collect and distribute food for, along with mentorship on how to navigate funding and community outreach.\u003c/p>\n\u003cp>“Mission Meals are the next generation of organizers and leaders in our community,” said Roberto Alfaro, executive director of HOMEY. He’s been involved in organizing spaces in the Mission for three decades and says that “it’s our duty and responsibility to support them and to show as much love as we can.”\u003c/p>\n\u003cp>In addition to physical space and guidance, HOMEY provides a stable source of financial support for Mission Meals. Funds granted by the San Francisco Human Services Agency (HSA) finance biweekly meal distributions held at HOMEY’s offices on Mission Street that are organized and led by Mission Meals.\u003c/p>\n\u003cp>While the collective still prioritizes community fundraising, Alemán shares that members of the collective had several conversations before establishing a partnership with HOMEY.\u003c/p>\n\u003cfigure id=\"attachment_11911159\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911159\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Volunteers pack bread, fruit, vegetables, eggs and milk into boxes during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Alemán echoes Belachew from People’s Programs: Mutual aid is meant to be the antithesis to institutions. With this in mind, members of the collective discussed whether working with financial resources provided to HOMEY by HSA would alter the foundation or independence of Mission Meals.\u003c/p>\n\u003cp>“We had a lot of conversations with our elders,” she said, “and came to the conclusion after seeing the corruption happening in local politics: Would we rather see this money go towards those hands, or for tax dollars to be put back into the community and in the hands of the people?”\u003c/p>\n\u003cp>The experiences of these past two years have transformed Alemán’s understanding of what mutual aid can look like — and what it takes to make sure this work continues to flourish. For her, a mutual aid network for the Mission should be powered by both the needs and dreams of the Mission’s residents, she explains.\u003c/p>\n\u003cp>“We’ve seen kids grow up … they’re 3 years old now. When they were infants we provided them with their first foods, and now they’re eating solids,” she said. “That’s been a really beautiful thing to see [despite these] circumstances.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>‘What keeps me going’\u003c/h2>\n\u003cp>On the Friday morning that San José’s Ngûyen Pham spoke with KQED, he was working on behalf of the Vietnamese American Roundtable at the \u003ca href=\"https://vasc.sccgov.org/home\">Vietnamese American Service Center\u003c/a> — a resource hub opened last fall by Santa Clara County that serves as a one-stop shop for Asian and Latino residents in the area to connect with a variety of health and social services.\u003c/p>\n\u003cp>Pham sat at a booth near the lobby, where he offered information on what additional rights workers have during the pandemic. Switching to Vietnamese, he listened to questions folks have about their jobs. He noted that there are many words and phrases in English that do not have a direct translation in Vietnamese — just one reason these conversations are critical for monolingual residents to feel fully prepared when standing up for themselves at their workplace.\u003c/p>\n\u003cp>“When we talk about mutual aid, it’s not just putting funds together, but also putting our heads together … to get accurate information to the community so that they can understand the pandemic,” Pham said.\u003c/p>\n\u003cfigure id=\"attachment_11911165\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911165\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ngûyen Pham of the Vietnamese American Roundtable, pictured at work in the Vietnamese American Service Center on March 4, 2022. \u003ccite>(Amaya Edwards/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When translating complicated labor laws, it’s not easy to balance both the original meaning in English \u003cem>and\u003c/em> cultural or linguistic cues in Vietnamese. But Pham and his colleagues at the Vietnamese American Roundtable have gotten a lot of practice in the past two years from \u003ca href=\"https://www.kqed.org/news/11872941/cultural-brokers-for-our-families-young-vietnamese-americans-fight-online-misinformation-for-the-community\">translating public health updates on COVID-19\u003c/a>.\u003c/p>\n\u003cp>They’re also using these skills to tackle tough conversations with older generations. “The younger Vietnamese generations who were born here, or who came here at a young age — there is some misunderstanding between them and the seniors who came here after 1975 with a lot of trauma from the war,” Pham explained.\u003c/p>\n\u003cp>“How do you even explain racial equity in Vietnamese?” he asks. “How do you bridge that gap?”\u003c/p>\n\u003cp>Pham remains hopeful that mutual aid has the power to change how many in his community think. His elders who first set up the first mutual aid networks in the South Bay Vietnamese community taught him that this work can take years, decades and even generations.\u003c/p>\n\u003cp>He now mentors high school students to pass on this knowledge, to make this work easier for younger folks. “It’s just a labor of love,” Pham said. “They are what keeps me going.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ngûyen Pham remembers where he was on March 16, 2020.\u003c/p>\n\u003cp>He was at his house in San José when he got a call from his workplace. “I was told to stay home and work from home,” he said. Santa Clara County had just ordered all residents to shelter in place for the next few weeks.\u003c/p>\n\u003cp>Pham works with the \u003ca href=\"https://varoundtable.org/\">Vietnamese American Roundtable\u003c/a>, a group that promotes workers’ rights and cultural programs for the Vietnamese community in the South Bay — \u003ca href=\"https://en.wikipedia.org/wiki/List_of_U.S._cities_with_large_Vietnamese-American_populations#Cities_with_more_than_10,000_Vietnamese_Americans\">one of the biggest Vietnamese enclaves in the country\u003c/a>.\u003c/p>\n\u003cp>As nonprofits, churches and libraries closed their physical doors and turned online to keep operating, Pham realized that thousands in his community could potentially lose access to food and other essential services these places provided them with. And he knew elders in the Vietnamese community with limited access to the internet were especially vulnerable to losing this aid when they needed it most.\u003c/p>\n\u003cp>He started making calls. He reached out to friends and old colleagues he knew from years of being involved in social work across Santa Clara County to figure out exactly what families and elderly neighbors would need during lockdown, and how to get these services out in the spirit of mutual aid.\u003c/p>\n\u003cp>People responded.\u003c/p>\n\u003cp>Friends were delivering hot meals to the elderly and translating critical information about the coronavirus into Vietnamese. They were even collecting funds to build coffins, for those who lost their lives to COVID-19 but whose families had limited financial resources.\u003c/p>\n\u003cfigure id=\"attachment_11911164\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911164\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55311_RS54092_VASC_MutualAid-11-qut-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ngûyen Pham pictured at a desk in the Vietnamese American Service Center on March 4, 2022. \u003ccite>(Amaya Edwards/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Mutual aid, historically — it’s been there in the community,” Pham said. And in the Vietnamese community, he notes, “the mutual aid effort really started out from helping underprivileged folks here and in Vietnam.”\u003c/p>\n\u003cp>After North Vietnamese forces took control in Vietnam in 1975, the Bay Area saw an influx of Vietnamese migrants. But traditional financial institutions like banks made it difficult for recent arrivals to access credit when they needed it the most.\u003c/p>\n\u003cp>“Small groups would … put money together to fundraise,” said Pham. “They would request from members a donation monthly and would use that money for scholarships, to build houses and things like that.”\u003c/p>\n\u003cp>These strategies employed by Vietnamese families to survive tough times in the U.S. served as the blueprint for young people like Pham to organize at the start of the pandemic — a time when the Bay Area saw many mutual aid efforts spring up.\u003c/p>\n\u003cp>The jarring nature of a global pandemic, paired with an economic downturn that left millions unemployed and unable to pay for basic necessities, left many to turn to mutual aid when local, state and federal governments fell short of providing the kind of support they needed. Many of these efforts received widespread media attention and subsequent financial support throughout 2020.\u003c/p>\n\u003cp>“The pandemic really taught us a lesson that everybody really needs to rely on one another,” Pham said. “When one person is hurt, the rest of the community is in pain.”\u003c/p>\n\u003cp>As time went on, though, organizers say that mainstream coverage — and funding — slowly started to fizzle out in many ways. But those involved in mutual aid work, like Pham and his friends, haven’t stopped organizing.\u003c/p>\n\u003ch2>‘Romanticized’ vs. reality\u003c/h2>\n\u003cp>Mutual aid is work.\u003c/p>\n\u003cp>Organizers invest countless hours each week to raise funds, find food and other essential goods, and maintain an online presence to let folks know what resources are available.\u003c/p>\n\u003cfigure id=\"attachment_11911145\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911145\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54181_038_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Gabriela Alemán, alongside a group of volunteers, packs bread, fruit, vegetables, eggs and milk into boxes during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>No one knows that as well Gabriela Alemán, co-founder of the \u003ca href=\"https://missionmealscoalition.org/\">Mission Meals Coalition\u003c/a> (MMC), a mutual aid network created in San Francisco’s Mission District a few weeks after city officials announced its shelter-in-place order in March 2020.\u003c/p>\n\u003cp>“People see the pictures and they like to hear the updates. But the reality is mutual aid is really, really hard,” she said.\u003c/p>\n\u003cp>Alemán, along with her sister Xiomara and her friend María Castro Noboa, began MMC by connecting immigrant families and seniors across the Bay Area to free warm meals and fresh groceries.\u003c/p>\n\u003cp>They later opened up \u003ca href=\"https://www.kqed.org/news/11853703/support-is-the-force-at-family-led-mission-meals-coalition-serving-the-community-runs-deep\">a free fridge in the Mission where residents could drop off food so others could take what they needed\u003c/a> — at a time when many residents had lost their jobs, and were struggling to keep up with expenses.\u003c/p>\n\u003cp>The group started MMC while they were holding down full-time jobs. They were doing all of this in their free time.\u003c/p>\n\u003cp>Soon after the fridge opened, news outlets across the region — including KQED — were drawn to MMC. Alemán acknowledges that media coverage played a big role in spreading the word about the group, but says there’s a lot more to the story.\u003c/p>\n\u003cp>“Mutual aid was really romanticized, especially with the fridge program,” she said. “Across the country, people were covering these fridges. They had gorgeous images of the fridges.”\u003c/p>\n\u003cp>“But the reality is it’s really hard to maintain a free fridge. There’s so many safety concerns around fridges — and I like to use that kind of as a metaphor for what mutual aid is,” said Alemán.\u003c/p>\n\u003cp>While the group still operates the fridge, they’ve grown to now distribute boxes of food to hundreds of families and workers in San Francisco and the North Bay. This also includes boxes catered specifically to folks with diabetes or prediabetes; baby food for new parents; and dental kits to promote oral health.\u003c/p>\n\u003cfigure id=\"attachment_11911147\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911147\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54171_028_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Community members repack food boxes into bags they can carry home during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues, in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Food justice goes beyond providing a single meal, Alemán explains. While folks could signal what their food needs are by what they take from the fridge, there’s a lot groups like MMC could miss. Who doesn’t have access to a kitchen? Who doesn’t have time to cook a healthy meal because they work two or three jobs to make rent?\u003c/p>\n\u003cp>This is where the preestablished connections within the community came in. “Our community engagement comes from our señoras,” she said. “The relationships they have built across the neighborhood and WhatsApp groups is incredible. You can’t find that anywhere else.\u003c/p>\n\u003cp>That’s some of the critical work that was left out during the flurry of media coverage in 2020, says Alemán. And it hasn’t gotten better since.\u003c/p>\n\u003cp>“I feel like people have moved on from the pandemic, from talking about food equity and food work,” she said.\u003c/p>\n\u003ch2>‘An undying love for our people’\u003c/h2>\n\u003cp>Mutual aid must also be a revolutionary act.\u003c/p>\n\u003cp>That’s according to Yemi Belachew, director of operations for \u003ca href=\"https://www.peoplesprograms.com/\">People’s Programs\u003c/a> — a West Oakland-based group founded by Delency Parham and Blake Simons in 2017 that provides free meals, organizes political education workshops and organizes bail funds for detained Black protesters.\u003c/p>\n\u003cp>When many homeless shelters closed at the start of the pandemic, \u003ca href=\"https://www.kqed.org/bayareabites/137476/for-peoples-breakfast-black-liberation-food-access-and-bail-funds-intersect\">People’s Programs quickly organized to get food, shelter supplies and other goods to unhoused residents across the East Bay\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11911169\" class=\"wp-caption alignnone\" style=\"max-width: 1170px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911169\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut.jpg\" alt=\"\" width=\"1170\" height=\"1162\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut.jpg 1170w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut-800x795.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut-1020x1013.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55312_Image-from-iOS-23-qut-160x159.jpg 160w\" sizes=\"(max-width: 1170px) 100vw, 1170px\">\u003cfigcaption class=\"wp-caption-text\">Members of the West Oakland-based mutual aid organization People’s Programs. \u003ccite>(Courtesy Yemi Belachew)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We’re organizing for independence,” Belachew said. And each of the resources offered by People’s Programs plays a role in the group’s goal of securing Black liberation in Oakland.\u003c/p>\n\u003cp>“Yes, there are people who are hungry. Yes, there are people who need these material needs,” she explained. “But we’re doing that with a political objective.”\u003c/p>\n\u003cp>The People’s Programs’ efforts to bail out Black people arrested in the summer of 2020 during protests following the murder of George Floyd by a Minneapolis police officer garnered \u003ca href=\"https://www.npr.org/local/305/2020/09/18/914028936/local-mutual-aid-groups-face-dwindling-funds-and-burnout-months-into-the-pandemic\">widespread attention across social media\u003c/a>. That visibility helped raise awareness about the food distribution work the group was doing — and folks outside of West Oakland started volunteering.\u003c/p>\n\u003cp>Volunteers and donations from outside the community have shifted in the past two years, but Belachew says that the support from within West Oakland among residents has stayed strong.\u003c/p>\n\u003cp>“When you build with us, you’re not here for one summer, one event, one moment. You’re here for the entirety of the organization,” she said. “And we’re investing in you as well.”\u003c/p>\n\u003cp>From the beginning, People’s Programs has envisioned creating permanent support networks for Black people in the Bay Area, Belachew says. And the media buzz around mutual aid efforts during 2020 — amplified by protests after George Floyd’s murder and the accompanying reckoning with racial justice in the country — did introduce this work to a wider audience.\u003c/p>\n\u003cfigure id=\"attachment_11911171\" class=\"wp-caption alignnone\" style=\"max-width: 1170px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911171\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut.jpg\" alt=\"\" width=\"1170\" height=\"1166\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut.jpg 1170w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut-800x797.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut-1020x1017.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55313_Image-from-iOS-22-qut-160x159.jpg 160w\" sizes=\"(max-width: 1170px) 100vw, 1170px\">\u003cfigcaption class=\"wp-caption-text\">Members of the West Oakland-based mutual aid organization People’s Programs. \u003ccite>(Courtesy Yemi Belachew)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Belachew says that this profile also made it easier for institutions like governments and corporations to appropriate the term, and use it for purposes that weren’t necessarily rooted in community.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Mutual aid as a concept has been co-opted by the state, by the media and other organizations,” she said. “Originally, the idea of mutual aid was that we were creating systems of support outside of this genocidal government — that we were supporting each other.”\u003c/p>\n\u003cp>She says that she’s continuing to learn what mutual aid can look like from other folks doing the work on the ground around the Bay Area and the country. Ultimately, a love for one’s people is why you do this work, said Belachew.\u003c/p>\n\u003cp>“An undying love for our people and our people’s liberation. It fuels you in times where your body might not,” she said.\u003c/p>\n\u003ch2>Adapting — and partnering — to survive\u003c/h2>\n\u003cp>As inflation rapidly drives up the cost of food and \u003ca href=\"https://www.kqed.org/news/11908640\">COVID-19 public benefits like eviction protections and unemployment benefits come to an end\u003c/a>, the need for mutual aid keeps growing.\u003c/p>\n\u003cp>Many families in San Francisco are turning to Mission Meals as they once again have to decide between buying groceries or making rent. Alemán makes it clear that the collective will always find a way to fill these needs — but stresses that with limited budgets, it’s not easy keeping up with the growing needs of the community.\u003c/p>\n\u003cfigure id=\"attachment_11911146\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911146\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54175_032_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Volunteers help keep a long line moving during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues, in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There were times last year where the group was not sure whether they’d make it to the next week, Alemán says. Neighbors and friends would pitch in when they could, and donations would come in through social media, but it was a constant battle to stay afloat and have enough food available for everyone who needed it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Alemán says that stress, along with all their other personal and work responsibilities, was very difficult for the group to manage. “Managing burnout in mutual aid is very real,” said Alemán.\u003c/p>\n\u003cp>So the group sought out help themselves.\u003c/p>\n\u003cp>They formed a partnership last year with \u003ca href=\"https://www.homey-sf.org/\">HOMEY, a 501(c)(3) nonprofit in the Mission that offers social services with a focus on violence prevention\u003c/a>. Thanks to this collaboration, MMC has found a much bigger base to collect and distribute food for, along with mentorship on how to navigate funding and community outreach.\u003c/p>\n\u003cp>“Mission Meals are the next generation of organizers and leaders in our community,” said Roberto Alfaro, executive director of HOMEY. He’s been involved in organizing spaces in the Mission for three decades and says that “it’s our duty and responsibility to support them and to show as much love as we can.”\u003c/p>\n\u003cp>In addition to physical space and guidance, HOMEY provides a stable source of financial support for Mission Meals. Funds granted by the San Francisco Human Services Agency (HSA) finance biweekly meal distributions held at HOMEY’s offices on Mission Street that are organized and led by Mission Meals.\u003c/p>\n\u003cp>While the collective still prioritizes community fundraising, Alemán shares that members of the collective had several conversations before establishing a partnership with HOMEY.\u003c/p>\n\u003cfigure id=\"attachment_11911159\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911159\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54185_042_KQED_HomeyFoodDistribution_03052022-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Volunteers pack bread, fruit, vegetables, eggs and milk into boxes during a Guerrer@s de la Ciudad food distribution event at Homey, a nonprofit focused on social and community justice issues in San Francisco’s Mission District on March 5, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Alemán echoes Belachew from People’s Programs: Mutual aid is meant to be the antithesis to institutions. With this in mind, members of the collective discussed whether working with financial resources provided to HOMEY by HSA would alter the foundation or independence of Mission Meals.\u003c/p>\n\u003cp>“We had a lot of conversations with our elders,” she said, “and came to the conclusion after seeing the corruption happening in local politics: Would we rather see this money go towards those hands, or for tax dollars to be put back into the community and in the hands of the people?”\u003c/p>\n\u003cp>The experiences of these past two years have transformed Alemán’s understanding of what mutual aid can look like — and what it takes to make sure this work continues to flourish. For her, a mutual aid network for the Mission should be powered by both the needs and dreams of the Mission’s residents, she explains.\u003c/p>\n\u003cp>“We’ve seen kids grow up … they’re 3 years old now. When they were infants we provided them with their first foods, and now they’re eating solids,” she said. “That’s been a really beautiful thing to see [despite these] circumstances.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>‘What keeps me going’\u003c/h2>\n\u003cp>On the Friday morning that San José’s Ngûyen Pham spoke with KQED, he was working on behalf of the Vietnamese American Roundtable at the \u003ca href=\"https://vasc.sccgov.org/home\">Vietnamese American Service Center\u003c/a> — a resource hub opened last fall by Santa Clara County that serves as a one-stop shop for Asian and Latino residents in the area to connect with a variety of health and social services.\u003c/p>\n\u003cp>Pham sat at a booth near the lobby, where he offered information on what additional rights workers have during the pandemic. Switching to Vietnamese, he listened to questions folks have about their jobs. He noted that there are many words and phrases in English that do not have a direct translation in Vietnamese — just one reason these conversations are critical for monolingual residents to feel fully prepared when standing up for themselves at their workplace.\u003c/p>\n\u003cp>“When we talk about mutual aid, it’s not just putting funds together, but also putting our heads together … to get accurate information to the community so that they can understand the pandemic,” Pham said.\u003c/p>\n\u003cfigure id=\"attachment_11911165\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11911165\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS55310_RS54088_VASC_MutualAid-10-qut-qut-1-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ngûyen Pham of the Vietnamese American Roundtable, pictured at work in the Vietnamese American Service Center on March 4, 2022. \u003ccite>(Amaya Edwards/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When translating complicated labor laws, it’s not easy to balance both the original meaning in English \u003cem>and\u003c/em> cultural or linguistic cues in Vietnamese. But Pham and his colleagues at the Vietnamese American Roundtable have gotten a lot of practice in the past two years from \u003ca href=\"https://www.kqed.org/news/11872941/cultural-brokers-for-our-families-young-vietnamese-americans-fight-online-misinformation-for-the-community\">translating public health updates on COVID-19\u003c/a>.\u003c/p>\n\u003cp>They’re also using these skills to tackle tough conversations with older generations. “The younger Vietnamese generations who were born here, or who came here at a young age — there is some misunderstanding between them and the seniors who came here after 1975 with a lot of trauma from the war,” Pham explained.\u003c/p>\n\u003cp>“How do you even explain racial equity in Vietnamese?” he asks. “How do you bridge that gap?”\u003c/p>\n\u003cp>Pham remains hopeful that mutual aid has the power to change how many in his community think. His elders who first set up the first mutual aid networks in the South Bay Vietnamese community taught him that this work can take years, decades and even generations.\u003c/p>\n\u003cp>He now mentors high school students to pass on this knowledge, to make this work easier for younger folks. “It’s just a labor of love,” Pham said. “They are what keeps me going.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Most mornings, around 8 a.m., dozens of people line up in San Francisco’s Civic Center Plaza outside the city’s new one-stop social service site — called the \u003ca href=\"https://sf.gov/location/tenderloin-linkage-center\">Tenderloin Linkage Center\u003c/a> — where food and showers are offered, along with referrals for housing, jobs, drug treatment and a range of other services.\u003c/p>\n\u003cp>On one recent morning, Christopher, who is unhoused and lives on the streets, was among those waiting outside the site, clinging to his bicycle. He said he comes here to use fentanyl in a safe environment where people don’t harass him.[pullquote align=\"right\" size=\"medium\" citation=\"Vitka Eisen, CEO, HealthRIGHT 360\"]‘It really takes a fair amount of time for people to build a relationship, and take positive steps towards their health. … It doesn’t happen because all of a sudden there’s a nice person here who says, ‘Hey, I can get you into treatment today if you want that.’ That’s not how that works.’[/pullquote]\u003c/p>\n\u003cp>KQED is using only Christopher’s first name because of safety concerns he has.\u003c/p>\n\u003cp>A long-time fentanyl user, Christopher comes here as often as he can, and is hoping this morning to finally get an appointment for a housing placement.\u003c/p>\n\u003cp>“I’ve been waiting a long time, a very long time,” he said. “I have faith that they will make it happen. It’s just that I need to make it happen.”\u003c/p>\n\u003cp>Christopher said he previously had a housing appointment set up by staff at the site, but overslept because he normally stays awake all night, and is ready to try again.\u003c/p>\n\u003cp>“This is not a life for me,” he said. “This [drug] has torn me down mentally and physically and in ways I can’t describe.”\u003c/p>\n\u003cp>San Francisco launched the linkage center in January as part of Mayor London Breed’s \u003ca href=\"https://www.kqed.org/news/11899726/sf-mayor-breed-declares-state-of-emergency-in-tenderloin\">state of emergency declaration\u003c/a> for the beleaguered Tenderloin neighborhood — “an effort to more quickly and directly connect people to services,” she said in a statement at the time. “We’ve made a commitment to this neighborhood and its residents and businesses, and we will follow through.”\u003c/p>\n\u003cp>The new site opened amid mounting pressure on city leaders to reduce open-air drug use and skyrocketing overdose deaths in the neighborhood.\u003c/p>\n\u003cp>But how well the site is working is still unclear. The latest data from the city shows that only a tiny percentage of visits have thus far actually resulted in drug treatment.\u003c/p>\n\u003cfigure id=\"attachment_11910684\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11910684\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022.jpg\" alt=\"A man in a large overcoat stands on a street next to a bicycle.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Christopher waits in line to get in to the Tenderloin Linkage Center in San Francisco on Feb. 8, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Between Jan. 31 and March 27, the center had more than 20,100 visits from people seeking everything from drug treatment and housing placement to job and mental health counseling. Fewer than 15 of those visits resulted in “completed linkages” for drug treatment services, in which placements were confirmed.\u003c/p>\n\u003cp>Meanwhile, the number of referrals for drug treatment — in which a person is told where they can access services and shows a willingness to do so — was higher, at nearly 110, but still made up a very small percentage of total visits.\u003c/p>\n\u003cp>Note that while many of those who visit the center experience substance use disorder, the exact percentage of visitors in this category is unclear.\u003c/p>\n\u003cp>KQED tabulated these figures using data from \u003ca href=\"https://sf.gov/information/learn-about-tenderloin-emergency-initiative\">weekly operations reports\u003c/a> published by the city’s Public Health Department, and its \u003ca href=\"https://sf.gov/data/reducing-fatal-and-non-fatal-overdoses-tenderloin\">dashboard on overdose deaths and reversals\u003c/a>. Drug treatment placements include those for outpatient, detox and residential services, as well as medication-assisted treatment.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11904277,news_11900195,news_11899726\"]Despite the low rate of completed linkages for treatment or referrals, some harm reduction advocates and city officials say the center holds promise because people who would otherwise be hard to reach are now showing up.\u003c/p>\n\u003cp>The San Francisco Department of Public Health said measuring success is more complicated than just reviewing the number of linkages.\u003c/p>\n\u003cp>“Achieving a basic level of safety and security is a necessary first step toward potentially being open to treatment, and making progress takes time,” the department said in an email. “By providing a safe space, we build relationships and work with guests to find ways to improve their health, including treatment for substance-use disorders, mental health, and other medical care.”\u003c/p>\n\u003cp>Vitka Eisen, CEO of HealthRIGHT 360, a nonprofit health provider that offers harm-reduction services at the linkage center, said it’s unrealistic to assume people who use drugs will suddenly walk in seeking treatment.\u003c/p>\n\u003cp>“It really takes a fair amount of time for people to build a relationship, and take positive steps towards their health,” she said. “That takes a minute. It doesn’t happen because all of a sudden there’s a nice person here who says, ‘Hey, I can get you into treatment today if you want that.’ That’s not how that works.”\u003c/p>\n\u003cp>And even if it did, Eisen said, people would still likely have to wait for those services because the county and the state are in the midst of a staffing crisis.\u003c/p>\n\u003cp>“We’re one of the largest providers of substance-use treatment in San Francisco, and we do not have enough staff to be able to complete the assessment to put people into treatment rapidly,” she said. “And once they get into treatment, we don’t have enough staff to prepare the treatment plan. A bed is just a bed if you can’t staff it.”\u003c/p>\n\u003cp>City officials also emphasize that one of the site’s goals is to prevent overdose deaths, and say staff there already have overseen more than 50 overdose reversals using the medication naloxone.\u003c/p>\n\u003cp>Dr. Daniel Ciccarone, an addiction and drug researcher at UCSF, said those reversal numbers are good news.\u003c/p>\n\u003cp>“The one shining star, check mark that I see is there’s no deaths on site, despite the fact that they’re engaging with active fentanyl users,” said Ciccarone, referring to data posted through the end of February.\u003c/p>\n\u003cp>Despite that achievement, he said, too few people who visit the linkage center have been connected to permanent, supportive housing. He worries that the root causes of addiction, like poverty and homelessness, are still not being adequately addressed.\u003c/p>\n\u003cp>Evidence shows that housing — particularly housing that includes case management and other wraparound services — often leads to positive health outcomes for people who use drugs, Ciccarone noted.\u003c/p>\n\u003cp>“We have done things like this before. We’ve put fences around the park, we’ve tried to cajole people into treatment, and the ER has their case management for frequent fliers [repeat visitors to the ER] and all that stuff, but yet generation by generation the problem gets worse,” he said. “We live in a wealthy city with a huge income disparity, and we simply don’t have enough resources for our poorest and most marginalized citizens.”\u003c/p>\n\u003cp>Last year, 645 people in the city died from drug overdoses, nearly a quarter of whom were unhoused or did not have a fixed address, according to the medical examiner’s office.\u003c/p>\n\u003cp>And in just the first two months of this year, 98 people in San Francisco already have died from drug overdoses — nearly a quarter of them in the Tenderloin.\u003c/p>\n\u003cfigure id=\"attachment_11910653\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11910653\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\" alt=\"A sandwich board sign on the street that says 'Tenderloin Linkage Center Entrance'\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">People wait in line to get in to the Tenderloin Linkage Center in San Francisco on Feb. 8, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet, as of February, even as some 1,600 unhoused people in the city had been approved for supportive housing and were awaiting their turn to move in, nearly 900 units sat vacant, due largely to bureaucratic delays, according to a \u003ca href=\"https://www.kqed.org/news/11906631/in-san-francisco-hundreds-of-homes-for-the-homeless-sit-vacant\">recent San Francisco Public Press/ProPublica investigation\u003c/a>. Filling those empty rooms would cut the waiting list by more than half, and house roughly one in every eight unhoused people in the city.\u003c/p>\n\u003cp>Jacqui Berlinn, co-founder of the group Mothers Against Drug Deaths, said her son Corey, who is addicted to fentanyl, recently came to the linkage center looking for housing.\u003c/p>\n\u003cp>“He was told the first time there was nothing available and he had to come back, and he went back a second time and he was told the same thing,” she said. “It’s incredibly frustrating. It makes me really angry because I feel like that would be a start to him getting well.”\u003c/p>\n\u003cp>Berlinn and several other mothers \u003ca href=\"https://www.kqed.org/news/11904277/whats-the-end-goal-a-group-of-mothers-protest-drug-use-at-the-tenderloin-linkage-center\">held a demonstration outside\u003c/a> the center in February, protesting its policy of allowing people to use illicit drugs in a fenced-off outdoor area attached to the building — an approach, they argue, that deters treatment.\u003c/p>\n\u003cp>DPH said in a statement that officials are working to eliminate barriers to care by having on-site staff trained to facilitate connections, and are working with behavioral-health providers to quickly accept referrals. The agency also defended the sanctioned drug use at the facility, noting that “the site design, staffing, and setup allow guests to be observed for safety at all times while respecting guest privacy.”\u003c/p>\n\u003cp>There also are plans, it said, to open a drug-free “sober living room” at the linkage center for those who want it.\u003c/p>\n\u003cp>Berlinn, though, said she has given up on waiting for the linkage center to help her son with housing or connections to long-term services. She said there are still too many systematic barriers when people seek assistance.\u003c/p>\n\u003cp>“They need treatment on demand,” said Berlinn, who is now researching treatment options outside of San Francisco. “It’s this whole ‘come back tomorrow’ that people are faced with, that makes them feel hopeless. It needs to be, ‘Let’s go, let’s do this, here’s your support, here’s what we’re going to do.”\u003c/p>\n\u003cp>\u003cem>This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2021 Data Fellowship. KQED’s Kate Wolffe contributed reporting for this story. \u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>KQED is using only Christopher’s first name because of safety concerns he has.\u003c/p>\n\u003cp>A long-time fentanyl user, Christopher comes here as often as he can, and is hoping this morning to finally get an appointment for a housing placement.\u003c/p>\n\u003cp>“I’ve been waiting a long time, a very long time,” he said. “I have faith that they will make it happen. It’s just that I need to make it happen.”\u003c/p>\n\u003cp>Christopher said he previously had a housing appointment set up by staff at the site, but overslept because he normally stays awake all night, and is ready to try again.\u003c/p>\n\u003cp>“This is not a life for me,” he said. “This [drug] has torn me down mentally and physically and in ways I can’t describe.”\u003c/p>\n\u003cp>San Francisco launched the linkage center in January as part of Mayor London Breed’s \u003ca href=\"https://www.kqed.org/news/11899726/sf-mayor-breed-declares-state-of-emergency-in-tenderloin\">state of emergency declaration\u003c/a> for the beleaguered Tenderloin neighborhood — “an effort to more quickly and directly connect people to services,” she said in a statement at the time. “We’ve made a commitment to this neighborhood and its residents and businesses, and we will follow through.”\u003c/p>\n\u003cp>The new site opened amid mounting pressure on city leaders to reduce open-air drug use and skyrocketing overdose deaths in the neighborhood.\u003c/p>\n\u003cp>But how well the site is working is still unclear. The latest data from the city shows that only a tiny percentage of visits have thus far actually resulted in drug treatment.\u003c/p>\n\u003cfigure id=\"attachment_11910684\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11910684\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022.jpg\" alt=\"A man in a large overcoat stands on a street next to a bicycle.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/003_SanFranciscoTenderloinLinkageCenter_02082022-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Christopher waits in line to get in to the Tenderloin Linkage Center in San Francisco on Feb. 8, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Between Jan. 31 and March 27, the center had more than 20,100 visits from people seeking everything from drug treatment and housing placement to job and mental health counseling. Fewer than 15 of those visits resulted in “completed linkages” for drug treatment services, in which placements were confirmed.\u003c/p>\n\u003cp>Meanwhile, the number of referrals for drug treatment — in which a person is told where they can access services and shows a willingness to do so — was higher, at nearly 110, but still made up a very small percentage of total visits.\u003c/p>\n\u003cp>Note that while many of those who visit the center experience substance use disorder, the exact percentage of visitors in this category is unclear.\u003c/p>\n\u003cp>KQED tabulated these figures using data from \u003ca href=\"https://sf.gov/information/learn-about-tenderloin-emergency-initiative\">weekly operations reports\u003c/a> published by the city’s Public Health Department, and its \u003ca href=\"https://sf.gov/data/reducing-fatal-and-non-fatal-overdoses-tenderloin\">dashboard on overdose deaths and reversals\u003c/a>. Drug treatment placements include those for outpatient, detox and residential services, as well as medication-assisted treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Despite the low rate of completed linkages for treatment or referrals, some harm reduction advocates and city officials say the center holds promise because people who would otherwise be hard to reach are now showing up.\u003c/p>\n\u003cp>The San Francisco Department of Public Health said measuring success is more complicated than just reviewing the number of linkages.\u003c/p>\n\u003cp>“Achieving a basic level of safety and security is a necessary first step toward potentially being open to treatment, and making progress takes time,” the department said in an email. “By providing a safe space, we build relationships and work with guests to find ways to improve their health, including treatment for substance-use disorders, mental health, and other medical care.”\u003c/p>\n\u003cp>Vitka Eisen, CEO of HealthRIGHT 360, a nonprofit health provider that offers harm-reduction services at the linkage center, said it’s unrealistic to assume people who use drugs will suddenly walk in seeking treatment.\u003c/p>\n\u003cp>“It really takes a fair amount of time for people to build a relationship, and take positive steps towards their health,” she said. “That takes a minute. It doesn’t happen because all of a sudden there’s a nice person here who says, ‘Hey, I can get you into treatment today if you want that.’ That’s not how that works.”\u003c/p>\n\u003cp>And even if it did, Eisen said, people would still likely have to wait for those services because the county and the state are in the midst of a staffing crisis.\u003c/p>\n\u003cp>“We’re one of the largest providers of substance-use treatment in San Francisco, and we do not have enough staff to be able to complete the assessment to put people into treatment rapidly,” she said. “And once they get into treatment, we don’t have enough staff to prepare the treatment plan. A bed is just a bed if you can’t staff it.”\u003c/p>\n\u003cp>City officials also emphasize that one of the site’s goals is to prevent overdose deaths, and say staff there already have overseen more than 50 overdose reversals using the medication naloxone.\u003c/p>\n\u003cp>Dr. Daniel Ciccarone, an addiction and drug researcher at UCSF, said those reversal numbers are good news.\u003c/p>\n\u003cp>“The one shining star, check mark that I see is there’s no deaths on site, despite the fact that they’re engaging with active fentanyl users,” said Ciccarone, referring to data posted through the end of February.\u003c/p>\n\u003cp>Despite that achievement, he said, too few people who visit the linkage center have been connected to permanent, supportive housing. He worries that the root causes of addiction, like poverty and homelessness, are still not being adequately addressed.\u003c/p>\n\u003cp>Evidence shows that housing — particularly housing that includes case management and other wraparound services — often leads to positive health outcomes for people who use drugs, Ciccarone noted.\u003c/p>\n\u003cp>“We have done things like this before. We’ve put fences around the park, we’ve tried to cajole people into treatment, and the ER has their case management for frequent fliers [repeat visitors to the ER] and all that stuff, but yet generation by generation the problem gets worse,” he said. “We live in a wealthy city with a huge income disparity, and we simply don’t have enough resources for our poorest and most marginalized citizens.”\u003c/p>\n\u003cp>Last year, 645 people in the city died from drug overdoses, nearly a quarter of whom were unhoused or did not have a fixed address, according to the medical examiner’s office.\u003c/p>\n\u003cp>And in just the first two months of this year, 98 people in San Francisco already have died from drug overdoses — nearly a quarter of them in the Tenderloin.\u003c/p>\n\u003cfigure id=\"attachment_11910653\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11910653\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\" alt=\"A sandwich board sign on the street that says 'Tenderloin Linkage Center Entrance'\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">People wait in line to get in to the Tenderloin Linkage Center in San Francisco on Feb. 8, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet, as of February, even as some 1,600 unhoused people in the city had been approved for supportive housing and were awaiting their turn to move in, nearly 900 units sat vacant, due largely to bureaucratic delays, according to a \u003ca href=\"https://www.kqed.org/news/11906631/in-san-francisco-hundreds-of-homes-for-the-homeless-sit-vacant\">recent San Francisco Public Press/ProPublica investigation\u003c/a>. Filling those empty rooms would cut the waiting list by more than half, and house roughly one in every eight unhoused people in the city.\u003c/p>\n\u003cp>Jacqui Berlinn, co-founder of the group Mothers Against Drug Deaths, said her son Corey, who is addicted to fentanyl, recently came to the linkage center looking for housing.\u003c/p>\n\u003cp>“He was told the first time there was nothing available and he had to come back, and he went back a second time and he was told the same thing,” she said. “It’s incredibly frustrating. It makes me really angry because I feel like that would be a start to him getting well.”\u003c/p>\n\u003cp>Berlinn and several other mothers \u003ca href=\"https://www.kqed.org/news/11904277/whats-the-end-goal-a-group-of-mothers-protest-drug-use-at-the-tenderloin-linkage-center\">held a demonstration outside\u003c/a> the center in February, protesting its policy of allowing people to use illicit drugs in a fenced-off outdoor area attached to the building — an approach, they argue, that deters treatment.\u003c/p>\n\u003cp>DPH said in a statement that officials are working to eliminate barriers to care by having on-site staff trained to facilitate connections, and are working with behavioral-health providers to quickly accept referrals. The agency also defended the sanctioned drug use at the facility, noting that “the site design, staffing, and setup allow guests to be observed for safety at all times while respecting guest privacy.”\u003c/p>\n\u003cp>There also are plans, it said, to open a drug-free “sober living room” at the linkage center for those who want it.\u003c/p>\n\u003cp>Berlinn, though, said she has given up on waiting for the linkage center to help her son with housing or connections to long-term services. She said there are still too many systematic barriers when people seek assistance.\u003c/p>\n\u003cp>“They need treatment on demand,” said Berlinn, who is now researching treatment options outside of San Francisco. “It’s this whole ‘come back tomorrow’ that people are faced with, that makes them feel hopeless. It needs to be, ‘Let’s go, let’s do this, here’s your support, here’s what we’re going to do.”\u003c/p>\n\u003cp>\u003cem>This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2021 Data Fellowship. KQED’s Kate Wolffe contributed reporting for this story. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Throughout the pandemic, Mously Diakhate has been treating people in need of urgent care in one of the Bay Area’s hardest-hit communities.\u003c/p>\n\u003cp>A physician assistant at LifeLong Medical Care Brookside San Pablo Health Center in the small East Bay city of San Pablo, which has suffered from the \u003ca href=\"https://www.coronavirus.cchealth.org/overview\">highest COVID-19 rate in Contra Costa County\u003c/a>, Diakhate has consistently shown up for her patients, even as community clinics like hers typically offer substantially lower salaries than do private practices.\u003c/p>\n\u003cp>“We went into medicine to help people,” Diakhate said. “A pandemic is a scary situation, but we have to step up, we have to step up.”\u003c/p>\n\u003cp>In addition to the constant risk of virus exposure she has faced over the last two years, Diakhate also has felt the looming weight of another major stressor: the $74,000 in student debt she owes.[pullquote align=\"right\" size=\"medium\" citation=\"Mously Diakhate, physician assistant\"]‘That’s my dilemma right now. It’s like, do I pay this student loan or do I use that money to help my family be more financially stable?’[/pullquote]While the U.S. Department of Education has paused payments and interest on federal loans since March 2020, that \u003ca href=\"https://studentaid.gov/announcements-events/covid-19\">respite is set to end in May\u003c/a>.\u003c/p>\n\u003cp>“That’s my dilemma right now,” said Diakhate, 33, an immigrant from Senegal who was the first in her family to attend college. “It’s like, do I pay this student loan or do I use that money to help my family be more financially stable?”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Diakhate, who mostly grew up in Oakland and is now a naturalized U.S. citizen, said she’s found a glimmer of hope in a recently introduced U.S. Senate bill that would forgive or fully repay student loan debt for frontline health care workers.\u003c/p>\n\u003cp>\u003ca href=\"https://www.congress.gov/bill/117th-congress/senate-bill/3828/text\">Senate Bill 3828\u003c/a>, introduced by Democratic Sens. Alex Padilla from California and Sheldon Whitehouse from Rhode Island, would benefit medical workers who have provided COVID-related health services during the pandemic. It would include physician assistants like Diakhate, as well doctors, nurses, medical interns, home health care workers, and emergency medical technicians transporting patients to hospitals.\u003c/p>\n\u003cp>The proposed legislation likely would have a major impact on California’s estimated \u003ca href=\"https://www.kff.org/other/state-indicator/total-health-care-employment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\">1.7 million health care workers\u003c/a>. It comes at a time when the state is struggling to expand its health workforce to meet the needs of an increasingly diverse population, and as longtime industry staffing shortages have been further exacerbated by pandemic burnout.\u003c/p>\n\u003cp>“Our brave frontline health care workers have fought tirelessly throughout the pandemic to ensure that our communities stay safe, often putting their own health at risk,” \u003ca href=\"https://www.padilla.senate.gov/newsroom/press-releases/padilla-introduces-legislation-to-grant-student-loan-forgiveness-to-frontline-health-workers%EF%BF%BC/\">Padilla said in a statement\u003c/a>, announcing his Student Loan Forgiveness for Frontline Health Workers Act. “Unfortunately, far too many of these workers are burdened by crippling student loan debt — that is simply unacceptable.”\u003c/p>\n\u003cp>There have been more than 35,000 COVID cases among California’s health care workers, resulting in roughly 400 deaths, according to Padilla’s office.\u003c/p>\n\u003cp>Dr. Janet Coffman, who teaches health policy at UCSF’s Healthforce Center, applauded the bill’s intent of recognizing health care workers’ deep sacrifices and challenges during the pandemic. But she said its current language about who would qualify for loan forgiveness seems “vague,” as hundreds of thousands — if not millions — of people likely would be eligible for the relief.[aside label=\"related coverage\" tag=\"student-debt\"]And a huge amount of funding would be needed to provide even a portion of that relief. For instance, most physicians who graduated last year shouldered an \u003ca href=\"https://students-residents.aamc.org/media/12846/download\">average student debt of $203,000\u003c/a>, according to the Association of American Medical Colleges. For recent dental graduates, it was even higher — nearly \u003ca href=\"https://www.adea.org/Seniors2021/#Fig5\">$302,000\u003c/a> — the American Dental Education Association reported.\u003c/p>\n\u003cp>“It makes sense to make it more targeted to those health professionals on the front lines in the hardest-hit communities, because the health professionals in those communities have the greatest exposure to COVID itself and the greatest stress associated with caring for people,” Coffman said.\u003c/p>\n\u003cp>Student loan debt is one of the main barriers preventing health professionals from working in underserved communities, where the pay is generally much lower, according to many health care experts.\u003c/p>\n\u003cp>Some current federal programs \u003ca href=\"https://www.aafp.org/students-residents/medical-students/begin-your-medical-education/debt-management/funding-options/forgiveness.html#:~:text=Government%20Loan%20Forgiveness%20Programs&text=National%20Health%20Service%20Corps%20(NHSC,service%20at%20an%20approved%20site.\">offer to forgive or repay a portion of student debt\u003c/a> for health professionals who commit to working in underserved communities, like rural areas or lower-income urban neighborhoods. But those grants are extremely competitive, and Diakhate said she has been hesitant to apply, in part because many of her colleagues have been rejected.\u003c/p>\n\u003cp>And because she is not a physician or a dentist, Diakhate doesn’t qualify for other assistance options, such as the state-funded \u003ca href=\"https://www.phcdocs.org/Portals/0/Infographic_CalHealthCares_Jan%202022.pdf\">CalHealthCares\u003c/a> program, which offers up to $300,000 in student loan repayments in exchange for a five-year commitment to work with Medi-Cal patients.\u003c/p>\n\u003cp>Diakhate said that the Padilla bill — if it passes — would make it easier for her to keep working with LifeLong’s mostly lower-income patients.\u003c/p>\n\u003cp>“That will be a burden taken off my shoulders and I can use whatever extra amount I can generate to further financially stabilize my family,” said Diakhate, who took a second job testing people for COVID-19 to make ends meet at home and help support her aging parents.\u003c/p>\n\u003cfigure id=\"attachment_11910230\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11910230 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut.jpeg\" alt=\"A woman in green medical scrubs looks into a microscope.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut.jpeg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-1536x1024.jpeg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physician assistant Mously Diakhate inspects a sample in a microscope at LifeLong Medical Care Brookside San Pablo Health Center in San Pablo, on March 22, 2022. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But whether the loan forgiveness proposal can become a reality remains a big question. A \u003ca href=\"https://www.congress.gov/bill/117th-congress/house-bill/2418\">similar House bill introduced last spring hasn’t advanced\u003c/a>, as approval of billions of dollars in pandemic-relief funding continues to stall in Congress.\u003c/p>\n\u003cp>Padilla and Whitehouse said they both plan to push congressional leadership for more support for their bill to overcome the 60-vote threshold.\u003c/p>\n\u003cp>Meanwhile, as yet \u003ca href=\"https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.html\">another COVID variant spreads across the country\u003c/a>, better support for health care workers is urgently needed, said Dr. Sergio Aguilar-Gaxiola, who directs the UC Davis Center for Reducing Health Disparities.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“There has been an increase in suicides [among health care workers] and certainly an increase in anxiety, mood disorders, and even substance abuse,” he said. “They have been working so much under such difficult circumstances.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Throughout the pandemic, Mously Diakhate has been treating people in need of urgent care in one of the Bay Area’s hardest-hit communities.\u003c/p>\n\u003cp>A physician assistant at LifeLong Medical Care Brookside San Pablo Health Center in the small East Bay city of San Pablo, which has suffered from the \u003ca href=\"https://www.coronavirus.cchealth.org/overview\">highest COVID-19 rate in Contra Costa County\u003c/a>, Diakhate has consistently shown up for her patients, even as community clinics like hers typically offer substantially lower salaries than do private practices.\u003c/p>\n\u003cp>“We went into medicine to help people,” Diakhate said. “A pandemic is a scary situation, but we have to step up, we have to step up.”\u003c/p>\n\u003cp>In addition to the constant risk of virus exposure she has faced over the last two years, Diakhate also has felt the looming weight of another major stressor: the $74,000 in student debt she owes.\u003c/p>\u003c/div>",
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"content": "‘That’s my dilemma right now. It’s like, do I pay this student loan or do I use that money to help my family be more financially stable?’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>While the U.S. Department of Education has paused payments and interest on federal loans since March 2020, that \u003ca href=\"https://studentaid.gov/announcements-events/covid-19\">respite is set to end in May\u003c/a>.\u003c/p>\n\u003cp>“That’s my dilemma right now,” said Diakhate, 33, an immigrant from Senegal who was the first in her family to attend college. “It’s like, do I pay this student loan or do I use that money to help my family be more financially stable?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Diakhate, who mostly grew up in Oakland and is now a naturalized U.S. citizen, said she’s found a glimmer of hope in a recently introduced U.S. Senate bill that would forgive or fully repay student loan debt for frontline health care workers.\u003c/p>\n\u003cp>\u003ca href=\"https://www.congress.gov/bill/117th-congress/senate-bill/3828/text\">Senate Bill 3828\u003c/a>, introduced by Democratic Sens. Alex Padilla from California and Sheldon Whitehouse from Rhode Island, would benefit medical workers who have provided COVID-related health services during the pandemic. It would include physician assistants like Diakhate, as well doctors, nurses, medical interns, home health care workers, and emergency medical technicians transporting patients to hospitals.\u003c/p>\n\u003cp>The proposed legislation likely would have a major impact on California’s estimated \u003ca href=\"https://www.kff.org/other/state-indicator/total-health-care-employment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\">1.7 million health care workers\u003c/a>. It comes at a time when the state is struggling to expand its health workforce to meet the needs of an increasingly diverse population, and as longtime industry staffing shortages have been further exacerbated by pandemic burnout.\u003c/p>\n\u003cp>“Our brave frontline health care workers have fought tirelessly throughout the pandemic to ensure that our communities stay safe, often putting their own health at risk,” \u003ca href=\"https://www.padilla.senate.gov/newsroom/press-releases/padilla-introduces-legislation-to-grant-student-loan-forgiveness-to-frontline-health-workers%EF%BF%BC/\">Padilla said in a statement\u003c/a>, announcing his Student Loan Forgiveness for Frontline Health Workers Act. “Unfortunately, far too many of these workers are burdened by crippling student loan debt — that is simply unacceptable.”\u003c/p>\n\u003cp>There have been more than 35,000 COVID cases among California’s health care workers, resulting in roughly 400 deaths, according to Padilla’s office.\u003c/p>\n\u003cp>Dr. Janet Coffman, who teaches health policy at UCSF’s Healthforce Center, applauded the bill’s intent of recognizing health care workers’ deep sacrifices and challenges during the pandemic. But she said its current language about who would qualify for loan forgiveness seems “vague,” as hundreds of thousands — if not millions — of people likely would be eligible for the relief.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>And a huge amount of funding would be needed to provide even a portion of that relief. For instance, most physicians who graduated last year shouldered an \u003ca href=\"https://students-residents.aamc.org/media/12846/download\">average student debt of $203,000\u003c/a>, according to the Association of American Medical Colleges. For recent dental graduates, it was even higher — nearly \u003ca href=\"https://www.adea.org/Seniors2021/#Fig5\">$302,000\u003c/a> — the American Dental Education Association reported.\u003c/p>\n\u003cp>“It makes sense to make it more targeted to those health professionals on the front lines in the hardest-hit communities, because the health professionals in those communities have the greatest exposure to COVID itself and the greatest stress associated with caring for people,” Coffman said.\u003c/p>\n\u003cp>Student loan debt is one of the main barriers preventing health professionals from working in underserved communities, where the pay is generally much lower, according to many health care experts.\u003c/p>\n\u003cp>Some current federal programs \u003ca href=\"https://www.aafp.org/students-residents/medical-students/begin-your-medical-education/debt-management/funding-options/forgiveness.html#:~:text=Government%20Loan%20Forgiveness%20Programs&text=National%20Health%20Service%20Corps%20(NHSC,service%20at%20an%20approved%20site.\">offer to forgive or repay a portion of student debt\u003c/a> for health professionals who commit to working in underserved communities, like rural areas or lower-income urban neighborhoods. But those grants are extremely competitive, and Diakhate said she has been hesitant to apply, in part because many of her colleagues have been rejected.\u003c/p>\n\u003cp>And because she is not a physician or a dentist, Diakhate doesn’t qualify for other assistance options, such as the state-funded \u003ca href=\"https://www.phcdocs.org/Portals/0/Infographic_CalHealthCares_Jan%202022.pdf\">CalHealthCares\u003c/a> program, which offers up to $300,000 in student loan repayments in exchange for a five-year commitment to work with Medi-Cal patients.\u003c/p>\n\u003cp>Diakhate said that the Padilla bill — if it passes — would make it easier for her to keep working with LifeLong’s mostly lower-income patients.\u003c/p>\n\u003cp>“That will be a burden taken off my shoulders and I can use whatever extra amount I can generate to further financially stabilize my family,” said Diakhate, who took a second job testing people for COVID-19 to make ends meet at home and help support her aging parents.\u003c/p>\n\u003cfigure id=\"attachment_11910230\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11910230 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut.jpeg\" alt=\"A woman in green medical scrubs looks into a microscope.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut.jpeg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS54972_IMG_2402-Diakhate-on-microscope-qut-1536x1024.jpeg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physician assistant Mously Diakhate inspects a sample in a microscope at LifeLong Medical Care Brookside San Pablo Health Center in San Pablo, on March 22, 2022. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But whether the loan forgiveness proposal can become a reality remains a big question. A \u003ca href=\"https://www.congress.gov/bill/117th-congress/house-bill/2418\">similar House bill introduced last spring hasn’t advanced\u003c/a>, as approval of billions of dollars in pandemic-relief funding continues to stall in Congress.\u003c/p>\n\u003cp>Padilla and Whitehouse said they both plan to push congressional leadership for more support for their bill to overcome the 60-vote threshold.\u003c/p>\n\u003cp>Meanwhile, as yet \u003ca href=\"https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.html\">another COVID variant spreads across the country\u003c/a>, better support for health care workers is urgently needed, said Dr. Sergio Aguilar-Gaxiola, who directs the UC Davis Center for Reducing Health Disparities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There has been an increase in suicides [among health care workers] and certainly an increase in anxiety, mood disorders, and even substance abuse,” he said. “They have been working so much under such difficult circumstances.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The search for COVID vaccines, tests and treatments could get easier Wednesday with the White House launch of \u003ca href=\"https://www.covid.gov/\">COVID.gov\u003c/a>, a website meant to be a one-stop shop for everything from free high quality masks to antiviral pills.\u003c/p>\n\u003cp>“We could not have done this six or eight months ago because we didn’t have all the tools we have now,” said White House COVID response coordinator Jeff Zients in an interview with NPR.\u003c/p>\n\u003cp>With the website launch, the White House is following through on a promise President Biden made in his State of the Union address. In that speech he announced a test-to-treat program “so people can get tested at a pharmacy, and if they’re positive, receive antiviral pills on the spot at no cost.”\u003c/p>\n\u003cp>The antiviral pills, especially Paxlovid from Pfizer, are highly effective at preventing hospitalization and death among people who are at high risk of severe disease from COVID infection. But they have to be taken within the first five days of the onset of symptoms. There’s been a disconnect between people getting diagnosed and actually getting these life-saving medications.\u003c/p>\n\u003cp>Up until this point, actually finding participating clinics and pharmacies wasn’t simple. According to the White House, there are now more than 2,000 test-to-treat locations around the country where people can get tested for COVID-19 and, if a prescriber says they need it, immediately get antiviral pills. COVID.gov has a new locator tool, making it easier to find these services quickly.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In addition, the site offers:\u003c/p>\n\u003cul>\n\u003cli>A vaccine/booster locator\u003c/li>\n\u003cli>A form to order free at-home COVID tests (currently 8 maximum per household)\u003c/li>\n\u003cli>A CDC community risk level lookup\u003c/li>\n\u003cli>A testing locator\u003c/li>\n\u003cli>Information about where to get free high quality masks\u003c/li>\n\u003cli>Information on COVID symptoms, treatment, testing and travel\u003c/li>\n\u003c/ul>\n\u003cp>“The new website is a great idea in theory,” said Jerome Adams, who served as surgeon general in the Trump administration. He said he has often been supportive of Biden administration initiatives but says they’ve always been reactive rather than proactive. So, Adams said a website is wonderful if you have the tools to utilize it like internet access and a computer.\u003c/p>\n\u003cp>The \u003ca href=\"https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/\">test-to-treat locator\u003c/a> can be more challenging to navigate on a mobile device than a desktop, for instance.\u003c/p>\n\u003cp>“The communities statistically most likely to need the services that are to be offered on the website are also the communities that are statistically most unlikely to be able to access it,” Adams added. “In other words, this could actually increase inequity.”\u003c/p>\n\u003cp>Many of the items on this new website have been available elsewhere, like information from the CDC about levels of COVID spread in your community or the form to order free at-home rapid COVID tests. But this puts them all in one place at a time when the White House is trying to move from the crisis phase of the pandemic to a time when it is manageable and not as disruptive as it has been.\u003c/p>\n\u003cp>[aside label='Coronavirus Resources and Explainers' tag='coronavirus-resources-and-explainers']“The nation’s medicine cabinet is full of effective treatments, we have free at-home tests, high quality masks, vaccines and boosters all available, so the website brings all these tools together and makes it convenient,” said Zients, who is leaving his role at the White House soon.\u003c/p>\n\u003cp>But, Zients added that if Congress doesn’t come through with the additional COVID relief funds the White House has been asking for, these tools may not be there when people really need them. At the moment, with COVID case numbers, hospitalizations and deaths are all on the decline, there are plenty of rapid tests. And antiviral pills, which had been scarce, are plentiful now, too. But that’s largely thanks to government purchasing contracts.\u003c/p>\n\u003cp>Already the White House has had to forgo a new contract for monoclonal antibody treatments and a program to reimburse providers for testing and treating people who are uninsured is winding down.\u003c/p>\n\u003cp>Congressional negotiations are ongoing.\u003c/p>\n\u003cp>Biden on Wednesday is scheduled to give an update on the country’s fight against COVID-19. In addition to drawing attention to the new website, Zients said Biden will “once again issue the urgent call for Congress to act and provide the funding.”\u003c/p>\n\u003cp>The concern is less about today. There’s plenty of supply. It’s about what happens six months from now if there is another COVID surge, like is happening now in Asia and Western Europe.\u003c/p>\n\u003cp>“We need to continue to protect the American people and prepare for any scenario,” Zients said. “I think it’s clear that the virus is unpredictable and moves fast and is not going to wait for Congress, so Congress needs to act urgently.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The COVID.gov website was designed to be as accessible and easy to use as possible. It is available in English, Spanish and a simplified Chinese, and the writing is purposely simple so the largest possible audience can understand and use the site. There is also a phone number for people who aren’t comfortable with the web.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit \u003ca href=\"https://www.npr.org\">NPR.org\u003c/a>.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+new+federal+website+aims+to+solve+a+key+COVID+problem%3A+where+to+get+antiviral+pills&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The search for COVID vaccines, tests and treatments could get easier Wednesday with the White House launch of \u003ca href=\"https://www.covid.gov/\">COVID.gov\u003c/a>, a website meant to be a one-stop shop for everything from free high quality masks to antiviral pills.\u003c/p>\n\u003cp>“We could not have done this six or eight months ago because we didn’t have all the tools we have now,” said White House COVID response coordinator Jeff Zients in an interview with NPR.\u003c/p>\n\u003cp>With the website launch, the White House is following through on a promise President Biden made in his State of the Union address. In that speech he announced a test-to-treat program “so people can get tested at a pharmacy, and if they’re positive, receive antiviral pills on the spot at no cost.”\u003c/p>\n\u003cp>The antiviral pills, especially Paxlovid from Pfizer, are highly effective at preventing hospitalization and death among people who are at high risk of severe disease from COVID infection. But they have to be taken within the first five days of the onset of symptoms. There’s been a disconnect between people getting diagnosed and actually getting these life-saving medications.\u003c/p>\n\u003cp>Up until this point, actually finding participating clinics and pharmacies wasn’t simple. According to the White House, there are now more than 2,000 test-to-treat locations around the country where people can get tested for COVID-19 and, if a prescriber says they need it, immediately get antiviral pills. COVID.gov has a new locator tool, making it easier to find these services quickly.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In addition, the site offers:\u003c/p>\n\u003cul>\n\u003cli>A vaccine/booster locator\u003c/li>\n\u003cli>A form to order free at-home COVID tests (currently 8 maximum per household)\u003c/li>\n\u003cli>A CDC community risk level lookup\u003c/li>\n\u003cli>A testing locator\u003c/li>\n\u003cli>Information about where to get free high quality masks\u003c/li>\n\u003cli>Information on COVID symptoms, treatment, testing and travel\u003c/li>\n\u003c/ul>\n\u003cp>“The new website is a great idea in theory,” said Jerome Adams, who served as surgeon general in the Trump administration. He said he has often been supportive of Biden administration initiatives but says they’ve always been reactive rather than proactive. So, Adams said a website is wonderful if you have the tools to utilize it like internet access and a computer.\u003c/p>\n\u003cp>The \u003ca href=\"https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/\">test-to-treat locator\u003c/a> can be more challenging to navigate on a mobile device than a desktop, for instance.\u003c/p>\n\u003cp>“The communities statistically most likely to need the services that are to be offered on the website are also the communities that are statistically most unlikely to be able to access it,” Adams added. “In other words, this could actually increase inequity.”\u003c/p>\n\u003cp>Many of the items on this new website have been available elsewhere, like information from the CDC about levels of COVID spread in your community or the form to order free at-home rapid COVID tests. But this puts them all in one place at a time when the White House is trying to move from the crisis phase of the pandemic to a time when it is manageable and not as disruptive as it has been.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The nation’s medicine cabinet is full of effective treatments, we have free at-home tests, high quality masks, vaccines and boosters all available, so the website brings all these tools together and makes it convenient,” said Zients, who is leaving his role at the White House soon.\u003c/p>\n\u003cp>But, Zients added that if Congress doesn’t come through with the additional COVID relief funds the White House has been asking for, these tools may not be there when people really need them. At the moment, with COVID case numbers, hospitalizations and deaths are all on the decline, there are plenty of rapid tests. And antiviral pills, which had been scarce, are plentiful now, too. But that’s largely thanks to government purchasing contracts.\u003c/p>\n\u003cp>Already the White House has had to forgo a new contract for monoclonal antibody treatments and a program to reimburse providers for testing and treating people who are uninsured is winding down.\u003c/p>\n\u003cp>Congressional negotiations are ongoing.\u003c/p>\n\u003cp>Biden on Wednesday is scheduled to give an update on the country’s fight against COVID-19. In addition to drawing attention to the new website, Zients said Biden will “once again issue the urgent call for Congress to act and provide the funding.”\u003c/p>\n\u003cp>The concern is less about today. There’s plenty of supply. It’s about what happens six months from now if there is another COVID surge, like is happening now in Asia and Western Europe.\u003c/p>\n\u003cp>“We need to continue to protect the American people and prepare for any scenario,” Zients said. “I think it’s clear that the virus is unpredictable and moves fast and is not going to wait for Congress, so Congress needs to act urgently.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The COVID.gov website was designed to be as accessible and easy to use as possible. It is available in English, Spanish and a simplified Chinese, and the writing is purposely simple so the largest possible audience can understand and use the site. There is also a phone number for people who aren’t comfortable with the web.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit \u003ca href=\"https://www.npr.org\">NPR.org\u003c/a>.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+new+federal+website+aims+to+solve+a+key+COVID+problem%3A+where+to+get+antiviral+pills&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Community clinics in California that have been waiting for more than a year to be reimbursed for COVID-19 vaccinations may soon be flooding state officials with tens of millions of dollars in bills.\u003c/p>\n\u003cp>The clinics, which serve California’s poorest and most vulnerable residents, may be owed as much as $408 million for the 6.1 million vaccinations they have administered to patients.\u003c/p>\n\u003cp>Now, many clinics say they’re teetering on the edge of a financial cliff and desperately need the money from the state Department of Health Care Services. Some say they already have been forced to cut back patient services by reducing their hours or postponing doctor’s visits.\u003c/p>\n\u003cp>Without funds from the state, CEO Jim Mangia said St. John’s Well Child and Family Center in South Los Angeles will have to shut down vaccination efforts by April 1.[pullquote size=\"medium\" align=\"right\" citation=\"Jim Mangia, CEO, St. John's Well Child and Family Center\"]‘It’s frustrating because the state says they’re committed to vaccine equity, but they’re not paying the vaccine equity providers.’[/pullquote]\u003c/p>\n\u003cp>The largest community health clinic in Los Angeles, St. John’s has administered more than 441,000 COVID-19 shots, mostly to people of color with lower incomes. The clinic is awaiting state payment for at least a third of them, costing $7 million; the rest have been reimbursed under private insurance.\u003c/p>\n\u003cp>“It’s frustrating because the state says they’re committed to vaccine equity, but they’re not paying the vaccine equity providers,” Mangia said.\u003c/p>\n\u003cp>California’s 1,300 community health centers are mandated to provide free or reduced-cost care to people with no or inadequate insurance. They’ve been integral to the state’s efforts to reduce vaccination inequities. About \u003ca href=\"https://data.hrsa.gov/topics/health-centers/covid-vaccination\">80% of vaccines provided at California’s community clinics have gone to people of color\u003c/a>, according to federal data.\u003c/p>\n\u003cp>The clinics were told not to submit claims to the state until now — a year after they spent millions ramping up to vaccinate patients — because the state and federal government had to figure out how to pay for vaccinations.\u003c/p>\n\u003cp>Last month, the federal government agreed to pay California $67 for each COVID-19 vaccination.\u003c/p>\n\u003cp>The Biden administration announced Tuesday that it had run out of money to pay for free COVID-19 vaccinations, tests and treatment. State officials said this will not affect reimbursement for vaccines already administered.\u003c/p>\n\u003cp>Health department officials said in a statement to CalMatters that they have no idea how much money they owe the clinics. The agency has yet to issue guidance on how exactly to submit their claims, and clinics don’t know how long it will take to get paid after sending the state their bills.\u003c/p>\n\u003cp>“It’s so painful that it’s been delayed,” said Andie Martinez Patterson, senior vice president of the California Primary Care Association, which represents community clinics. “Health centers have been holding millions of dollars of claims for over a year. We are desperate that it comes as soon as possible.”\u003c/p>\n\u003cp>Several clinics told CalMatters that services to their patients are suffering because of the payment delays, since they’ve been forced to use their federal emergency funds to cover the cost of vaccines instead of salaries and other primary care services.\u003c/p>\n\u003cp>Patterson said she hasn’t heard of any clinics closing, but many have cut back. That means fewer providers and longer wait times for patients who need medical care.\u003c/p>\n\u003ch2>Where is the money?\u003c/h2>\n\u003cp>Before the pandemic, there was no system in place to pay community clinics for a single service like a vaccine. Typically, shots or scans are billed as part of a provider visit, but that requires being seen by a doctor, which doesn’t happen at walk-up clinics or mass vaccine drives.\u003c/p>\n\u003cp>Instead, state officials told community clinics to hold onto their receipts while the Department of Health Care Services and federal government worked out the payment system.\u003c/p>\n\u003cp>The health department blames the federal government for the delay in payments. \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA-21-0020-Pending.pdf\">California’s initial request for alternative payment\u003c/a> was submitted to the federal government in March 2021, but it wasn’t approved until the end of February, nearly a year later.\u003c/p>\n\u003cp>“The request for reimbursement for these ‘vaccine only’ visits required additional guidance from [the Centers for Medicare and Medicaid Services] and modifications to the original proposal,” a spokesperson said in a statement. Also, the state agency said it “needed to work collaboratively with clinics to obtain data to support the modified proposal of $67 per administration.”\u003c/p>\n\u003cp>Community clinics say they felt a responsibility to administer vaccinations to their patients rapidly, even if payment wasn’t guaranteed.\u003c/p>\n\u003cp>“I don’t think there is anyone who lives in South LA who hasn’t lost a loved one, lost a job, lost a home because of COVID,” Mangia said. “In the midst of that incredible suffering, we decided to mobilize.”\u003c/p>\n\u003cp>St. John’s had considerable expenses, reaching into the millions of dollars: It purchased freezers to store 80,000 vaccines, opened 26 vaccination sites in Los Angeles and hired nearly 600 people to run the clinics six days a week.\u003c/p>\n\u003cp>The clinic received nearly $20 million in federal funds from the American Rescue Plan Act, which was supposed to subsidize primary care efforts. But Mangia said most of those funds were used to pay for vaccination efforts. The $7 million the state owes St. John’s is a drop in the bucket compared to its total costs, but it would still help, Mangia said.\u003c/p>\n\u003cp>Now, just as St. John’s is focusing its efforts on vaccinating children under 5, it will have to close its vaccination sites within two weeks without the funds.\u003c/p>\n\u003cp>“It’s not like we have the capacity to float that kind of money for an extended amount of time,” Mangia said.\u003c/p>\n\u003cp>In Orange County, the Families Together health center has consistently been among the top 10 vaccine providers, administering 56,000 shots in the past year. Between COVID-19 tests and vaccines, about 28,000 patient visits have not been reimbursed, CEO Alexander Rossel said, adding that the clinic is owed at least $1 million for those services.[aside postID=\"news_11908072,news_11902149,news_11901829\" label=\"Related Posts\"]Last year the center’s board allocated general funds toward vaccination efforts despite not knowing whether they’d be reimbursed.\u003c/p>\n\u003cp>“We were struggling for a while. We used a lot of money to deliver these 56,000 vaccines,” Rossel said. “The emergency funds got to the state and the cities and not to the clinics. We’re still waiting for the money.”\u003c/p>\n\u003cp>Rossel said the clinic has worked hard to meet the community’s needs, vaccinating more than 80% of local teachers and sending a mobile clinic to restaurants and shopping centers to serve essential workers.\u003c/p>\n\u003cp>He said he’s disappointed in the lack of support and confidence from the state and local health department, which opted to first open mass vaccination drives at places like Disneyland. Rossel said low-wage workers couldn’t afford to wait hours in line or get the information needed to convince them the vaccine was safe.\u003c/p>\n\u003cp>Community clinics are still upset that the state health department didn’t prioritize them and get them vaccines quickly last year to help their patients with low incomes.\u003c/p>\n\u003cp>“We had to literally fight to get ahold of those vaccines. The federal government started giving us vaccines directly but that took six to eight months,” Rossel said.[pullquote size=\"medium\" align=\"right\" citation=\"Alexander Rossel, CEO, Families Together\"]‘I’m hoping and praying that the state and the county look back and learn what was the best way to deliver vaccines and resources, and I’m hoping they have learned that the community clinics were one of the top-tier responders and they don’t forget about us again.’[/pullquote]Mangia said St. John’s also had to fight for vaccines, sending a letter to the state signed by 100 community organizations demanding the vaccine be sent to South Los Angeles after it had first been sent to UCLA and Cedars-Sinai instead.\u003c/p>\n\u003cp>The delayed payment is yet another blow to the fragile, but essential, health care system.\u003c/p>\n\u003cp>“I’m not a politician. I don’t pretend to be. But I’m disappointed,” Rossel said. “I’m hoping and praying that the state and the county look back and learn what was the best way to deliver vaccines and resources, and I’m hoping they have learned that the community clinics were one of the top-tier responders and they don’t forget about us again.”\u003c/p>\n\u003ch2>The fallout at community clinics\u003c/h2>\n\u003cp>Complicating matters, health centers are struggling with the same employee burnout that hospitals and private clinics have seen during the pandemic — but their margins are even thinner now.\u003c/p>\n\u003cp>“There’s a lot of fear around not having enough money to make it,” said Dori Rose Inda, CEO of Salud Para La Gente in Watsonville, which serves about 30,000 patients with lower incomes.\u003c/p>\n\u003cp>Salud Para La Gente saw precipitous drops in revenue during the first six months of the pandemic, when patients were told to avoid nonemergency care. The health center was only able to survive the past year with a $5 million American Rescue Plan Act grant, Inda said, but that money is all but gone.\u003c/p>\n\u003cp>“We literally pivoted everything to work differently during COVID,” Inda said. “Now as the grants are ending, we’re faced with … figuring out how to go full steam into primary and preventative care again and engage with people who are behind in the care that they need who may be sicker because of that.”\u003c/p>\n\u003cp>In Redding, at the Shasta Community Health Center, staff turnover has been high, with workers getting sick or burnt out. Also, about 10% left when the state vaccine mandate for health care workers took effect, CEO Dean Germano said. He has five times more job openings than normal.\u003c/p>\n\u003cp>“When you don’t have a supportive workforce, it really does impact your clinical efficiency and patient happiness, too, if they can’t get through the phone quickly or get an appointment when they want it,” Germano said.\u003c/p>\n\u003cp>Revenues haven’t bounced back, with patient visits still below pre-pandemic levels, particularly on the dental side, where the clinic sees only about half as many patients as before.\u003c/p>\n\u003cp>Shasta Community used some of its $5.6 million rescue grant to increase salaries to try to stay competitive, but most of it went toward breaking even on vaccine distribution, Germano said.\u003c/p>\n\u003cp>In Modesto, Angela Millan said staff turnover is so high and funding so limited that some clinics at Golden Valley Health Centers have not reopened.\u003c/p>\n\u003cp>“They told us there was not enough staff or providers. They’re saying there’s not enough funds for these clinics to reopen,” Millan said.\u003c/p>\n\u003cp>Millan, who handles patient scheduling, said every few months she’s told to remove a doctor from the schedule because they’ve left, leading to long wait lists.\u003c/p>\n\u003cp>A spokesperson for Golden Valley Health Centers said one clinic is closed for renovation and attributed staffing shortages to widespread lack of health care workers, not funding problems.\u003c/p>\n\u003ch2>Long-term solutions needed for clinics\u003c/h2>\n\u003cp>A bill introduced by state Sen. Bob Hertzberg, a Democrat from Van Nuys, aims to help alleviate some of the financial burden exacerbated by the pandemic by investing $400 million annually in community health centers to be spent on wages, workforce training and improved care.\u003c/p>\n\u003cp>He said the delayed COVID-19 vaccine payments are just one symptom of a long-standing funding gap for community clinics.\u003c/p>\n\u003cp>“Health care for millions of Californians is on the line if we fail to support our state’s community health clinics,” Hertzberg told CalMatters. About a third of the state’s 12 million Medi-Cal enrollees rely on community clinics for health care.\u003c/p>\n\u003cp>Employees at health centers make between 5% and 25% less than hospital workers, according to the Service Employees International Union, co-sponsors of Hertzberg’s bill. SEIU California represents roughly 14,000 health center workers.\u003c/p>\n\u003cp>“The wage gap is pretty significant,” said Joseph Bryant, president of SEIU 1021 in Northern California. “One of our clinics that we were recently able to get some substantial wage increases for, they were hovering just above minimum wage for many of the physician assistants, in the ballpark of $17 to low $20s.”\u003c/p>\n\u003cp>The state health center association also has made a budget request, asking for changes to be made in the way health centers are reimbursed, focusing on the value of services provided rather than volume.\u003c/p>\n\u003cp>Should either effort pass, workers say it could make a big difference.\u003c/p>\n\u003cp>Brisa Barrera, SEIU member and lead medical assistant at Santa Rosa Community Health, said two new medical assistants quit after three weeks because the workload was too much.\u003c/p>\n\u003cp>The churn is affecting patients, too. Some referrals for specialty care are four months old, and specialists have told the clinic they can’t take any more patients.\u003c/p>\n\u003cp>“There are patients telling me, ‘I don’t even bother calling the clinic anymore because the wait time for a live person to answer is over an hour.’ So treatments get delayed,” Barrera said.\u003c/p>\n\u003cp>She thinks about leaving herself sometimes, but as a former Medi-Cal patient, she knows it makes a big difference when patients see a face they recognize.\u003c/p>\n\u003cp>“My parents struggled because of translation, because of culture, because of their financial issues,” Barrera said. “These are patients that need access to care that don’t get the best care elsewhere. If I’m not here for my patients, who is going to take care of them?”\u003c/p>\n\u003cp>\u003cem>This story was updated to reflect that a source intended to say that physician assistants, not physicians, earn a certain wage. Also, t\u003c/em>\u003cem>his story was updated on March 21 with a comment from Golden Valley Health Centers.\u003c/em>\u003c/p>\n\u003cp>\u003cem>CalMatters health coverage is supported by grants from the Blue Shield of California Foundation, the California Health Care Foundation and the California Wellness Foundation.\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "A year after ramping up to vaccinate 6 million residents with lower incomes, community clinics are in dire financial straits waiting for state money. Some are cutting services.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Community clinics in California that have been waiting for more than a year to be reimbursed for COVID-19 vaccinations may soon be flooding state officials with tens of millions of dollars in bills.\u003c/p>\n\u003cp>The clinics, which serve California’s poorest and most vulnerable residents, may be owed as much as $408 million for the 6.1 million vaccinations they have administered to patients.\u003c/p>\n\u003cp>Now, many clinics say they’re teetering on the edge of a financial cliff and desperately need the money from the state Department of Health Care Services. Some say they already have been forced to cut back patient services by reducing their hours or postponing doctor’s visits.\u003c/p>\n\u003cp>Without funds from the state, CEO Jim Mangia said St. John’s Well Child and Family Center in South Los Angeles will have to shut down vaccination efforts by April 1.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The largest community health clinic in Los Angeles, St. John’s has administered more than 441,000 COVID-19 shots, mostly to people of color with lower incomes. The clinic is awaiting state payment for at least a third of them, costing $7 million; the rest have been reimbursed under private insurance.\u003c/p>\n\u003cp>“It’s frustrating because the state says they’re committed to vaccine equity, but they’re not paying the vaccine equity providers,” Mangia said.\u003c/p>\n\u003cp>California’s 1,300 community health centers are mandated to provide free or reduced-cost care to people with no or inadequate insurance. They’ve been integral to the state’s efforts to reduce vaccination inequities. About \u003ca href=\"https://data.hrsa.gov/topics/health-centers/covid-vaccination\">80% of vaccines provided at California’s community clinics have gone to people of color\u003c/a>, according to federal data.\u003c/p>\n\u003cp>The clinics were told not to submit claims to the state until now — a year after they spent millions ramping up to vaccinate patients — because the state and federal government had to figure out how to pay for vaccinations.\u003c/p>\n\u003cp>Last month, the federal government agreed to pay California $67 for each COVID-19 vaccination.\u003c/p>\n\u003cp>The Biden administration announced Tuesday that it had run out of money to pay for free COVID-19 vaccinations, tests and treatment. State officials said this will not affect reimbursement for vaccines already administered.\u003c/p>\n\u003cp>Health department officials said in a statement to CalMatters that they have no idea how much money they owe the clinics. The agency has yet to issue guidance on how exactly to submit their claims, and clinics don’t know how long it will take to get paid after sending the state their bills.\u003c/p>\n\u003cp>“It’s so painful that it’s been delayed,” said Andie Martinez Patterson, senior vice president of the California Primary Care Association, which represents community clinics. “Health centers have been holding millions of dollars of claims for over a year. We are desperate that it comes as soon as possible.”\u003c/p>\n\u003cp>Several clinics told CalMatters that services to their patients are suffering because of the payment delays, since they’ve been forced to use their federal emergency funds to cover the cost of vaccines instead of salaries and other primary care services.\u003c/p>\n\u003cp>Patterson said she hasn’t heard of any clinics closing, but many have cut back. That means fewer providers and longer wait times for patients who need medical care.\u003c/p>\n\u003ch2>Where is the money?\u003c/h2>\n\u003cp>Before the pandemic, there was no system in place to pay community clinics for a single service like a vaccine. Typically, shots or scans are billed as part of a provider visit, but that requires being seen by a doctor, which doesn’t happen at walk-up clinics or mass vaccine drives.\u003c/p>\n\u003cp>Instead, state officials told community clinics to hold onto their receipts while the Department of Health Care Services and federal government worked out the payment system.\u003c/p>\n\u003cp>The health department blames the federal government for the delay in payments. \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA-21-0020-Pending.pdf\">California’s initial request for alternative payment\u003c/a> was submitted to the federal government in March 2021, but it wasn’t approved until the end of February, nearly a year later.\u003c/p>\n\u003cp>“The request for reimbursement for these ‘vaccine only’ visits required additional guidance from [the Centers for Medicare and Medicaid Services] and modifications to the original proposal,” a spokesperson said in a statement. Also, the state agency said it “needed to work collaboratively with clinics to obtain data to support the modified proposal of $67 per administration.”\u003c/p>\n\u003cp>Community clinics say they felt a responsibility to administer vaccinations to their patients rapidly, even if payment wasn’t guaranteed.\u003c/p>\n\u003cp>“I don’t think there is anyone who lives in South LA who hasn’t lost a loved one, lost a job, lost a home because of COVID,” Mangia said. “In the midst of that incredible suffering, we decided to mobilize.”\u003c/p>\n\u003cp>St. John’s had considerable expenses, reaching into the millions of dollars: It purchased freezers to store 80,000 vaccines, opened 26 vaccination sites in Los Angeles and hired nearly 600 people to run the clinics six days a week.\u003c/p>\n\u003cp>The clinic received nearly $20 million in federal funds from the American Rescue Plan Act, which was supposed to subsidize primary care efforts. But Mangia said most of those funds were used to pay for vaccination efforts. The $7 million the state owes St. John’s is a drop in the bucket compared to its total costs, but it would still help, Mangia said.\u003c/p>\n\u003cp>Now, just as St. John’s is focusing its efforts on vaccinating children under 5, it will have to close its vaccination sites within two weeks without the funds.\u003c/p>\n\u003cp>“It’s not like we have the capacity to float that kind of money for an extended amount of time,” Mangia said.\u003c/p>\n\u003cp>In Orange County, the Families Together health center has consistently been among the top 10 vaccine providers, administering 56,000 shots in the past year. Between COVID-19 tests and vaccines, about 28,000 patient visits have not been reimbursed, CEO Alexander Rossel said, adding that the clinic is owed at least $1 million for those services.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Last year the center’s board allocated general funds toward vaccination efforts despite not knowing whether they’d be reimbursed.\u003c/p>\n\u003cp>“We were struggling for a while. We used a lot of money to deliver these 56,000 vaccines,” Rossel said. “The emergency funds got to the state and the cities and not to the clinics. We’re still waiting for the money.”\u003c/p>\n\u003cp>Rossel said the clinic has worked hard to meet the community’s needs, vaccinating more than 80% of local teachers and sending a mobile clinic to restaurants and shopping centers to serve essential workers.\u003c/p>\n\u003cp>He said he’s disappointed in the lack of support and confidence from the state and local health department, which opted to first open mass vaccination drives at places like Disneyland. Rossel said low-wage workers couldn’t afford to wait hours in line or get the information needed to convince them the vaccine was safe.\u003c/p>\n\u003cp>Community clinics are still upset that the state health department didn’t prioritize them and get them vaccines quickly last year to help their patients with low incomes.\u003c/p>\n\u003cp>“We had to literally fight to get ahold of those vaccines. The federal government started giving us vaccines directly but that took six to eight months,” Rossel said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Mangia said St. John’s also had to fight for vaccines, sending a letter to the state signed by 100 community organizations demanding the vaccine be sent to South Los Angeles after it had first been sent to UCLA and Cedars-Sinai instead.\u003c/p>\n\u003cp>The delayed payment is yet another blow to the fragile, but essential, health care system.\u003c/p>\n\u003cp>“I’m not a politician. I don’t pretend to be. But I’m disappointed,” Rossel said. “I’m hoping and praying that the state and the county look back and learn what was the best way to deliver vaccines and resources, and I’m hoping they have learned that the community clinics were one of the top-tier responders and they don’t forget about us again.”\u003c/p>\n\u003ch2>The fallout at community clinics\u003c/h2>\n\u003cp>Complicating matters, health centers are struggling with the same employee burnout that hospitals and private clinics have seen during the pandemic — but their margins are even thinner now.\u003c/p>\n\u003cp>“There’s a lot of fear around not having enough money to make it,” said Dori Rose Inda, CEO of Salud Para La Gente in Watsonville, which serves about 30,000 patients with lower incomes.\u003c/p>\n\u003cp>Salud Para La Gente saw precipitous drops in revenue during the first six months of the pandemic, when patients were told to avoid nonemergency care. The health center was only able to survive the past year with a $5 million American Rescue Plan Act grant, Inda said, but that money is all but gone.\u003c/p>\n\u003cp>“We literally pivoted everything to work differently during COVID,” Inda said. “Now as the grants are ending, we’re faced with … figuring out how to go full steam into primary and preventative care again and engage with people who are behind in the care that they need who may be sicker because of that.”\u003c/p>\n\u003cp>In Redding, at the Shasta Community Health Center, staff turnover has been high, with workers getting sick or burnt out. Also, about 10% left when the state vaccine mandate for health care workers took effect, CEO Dean Germano said. He has five times more job openings than normal.\u003c/p>\n\u003cp>“When you don’t have a supportive workforce, it really does impact your clinical efficiency and patient happiness, too, if they can’t get through the phone quickly or get an appointment when they want it,” Germano said.\u003c/p>\n\u003cp>Revenues haven’t bounced back, with patient visits still below pre-pandemic levels, particularly on the dental side, where the clinic sees only about half as many patients as before.\u003c/p>\n\u003cp>Shasta Community used some of its $5.6 million rescue grant to increase salaries to try to stay competitive, but most of it went toward breaking even on vaccine distribution, Germano said.\u003c/p>\n\u003cp>In Modesto, Angela Millan said staff turnover is so high and funding so limited that some clinics at Golden Valley Health Centers have not reopened.\u003c/p>\n\u003cp>“They told us there was not enough staff or providers. They’re saying there’s not enough funds for these clinics to reopen,” Millan said.\u003c/p>\n\u003cp>Millan, who handles patient scheduling, said every few months she’s told to remove a doctor from the schedule because they’ve left, leading to long wait lists.\u003c/p>\n\u003cp>A spokesperson for Golden Valley Health Centers said one clinic is closed for renovation and attributed staffing shortages to widespread lack of health care workers, not funding problems.\u003c/p>\n\u003ch2>Long-term solutions needed for clinics\u003c/h2>\n\u003cp>A bill introduced by state Sen. Bob Hertzberg, a Democrat from Van Nuys, aims to help alleviate some of the financial burden exacerbated by the pandemic by investing $400 million annually in community health centers to be spent on wages, workforce training and improved care.\u003c/p>\n\u003cp>He said the delayed COVID-19 vaccine payments are just one symptom of a long-standing funding gap for community clinics.\u003c/p>\n\u003cp>“Health care for millions of Californians is on the line if we fail to support our state’s community health clinics,” Hertzberg told CalMatters. About a third of the state’s 12 million Medi-Cal enrollees rely on community clinics for health care.\u003c/p>\n\u003cp>Employees at health centers make between 5% and 25% less than hospital workers, according to the Service Employees International Union, co-sponsors of Hertzberg’s bill. SEIU California represents roughly 14,000 health center workers.\u003c/p>\n\u003cp>“The wage gap is pretty significant,” said Joseph Bryant, president of SEIU 1021 in Northern California. “One of our clinics that we were recently able to get some substantial wage increases for, they were hovering just above minimum wage for many of the physician assistants, in the ballpark of $17 to low $20s.”\u003c/p>\n\u003cp>The state health center association also has made a budget request, asking for changes to be made in the way health centers are reimbursed, focusing on the value of services provided rather than volume.\u003c/p>\n\u003cp>Should either effort pass, workers say it could make a big difference.\u003c/p>\n\u003cp>Brisa Barrera, SEIU member and lead medical assistant at Santa Rosa Community Health, said two new medical assistants quit after three weeks because the workload was too much.\u003c/p>\n\u003cp>The churn is affecting patients, too. Some referrals for specialty care are four months old, and specialists have told the clinic they can’t take any more patients.\u003c/p>\n\u003cp>“There are patients telling me, ‘I don’t even bother calling the clinic anymore because the wait time for a live person to answer is over an hour.’ So treatments get delayed,” Barrera said.\u003c/p>\n\u003cp>She thinks about leaving herself sometimes, but as a former Medi-Cal patient, she knows it makes a big difference when patients see a face they recognize.\u003c/p>\n\u003cp>“My parents struggled because of translation, because of culture, because of their financial issues,” Barrera said. “These are patients that need access to care that don’t get the best care elsewhere. If I’m not here for my patients, who is going to take care of them?”\u003c/p>\n\u003cp>\u003cem>This story was updated to reflect that a source intended to say that physician assistants, not physicians, earn a certain wage. Also, t\u003c/em>\u003cem>his story was updated on March 21 with a comment from Golden Valley Health Centers.\u003c/em>\u003c/p>\n\u003cp>\u003cem>CalMatters health coverage is supported by grants from the Blue Shield of California Foundation, the California Health Care Foundation and the California Wellness Foundation.\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"politicalbreakdown": {
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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"radiolab": {
"id": "radiolab",
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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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"reveal": {
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"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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},
"science-friday": {
"id": "science-friday",
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"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
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"snap-judgment": {
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"title": "Snap Judgment",
"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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