Rough Sleepers

November 7, 2022
Pulitzer winner Kidder (A Truck Full of Money) spotlights in this poignant account the Boston Health Care for the Homeless Program, “the country’s largest medical system wholly devoted to the care of homeless people.” At the center of the narrative is Jim O’Connell, the program’s founding physician and organizer of its Street Team, which ministers to people who shun shelters and live “mainly outside or in makeshift quarters.” According to Kidder, the Health Care for the Homeless Program works against the grain of corporate medicine by emphasizing continuity of care and the importance of listening attentively to and spending time with homeless people. Interwoven with O’Connell’s story are those of his patients, including Tony Columbo, who spent 18 years in prison for sexual assault and struggles with substance abuse and mental disorders. Drawing on five years’ worth of reporting, Kidder vividly portrays life on the streets and in the program’s health clinics, and sheds light on various legal and policy matters, though the focus is less on the institutional forces that contribute to chronic homelessness than on the individual lives it touches. Keenly observed and fluidly written, this is a compassionate report from the front lines of one of America’s most intractable social problems.

Starred review from November 15, 2022
Noted long-form journalist Kidder rides along as clinicians try to serve one of Boston's most marginalized populations. The term rough sleeper is not used much in American English. It's a borrowing from the British way of describing the people who sleep where sleep is not intended: doorways, sidewalks, culverts, etc. Kidder's hero, Dr. James Joseph O'Connell, has spent decades with volunteer and paid workers driving in a medicine- and supply-stuffed van to the places where this population gathers. Many of the rough sleepers are mentally ill or addicts. Most are White, perhaps because, as O'Connell ventures, "the Black and Latino communities are more willing than Boston's white world to harbor their homeless." In any event, "once people have fallen to living on the streets, they have reached a certain horrible equality." Against the work of O'Connell and his Boston Health Care for the Homeless Program stand an array of bureaucrats and the police, who regularly roust the homeless from their camps and nooks, forcing them to find even less hospitable places to survive the night. O'Connell, now well past retirement age, is the tutelary angel of the piece, but many lesser heroes work around the clock to save lives and treat the downtrodden with dignity. The job is thankless and endless. As O'Connell's mentor told him, "We're way down on the solution scale," and indeed, finding a solution to homelessness is a sociological and economic problem more than a medical one. For all that, said one worker, O'Connell keeps on trying: "This is really about accountability, system design, performance. Until that's fixed, Jim is basically standing at the bottom of a cliff, trying to save people." Sometimes he succeeds, but too often, for reasons institutional and personal, some people can't and won't be saved, and many who can be will slip between the cracks. A searching, troubling look at the terrible actualities of homelessness.

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