The idea was to roam a four-block sector of skid row in downtown Los Angeles, but a MASH unit of outreach workers didn’t get far Friday morning.

It took two hours to circle a single block in the human catastrophe that is skid row.

From the moment the nurses, mental health specialists, addiction counselors and other team members hit the street, they drew a crowd. Especially when people discovered that their mission is to find housing for people living in tents on the city’s sidewalks or in business owners’ doorways.

“We’re like magnets out here,” said Elizabeth Hill-Nishimura, a mental health worker.


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A heroin addict with grotesquely swollen arms and hands pulled back gauze on his right arm to reveal an oozing, quarter-size hole. He pinched the area around his gaping abscess and squeezed puss into the gutter.

The team found and examined two dialysis patients, one with yellow eyes and skin.

A woman in her late 60s sat in front of her tent with medication for diabetes and epilepsy, and nurse Carrie Bach administered eye drops for her glaucoma.


Elizabeth Hill-Nishimura and Tulus Hairston are outreach workers trying to help L.A.'s homeless. (Mark Boster / Los Angeles Times)

A woman of about 40 said she’d been raped multiple times, and beaten as well, and signed up for help.

Tents lined entire blocks, reefer filled the air, people with mental illness talked to themselves, sirens screamed.

Mankaa Fokwa, a nurse practitioner, visited skid row for the first time recently to see if she wanted to work with the outreach team.


“When I drove down here,” Fokwa said, “I could not believe this is the United States of America.”

Equally shocking was the fact that such conditions could be allowed to exist — a few blocks from the local halls of power — without more than piecemeal intervention over the years and never enough temporary or permanent supportive housing.

“I would have thought skid row had tons of outreach ... but in reality there isn’t,” said Marc Trotz, L.A. County’s director of Housing for Health. “I never see anyone kneeling down helping somebody.... If you’re really serious about areas that have high concentrations of homeless people, you have to treat this like a natural disaster or a health emergency, which it is.”

This new outreach strategy is a big, long-overdue step in the right direction, and part of a collaboration between city, county and nonprofit agencies. Four six-person teams have been going out five days a week for two weeks now, gathering names and stories and trying to link people with services and ultimately get them off the street and out of the revolving doors at hospitals, courts and jails.


It’s way too early to know how well this is going to work. A lot of people on skid row are seriously addicted, mentally ill or both, and too damaged to make good choices.

But it’s one of the smartest approaches I’ve seen, and it’s about time. We’ve long had hordes of people living on Southern California’s streets and under its freeway overpasses because of the climate, low wages, high rents, untreated mental illness and other factors. But the numbers have spiked, up to about 44,000 countywide, with new encampments all over the place.

A small number of the people living in these wretched places have assaulted and robbed people who live or work in these areas. This has driven up crime rates. And that, more than the thought of a tired old woman like Barbara Brown, dying on the street in a heap of wet bedding as she did earlier this month, is what tends to get people’s attention.

Under pressure to do something, city and county officials have produced fat reports filled with ambitious proposals. And state officials have come up with a $2-billion housing plan. With enough cooperation, something good could come of all this, but that’s going to require public support and political courage.


The L.A. city plan, for instance, calls for a $1.9-billion investment over the next 10 years, mostly for housing. And that’s on top of $100 million annually Mayor Eric Garcetti wants to spend on other homeless programs, without cutting into other city services or creating a huge budget deficit. No easy feat.

“I will push for as much as we can get,” Garcetti told me last week.

He said he’s been doing his own on-the-street research in homeless communities. He mentioned six sources of money he would support tapping, including document fees and something known as a linkage fee on new developments. He said he’s open to any source of new funding but has doubts that voters would approve a parcel tax or housing bond.

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Our conversation made it even more clear to me that Garcetti understands the complexities and huge costs of an honest fix.

If he wants to establish a steady source of money and be the mayor who helps to solve the crisis of people living like stray dogs in a city of riches, however, he’s going to have to get out front and pull, rather than stand back and push.

Or, as the city plan from city administrative officer Miguel Santana puts it: “While the costs to fully address homelessness are significant, the cost of inaction will continue to grow.”

There was no inaction or hesitation on the part of the team I tagged along with Friday. It included engagement workers Hector Gonzalez and Tulus Hairston and addiction specialist Debra Fracasso.


By the end of morning rounds, the team had directed three people into detox programs. They learned that one of their earlier contacts had already moved into housing and another was about to be placed.

Hairston and Fracasso have an advantage on the streets. They were both once homeless and resisted help, so they know how to relate, and they’re not discouraged when someone brushes them off at first, as people with mental illness often do.

“We have to get them to trust that we’re going to work with them all the way through,” said Hairston, who was diagnosed with schizophrenia and went from homelessness to a rescue mission to transitional housing to having his own place. He wants to get a college degree in public policy.

“This is what we came from. This is us,” Fracasso said after interviewing a woman with mental health issues and four years of homelessness. “Just because people are down here doesn’t mean they can’t change.”


steve.lopez@latimes.com

Twitter: @LATstevelopez

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