Name: Dr. Barry Zevin
City: San Francisco
Position: Medical director, San Francisco Homeless Outreach Team
J.: You provide medical care for homeless people. What health problems are most common in this population?
Dr. Barry Zevin: We work directly in the streets and parks and wherever our patients are. We also have a very small clinic where people can come in and see us. I see a lot of problems related to neglect of health and neglect of self-care. Sometimes we see things that are directly related to homelessness, such as lice or skin infections from not having access to hygiene facilities.
People assume that most homeless people have mental health issues or addiction problems. How accurate is that?
Many have medical and mental health problems, substance-abuse disorders and cognitive disabilities. Up to 50 percent of homeless people have some kind of cognitive disability from either head trauma or mental disability from childhood. People think about addiction in this population, but they don’t realize that disorders that make it difficult to even think are quite common as well.
Homelessness is a problem of poverty. Addiction and mental health disorders are common everywhere in society, but they can lead people to poverty and homelessness.
What other misconceptions are out there?
People think homelessness is a choice. I’ve been doing this work for 25 years, and I don’t hear anyone say they like being homeless. It’s not an adventure for them. It’s just too painful to think that we’ve created a system and a society where people really don’t have any other option. Most of the people I see care about their health. They may have other things to do to survive that get in the way of going to the doctor. But virtually everyone I see cares about their health.
What are the health consequences when homeless people are forced to relocate?
The people in encampments are really desperate for anything that feels safe and secure. Disrupting that is stressful on their health. If I know where someone suffering from a particular problem is on the street, I can find them and help them. But if they get moved around, I can’t find them.
How did you get interested in the work you do with the homeless?
I try not to say “the homeless.” It groups a very diverse population into something that is pejorative.
I grew up in the suburbs. I would go into New York City in the late ’70s and early ’80s. I was always curious about the homeless people I saw, but I didn’t have any insight into who or what they were. I got interested in working with the homeless here for a couple years. Twenty-five years later, I’m still doing it because I think the work is necessary and compelling. My medical practice is as challenging and diverse as any internist. I talk to colleagues in private practice who complain of being bored, but there are no two days that are the same kind of problems in my career.
You also work on improving health care access for transgender people. What are the typical barriers to access?
Many transgender people are very discriminated against in the medical system. They went to a doctor’s office or a hospital and someone mocked them or literally said, “We don’t treat people like you here.” Now we’ve done a lot of education, but still, sometimes somebody comes in and says “This is my name, I prefer female pronouns,” and we can’t even get our medical records to record the proper name and pronouns.
We work to provide better access to all kinds of health care and better quality of care for transgender people. The big thing in the past two years has been an effort to educate everyone in the San Francisco Department of Public Health in transgender 101. We also try to improve access to transgender surgery for people for whom it’s important to treat their gender dysphoria. That was unthinkable just a few years ago.
This seems like it could be a depressing occupation. What do you do to keep your spirits up?
I don’t find the work depressing. I work directly on a one-to-one basis with my patients and we see many very sad, very difficult patients and stories. But it only takes one a month, one every six months, where someone makes big changes and gets their health and life together to keep me going. It helps me say with total authenticity that change is possible. That’s a tremendous antidote to this work. And I get a lot of gratitude from my patients.
Are you involved with the Jewish community, and do Jewish values play a role in your work?
For the past eight or 10 years, we’ve been doing a homeless Passover seder. It’s a misconception that there are no Jewish homeless people. I’ve been taking care of Jewish homeless people for years.
One of my colleagues, a Jewish social worker, was seeing Jewish homeless people who had mental health disorders or addiction disorders and felt utterly alienated from the Jewish community. We started talking about what we could do to give them more connection to their community. And we came up with the idea of “A Matzah Ball for All.” Every year we scramble around to put it together, and we’ve managed to always do it. I’ve toyed with the idea of reaching out to synagogues and leaders, but it works better as a grassroots thing, and it spread through word of mouth.
It’s not just for Jewish people; anyone can come if they’re interested. We go through a basic Passover meal and haggadah and then add on to how people are feeling oppressed by homelessness and what’s personally plaguing them. And it’s been really a positive thing. One person who comes regularly is a trans woman who came from an Orthodox family. Her father forced her out of her family, and she fell into a very bad place with drugs and mental health. The seder feels to her like a way to connect with her heritage and who she was before she fell into this downward spiral.
That’s my connection with the Jewish community.
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