Tiffany Wang

DPCS Intern 08X, San Francisco

The Non-Working Poor
San Francisco is a contradictory city, which makes it so agreeable to me. It is equally
cultured and crass; flourishing and failing. I turn a corner, and the mass of worldly and wealthy
businesspeople bee-lining towards the United ations !la"a is replaced with the statistically
poorest of our nation#s homeless. $etween the homeless and wealthy population e%ists a
relationship that oscillates from polite awkwardness to a &ery palpable tension. I chose this
internship two quarters ago because I thought that working with the poor of a wealthy city would
help me gi&e something back after taking so much from 'artmouth. (he homeless reminded me
of what my parents could ha&e become, had they not worked so hard after immigrating here. So I
ha&e always felt that tension, and though I do not feel it resol&ed at the end of this internship, I at
least understand more about its nature. (his summer has gi&en me the hopeful taste into
medicine and non-profit work that I had sought, but it has also gi&en me a taste of the
tremendous power and momentum of circumstance in people)s li&es, and the force and luck
required to o&ercome circumstance.
(he city#s long history of homelessness has beaten out a quick and familiar path for future
generations of homeless to follow. *&ery generation seems to be more and more comfortably
dressed in the uniform of homelessness--the tweed blanket, the cardboard sheet, and the hea&y,
unseasonal +acket. ,ne of my super&isors at the -ustice *ducation and .olunteer /d&ocacy
department said it best. 0e ha&e all these in&isible markers in our li&es, she had said. 0e ha&e a
name to our bank account, a lease to our house. 0e ha&e relationships that confirm our e%istence
and e%pand our knowledge of oursel&es. For the homeless, the lack of shelter, food, money, and
connections amounts to much more than physical hunger and homelessness. It becomes a
negation of their physical e%istence, and they fall into a kind of spiritual in&isibility. 1any of the
homeless at the St. /nthony)s 'ining 2oom, I disco&ered, ate their tray lunches in a silent da"e,
and kept their heads down in the presence of staff, e&en though we made more effort to chat with
them than we did with other staff members. (hey seemed past a state of despair. Instead, they
were confused with their own shame, as if they had been dragged there by a purely physical need
for food e&en as their brain knew that they belonged somewhere else. (hat self-deprecation was
my super&isor)s number one obstacle to helping the homeless apply for +obs, or work hard at the
ones they currently had. obody felt important enough to take themsel&es seriously. If
somebody doesn#t show up to work, she had said, then they probably don)t think that they are
important enough to show up.
In the (enderloin of San Francisco, it seems that nobody feels important, or hopeful.
/lcohol and drug rehabilitation programs sit ne%t to liquor stores. *&ery other building is a free
clinic or childcare center, and e&ery corner has ten or so people smoking, sleeping, complaining,
and arguing. (he ones who harass you, you learn, are the new ones on the block. (hey still ha&e
the fresh indignity that dri&es protest. (he chronically homeless are mostly silent. 2ent is high
for the middle class, so it is unmanageable for them, and the loss of shelter, +ob, and dignity
occur sequentially, like dominoes.
1y internship orientation started in the dining room, which is the flagship program of the
St. /nthony#s Foundation. (he non-profit is one of the biggest and most established in San
Francisco, with more than ten departments and a newly built building to mo&e into ne%t year. $ut
at the beginning, there was only a dining room. It smells of chlorine in the morning, and dirt,
urine, and smoke the rest of the time. (he building originated as an auto repair shop, and so a
huge ramp remains where the homeless line up for the daily meal. /t 34544 am the seniors and
the disabled form a line outside and get tickets for their meal, and at 33536 the normal line starts,
a&eraging 7,644 people a day. (he place is so worn and used that it is strange to imagine how
momentous and important each day is here. (he ma+ority of the clients eat their only daily meal
here, and so the dining room, without e%aggeration, sa&es li&es.
!ri&ate high schools and church mission groups send kids o&er biweekly to &olunteer
here, and the regular crew of senior women and disgruntled husbands form the dining room#s
core force. (his is not a go&ernment-funded organi"ation, I remind myself, and yet they ha&e at
least twenty-fi&e &olunteers a day, e&en during the school year. 0hat in&isible hands are at
work8 For the time being, I see hands folding napkins, stirring &ats of pasta and sauce. Some are
pouring +uice, and some are putting on late% glo&es and aprons. Some on the security team are
talking on their walky-talkies, carefully watching the ones in wheelchairs or the ones making
trouble. It#s an e%tremely elaborate system and workforce for our clients, who rarely get ser&ed
or smiled at. 1ost look angry and tired. $ut they are different people in your pro%imity, and
many profess their gratitude so fer&ently that you feel embarrassed. (he clientele does &ary,
though. 1any are so hungry that they can only barely produce a smile before they start to eat.
!eople sing and preach gospel, or talk about the elections. (hey make up stories about their
ele&en daughters, their !ortuguese heritage, and the life they had before they found themsel&es
here. (hey complain about the country. Some +ust sit and eat in silence, as if they could hardly
belie&e what they are doing.
9ere, I line up and ser&e trays, clean tables, and pour water for three and a half hours. I
ha&e ne&er seen people so truly grateful for a cup of pasta, or a carton of milk. I think continually
back to when I am grumpy when I skip a meal, or half-hearted when I recei&e a good one.
$ussing tables is an especially humbling and tiring e%perience, and I am embarrassed by my
inability to carry more trays and my a&ersion to wiping up scraps of lefto&er food. I sit and eat
with them one day a week, and their stories are shockingly relatable. ,ne is a &eteran who
cannot manage his !ost (raumatic Stress 'isorder and had to quit his +ob. ,ne is a single mother
whose husband had abused her and left her with three children. ,ne is an immigrant who mo&ed
here a month ago because the +ob opportunities back home were not adequate, and he has
absolutely nothing and nobody in the world as of this immediate minute in time. ,ne is a senior
whose children ha&e all grown up and forgotten about her, and one is a drug addict whose
brother e%posed him to drugs when he was twel&e, so :what could I do8; 9ope for the better, we
instincti&ely say. *at this meal, and go to our employment program. <o see the podiatrist at the
free clinic, and get a sugar screening in case you are diabetic. $ut we feel like we are crying
wolf, because they#&e heard it day after day. It really is a =atch-77. >ou ha&e to hope and think
positi&ely to be proacti&e enough and change your situation, but unless your situation changes,
you don#t feel like hoping or thinking positi&ely.
,f course, nobody pretends they are all e%cused from blame. (hey ha&e been selfish and
la"y, and chosen some form of temptation. $ut without the parenting to teach us the rewards of
diligence and delayed gratification, I know that I too would easily be left to flounder in my own
&ices, and grope my way towards a stable life that nobody taught me to work towards. I begin to
feel that e&ery success story has to ha&e e&erything +ust right. 0e are the strange ones with our
circumstances lined up +ust so. >ou must ha&e parents who nourish and support you; a home to
study in and meals to keep you ali&e. >ou must ha&e access to schools and at least a few teachers
who ha&e moti&ated, inspired, and truly taught you. >ou must work hard, but only after you ha&e
been taught that working hard actually does something. 1ost of the time, it seems that working
hard ne&er results in much. (hose who ha&e found a +ob--e&en with their criminal record--cannot
find a way to mo&e out of the building that causes them health problems, while those who ha&e
registered to &ote to change their situation cannot find the resources to educate themsel&es about
what)s going on. (hose who ha&e completed St. /nthony)s training program to obtain their <*'
ha&e to sa&e up for weeks to come up with the fee needed to take the test, while others who ha&e
found a homeless shelter cannot find one that also takes their child. It is the most difficult and
enmeshed obstacle course I can imagine, and the intricate relationship between chapters of (he
0orking !oor is tragically embodied in e&ery client St. /nthony)s ser&es.
I am supposed to be energi"ed by my participation in multiple wings of St. /nthony)s
rather than one, but instead I am o&erwhelmed as I reali"e how comprehensi&ely daunting it is to
help e&en one person gain a foothold on society. 1y second area of work was at the free clinic,
where patients without medical insurance could access general physicians, pediatricians, and
podiatrists. Ironically, the health care at the clinic seemed infused with much more compassion
that I am used to from my own doctors. 0hile the dining room was a chaotic snapshot of the
whole (enderloin population, the clinic was a small family of patients and pro&iders, and an
unusual one. (he clinic format allowed patients to circulate around different doctors and
ser&ices, and 0ednesday administrati&e lunchtime meetings focused less on administrati&e work
than on specific patients needing staff collaboration for more holistic treatment. It had e&erything
a regular clinic would ha&e?an abundance of patient charts, referral forms, doctors) offices,
pharmacies, and labs, but without the spacious rooms and new medical equipment. It seemed to
me ironic, as the clinic seemed to deser&e new facilities with more urgency than any of the
clinics I)&e been to in my lifetime. I suppose I do need state-of-the-art facilities for my check-
ups, but the man star&ing on the street probably need them much more urgently.
1ost of the nurses, medical assistants, and doctors work for a &oluntarily reduced salary
to alle&iate St. /nthony)s costs, and they work affectionately around the assortment of
difficulties that their colleagues in other clinics ne&er dealt with. (hey na&igate cramped
hallways and patient rooms with handfuls of patient charts not yet computeri"ed into the medical
database. 'octors lack the professional pride naturally entitled them and handle labs and
medicine distributions themsel&es when the nurses are busy. (hey take their time to ask patients
about their shelter registration forms and disobedient children, watching themsel&es slip
progressi&ely later on the patient schedule with each prolonged appointment. @o&e is necessary
and ob&ious in this community. /nd with the comically outdated medical equipment, I learned
that the good humor necessary to working in such an unusual clinic was a necessary symptom of
their dedication to a much deeper cause. I learned to acquire a superhuman patience with patients
who could not describe their symptoms, or worse yet, dismissed the importance of their own
healthcare. :9elp those who cannot help themsel&es; turned into :help those who do not want to
help themsel&es.;
I helped triage, screen, and usher in many of the patients whom I usually ser&ed in the
dining room. /fter three weeks of training, I learned to take their &itals, assess their primary
complaint, and ask them the barrage of questions that painted more of a personal portrait of their
li&es than a medical one. 0hat and when was their last meal8 'o they smoke, drink, or use
drugs8 9ow old are they and where are they from8 0hat were their medical problems and when
did they acquire them8 'id they ha&e shelter, and did they ha&e children8 (he outlines of
peoples) li&es that I had only imagined in the dining room began to fill themsel&es in. / good
percentage of the population consisted of illegal immigrants who sought work here to support
their families back home. Some were seniors who had learned to cope with their many medical
problems with a pleasant, resigned annoyance. I started to function as part-time translator for the
=hinese patients, and only then did I feel a deep cultural sadness for all the =hinese immigrants
who could only fumble with the scarce opportunities granted them. 9ere I was, seamlessly
transitioned by &irtue of my /merican birth and cheerfully na&igating the natural difficulties of
occupying two worlds, and I was translating medical complaints for patients the age of my
grandparents in perfect *nglish. (hey eyed me with a bi"arre fascination, as if I was wholly
familiar and unfamiliar at the same time. I caught myself spewing ad&ice at them, rambling
about dangerous parts of San Francisco and suspicious employers, or nearby cultural centers and
homeless shelters. I saw the good-natured hope with which they saw opportunity here, but my
instinctual responses were not to encourage, but rather to caution them of how difficult life
would be. *&en my parents, obstinately well ad+usted after twenty years in the U.S., still ha&e
difficulty when distinguishing between linguistic and cultural contradictions they must learn to
conquer and those they must learn to blissfully ignore. /nd in those moments, I caught myself
negating almost immediately that essence of /mericanism that years of schooling has instilled
within me. (hat solid cultural identity I had possessed melted ambiguously, totally confused.
9ow real are the opportunities here8 I suppose it depends. $efore this internship, I had a
&ery clear answer. (he road to 'artmouth has consisted of hurdles and roadblocks, but rarely
ones that ha&e made me seriously doubt my ability to +ump or circum&ent them. /t least, I ne&er
felt that the danger of failing a big test had anything to do with the dinner I)d eat at home
afterwards. 1y path to a good education?a good life?has been shown to me with such clarity
that I often forget the work it has taken my parents to lay it out. $ut I ha&e always thought that
what I ha&e owed them, like what e&ery child owes their parents, could be paid back in diligence
and simple hard work. I would go to college and somehow better the world. It is true that
mobility and success has been promised me by my schools and my family and my country, and
that it is not realistically promised e&ery person here. I should do something about that as a
member of the human race. $ut academic and familial responsibilities resonate together, while
ci&ic responsibilities belong on a separate rung. *qually important, but separate.
1aybe my clinic interaction with the constant flow of poor and hopeful =hinese
immigrants has forced a cultural lens onto my eyes, but I no longer feel the separation so
distinctly. 1y personal responsibility towards my parents and my responsibility towards the
patients I saw in the clinic may not be identical, but I feel that they are related. ,ur super&isor
had bought a communal +ournal for the interns to write in, and sent it to us at the end. I had
written5
:(oday we saw a man and his son from (ibet. (heir skin was so dark; I could hardly tell
where they were really from. /ll of their clothes looked like things my parents wore when they
were young. I had no idea what he was saying, but I was the closest translator they could find.
$ut he only understood half of what I said, and I understood none of his medical complaints. It
was so frantic. / bunch of doctors lining up and asking him what was wrong, and he was trying
to tell them. 'r. $ledsoe tried to find the /(A( translator on the phone, but they put us on hold
for too long. /nd e&erybody was +ust looking at meBall the nurses and medical assistants in the
hallway who had come into the room to help. $ut I really don)t know the word for :anemic; or
:deficient; in =hineseBI still don)t know what)s wrong with him. I felt so useless. 9e said that
he had come because they don)t treat his son)s condition in (ibet. (hey left behind his wife and
they came here, and so our clinic is literally the reason he came to /merica. /nd I don)t e&en
know what he)s saying. 0hat is he saying8 I guess it)s not my faultBfeels like it is though.;
(he detecti&e work it took the doctors to finally diagnose his son came slowly, but they
were accustomed to it. *&ery client that comes through the clinic is yet another mystery to be
sol&ed. (hey may come to the clinic, but one needs to ask them a series of uncomfortable
questions to disco&er the real source of their problems, of which there are usually many. /nd
e&en if somebody helps to identify them, the money and resources it takes to sol&e their
problems need to magically surface. /nd then, e&en if their problems are sol&ed, there is nobody
to go out into the world with them for the ne%t couple of months, and make sure that their +ob or
shelter is maintained. 'a&id Shipler calls the working poor the in&isible in /merica, but what
about the workless poor8 /re they more in&isible, more helpless8
>ou wouldn)t think so, +udging by some of their dispositions. / man named Indian -oe
used to wait in the St. /nthony)s dining room line that snaked around three blocks and two
corners, burning incense and polishing his sunglasses. 9e was, in his words, the happiest man on
*arth. 9e owed nobody anything, and nobody owed him anything in return. Indian -oe said that
people with too much stuff get preoccupied with it. (he people he knew with family in the area
had more quarrels and troubles than happy times. 9is friends who had gotten +obs in local
con&enience stores or touristy gift shops hated the work, and nobody has e&er treated him more
nicely than at St. /nthony)s. 9is shelter)s the only place he)s li&ed in that doesn)t mind his dog,
and he ne&er has to fi% or repair anything. If happiness really is the most important thing in life,
then clearly Indian -oe has reached more success than me. I could only aspire to that kind of
inner peace. *&en the patients in the waiting room sat without complaint for an hour as the
doctors ran behind schedule, and I recall how irritated I get after waiting for twenty minutes. /
couple weeks into the internship, I start to feel embarrassed whene&er I approach somebody with
sympathy. (alking to them, there ne&er seemed to be anything to be sympathetic about.
/t the end of the day, it is this curious feeling of hope that one must cling onto. (he
pediatrician at the clinic had told me?without hope, her daily interaction with drug addicts,
abused women, and diabetic seniors would be unbearable. $ut with hope, she belie&es that she
en+oys her +ob e&en more so than her friends at other clinics, whose patients complain about their
toothaches and busy days and imperfections in their li&es. 9er patients, on the other hand, are
quite happy when they ha&e toothaches. :It)s greatC It)s the only thing wrong with me. I)m still
ali&e,; one woman had said to her. 0ith each client and patient I had seen, I had thought that the
end of this internship would lea&e me tired and o&erwhelmed. $ut I am continually surprised by
how much I miss St. /nthony)s, and how immediate the e%hilaration was when my work is put
to use. (reating a man)s foot allows him to walk around and answer +ob offers. <i&ing a man
lunch and dinner allows him at least one more day. For once in my life, I am of use as human
being, and not +ust as a student or a daughter.
I am con&inced that the rewards of nonprofit work are plenty, and that I will search for
opportunities when my schooling is finished. /merica)s health care system has left so many
behind; the numbered of uninsured citi"ens is staggering. I only hope that the state of the country
when I enter the workforce is a different one. For right now, though, I cannot consider what I
will do in the future. (here are an infinite number of things that one can do in medicine and
public or global health, and I do not doubt that the residue energy and awareness from this
summer)s internship will help fuel me for a long time to come. For right now, what immediately
concerns me is the transition to 'artmouth life, where I will ine&itably feel that my complaints
will be tri&ial, and that my problems could be worse. I hope that the power of perspecti&e will
help me think larger as I continue college, and that I do not dismiss tra&el and &olunteer
opportunities offered me. 1ost importantly, I am grateful to e&erybody who has contributed
positi&ely to the power of circumstance in my life, when the power of circumstance has made
life so difficult for the clients of St. /nthony)s.