Syphilis. Hepatitis C. Wounds. Poor dental hygiene. Domestic violence. Substance use.
These are some of the concerns Raye Fleming and her team at the Community Action Partnership of San Luis Obispo (CAPSLO) have noticed since beginning their services in the Santa Maria Riverbed.
“We’ve also found a lot of primary care issues, and 5Cities Homeless Coalition has gotten them into private providers or into clinics so that they can get those met,” said Fleming, CAPSLO’s health services director. “We can do basic wound care, but we are a reproductive health care clinic, and so what we provide is, you know, all methods of birth control, and we test for all STIs and we can treat for most STIs.”
CAPSLO received a $500,000 American Rescue Plan Act grant during the pandemic to purchase a mobile health care clinic to serve SLO County’s “outlying areas” with limited access to care, Fleming said. As CAPSLO formed its services, it had a grant from Dignity Health to provide services in Grover Beach at 5Cities Homeless Coalition’s Cabins for Change.
“5Cities Homeless Coalition has a team of three people that do outreach, and they’ve been going down to the riverbed to talk to them about their needs and obviously housing, and what they started to discover were medical issues,” Fleming said.
Those issues prompted her organization to show up alongside 5CHC to provide reproductive health care services.
An estimated 110 to 150 people once lived in the Santa Maria Riverbed when both SLO and Santa Barbara counties, in partnership with Caltrans and the city of Santa Maria, began a phased encampment cleanup process in July. Caltrans spearheaded its effort under the Highway 101 bridge in September, and the coordinated effort moved west in October.
As cleanups occurred, nonprofit organizations teamed up to provide health care, syringe exchange, animal care, food, water, and shower services every Tuesday—with dental care scheduled to come online on Oct. 8.
Santa Maria’s Good Samaritan Shelter had eight clients come into the Santa Maria emergency shelter and 10 to Hope Village, Santa Maria’s interim housing facility on county-owned property, Good Sam Director of Homeless Services Kirsten Cahoon told the Sun. SLO County’s side has struggled keeping up with the housing demand, with 5CHC experiencing a waiting list of 200 to 300 people.
Despite efforts to be consistent and build trust with the encampment’s population, it’s been challenging for service providers to stay in contact with some folks in the riverbed as they move during the cleanups.
“What it really is, is the people just move to another location. It’s not solved,” Fleming said. “I’m unsure about what the solution is for just moving people around in the riverbed, because that’s what happens. That’s their home. They don’t have any other place to go.”
The riverbed is a dangerous and unsanitary place for community members to live, and leaving them there allows for more health concerns and issues to flourish, 4th District Santa Barbara County Supervisor Bob Nelson said.
“This isn’t Burning Man out there,” Nelson said. “In no uncertain terms should living in the riverbed ever be romanticized as anything other than the most inhumane place for anyone to be living in the community.”
When cleanups began in July, several people in the riverbed tested positive for syphilis—a sexually transmitted infection that people can get when someone has a syphilis sore, and women can pass on to their fetus, Fleming said. People need three treatments, three weeks in a row, once someone tests positive for syphilis. If they miss treatment, the whole process starts over.
“And the county of SLO Public Health was aware of the positive syphilis tests, … because we have to report those to the county. And they said, ‘We don’t want those people moved. We want them to get their treatment completed,’” Fleming said. “Well, it didn’t work, and they were all dispersed.”
Fourth District Supervisor Nelson told the Sun that the counties did hold off on the cleanups for four weeks until treatment was complete, following the SLO County Department of Public Health’s guidelines.
“There was a little bit of back-and-forth on what the right solution was. Ultimately, it was decided that [the cleanup] was delayed until the treatment was complete,” Nelson said. “Three-week treatment, and we delayed our process out of an abundance of caution. We changed our timeline. All of this has been done in coordination with SLO County Public Health.”
Linda Belch, SLO County’s deputy director of Adult and Homeless Services, added via email that the agencies hold regular meetings between service providers and those working on the encampments so details “can be discussed and worked through.”
“I am aware that adjustments to the timeline for the work on the encampment have been made periodically to accommodate needs such as health treatment and that everyone involved is working together to try and ensure continuity of care,” Belch said.
SLO County Public Health Department Public Information Specialist Tara Kennon said the department requested that syphilis treatment be “a high-priority consideration when it came to decisions about moving.”
“Our understanding is that partners were managing a complicated set of circumstances and that in cases where residents were moved before completing treatment, our team has worked to follow up with them at their new locations to continue treatment,” she said.
Every Tuesday, CAPSLO runs its mobile clinic, staffed by a nurse practitioner and two medical assistants. CAPSLO typically sees 20 to 25 patients per day in its brick-and-mortar facilities in SLO and Arroyo Grande, and the mobile clinic sees about four to six patients a day. With grant funding covering operation costs until December 2025, CAPSLO is seeking other funding to sustain its efforts.
Since July, 28 people have tested positive for syphilis and five people tested positive for hepatitis C—a blood-borne disease that’s usually obtained through sharing needles, but it can be obtained through sex if there’s torn tissues and blood gets into those tissues, Fleming said.
CAPSLO can treat chlamydia and gonorrhea right on the spot, and provide the three-week treatment needed for syphilis, but hepatitis C needs extensive treatment and blood work that needs to be managed by an infectious disease or primary care provider. Nobody had tested positive for HIV in the riverbed through CAPSLO resources as of Oct. 3.
“We did find a woman who … was pregnant, didn’t know she was pregnant. Also had syphilis,” Fleming said. “She took housing for one night and then was back in the camp, and I don’t know where she is now because some of them we’ve lost contact with.”
5CHC Executive Director Janna Nichols added that people have also been diagnosed with abscesses, and another woman was diagnosed with cervical cancer.
“A variety of health care issues that have gone undiagnosed by a virtual lack of health care,” Nichols said.
The 5CHC outreach team is finding challenges in keeping track of the people they’ve served, with individuals moving into more remote areas.
“For us, I understand some of the reasons behind the clearing, and I certainly appreciate the need to address the issue, but the impact is that people are being displaced,” Nichols said. “We still haven’t housed them, we’re having a harder time finding them, or having to walk farther to find them.”
Santa Barbara County Supervisor Nelson said that the county and its partners will engage with private property owners and other jurisdictions to try and prevent people from going into more remote areas.
“We’ve got a robust social safety network, and we’ve been out there full-force—Animal Services, Public Health,” Nelson said. “I think we’re constantly adjusting the strategy to the circumstances. If people continue moving further west, then we are going to keep moving further west. … We are going to continue providing services out there as we help people move beyond the riverbed.” m
Reach Staff Writer Taylor O’Connor at toconnor@santamariasun.com.
This article appears in Oct 10-20, 2024.