‘Mobile Health Services Work!’
Urban Matters: Tamara, let’s start with some basics about Bronx Mόvil, the organization you helped found. What does it do, how does it do it, and who do you serve?
Tamara Oyola-Santiago: Bronx Mόvil is a project of radical love. We are a cooperative mutual aid collective that has become a harm reduction organization. Harm reduction is both public health and a movement that centers the human rights of people who use drugs. We believe that the War on Drugs should end, and that requires centering as leaders people who use drugs, who have experienced incarceration, housing insecurity, homelessness, and oppression. We believe that harm reduction must be 24/7, mobile, and culturally and linguistically centered.
On weekends and holidays, we hit the streets of the Bronx and Washington Heights with sleeping bags, mini-flashlights, mylar blankets, syringes and injection kits, PPE [personal protective equipment], food, bottled water, wound care kits, clothes, naloxone, fentanyl testing strips, and lots of information and resources. The Breadline of St. Francis donates 100-120 meals each weekend, and others donate time, supplies, or support the work in other ways.
UM: Bronx Mόvil was about two years old when Covid-19 hit New York City. What immediate effects did the pandemic have on the daily lives of the people you serve, and on your work?
TOS: The first two years were completely self-funded. But we also shared our information with the State and City Departments of Health, community leaders, community-based organizations in the harm reduction world, and with elected officials. So when the pandemic hit, the City Department of Health knew of our work and asked if we were doing outreach. Our resounding ‘yes’ translated into funding.
How has the pandemic impacted our communities? While we sheltered at home, they also did, except their home is the streets. The closure of the subways was an eviction. No access to libraries or coffee shops meant no access to free WI-FI, water, or respite from the elements. The closing of the bodega and barbershop meant no work. Community-based organizations closed and later started providing services virtually; for folks living on the streets that meant no access to case management or direct medical or mental health care.
And yet folks survive the streets in community, and we saw first-hand how at the height of the pandemic, our participants created expansive networks of care. Kinfolk networks – living quilts of love – are emblematic of communities of color and we saw this in action. Participants themselves will say, Nosotros mismos nos cuidamos. (“We took care of ourselves.”)
UM: Are there lingering overhangs from the pandemic for Bronx Mόvil and for people who use drugs and are unhoused?
TOS: At the height of the pandemic our participants were abandoned. The initial rollout of vaccines via appointments limited access to them. The one-shot [Johnson & Johnson] vaccine meant easier access at shelters and food distribution centers but was then discontinued due to medical concerns. While the City Department of Health now has mobile testing and vaccine sites, these are slowly being shut down. That means less services to folks who live on the streets. Many organizations like Bronx Mόvil who once received free PPE are now having to purchase surgical-grade masks and hand sanitizer.
What we learned during the pandemic is that mobile health services work! We need to take health to the streets so that folks who are experiencing housing insecurity, who work long daytime hours, who are unable to leave their communities for whatever reason, can access comprehensive medical and mental health care and services at all times. And these services must be multilingual and culturally centered.
UM: Drug overdose deaths in New York City (and nationally) spiked during the first year of the pandemic. At least partly in response, last November the City opened the first two supervised drug injection sites in the nation. As a public health professional, what do you think the effect has been – and what should happen next?
TOS: I am a board member of OnPoint NYC, the organization that opened the Overdose Prevention Centers (OPCs). A study just published demonstrates that the OPCs are viable, effective, and lifesaving. They should be part of our public health framework. OPCs provide a safer space where, under the supervision of trained staff members, participants can access sterile equipment for use and tools to check their supply for the presence of fentanyl, a synthetic opioid which is a major contributor to the overdose crisis. Wraparound services include mental health care, counseling, and social services.
The recent OPC study demonstrates there is decreased overdose risk among participants. Yet because Federal policy shapes drug use as a criminal matter it does not permit funding for OPCs. This needs to change.
The basis of harm reduction is this: To honor the dignity of all persons. The War on Drugs is a war on people. So in addition to opening OPCs and robustly funding programs like Bronx Móvil, we must end criminalization of drug use. Instead of incarceration, let’s build healthier communities where housing is safe and secure, gentrification is replaced by vibrant communities that have jobs with living wages, and robust education, medical and mental health care. Safer communities are in reality well-resourced ones.
UM: Calling them dangerous and unsanitary, Mayor Eric Adams has made clearing homeless encampments a priority. Impatience with encampments has loomed large in recent elections in San Francisco and Los Angeles, too. Again, speaking as a public health professional, what do you think the right course is?
TOS: The language used by elected officials across the USA declares a war against poor people. Poverty is being criminalized. It is rooted in capitalism where people are believed to be poor because of their personal failure, hence, laying blame on individuals, instead of systems of oppression. And in the USA poverty is deeply linked to the legacy of slavery. So when we talk about class we must also talk about race. Rev. Dr. William Barber, leader of the Poor People’s Campaign, talks about shifting the moral narrative and building a broad-based, multi-racial movement to change an “impoverished democracy.” I agree!
Tamara Oyola-Santiago is a co-founder of Bronx Mόvil. A public health educator and activist, she also co-directs the Institute for Transformative Mentoring at the Center for New York City Affairs at The New School.
Photo by: Bronx Mόvil Instagram