The stories below are being collected in and around Knoxville, Tennessee. They have been edited for length and clarity, but not content.
“A few weeks ago, my partner came down with flu like symptoms, but tested negative for the flu. The doctor wanted to test for COVID-19 but my partner did not meet the requirements, even though they work at a credit union with hundreds of customers and international travelers daily. My partner went back to the doctor because they were still super sick, and they tested negative for the flu, strep, mono, and had clear sinuses and no pneumonia. The doctor still would not test my partner because they haven’t been in contact with a confirmed case.
A week later, I became sick with a dry cough and fever, which progressed into shortness of breath. I have no health insurance, so I went to a clinic to ask about a test. This was before there was any real info about the test shortage and the administration was still trying to say that anyone could just walk into a doctor and get a test. The doctor was so rude that I left in tears before he even took vitals. He had horrible bedside manner and actually rolled his eyes at me when I asked him to please speak to me with a different tone. He had a nurse lead me out a back door because I was so upset and crying and he was still yelling at me down the hall "If you are sick enough to be tested you need to be at a hospital." They still charged me $125.
I called the health department and they said I couldn’t get tested until I needed to be hospitalized. Also, they said that I couldn’t have COVID-19 because I haven’t traveled and it isn’t in Knox County. Now, I am pretty sure that I have pneumonia and I am monitoring my oxygen levels. A friend who is an ER doctor said it is highly likely at this point that I have COVID-19, but he still cannot get me a test. I cannot afford an ER visit either. The message that was communicated from the Health Department to me was very much go to the ER if you are sick enough to be tested or go to your doctor. I think that in addition to being an irresponsible way to contain an outbreak, only testing the very sick, it also ignores the fact that a significant portion of our community can't just go to the ER and/or do not have a doctor because we have no health insurance. We especially cannot go if they will still not test us.
The school has been closed for over a week now but several of my students now have a mild cough. This is a complete fail. This has been an extremely frustrating and at time infuriating situation.
We need free and accessible testing in our community. I worry constantly about the families that may be at risk because I cannot get a test. We have self-quarantined, but there were days I could have passed it at school. I know that my students, even those who are now showing signs of illness, will most likely be ok. But what about their families?”
— Preschool teacher, Knox County, Tennessee
“On Sunday, March 8th, I returned home from a weeklong trip to a major US city. I flew there to attend a conference and stayed at the conference hotel for the majority of the trip, which was located approximately a block from multiple conferences that made news for people testing positive for COVID 19. I took precautions throughout the trip and washed my hands often, but unfortunately by the time I returned home, I was experiencing a myriad of symptoms including a fever, sore throat, congestion, and cough. I stayed home from work, assuming that it was likely just a cold, but not wanting to put anyone at risk. Although the fever was short-lived, my cough continued to worsen, leading to long coughing spells that left me breathless.
At the encouragement of my coworkers and my partner, I called the local health department’s COVID 19 hotline. When I reached someone, I shared my symptoms, and the person asked where it was I had flown. After disclosing the city, they stated that it “wasn’t a priority location” and asked if I had been in direct contact with anyone who had tested positive for the virus. I shared that I had not been around anyone who had received a test for COVID 19, and she told me I wasn’t eligible for a test, encouraging me to call my primary care provider (PCP). It did not feel like the appropriate time to express my frustration with the idea that in order for someone to receive a test, they must know that they were exposed to someone else who had received a test that very few people have been able to meet the eligibility requirements for.
I called my PCP. My PCP shared that they wanted me to stay home and treat my symptoms. I was told if the fever returned, shortness of breath worsened, or I felt generally worse, I was to call the office back prior to going to the emergency room. Fortunately my symptoms didn’t worsen to the point that I felt like I needed to go to the ER, but it was simultaneously validating of my concerns and alarming to me that the doctor was so concerned when the health department had been forced to turn me away.
The worst part of this is that as my symptoms begin to lessen, I still don’t feel comfortable returning to work. I don’t (and will never) know definitively if my illness was a particularly bad cold, COVID 19, or something else altogether, and I don’t know when I will cease to be contagious. Had I received the test, I would have been able to make informed decisions in order to protect my loved ones, colleagues, and fellow community members, while also creating a plan for returning to work and/or volunteering to help others in our community who could be most negatively impacted by this virus.
It is good public health practice to enable people to have access to testing for a myriad of illnesses, because knowing one’s status is one of the best ways to protect themselves and others. I am frustrated by my personal experiences, but I am also increasingly concerned about those among us who are older and/or immunocompromised who may be unable to receive testing and may realize they are sick when it is too late as well as those whose symptoms are so mild that they unknowingly have exposed others to the virus. The response to COVID 19 has left me feeling exasperated with the US public health system, and I am concerned about the wellbeing of our communities in the days, weeks, and months to come.”
— Public health worker, Knox County, Tennessee
What is happening?
Michael Dunthorn, who manages homeless programs for the City of Knoxville, recently spoke with WUOT regarding the project. The city is planning to build a day-use area under the I-40 Bridge at Broadway. The space will have fencing, assumedly like the fencing currently in the parking spaces in the area, which is tall metal fencing without barbed wiring. The space will have a gate that opens in the morning and closes at night. To clear up any confusion, people are NOT allowed to sleep there. There will be water and mobile toilets that will be cleaned and replenished every night. Some social services will also be provided via two social workers newly hired by Volunteer Ministries. It is unclear if these social workers will be provided any funding to help people, or if they will solely be referring people to resources that are already available. What is highly significant is that there will be security in the space during the day, providing a police presence that current residents say will be intimidating. TDOT currently owns that space and gave approvals for alterations at the end of July 2018. Dunthorn said the current population had been consulted about the space via informal conversations and surveys, yet it is unclear the results of these engagements or when and if these engagements happened.
What are the effects of this?
As presented in a WUOT interview, the assumption of Knoxville organizations who serve people who are unhoused is that the people who do not seek their services primarily do not want any help because they are “resistant” or are unwilling to change behaviors. Some acknowledgement is given to lack of trust for institutions. Research throughout the country has shown us that people who are unhoused often do not seek services because they find that the services do no appropriately address their needs and constraints. These services rarely address the structural violence perpetrated against poor people, people of color, LGBTIQ, or people who use drugs by government agencies, non-profit organizations, or the larger society.
Expecting someone who is unhoused to attend an appointment at a specific time away from where they are sleeping assumes that people have watches and transportation, assumes that people have safe spaces to keep their belongings while they attend an appointment, and assumes that the person has not faced any instances of violence or upheavals that prevent them from getting to the agency. Furthermore, people who are unhoused may be wary of shelters and state agencies because they have been traumatized in these systems. This trauma may have occurred because of administrative rules that do not adequately address the marginalized status of people seeking services, because of conflict with a staff member, or because of a conflict with another person seeking services. Further, many in this population have had traumatic experiences with other representatives of the state, including law enforcement and child protective services. One woman told me she would never try to go a Knoxville shelter again because when she was unhoused with her then nine-year-old son, they told her she could stay in the shelter but her child would have to stay by himself in the adult men’s shelter. These experiences that reveal the irrationality of the system make people never want to use the system again.
We understand that no one wants substance abuse to occur. Yet we have known for decades that some levels of substance use will continue to occur no matter how many resources are poured into law enforcement, treatment, or prevention. Thus harm reduction, especially community driven and grassroots harm reduction, must be considered. Harm reduction programs work to decrease the negative effects of substance use. While the end hope might be recovery, people must be met where they are and given services to prevent overdose deaths, HIV and hepatitis, and homelessness. The community under the bridge at this moment is in some ways a community driven harm reduction space. People are able to form social bonds. There are most likely negative aspects to these bonds, but there are also positive aspects. If people do not use or inject drugs in isolation, they are less likely to die of overdose. If they do overdose, they are more likely to be administered naloxone, to receive medical care, and thus to survive an overdose. Being able to have a routine decreases the risk environment in which people use drugs. If people know where to get unused syringes and know where they can use without being disturbed, they are more likely to use drugs in ways that prevent them from dying.
From these understandings, the proposed space seems to serve several functions. First, it turns this space from a place that is controlled by the people who live there into another place that is controlled by social services and law enforcement. These places already exist in Knoxville.
Second, it eliminates drug use from the area. While eliminating drug use from a space seems like an intrinsic positive, there are many consequences to this. It is highly unlikely anyone will cease deleterious drug use just because they are moved from a space where it can occur. As people are dispersed from a space, they are more likely to use drugs in isolation, resulting in higher overdose rates. As people are removed from their social connections, they are less likely to have access to unused needles and to be able to use at their own pace. This is important, because if people become sick with withdrawals, they may not have the time to find a safe way to use. As social connections are weakened or eliminated, people are more likely to suffer from negative mental health effects, which may increase drug use. To be clear, eliminating drug use from this particular space will do little to prevent or lessen drug use. Previous published research actually indicates it might increase drug use within this population. More, research from Denver after similar removals showed an increase in heroin combined with meth use, creating increased overdoses from the mixing of substances. People increasingly used meth to stay awake, since they had no place to safely sleep. What this action will do is further hide poverty, homelessness, and drug use from those in the process of gentrifying the surrounding neighborhood.
What are possible alternatives?
We understand that change is going to happen. We understand that new businesses and residencies will not tolerate the presence of people who are poor. If the city government does nothing, these organizations may utilize defensive tactics, which many are already doing in terms of fencing areas. Change is also necessary to improve the quality of life for those who lived under the bridge. The fact that we have tolerated this condition for decades, but now that some wealthy white people want to walk through the area, we all of a sudden find the conditions unacceptable is shameful. We agree that resource provision should be increased. Yet we contend that displacement will not improve their quality of life. Other options are possible.
Several organizations have risen to address these concerns in communities across the US. Of course every community is different and requires individualized approaches. Asheville is a city within our region with several organizations taking innovative and empowering approaches with people who are unhoused. BeLoved Asheville does not seek to manage people who are unhoused or to hide poverty. BeLoved is a community-based approach meant to empower those living on the margins through its Tiny Homes Community Project, Rise Up arts studio, Homeless Voice project, Street Medics Team, Free Village Farmers Market, Mutual Support Resource Center, and Grove Street Community Gardens. There are dozens of such organizations across the country that are examples of what we could do to promote life instead of death.
Other options include micro-communities of tents, self-made structures, modular housing, and tiny homes (real tiny homes, not the luxury ones on Western Avenue; those are pretty cool, but I’m not sure part of the solution here). Some people who are unhoused are understandably uninterested in shelters, but these micro-communities have the potential to provide empowering and democratic spaces. Single room occupancies (SROs) have been also been utilized for decades. If there is a half million in funding to pave a small area, surely there is some funding for these services? I have no doubt people are going to die because of this displacement, but they were dying before this displacement, because we only do something when it messes with the development of the Regas Building or something similar. And by “do something” I mean cause more harm, instead of actually helping fix anything, which requires immediate resources, long-term organizing, and social change.
I originally wrote this as a statement from a group, hence the "we":
We fully support the STAY Project and Y’ALL members who peacefully protested JD Vance. Activism against those who further inequalities has a long history in Appalachia. Denying that history and the current iterations of that history is denying Appalachia. Women have been at the forefront of much of this activism, as they were on Sunday, April 8. Yet we cannot forget the people of color and LGBTQ activists who have revealed the love and bigotry that persists in Appalachia.
JD Vance ignores non-white, non-heteronormative peoples. The perpetuation of stereotypes of Appalachia as all white and uniquely addicted to opioids supports systems of power that have created pharmaceutical companies that exploit Appalachian bodies, economic environments in which selling illegal substances is a primary financial option, carceral institutions that disproportionately incarcerate people living in poverty and people of color, and agencies that harass and imprison immigrants. These issues cannot be parsed out. All are rooted in systems of domination. Narratives that do not explicitly address these systems inevitably reproduce inequalities.
We do not oppose the right of JD Vance to speak. But when he attempts to speak for all of Appalachia, we will protest. When he furthers an agenda that hurts our communities, we will protest. When he refuses to engage us in meaningful conversations, we will protest. When people celebrate the likes of JD Vance by rushing to his panel and refusing to attend other panels on substance use, we will protest.
We are stronger than you, JD Vance. We have outshone the likes of you many times before. But you could be different. Go to the library. Read bell hooks, Crystal Wilkinson, Helen Lewis, Silas House, Dwight Billings, Mary Anglin, and the list goes on and on. If you refuse to take the time to read the work of or engage with those who have gone before you, we will educate you. Let us be clear, we do not want to take the time from our care work in our communities to educate you. It does not bring us joy or validation. It is you wasting our time. The action you witnessed on April 8 represents our duty to call out those who do not make clear the systemic oppression that has created poverty, poor health, substance abuse, and early death in Appalachia. We will turn our backs on anyone who supports the structures that are killing us.