Life on the Edges #153

Bruce Fitzgerald:

Everything we do in emergency management is getting people to lean forward and pay attention to what's going on and be ready when something does happen so that the impact's not as bad on them.

Joshua Frances:

We're planning for the worst and making plans for things that we hope we never have to use. But we also follow data and historical events across the country from, you know, our colleagues and realize that things really do happen and, and they will happen. It's just a matter of when and what magnitude they'll be. So we have a duty to be ready.

Mark Swann:

Where we start at Preble street is always just saying, hi, what's your name? How can I help you? And it's not about a Medicaid number. It's not about what's your diagnosis or what your troubles are. It's, well, who are you and how can I help? And it all stems from there.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 153, Life on the Edges, airing for the first time on Sunday, August 17, 2014. How do we handle ourselves when life throws us a curve? Bruce Fitzgerald of the Maine Emergency Management Agency and Joshua Francis, Director of Emergency Management at Maine Medical center, give us valuable information about emergencies, how we might be impacted, and how we can best prepare. Mark Swan of the Preble Street Resource center discusses what happens when life goes awry and how we might help our neighbors.

Dr. Lisa Belisle:

Thank you for joining us. As listeners of the show know, we really enjoy spending time with people at all levels of healthcare and wellness and public health. Today we're speaking with two individuals that we really in fields that we don't

Dr. Lisa Belisle:

spend as much time with, but we're happy to have them here.

Dr. Lisa Belisle:

This is Joshua Francis, who is the Director of Emergency Management at Maine Medical

Dr. Lisa Belisle:

center, northern New England's largest and only Level 1 trauma center. And Bruce Fitzgerald, who is a director of the Maine Emergency Management Agency, a role that he has held since February 2014. Bruce has worked for MEMA for 10 years now.

Dr. Lisa Belisle:

Thanks so much for coming in.

Mark Swann:

Sure.

Bruce Fitzgerald:

Thanks for having us.

Dr. Lisa Belisle:

So September's an important month for you, Booth.

Dr. Lisa Belisle:

Tell me about that. Sure.

Bruce Fitzgerald:

Well, September is National Preparedness Month. And so this is a campaign that's been going on for a few years now. The Federal Emergency Management Agency, fema, sponsors this initiative. And so here in Maine, we try to publicize emergency management strategies for homes, families, businesses, communities. We want people to be ready for emergencies. Kind of our slogan is to make a kit and have a plan and be prepared. And so we talk about that all month. We have different initiatives going on that help to underscore that.

Dr. Lisa Belisle:

Joshua, how does MEMA work with the Maine Medical center?

Joshua Frances:

Well, since 9 11, the venture between health care and emergency management has strengthened. The relationships have grown to a point where we all work collaboratively together on a day to day basis. It's not just during disasters anymore. I'd venture to say that all hospitals, including Maine Medical center, participate in National Preparedness Month in one way or another. At Maine Medical center, we do a big, huge employee campaign. At an employer as large as Maine Medical center, and as a major health care facility, we're only as good as our staff that come to work. So our initiative around preparing our employees and making sure that they're ready for disaster will help us in the long run when that really bad day happens and people call on the health care system and we're really, really taxed.

Dr. Lisa Belisle:

It is very important. And I know in my work with Central Maine Medical center, we do a lot of every year we go through and we learn about codes and what happens if there's a hostage situation, and what do you do with poison control. And it's something that you don't use every day, but it's really important because on the day that you need it, you need it. What are some of the things that, Bruce, you think people should know about as far as being prepared for a disaster? What are some of the disasters that people might even encounter?

Mark Swann:

Sure.

Bruce Fitzgerald:

Well, Maine's number one hazard is flooding, and we can have flooding in any time of the year. So, you know, typically people think of spring flooding when we get rain, but we've seen flooding disasters happen in November or even in January and February when you get our typical, you know, winter thaw. So flooding's our number one hazard. Then we also worry about hurricanes. And so all of the wind and rain that comes along with that. We've seen those with some of the major, major storms in the last few years. Luckily, Maine's been spared by the worst of that weather. And then in the wintertime, we have severe winter storms. Of course, last winter we had a major ice storm that knocked power out for a long time. So the skills that people can have at home and the things, the steps that they can take at home really apply to any emergency. Our biggest concern is really a lack of power. And so if you're going to have a generator, we want people to run generators safely outside their home. If you have to cut up trees, we want people to use their chainsaw safely. If your home gets some water in it, we want people to be aware of mold and take steps for that. So for us, it's really just public awareness and making sure we're getting all of this messaging out. We work with main cdc, we work with Josh and the hospitals to get information out through their channels. And so everything we do in emergency management is getting people to lean forward and pay attention to what's going on and be ready when something does happen so that the impact's not as bad on them.

Dr. Lisa Belisle:

And hurricane season is coming up pretty soon.

Bruce Fitzgerald:

It is. Well, we're in hurricane season now. It actually starts in June, but typically our worst storms happen at the end of summer and into the fall. You know, we've seen Irene and Sandy in the last couple of years, but we had Tropical Storm Arthur, which impacted Washington county earlier this summer, knocked power out there for almost a week to many homes. So people need to be ready for that kind of weather anytime. And we've seen some tornado activity this summer. We've seen some pretty strong wind. And so, you know, a hurricane itself is bad, but we have the lesser effects of that at other times during the year.

Dr. Lisa Belisle:

I remember when I was a resident at Maine Medical center during the big ice storm, I think the one that we had last winter, to me, didn't seem quite as big as the one that I remember, and I think it was maybe 1998. 1998, exactly. And I remember that people would come in to the hospital because they didn't have power at their houses, so they needed to plug in their oxygen tanks and they needed other things that were related to their health. So they weren't necessarily sick, but they didn't have access to power. So this is something that we need to think about when it comes to people with illnesses.

Joshua Frances:

Yeah, it's very true. So hospitals in the community are one of those very few safe haven places that folks know that they're able to go to at any time during a disaster. 247 and we saw that we had a major impact during the ice storm in 98 from the public who needed warm meals, they needed a warm place to stay. And so through our disaster planning process we actually stockpile food to do disaster meals for up to like 30% more on a daily basis so that we could absorb that influx. And then we work on plans for things like ventilator dependent patients who normally during normal times take care of themselves and are self sufficient but without power or their life saving equipment may not work. And we're able to bring them in to the facility because we do run 100% on generator.

Bruce Fitzgerald:

We do a lot of collaborative planning with the hospitals with main CDC and the Red Cross for when we're going to open shelters or even warming centers. And just as you said, what a lot of people are looking for is a place to come in and charge their cell phone and maybe get a cup of coffee or a hot meal and possibly plug in their oxygen or some medical needs. And then Mainers are really resilient and a lot of people go home for the night even though it's cold and it's dark. But you know, they're able to take care of themselves. Which is. It tells us that our message is getting out there and that people are paying attention.

Dr. Lisa Belisle:

And you've mentioned the Maine cdc, the Maine Centers for Disease Control. I think they're the Maine Centers for Disease Control and Prevention because we had Dr. Panette on. And I know that what has happened

Dr. Lisa Belisle:

since 911 is, is that there really

Dr. Lisa Belisle:

has become this much greater collaboration between public health and emergency services and emergency management. And it's something that I think was a long time coming.

Bruce Fitzgerald:

And it's still not perfect, but it's definitely better than it used to be. We have a lot better coordination now with Dr. Panette. She's actually a member of our Homeland Security Advisory Council. And so we try to coordinate the grant funding that comes through Maine CDC and MEMA so that we're not buying duplicate items. You know, we work through county emergency management agencies and they have relationships with their hospitals and their regional resource centers, which is another public health piece of architecture there. So there's a lot more conversations that are happening instead of people doing all of their own work in their own space.

Joshua Frances:

I think the planning efforts have really benefited us for the coordination amongst who holds what position and how to reach them in times of disaster. So the most beneficial part of planning is building those relationships so that you're not meeting new people. I know from the local perspective within Portland, it's very easy for me to pick up the phone and call the police chief or the fire chief or the emergency management director or the county emergency management director. And we have a. Built a relationship over so many years that they pick up the phone, they know what we're talking about, what our needs are, and it just makes everything so much smoother and much more coordinated.

Bruce Fitzgerald:

That's the great thing about Maine. We all know each other by our first names. And you can pick up the phone and call somebody and get the help that you need, and it's just knowing who to call.

Dr. Lisa Belisle:

I do have that sense. When we had the Lifelite team in to talk to us about their program and having spent time up there also, and writing an article about them for Maine Magazine, they talked about an attempt to make things seamless, that they were just threads in a tapestry. And so they mentioned all of the different organizations that you're talking about, plus the primary care doctors, plus hospitals in northern Maine, and everybody all working together. And I think that we are benefited by technology now because we now can reach out to somebody in Fort Kent and have a connection with them in a way that we never could before.

Mark Swann:

Right.

Bruce Fitzgerald:

Benefit too, from the fact that Maine is still pretty small. We're rural, and a lot of things are spread out. Josh and I both went to New York City after Hurricane Sandy a couple of years ago, and we've never really done a real detailed talk about it, but I know that it was really nice to know that I was coming back to Maine and we didn't have some of those challenges that we saw in New York. Eight and a half million people in the way of a gigantic storm and all of the personal and language barrier issues. And for all the resources that New York City has, they have huge challenges that we don't face here in Maine. And it's just. It's nice to know that it's a smaller community.

Dr. Lisa Belisle:

It's kind of funny. As we're talking, we actually heard a siren go along behind you. And it did remind me of the sort of. Just every day something like this could happen. I mean, you think that you are immune from, say, a hurricane or a flood, but these things, even microbursts, where you get sudden high winds and rains or hail, these things all. All can happen. Natural disaster is something that it's difficult to prepare for. But at the same time, there are Some steps you can take. Now, you talked about making sure that you have a generator that runs well, what are some other very specific things that people can do, whether medically or more general, to prepare?

Bruce Fitzgerald:

Well, we have some lists on our website and I'll put in a plug for mainprepares.com which is our informational website, where we have home emergency kit lists and things that you can go out and buy. So canned food, non perishable food, having a manual can opener because of course you don't have power. There are a lot of things on the market now for being able to charge your phones and that sort of thing. You know, spare battery packs for your electronics. We want people to have three days worth of water, and that's three days per person. We want people to have some cash because the ATMs may not be working. If you do have a generator, make sure you have some spare gasoline. You know, things like that, things that you look around and you need medicine and you can talk about them, the medical side of it. But, you know, we want people to have everything that they would need in their regular life to be able to take care of themselves for 72 hours. And generally speaking, the power may not be back on after 72 hours, but it gives us time to get a shelter open, if that's what we need to do. If we had a very serious event, we'd be bringing in food and water and ice and tarps and all the resources that people would need. But at a statewide perspective, we need to know that people are able to take care of themselves while we get all of that other material in and ready to help people.

Joshua Frances:

There's been great strides on the medication side done with the insurance company community. The VA system actually really set the bar really high after Hurricane Katrina, where people with chronic disease were without their insulin and cardiac medications for a long time. So now many insurance companies are allowing folks to fill three months worth of prescriptions which 10 years ago you would not have seen, which is fantastic for the public health and the health care infrastructure after a disaster. And that's really important step forward since Hurricane Katrina, which really drove that change.

Dr. Lisa Belisle:

It seems as though people are more aware than they ever used to be of the possibility that life could really turn on a dime. As you mentioned Hurricane Katrina, there's Hurricane Sandy, there's nine, 11. I mean, I know you're relatively young guys, so you're growing up at a time where all this stuff is happening, so it's just the norm. I think there maybe was a group of us that work a little sheltered from that, you know, big things weren't really happening. We felt pretty safe. So what's the, you know, why prepared. But there's a nice balance, I think, between being aware that this happens and being able to be prepared and not getting too fearful because it's just part of life.

Joshua Frances:

I mean, we're planning for the worst and making plans for things that we hope we never have to use. But we also follow, you know, data and historical, you know, events across the country from, you know, our colleagues and realize that things really do happen and they will happen. It's just a matter of when and what magnitude they'll be. So we have a duty to be ready.

Bruce Fitzgerald:

It's all about taking steps to make sure that when an event like that does happen, that it's not as bad on you and your family and your community and that you can bounce back from it faster. It's all about kind of a concept of resilience. So, you know, once you, if you're ready for things and you have a plan and you've got all of your supplies ready and you're ready to go, then you can get back on your feet quicker.

Dr. Lisa Belisle:

There are obviously people out there who have skills in the medical, public health emergency fields. And I know that there's always a great need for volunteers.

Bruce Fitzgerald:

Yeah, absolutely. You know, anytime that people want to get involved, they can contact their county emergency management office. Volunteer Main is another resource that we use to match people up, people who have special skills and want to give some time. You know, we don't have a lot of paid positions in emergency management, but we'll take all the free help that we can get. And there's a lot of people out there with specialized skills from their jobs that we can use either in a disaster or also in a non disaster for planning and preparedness and conducting exercises.

Joshua Frances:

And on the medical side, there's probably two major avenues. The first is Maine Response. That's the volunteer medical provider registry, which is every state has and run through main CDC and that's mainresponse.org that's for non practicing or practicing or retired medical folks who would be interested in volunteering during a disaster. And then the Metropolitan Medical Response System or Main Task Force 1 is the state disaster Medical Assistance team. And people can find out about that@metf1.org

Dr. Lisa Belisle:

well, it's really been a pleasure to speak with each of you. I think those of you who are listening, there's no way for you to know this, but these are very highly qualified individuals who have multiple degrees behind their names, lots of experience, and we'll have all of this information on our website. I would encourage people to learn more about emergency preparedness, about the emergency management system, about emergency medical, emergency medical system. And maybe even this is just a thought, maybe even if you're listening and somebody who's interested in the field, learn more about how this is a possibility for you to go into this field, because I think it's become increasingly important. It's an increasingly important part of medicine in general. And I think we're making great strides. So that makes me feel pretty great about having you in here today. We've been speaking with Joshua Francis, who's the director of Emergency Management at Maine Medical center, and also with Bruce Fitzgerald, who is the director of the Maine Emergency Management Agency. Thanks so much for coming in and preparing us for September. And how can people find out more about what you're doing?

Bruce Fitzgerald:

Well, our website is mainprepares.com and we have all kinds of information there on the different hazards that we face in Maine and how you can be ready for them, what you can can do in your school, your home, your family, your business preparedness. We have a Facebook page. We have a Twitter account, and I would ask that people sign up and follow us. I am not a Facebook person, but I clearly recognize that you can reach out to thousands of people in seconds this way. And it's a really powerful tool for us to get the word out to people.

Joshua Frances:

And any information about impacted medical services or information on the healthcare system in general is put out on the main CDC website during disasters. And surely people also come to the hospital for hard information when there's no power. And people can visit maine medical center mmc.org for that information.

Dr. Lisa Belisle:

Well, thank you so much for all the work that you're doing and for coming in and talking to us today. It's really been a pleasure.

Joshua Frances:

Thanks.

Bruce Fitzgerald:

Thanks for helping us get the message

Mark Swann:

out

Dr. Lisa Belisle:

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[Unidentified voice]:

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Dr. Lisa Belisle:

it really is a great privilege of mine to spend time with individuals who continue to show up on a daily basis and try to come up with solutions for some of our bigger problems and problems that maybe we think don't impact us because they aren't ours, like homeless or mental illness, but they are because they belong to our communities. Today's guest is Mark Swan. He is executive director of Preble street,

Dr. Lisa Belisle:

an organization that provides services to help and find solutions for those who are experiencing homelessness, housing, hunger and poverty.

Dr. Lisa Belisle:

And really so much more. Mark, thanks so much for coming back in again to speak with us about the work. Mark, you were one of our very early guests on the doctoralisa Radio Hour and you spoke about about programs that were going on in Preble Street's 20 year anniversary. It's now 23 years you've been working with this organization, Right? And there's still still work that you're doing that's new and different and innovative and you're still addressing problems that are difficult.

Mark Swann:

Yeah, there's still unfortunately more work to be done. But just to clarify, we're actually about to have our 40th anniversary as an organization. So it was my 20th anniversary at being at Preble street, so it's now been 23 years for me. But in 2015 we'll be celebrating our 40th anniversary as an agency, which is really exciting. But to your question, yeah, there's more work to be done. The human service system and Sector has just changed so dramatically. And with that, you know, Preble street has responded and tried to, excuse me, tried to stay ahead of that, tried to be creative and innovative and address needs as they arise in the community. But really, the last few years we've really tried to focus on more solution oriented work. I think people know about us as a soup kitchen or shelter, the emergency work we do, which we're incredibly proud of, and we do a lot of that. But our focus, I think the last few years has really been on are there different kinds of housing solutions that we can either be part of or do ourselves? Is there advocacy work we can do? Are there innovative programs that we can start, you know, working with kids and young people, with veterans? So we do have a lot going on and we're trying to be rather intentional in what we take on.

Dr. Lisa Belisle:

The last time that we had somebody from Preble street, there was a discussion about the Lighthouse Shelter. And I think that was two or three years ago when that was founded. How is that doing?

Mark Swann:

It's great. We actually renamed it, we named it the Joe Chrysler Teen Shelter after our founder, Joe Kreisler. And we moved to a new location, expanded the beds from 16 to 24. It's been, unfortunately, it's full most nights, but it has just been a great, great program and much, much better for the kids. It serves runaway and homeless kids who are on their own. And one of the great things about that program is we've been able to sort of build momentum off that new shelter and kind of leverage that work to where we are now. We're just starting, actually this month, a new program called First Place, which I think is a cool name, First Place. And it's a transitional living program for kids to kind of graduate out of the shelter, live on their own. They'll be in an apartment in the community and Preble street will have leases with the landlord will take responsibility for that. The young people will pay a percentage of their income, if they have income to pay for the rent. And the whole focus is to really surround the young person with services, with educational opportunities, with employment, vocational work, with the goal within a year or two to move that young person into real self sufficiency and independence and then get another young person in there. So it's a fairly tried and true model around the country. We've talked to people who are doing this in other parts of the United States, but unfortunately there's very, very little of that here in Maine. So we've been wanting to do this for a couple Years and again, when we had success with the shelter, we were able to talk to actually a private funder, it's the John T. Gorman foundation, said, you know, we love what you're doing with the shelter. What are you doing beyond that? And we said, well, we know exactly what we want to do beyond that. We just need the resources to do it. There has not been state or federal funds to do that kind of transitional program. So to have a private foundation step up and say, hey, we believe in you and we'll do this and we'll let you get it started, at least get a pilot going for a couple years and show your success, do the research you need to do. So it's a great example of working with private philanthropy when the government isn't there for you, but hopefully to prove ourselves so we can have sustainability long term.

Dr. Lisa Belisle:

For people who aren't quite as familiar with homelessness in the teen population, how do kids get to that place generally?

Mark Swann:

Well, it's one of the saddest things I've learned in my job that, you know, this was years ago, but realizing that sometimes for young people, the smartest decision they can make is to get out of the home because where they're living is just really unsafe, unhealthy, or even dangerous. So a lot of, you know, we don't see many kids that might fit the stereotype of, you know, an after school special of, you know, a young person who, you know, doesn't like the rules with their parents and is, you know, kind of a challenging young person. No, these are kids who are in homes that, you know, there's drug abuse, there's violence, there's a lot of abuse going on and really they need to get out to be safe. So they're making that decision and. But then they end up on the street and they don't have anybody and they're on their own. So one of the things we try to do really quickly with young people is get them out of the street culture, get them out of the shelters as quickly as possible, and build healthy relationships with adults which they maybe haven't had for a long time. We have a young girl who just came into our shelter about two months ago and she had been pretty dramatically abused by her family, including physical abuse and there was drug use in the home. And she came to our shelter at 11 o' clock on a Friday night and just said, I need a place to be. I want to finish my school year. She was very motivated, knew she had to get out of the house. So she Stayed at our shelter to get through the school year. We're now working with her and a family member, a relative, to engage with that family to see if she can stay there, because we know family is important. I mean, every story is different, but I'm always struck at the resiliency of these young people and the motivation. They do not want to be on the street. They're in our teen shelter, they're in our teen center. And invariably they say, we don't want to be in the adult shelters. We don't want to kind of graduate to that life. So they're pretty motivated.

Dr. Lisa Belisle:

This is a vulnerable group.

Dr. Lisa Belisle:

They're young. They don't necessarily have means. Maybe aren't even old enough to work, can't get a work permit. And even if they could, not necessarily someone that would be hired by an employer. Has there been an issue with sex trafficking and sex exploitation of this age group?

Mark Swann:

Yeah, actually, we really saw this starting three or four years ago in Portland. And at our shelter, we had more and more young people, mostly girls, coming in and telling us horrific stories as they tried to escape from an adult who was basically prostituting them over the Internet in cheap motels, really up and down the 95 corridor all the way from Washington to. To Bangor, you know, pretty organized and, you know, horrible. They would bring these girls in, get them hooked on drugs, threats of violence, and basically, you know, keep them in a motel room and prostitute them. So we started to see more of this reached out to law enforcement, both at the local level and also the FBI and others, because of the interstate nature of it. And over the last couple years, there's been really some good movement at organizing all the players around this. So law enforcement, social services, the faith community, everybody's kind of organized. So when a young person does show up at our doors, we can serve them better, quicker, be more responsive, recognize that they're victims. They're not the criminals here. So a lot of work has happened, and I love the organic nature of how that all came about. And then we were able to apply for some money from the Department of Justice to really take it to the next level. So, in other words, we didn't chase the dollars that there was this grant application available. But really we said, hey, we're doing this. We need to resolve this in some fashion. And then later on found out, hey, we can get some resources for this. So the funding we got last year enables us to work, get that coalition really solid. So there are systems in place. It's not just who you know at the police department or who, what cell phone you have for the FBI. But it's really a more organized way to respond. But also we have some funds to help the young people, some, you know, tools in the toolbox. So one of the big issues is if, if a young woman is in a criminal case against her pimp, that we have some resources to keep them safe and have some housing for them and the services they need. So they're not in shelters, they're not on the street anymore. They're not vulnerable. They're not, they're sort of maybe even in a different city or a different state. So we can really organize this up and down along 95 with other providers in law enforcement on the East Coast. So it's very exciting and just has gotten started the last six months or so.

Dr. Lisa Belisle:

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[Unidentified voice]:

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Dr. Lisa Belisle:

of individuals that there seems to be some hope because they're younger and you've described this resiliency that they have. You also work with individuals that challenge us as a society. You work with individuals who are mentally ill. You work with veterans who have PTSD issues and then people who have drug abuse issues. And even though they're not that different than the rest of us, somehow they've sort of crossed a line that many of us don't think that we ourselves would ever cross. But there is even hope there There are things that you are doing with, with these people, our brothers and sisters that are. That is working, that are working.

Mark Swann:

Oh, extraordinary, extraordinary individuals doing great things in their lives, really trying to turn things around. And they are our brothers and sisters. You know, I spoke a few years ago now at United Way board of directors meeting on a specific issue. And as I was sitting there surrounded by, you know, probably 20 people who are kind of community leaders in Portland or Greater Portland, and bank presidents and lawyers and corporate executives, I realized as I looked around that probably four or five of those people I had had private conversations with in the previous year or two about their family members who were on the street, their children or their brother. And I just realized how it really does touch all of us. And people may be a little bit surprised to know that, but they're not anonymous, faceless people. They're real people and they're part of this community and they have family connections. They just need some support and they need somebody to take notice of them and be there for them and build some community. Where we start at Preble street is always just saying, hi, what's your name? How can I help you? It sounds so simple, but it really is just about, you know, welcoming people, treating people the way we want to be treated, looking people in the eye. And it's not about a Medicaid number. It's not about, you know, do this intake. It's not about what your diagnosis or what your troubles are. It's, well, who are you and how can I help? And it all stems from there. So again, a lot of it starts at our soup kitchen and our shelters. That's a great way to connect with somebody and build a relationship and get to know their name and what's going on with them. I mean, we're going to serve 550,000 meals this year alone. So food is good. And getting to know somebody while you're breaking bread with them is a great way to start a social work relationship. We are social workers, and so it's great to provide that basic service, but really it is about, you know, how can we get you so you're off the street, so you're out of the shelter, so you're re engaged with your family, so you're getting a job so you can negotiate with a landlord in a way that works. So over the years at Preble street, you know, we've grown and taken on new programs and started new approaches, but it really is all about, you know, starting where the person's at. Providing some services is Having a relationship, it's a give and take. You know, people need to participate and, you know, take some responsibility for themselves to be part of those solutions. But we have some incredible work around housing. Our Logan Place project, which we did with Avesta Housing and then Florence House. I mean, those are game changers. Those programs really, not only were light bulbs going off for Preble street, they really changed the conversation in Maine around how we can truly end homelessness. We know we can. We have the data. We have the statistics. The night Logan place opened in 2005, the numbers in shelters in Portland went down 10% that very night and stayed down for four years till the recession hit. Just an extraordinary one project for 30 people. But we targeted people who were chronically homeless who essentially lived at what are supposed to be emergency shelters and provided housing and the supports needed. So the shelter numbers went down, people's lives changed dramatically. And we did a cost benefit analysis of costs before people moved into Logan Place and after they were in and showed that it saved communities extraordinary amounts of money and people were doing better. So the learnings from Logan Place, that's what helped us get support for Florence House. That's why we're working. Even as we speak, we're trying to build another Logan Place for chronically homeless adults. That just that one effort alone, I think is something we're probably the most proud of at Preble street because it was such a game changer. But in addition to that, as you mentioned, we're now doing veterans work statewide. We have offices in Lewiston and Bangor. So we're working with veterans who are homeless and their families. And in two years, over 500 veterans in Maine have moved out of shelters because of that one program. An extraordinary result. The number of homeless veterans in Portland went from 15% of the total to about 5 in the two years we've been running this program. So it just. It's things like that that show these things really can work. When you're thoughtful and smart and you have the resources and you're intentional in how you do your work and you do the research and data, you can really make a difference. That's what keeps us going, and that's what gets us up in the morning to do this work. It's also the frustrating part because it's so hard to get those things. Things going. And we're kind of pushing a rock up the hill, you know, because we can do a lot as an agency and with different partners that we work with. But at the same time, if people can't get on Medicaid because the state won't take main care expansion on, then we're going to lose ground. When that happens with a housing market like we have in Portland, I mean, I think that the rental rate, rental rate now is less than 3%. I mean, it's incredibly tight housing market. So that makes it tough. You know that first place program I mentioned for kids? We have all the pieces in place. We have the kids, we have the social workers, we have the funding we need to rent apartments. We can't find apartments. You know, a few years ago we could have, but now the pendulum has swung. So one of the frustrating things I think for us as an agency is the things outside our control, other agencies making decisions, closing programs, things like that make it tough, but we're still at it.

Dr. Lisa Belisle:

You do raise an interesting point, and that is that despite the fact that the economy has shifted, there are things that are happening, state agencies closing or funding sources, ships shifting or government making different choices that are still impacting individuals at different economic stages in their lives. So we're still seeing, I think most people who live in this area have seen individuals who are panhandling at intersections with signs. And they're men and women and older people and younger people and people of all different races. And that feels, feels like a contrast between what we're hearing about the economy recovering.

Mark Swann:

Right, right. It's really quite in your face, isn't it? I mean, panhandling, probably not a day goes by that somebody doesn't ask me something about that. And it's a challenge. It's a challenge for an individual. You're sitting in your car and you're faced with poverty right there. We did a survey with the police department last year of those who were panhandling. The vast, vast majority of people that were panhandling are people we knew, people in the shelters or in and out of the shelters, Very, very poor people. The majority of people talked about the money they were receiving. They were using to buy groceries or do their laundry or help to pay back utility bill. Of course, there's some people who use it for unhealthy things. You know, we know that people will drink or do drugs. We understand that that happens as well. It's a big challenge. And you know, one of the things we're trying to do, you know, we have an outreach team that's out there every day along with the home team, which is part of Milestone. And we're talking to those folks, trying to get them in for services, making sure they know what's available. And the vast majority of them do know what's available, but they just don't have any money. I mean, it's, you know, people ask all kinds of questions about it, but it basically comes down to the economics of it. People don't have money, and that's one way they can get money.

Dr. Lisa Belisle:

It is an interesting issue for me, even. I mean, as you're describing, you're sitting in your car and there's somebody who has a sign, and. And for me, there's always an internal struggle that goes on. And sometimes I'll give some money. Sometimes I don't have money to give. I don't have a dollar or five dollars or whatever. Sometimes I feel more conflicted about it. I'm not sure where the money's going to go to, but it is very in your face. And it's in your face in a way that maybe people that are hungry is not quite as in your face. Is there something that people can do as they're sitting in their car feeling that way to. To help with this problem rather than feel very hopeless?

Mark Swann:

I think people dramatically overthink that moment and that potential exchange. I think people should do what they think is right. And that's different for everybody. And I'm not saying that means you have to give them money. Do what you think is right. If your concern, if you just are so concerned that they're going to take that dollar and do something you wouldn't approve of, then don't give them the dollar. It doesn't mean you're a bad person. You can just hang on to the dollar, do something good with that dollar some other time. On the other hand, if it feels right to give the person a dollar, give the person a dollar, smile when you do it. Don't have any prejudgment or of what they're going to do with that dollar. Make it a real charitable impulse. It's not philanthropy. You're not going to change that person's life one way or the other with a buck. You're just not. Just go with your heart, do what your gut instinct is and you won't go wrong, and then move on. It's amazing to me how I think it just shows how complicated poverty is and most people aren't confronted with it. Most people aren't in our soup kitchen or have never been to a shelter. Don't have the language about that, don't understand what that means. And I think we need to do a better job kind of communicating about that. But I do think in the moment it's a human to human face to face contact. If you're not going to give somebody the dollar, you can still look at them, you can still say hi, you can, you can still nod, you can still smile. That means a lot to people. We hear that all the time. I heard a great story of actually it's an actress in Hollywood who dressed down as a street person and went and was challenged to go get some money from panhandling. And she went to an outdoor cafe in Hollywood and went over to two women who were sitting having lunch and, and just kind of asked them if they could help. And one of the women didn't look up and reached into her purse and pulled out $5 and handed it to her. And the actress turned and walked away. And at first she was elated because she got $5 and then she burst into tears when she realized they never even looked at her. Neither women even sort of acknowledged they kept talking and the woman just took the five and, and it just, that story just really resonates with me. And I know just from the people I know who have panhandled, it's amazing how belittled. Well, it's not amazing. They feel belittled doing it. And there's a lot of people who react pretty negatively to them, which I don't get at all. If you have opinions, I don't know why you would bark it out the car window at somebody or throw coffee at them or call them names. It's. That's just so unkind. I don't understand it.

Dr. Lisa Belisle:

As a family doctor, I've had the chance to work at the county jail and I've worked in poorer parts of the state of Maine and poorer parts of the city of Portland. And what has always struck me is that you can sit with someone who has the worst story that you could possibly imagine. So much trauma, so much tragedy, so much fear, anger, all of the sort of most difficult of human emotions, and yet they, they're somehow able to kind of pull together and really still be happy in their lives. It always, it takes me back sometimes, it takes me aback sometimes as I'm talking to people, people that this resilience that you keep speaking of can be

Dr. Lisa Belisle:

so present in the worst of situations.

Dr. Lisa Belisle:

Have you seen any sort of characteristics that kind of seem to pull things in that direction of resiliency rather than despair?

Mark Swann:

Well, I think part of that is people sort of looking out for each other too. That's. There becomes kind of a community, a support group, if you will, that happens on the street and in shelters where somebody who's pretty down and out and is struggling with a lot of tough things will find it in himself or herself to look out for the person who maybe even has it a little tougher than he does. You know, maybe it's an older person or somebody more frail or somebody with a prosthetic leg and needs to be carried around a little bit. And I mean, I've had this weird job for a long time where I, you know, I spend an awful lot of time with very, very poor people, but I spend a little bit of time too with very, very rich people who are donors to Preble street and are wonderful and have done great things for us. And you know, they're all the same. Everybody's the same, you know. And, you know, I think probably the most generous people I've ever met are some of the. More. Some of the poorest people I've ever met. And they, the expression, you know, give the shirt off your back, I mean, they literally will give the shirt off their back to help somebody stay warm. It's amazing. So I think by reaching out to each other, they kind of build strength off that and their self esteem is served by that for sure. And they kind of become strong with each other. And it's extraordinary to witness, I'll tell you that. And actually when we built Logan place, there are 30 people who live there and we built a community room and everybody has their own apartment. And it's, there's, there's all kinds of independence and privacy, of course but we were surprised the extent to which people did want to break bread together and be together. So when we built Florence House, we built more of that kind of community space. People need each other, and that's a wonderful thing.

Dr. Lisa Belisle:

Last summer, when I saw you, Mark, you. You and I were at an event for Share Our Strength, which is the organization that is seeking to end childhood hunger not only in Maine, but also across the United States. And you were talking to me about turning 50 and this sort of, how old are you? Well, one of us was turning 50, let's say. I think I'm remembering this correctly and how it had caused you to be somewhat interesting about where you had been and where you were going and sort of some of these pivotal moments in your life. You've now had a year to kind of figure out those thoughts. What have you come up with?

Mark Swann:

I feel incredibly, incredibly lucky and blessed to have had this job and a healthy family and all those things one does when you, you know, you hit the midlife point. When I started, Preble street was just a couple staff and some students and some volunteers. Had a great mission, a great board, but it was really tiny and we've grown quite a bit and we're doing a lot more. And it's been, you know, just an extraordinary ride to be on for 20 plus years. And watching the organization kind of go from infancy to maybe we're young adults now, but it really calls the question, so, what's next? And okay, we're at this point, we're at some platform, whatever it is, where do we go next? And that's an incredibly interesting question to me. And I'm very excited to kind of explore that and see where that goes. And that's one of the reasons we're in Bangor and Lewiston right now, sort of spreading that mission and that work and the philosophy behind Preble street to different communities. It's why we've got a bunch of different housing options out there right now that we're looking at. I'm not sure which will happen, but hopefully one or two will. And that's new for us. We're starting a recovery house for women, very small, with St. Luke's local church. And it's a really nice faith community partnership. We're going to kind of try that out. So in the transitional living program I mentioned for kids is a lot of new things we're trying, and we're really looking, trying to look ahead five years. Not in any, you know, fancy strategic plan that will sit on a shelf, but really recognizing that the community's changing, the economy's changing demographics in Maine, and most particularly the human service sector has just dramatically changed. When I point out to people that in the last 10 years, five agencies have closed six homeless shelters in Portland, they're usually kind of surprised by that. But that's pretty dramatic when you think about, you know, so who the players are, who's doing the work, who's changed focus. But, you know, Salvation army closed a shelter, Ingraham Youth Alternatives, Catholic Charities, and the Y, of course, the ywca, which is closed entirely. That's pretty dramatic, but has sort of gone under the radar screen. People don't notice when things go away as much as they notice when things start. But that's changed Preble Street's role pretty dramatically. And now we want to sort of plan what's next and to be ready for further changes if they occur or when they occur. So I'm pretty jazzed up for the next decade or so.

Dr. Lisa Belisle:

Mark, it's really been a pleasure to talk with you today. I mean, you're doing great work. I think there's no other way to say it. How can people find out about Preble street and the work that you've been doing with Preble Street?

Mark Swann:

Probably the easiest way is the website, preblestreet.org but, you know, honestly, we consider ourselves pretty, pretty available, accessible and transparent. And people can call and, you know, come down and see the place. 775-0026 is the phone number. And we are constantly looking for volunteers. We have three different soup kitchens now and a food pantry. So we're looking for volunteers. We're always looking for clothes and for food donations. And of course, financial support is a big part of my job to find that. So we want people to know more about us. My experience, absolutely 100% is the more people do find out about pebble street or get involved, the more they're interested, the more they're supportive of the work. And a lot of eyes kind of get opened, I think, by getting involved with us. So people can call me anytime or get online and check us out.

Dr. Lisa Belisle:

We've been speaking with Mark Swan, the executive director of Preble street, and really one of Maine's 50 people that Maine magazine has put out there. And we continue to support the work that you're doing. Maine magazine does, and I do personally, and I'm glad to see a fellow Bowdoin graduate is doing so much good for the world. You make me very proud.

Dr. Lisa Belisle:

So.

Mark Swann:

So thank you, Lisa.

Dr. Lisa Belisle:

Thank you for being here today.

Mark Swann:

My pleasure.

Dr. Lisa Belisle:

You've been listening to the Dr. Lisa Radio Hour and podcast show number 153, Life on the Edges. Our guests have included Joshua Francis, Bruce Fitzgerald and Mark Swan. Read about Mark Swan in Maine magazine on our 50 people list. For more information on our guests and extended interviews, visit Dr. Lisa.org the Dr. Lisa Radio Hour and Podcast is downloadable for free on itunes. For a preview of each week's show, sign up for our e. Newsletter and like our Dr. Lisa Facebook page. Get Twitter updates by following me as Dr. Lisa and see my daily running photos as bountiful1 on Instagram. We love to hear from you, so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring the Dr. Lisa Radio Hour to you each week.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle.

Dr. Lisa Belisle:

I hope that you have enjoyed our Life on the Edges show. Thank you for allowing me to be a part of your day. May you have a bountiful life.