Emily Vainstein steps out of her white bug and plants two feet on Gladys Avenue, one of the liveliest streets of Los Angeles’ Skid Row. “Water!” Vainstein shouts through her N95 mask, pacing down the sidewalk, holding up a gallon in her left hand and a bottle in her right. “Water. Agua! Does anybody need water?”

Before she can finish her sentence, unsheltered homeless people emerge from tarps, tents and makeshift forts. Each is looking for a gallon or bottle of water — whatever Vainstein can spare.

For more than 45,000 Los Angeles residents, home looks different. It often takes the form of a tent on a sidewalk. For these individuals, some of the most basic necessities of life — like water and health care — are often the hardest to find. USC students and faculty have stepped in to help.

“The homeless community is USC’s neighbor, whether they choose to recognize it or not,” said Vainstein, a Trojan alum and current graduate student at USC. “The homeless community surrounds the entire off-campus area and is virtually impossible to ignore.”

Vainstein is a volunteer with Water Drop L.A., a grassroots organization founded by three USC students in the summer of 2020. Every Sunday, it brings about 2,000 gallons of water to thousands of Skid Row residents. Another USC organization, the Keck School of Medicine’s street medicine team, provides free and direct care to the unsheltered on the streets all over Los Angeles.

Los Angeles County is home to about 66,000 homeless people, 68.2% of whom are unsheltered, meaning the individuals live on the street, according to the Los Angeles Homeless Services Authority. Without health insurance, most are left to fend for themselves during the COVID-19 pandemic. They rely on outreach organizations for food, water, shelter and medical attention.

Catie Cummings, Water Drop L.A. co-founder, set out to tackle water insecurity on Skid Row in July. While distributing burritos to the homeless in front of City Hall, almost everyone who took a burrito also asked if she had any water. “I came to the sad conclusion that it can be really challenging, if not sometimes impossible, for them to access safe, clean drinking water,” she said. “Especially during COVID, a lot of people turn to places like restaurants or libraries for water, and those places are closed or restricted now.”

Thus, Water Drop L.A. was born.

On Sundays, after Cummings picks up thousands of gallons of water from Costco, she meets volunteers in the Saint Marks Lutheran Church parking lot, just across the road from USC’s gates. As tight as an assembly line, students start loading dozens of cars up with gallons and bottles of water, granola bars, hygiene kits and fresh T-shirts for their first load of “drops” on Skid Row.

USC volunteers are distributing free water on Skid Row. (Photo by Lauren Merola)
USC volunteers are distributing free water on Skid Row. (Photo by Lauren Merola)

After all the cars depart, Cummings follows. She tames her nearly 25-foot long U-Haul in front of Catch 21, a restaurant in the heart of Skid Row, for volunteers to come back for second and third loads. Most weeks, Cummings looks forward to the encouragement and help from Catch 21 worker Kevin Call, a former unsheltered Skid Row resident, who she considers a mentor.

Call said Water Drop L.A. offers lifesaving resources to the unsheltered homeless population in Downtown Los Angeles, especially during a pandemic, where water is vital to proper hygiene care. It is an organization he wishes to have encountered when he lived on the streets about 10 years ago. When Call was homeless, he would turn to the owner of Catch 21 for free food. It’s what inspired him to start working and volunteering there himself, handing out free food to the unsheltered who come by.

“Any time I reach out to somebody that’s homeless, I’m always thinking about how that could still be me,” Call said. “How I would feel if I was in that position.” Call added many on Skid Row feel misunderstood, labeled as drug addicts, cons and thieves. “People come to Skid Row because they had a bad break,” Call said. “Not everybody’s hooked on drugs. Some are here because they couldn’t pay their rent or had a bad turn in their life.”

With the added threat of COVID-19, resources offered on Skid Row have been depleted. The city of Los Angeles has decided against the yearly installment of temporary water fountains in an attempt to halt the spread of the virus, Cummings said. The lack of fountains has added to the problem of water insecurity on Skid Row. About 9,000 individuals living on Skid Row share five permanent water fountains as their main water source. Typically, the city of L.A. attaches water filtration systems to the community’s fire hydrants every summer to increase the water supply. The minimal supply of drinkable water is why Water Drop L.A. prioritizes the Skid Row area, Cummings explained.

“Skid Row is essentially the backyard of USC’s campus and it is also one of the most devastatingly dense homeless populations I have ever seen or experienced in my entire life,” Vainstein said. “I think it needs as many resources and hands-on deck as it can get. I think it’s really important that Water Drop prioritizes Skid Row over other areas in L.A. because it is a student-led organization and primarily consists of USC Students.”

In Los Angeles, COVID-19 was expected to rip through homeless communities viciously due to condensed populations and individuals’ inability to conventionally shelter-in-place. According to the Los Angeles County Department of Public Health, there have only been 1,846 identified positive coronavirus cases among the Los Angeles County homeless population from March to October.

That’s a small margin in a population of 66,436 people.

Since March, USC Keck School of Medicine’s street medicine team finds that the positive rate among the homeless has remained low. Joseph Becerra, a community outreach worker for the street medicine team, said on Nov. 4 his team has only encountered one positive patient since March. “We started doing COVID testing on the street and we found the rates were really low,” said Brett Feldman, director of USC Keck’s street medicine program. “In a cruel way, they were already socially distanced.”

Since March, the street medicine team has been tending to unsheltered individuals daily, providing COVID-19 testing and administering necessary care on sidewalks and under its bridges. Feldman said the only difference in the team’s work during the pandemic is the use of personal protective equipment. The number of appointments and patients they care for a week remains unchanged.

Feldman and Becerra’s work starts in the LAC+USC hospital Medical Center — a 600-bed, USC-affiliated public hospital near Boston Heights. From there, they follow discharged, homeless patients to the streets for continual check-ups.

The street medicine team and Water Drop L.A. team helps combat the spread of COVID-19 in homeless communities — providing healthcare and water for hydration and hygienic purposes. (Photo by Chris Shinn)
The street medicine team and Water Drop L.A. team helps combat the spread of COVID-19 in homeless communities — providing healthcare and water for hydration and hygienic purposes. (Photo by Chris Shinn)

Becerra relates his team’s work in the hospital to that of the cardiology wing. Patients who have heart problems are sent to a cardiologist for a consult. Similarly, homeless patients are sent to Becerra for a consult. After they’re discharged, Becerra meets the patients at their homes on the streets for check-ups. “My job has a lot of different avenues,” Becerra said. “Not only am I in charge of navigating our patients in L.A., I also make sure our team is OK in the areas that we go. I know who’s involved in the area, like the gangs, the people, the culture and the community.”

Though the work is hard, USC Keck School of Medicine Chair of Family Medicine Jehni Robinson said it is worth it. Her vision for street medicine — including the two teams that span the county — goes far beyond health care. The team also partners with housing and social justice organizations to cater to any and all needs of their patients.

“The questions we’re always asking our patients are, ‘Who else are you talking to? Who are you coordinating with?’” Robinson said. “We really get to know the different resources that are available and the different partners that we have in the community. That’s critical because what we do is health care. Our specialty is not housing, but we have to be aware of all the different resources that are out there.” Robinson said the second team — which works primarily in the Pasadena area — is in partnership with a few organizations, like Union Station Homeless Services.

In early September, Feldman met a homeless woman — whose name he did not disclose — who had a large, cancerous growth on her nose. She knew it was there, but the woman wasn’t able to get health care. She was too concerned with threats to her safety to worry about it, let alone the coronavirus.

After diagnosis, Feldman asked if the woman was interested in receiving treatment. Street medicine is patient-led and prioritizes humility, allowing the patient to set the agenda, Feldman said. After the woman agreed to treatment, Feldman found a dermatologist willing to see her. But because of insurance issues, it was going to take a minimum of six weeks to get her insurance problems solved and her seen. “There’s all kinds of bureaucratic barriers in the healthcare system that prevent her from being seen,” Feldman said. “In the meantime, she’s now aware that she has this cancer and is still living outside.”

Unsheltered individuals have a life expectancy of 42-52 years, which is 20-25 years less than housed people. According to Maslow’s hierarchy of needs, a psychology theory classifying the universal needs of people, the most basic human needs are physiological. Food, water, warmth and rest are the foundation. “They know that they have a bed tonight,” Feldman said. “They know they’re going to get three meals a day. They’re going to get a shower. They can start worrying about other things.”

Like COVID-19.

Maslow’s hierarchy of needs doesn’t neatly apply to the homeless during the COVID-19 pandemic. Once an unsheltered individual is housed and fed, they should, in theory, be able to focus on psychological needs. Or so health officials, like Feldman, thought. But in 2020, sheltered living is not the safest option for homeless individuals. In fact, placing someone in a shelter — indoors and closer to other people — takes more thought and caution when trying to prevent the airborne COVID-19 virus from wreaking havoc.

The street medicine team and Water Drop L.A. team know their work helps combat the spread of COVID-19 in homeless communities — providing healthcare and water for hydration and hygienic purposes. In order to prevent the escalation of the epidemic, the two know their work has to prioritize consistency. “The biggest challenge is just making sure that we have the water to give the community,” Cummings said. “Since the beginning, we’ve wanted to emphasize accountability, so the community knows that we’re going to be back each week and it’s not a one-time transactional thing for us.”

Being available and approachable for the unhoused is a priority for both USC affiliates. They’re both invested in the notion that people are people, no matter where or how they live.

Numerous individuals that both Feldman and Cummings have talked to are living on the streets because of situations out of their reach. Feldman spoke with an unsheltered individual who ended up on the street because he lost a job. Cummings knows a Skid Row resident who lives unsheltered because a family member had cancer and needed help paying the bills.

For Feldman, homeless people will be best served once people move past a fear-based approach to them. Feldman said the vast majority of unhoused individuals are not dangerous. He’s never felt threatened on the streets.

Neither has Vainstein, standing at a benign 5′3″. “I have never felt threatened on Skid Row or at any point during water drops,” she said. “Everyone I have interacted with is either eager to help or eager for help. All of the homeless people we interact with are gracious and polite and are without a doubt more well-mannered than half of the kids I went to school with.”

“One interesting thing is we ask all of our patients, ‘What are the top three things you’re worried about?’” Feldman said. “Inevitably, one of those three things is really easy to fix.” Feldman is used to hearing answers about where the individual’s next meal is coming from or how to fix the hole in that person’s shoe. Normally, Feldman hears answers that he, and housed people in general, don’t worry about. But during the pandemic, where many are experiencing financial insecurity and living paycheck-to-paycheck, Feldman has seen more sheltered people sympathize with the unhoused population.

COVID-19 has also minimized the “otherness” of the unsheltered homeless. COVID-19 doesn’t inspect one’s housing complex before deciding whether or not to multiply and attack its host. “Anybody can get COVID,” Feldman said. “COVID is not something that you only get if you do something bad.”

It is not unthinkable for conventionally housed people to now be able to relate to the unsheltered. With joblessness skyrocketing, the usual gulf between the two groups has shrunk during the pandemic. “Now, there’s people who are waiting in lines to pick up lunches,” Feldman said. “They’re waiting in the same line as the people experiencing homelessness. Now they’re sharing that experience together.”

Whether students and faculty realize it, unsheltered homeless people in Los Angeles are USC’s neighbors. For Cummings, these people aren’t different from her or other students just because they didn’t get the same opportunities she did, like attending USC. “We all have a responsibility to help each other,” she said.

It could take an unprecedented amount of time for the unsheltered homeless population to have access to affordable housing, sustainable water sources and viable insurance plans. In the meantime, USC students of Water Drop L.A. and faculty of the street medicine team will continue to help where they can.

“Some people talk about it and some people be about it,” Call said. “Talking about it don’t change nothing. It’s about what you’re willing to do to put your hands in and help the people.”