1. Provide the title of your story or series and the names of the journalists involved.
"Homeless with Cancer" by Cynthia Ryan Photographs by Sylvia Plachy Edited by Jessica Gorman, Executive Editor, CR Magazine
2. List date(s) this work was published or aired.
Fall 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
"Homeless with Cancer" reveals stories about living with a life-threatening disease on the streets of Birmingham, Alabama. As a breast cancer survivor diagnosed twice in the past 17 years, I sought to give voice to men and women in my city who find themselves facing yet one more challenge with far fewer resources than most of us have within our reach. The result was a year-long immersion in a community that changed both their lives and mine, and I hope, those of readers who thought they knew all there was to know about how a cancer diagnosis alters a person's self-identity and purpose in life. Since I reported this story, it has continued to evolve through the friendships I forged on the streets of Birmingham. With a lot of help from the homeless cancer survivors who welcomed me into their lives, I have learned to walk with Edwina, Roderick, Lisa, Ervin, Charles, and Franklin through difficult treatments, physical and emotional hurdles, and daily obstacles to accessing adequate health care.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
One of the greatest difficulties I experienced while reporting this story was a lack of documented information about subjects. In most cases, I was required to fact-check the same information numerous times, since some of the subjects I profiled suffer from mental illness or experience immense shame and tend to vary their stories. Phone calls and visits to various facilities through which subjects traveled and verification of specific details through friends, pastors, and health care specialists helped me to piece together the facts. In those few instances when verification was not possible, I did not report the information. I also turned to traditional sources such as websites providing information about institutional responses to homelessness in urban and rural areas across the country, descriptions of respite facilities serving members of this population, and statistics on the number of homeless in America. Unsurprisingly, the data available is far from complete. In the story, I mention the additional layer of complexity that this lack of accurate tracking of the homeless population creates. Lastly, I utilized medical research reports that address either the problem of late diagnosis of cancer, heart disease, or other physical burdens among members of this population or efforts to implement screening and diagnostic programs in specific communities. I found one local doctor, Stefan Kertesz, to be particularly helpful. Kertesz is a physician at my institution (UAB) who worked extensively with the homeless in Boston through a program established by Harvard Medical School.
5. Explain types of human sources used.
In addition to interviewing and interacting with members of the homeless community suffering from cancer (Edwina Sanders, Lisa Brown, Charles Geer, Ervin Miles, Roderick Turner, and Franklin Wells), I worked closely with staff members, especially assistant pastor Rachael Martin, at Church of the Reconciler, a Birmingham-based mission church serving the poor and indigent in the city. There, I found other people who provided a continuum of perspectives on the health challenges facing the homeless–health practitioners from the area who volunteer their time to address at least some of the health care needs of the community and many others who offer services ranging from transportation to warm clothes to emotional support for individuals who have lost the will to survive. Other valuable sources included staff at Jefferson County Cooper Green Mercy Hospital, the county facility where most of the local homeless seek medical care, oftentimes too late. Individuals from local nonprofits also provided information about the severity of problems faced by the homeless diagnosed with cancer, as well as details about the available programs for this population in Birmingham and elsewhere in the country. Since I did not locate any institutions that work specifically with the homeless who have been diagnosed with cancer (other than the National Health Care for the Homeless Council, which addresses a wide range of health needs), I needed to draw on existing resources to address the intersections between a largely under-investigated population struggling with a particular disease classification.
6. Results (if any).
In short, what I discovered through working on this story is that the current health care system is woefully underprepared to address the needs of homeless cancer patients–if these individuals make it to a health care facility at all. This lack of preparedness, I think, is linked to misunderstandings about who the homeless are and the diversity of individuals in this community (for example, those born into homelessness or those who fall into homelessness later in life), the beliefs and values that motivate or dissuade those suffering from cancer to seek assistance (a primary example is the misconception among many African American homeless raised in the South that "white coats" will use them to conduct experiments, a fear embedded in historical fact in Alabama), and the basic needs that must be met to affect the poor prognoses experienced by the majority of cancer survivors in this population (for instance, accessibility to grocery stores and transportation, and the money to make use of these services). A number of positive changes have occurred since the story was published. The men and women featured have benefited in several ways: through offers of temporary housing, contributions to a church fund providing medical vouchers for use at Cooper Green, and invitations to accompany individuals featured in
the story to check-ups and treatments. Two of the most exciting results of the story have been an offer from the local Komen affiliate to help fund a breast cancer prevention and detection program for homeless women in the community (a project on which I am currently working) as well as outreach from a medical center in Birmingham to help one of the subjects in the story, Edwina Sanders, with needed follow-up surgery.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No needed corrections or clarifications have been requested. I did publish an op-ed in The Birmingham News on health care access with reference to the article (and to the AACR's annual meeting on cancer health disparities) following publication of "Homeless with Cancer" in CR. The op-ed can be found at http://blog.al.com/birmingham-news-commentary/2010/10/viewpoints_we_must_help_each_o.html.
8. Advice to other journalists planning a similar story or project.
Be willing to challenge the definition of a "good story" and celebrate your ability to bring attention to people and places that audiences may not necessarily embrace willingly. The story I've reported has led to several positive outcomes, while countering much media coverage about cancer that emphasizes an uplifting narrative of hope. As a survivor, I sometimes had to push myself to face the rawness and pain of cancer on the streets, but what I have learned about strength and resilience in the most unlikely of places has been well worth any emotional or physical risk. It is still difficult to experience cancer through the eyes of people who have to fight for every resource in a health care context. The best stories are difficult, though, so I guess I wouldn't want to feel any other way.