This conversation took place over a number of weeks in April & May & June 2020.
Dan Shea:
So, who are you and where are you?
Nicole:
hi dan,
my name is nicole, i’m a public health nurse and am graduating from nurse practitioner school in a few weeks! i live in jamaica plain.
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DS:
Hey Nicole! So, what has this whole pandemic experience been like for you thus far?
Nicole:
It’s been really difficult, as I imagine it’s been for everyone in different ways. My work has had to suspend some of our services and get creative about how we provide other services in a safe and effective way. For those of us who work out in the community, we’re always thinking about how to support and protect some of our most vulnerable community members, which are those experiencing homelessness. We always knew COVID-19 was going to impact homeless individuals, but it’s especially challenging for people who physically can’t social distance and have nowhere to go to quarantine. So it’s been a lot of problem solving, being flexible with day-to-day changes and trying to piece together resources where we can.
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DS:
Being homeless is hard enough. I can’t even imagine dealing with the pandemic on top of that. Thank you for the work you are doing Nicole. What is a day been like for you during the pandemic? Are you and those you work with experiencing the shortage of protective gear that has affected so many in the medical professions? Is the proper information about Covid-19 getting to the homeless population in your experience?
Nicole:
My work varies day to day, in general we go pretty much where we’re needed. I’ve been spending one day a week at a drop-in office in Lowell where we’re providing safe injection supplies and syringe exchange services. We also do a lot of outreach to encampments for those who may not otherwise seek out healthcare or needle exchange. A lot of my time is spent coordinating, problem-solving and advocating for patients who still need to deal with other issues like substance use and HIV in the context of a pandemic. We’re very fortunate to have enough basic PPE, but I’m not experiencing the same levels of exposure that my friends on the inpatient side are currently facing. I feel so frustrated and angry at our government and healthcare system for failing our essential/front line healthcare and service industry workers in this way.
I think the state and those who work with homeless individuals are trying their best to get that information out in a way that is sensitive to their personal experience and the limitations of their situations. There are so many logistical aspects to consider. How do you go through a drive through testing site for COVID-19 if you don’t have a car? How do you get a provider ordered test when you haven’t been connected to healthcare in years? If we’re going to provide education we also need to ensure access.
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DS:
Access, yes. Healthcare for all, medicare for all. If we had this in our country how do you think that would affect you and your colleagues ability to do your jobs? Do many healthcare workers support an idea like medicare for all in your experience??
Nicole:
The dearth of proper equipment and gear is just stunning. How do you think this pandemic and the many mistakes made in dealing with it will affect or change the healthcare system. Do you at all feel a growing political agency via your profession? It seems to me that you all, the heroes saving the day right now, may come out of this whole disaster with an ability to affect some real change if unified.
i think universal healthcare, medicare for all would completely revolutionize the healthcare system as we know it in the united states. this is a really complex issue, but as a nurse working in massachusetts, i’ve seen the impact of masshealth firsthand. the majority of my patients rely on masshealth for all of their medical needs, as they don’t have the financial means to afford medication co-pays, hospital stays, ER visits, etc., let alone monthly premiums. i do think many healthcare workers support universal healthcare in some form, because we’ve see how insurance reimbursement drives things like length of hospital stays and how being uninsured in some places prevents people from seeking care, especially now with COVID-19 testing and treatment.
we’re in completely uncharted territory in regards to the unfortunate situation with lack of PPE. protective equipment in healthcare was always understood to be single use and worn for a short time. i hope that this pandemic will lead to an overhaul of PPE manufacturing, stocking and evidence-based guidelines for safe reuse, as well as protective measures for frontline healthcare workers. it’s devastating to think how many of the thousands of COVID-19 cases amongst healthcare workers could have been prevented with adequate PPE. healthcare workers should not be wearing trashbags or fear getting fired for refusing to provide care without proper protective gear. i do feel some movement to organize, but i’m not sure how widespread it is. i’m hopeful that as a profession we can get the support we need from the state and federal governments, but i worry that the gray area between nursing rights and responsibilities make this a confusing issue for nurses and legislators.
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DS:
Can you get more into this gray area?
How do you feel city, and state government has done in responding to the covid situation? And what about everyday residents, the general population, do you think folks in our state are taking the situation seriously?
Nicole:
working in healthcare means you have some desire to care for and support people at their most vulnerable. we have a responsibility to these patients, but we also have rights to protect ourselves. the gray area has probably affected anyone who deals with direct patient care. the “hero” rhetoric and immense societal and administrative pressure to provide excellent care shouldn’t undermine the safety and wellbeing of frontline healthcare workers.
i think on the whole, boston and MA have taken this really seriously, and there’s been a huge increase in access to testing and treatment for covid-19. since i work mostly with those experiencing homelessness, i’ve seen some extremely innovative solutions for helping to temporarily house and protect those individuals as we get through this.
as far as the general population goes, that seems to vary. most people i know are still social distancing, working from home and wearing masks outside. of course there will always be people who don’t take it seriously, and i think it’s especially hard if you don’t have any direct connection or experience with covid-19. i just hope people can stick it out a little longer, especially for the sake of their vulnerable family, friends and community members.
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DS:
Can you tell me about some of the temporarily housing innovative solutions you’ve seen? I’d love to hear about that.
Massachusetts is moving slowly with reopening which I have to say I agree with, even if I rarely agree with much else
our politicians do. Can you share any observations or thoughts on working at the makeshift convention center hospital?
Nicole:
The state, as well as some individual cities have set unhoused people up in hotels, college dorms and school gymnasiums to name a few. These kind of solutions are so exciting because resources have been made available and people are thinking creatively about how to connect our community members to services despite the incredibly difficult circumstances right now. Maybe it’ll open the door for shelters and transitional housing in the future, we’ll see!
Working at the field hospital at the convention center was a completely unique experience. The scale of it is huge which can feel a little daunting, but it was amazing to work alongside really dedicated people to care for patients who are experiencing homelessness and recovering from covid-19.
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DS:
It’s great to see unused resources being put to such use. But Boston hasn’t used college dorms or hotels, etc. to temporarily house homeless individuals. Why do you think that is?
What are your thoughts on how we’re re-opening businesses here?
And after a day of getting into the thick of it, as you do everyday, how do you relax when the day is over?
Nicole:
Boston has been using Suffolk University dorms to temporarily shelter Covid negative individuals who are unhoused. There are also a few different isolation and recovery shelter sites for people who are unhoused and Covid positive as well. I do wish there were more local sites, but I suspect it’s mostly up to the universities or hotels themselves in terms of who is willing to utilize their spaces for shelter. Not sure about the logistics of that or who forms those relationships, but it seems like a big undertaking.
I’m torn! I know it has to happen eventually, I’m a little wary of some of the Phase 1 and 2 businesses and would limit it a little more. The plan puts a lot of trust in the public and business owners to maintain social distancing practices and encourage people to wear masks. I just think it’s going to be really difficult and the more places we can go, the harder contact tracing will be.
I take a really long shower, catch up on the news and make dinner with my roommates!
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DS:
Wow my college doing some good. I’m glad to hear that this is happening here.
We’ll see where the reopening takes us. I think I’l be wearing a mask for a long time, beyond suggested, and I honestly
can’t see going into places of business beyond the likes of supermarkets etc. for a very long time. I’m sorry small business owners.
And with that I’ll ask if you have any parting thoughts to leave with us about this experience we’ve all shared in one way or another, and about the future?
Nicole:
yeah i totally agree. i’ll be doing the same, and trying to support local business as much as possible! as terrible as this whole experience has been for people, i hope it brings about some form of change to challenge the power structures and systems we’ve come to accept. covid-19’s disproportionate burden of illness and death among Black and Brown individuals is yet another wake up call that change needs to happen now. going forward we all need to contribute to mutual aid networks and promote of the well being of our neighbors and community members!
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