The Silent War - Part III

The short commute from work to my home is only about eight miles long but the change in environment is astounding. I live in a quite area at the edge of the woods where bears are the biggest threat we worry about. A much smaller town is only a mile away and relatively quiet. The city I work in is only a few miles further.

The city where I work is fraught with decay that only feeds the heroin culture. As I drive home, I drive through rows of tightly packed homes, separated by barely a few feet in a few limited designs that seem rather indigenous to this area. Not quite row homes, most of them are the same ones that were built when the city was founded in the late 1800's. Aside from a few major thoroughfares, the streets are narrow, in a tightly laid out grid pattern. A pretty impressive feat considering this is a mountain town and hills are not usually amenable to this degree of order.

The center of town is divided down the middle, much like Chicago, only not with a scenic river, but with a very polluted system of railroad shops and tracks. The tracks run the entire length of the town, north to south and in most of the city, one cannot traverse east to west without crossing a bridge. The grime and dirt permeates the inner city and only adds to a feeling of decay. It reminds me of the grime I saw coating the towers of the now ill-fated Charity Hospital in New Orleans years ago.

Ruined in Hurricane Katrina, the building is considered a total loss and will eventually be torn down, but for the uninsured of New Orleans, Charity Hospital was the only public hospital they had to turn to pre-Katrina. I saw Charity Hospital when I took my Board Certification exam in 2004, before Katrina hit, and it gave me an uneasy feeling that never left me. Ironically, I passed my board exam, a very difficult thing to do in psychiatry. A victory for me that day, a loss for many more not much later. I have since returned to New Orleans for the Sugar Bowl, but I felt the need to visit this now defunct institution and pay my respects. The photograph above was taken on New Years Eve 2009 and the top of the building does not look much different than it did all those years ago. Although this town has not suffered the tragic loss near the degree of New Orleans, sometimes I see the same creepy sooty grime dripping off the taller buildings of the city here and that same feeling comes to me. Something is not well in this town.

Many of the residents of the inner city are retirees on fixed incomes who do their best to maintain their homes. They often live in fear but cannot or will not leave their lifelong homes. There is a certain number of working class families that remain in this area, but a large part of this area has fallen to low income and section 8 housing. The crime rate has skyrocketed and those that have the luxury of moving out of the inner core of the city do, often without being able to sell their inner city homes. Many elderly residents, and there are quite a few here, pass away and the homes are left abandoned. Foreclosures have left many properties vacant as well.

This has left a growing problem of blighted homes, many with red condemned signs posted so long ago that they have long since faded to pink or even white. Absentee landlords have little interest in paying the money to demolish a property that has been condemned. This will only cost them money and leave them with an empty lot that will go unsold. Better yet to ignore the property. The city has limited ability to demolish blighted homes without a lengthy legal process and since the age of the homes is quite old, many contain asbestos and lead paint making the demolition quite expensive. Funding for this is limited. Most abandoned homes have long been stripped of any resellable items. Copper pipes, light fixtures, and wood paneling that could have been salvaged and sold to finance the demolition are stolen by drug addicts desperate for money for their next fix, cutting a viable source of funding for these projects out, also.

Abandoned home are well known to be obvious health risks, attracting rats, pigeons, raccoons and the like, but they have other lurking hazards. Abandoned homes are a perfect cover for "shooting galleries" and make for a discrete location from which dealers can make their transactions out of the public eye. The number of blighted homes grows daily. Not all of the heroin use in the city is restricted to abandoned homes but to me they are a constant reminder of a city in pain. The middle class flees to the outlying communities with sprawling rows of new subdivisions that offer safety and respite from the troubled inner city where they work. No different than Detroit, just on a smaller scale.

Something needs to change....

The Silent War - Part II

Heroin has been a specter looming over this city for as long as I have lived here and it amazes me how long it has been allowed to continue without public outrage. Our young people die at rates that never cease to astound me. I am not trained to deal with substance abuse, my training is in general adult psychiatry, but every day a significant portion of my time is devoted to dealing with the walking dead. I cannot stand to keep my silence any longer.

This city is of moderate size, about 100,000 if one included the outlying suburbs, two hours away from any truly large city and quite industrial although the surrounding areas are quite rural. Much smaller than my hometown of closer to two million, but wracked by a heroin problem like I have never seen anywhere else. Not even in much larger cities have I seen this. Too small and naive to understand the problem and too underfunded to fight it, the epidemic grows like a cancer in our youths, mostly high school aged and early 20's who are too young to know any better. Before they know it, they are enslaved to the big drug dealers in Brooklyn and Philadelphia who supply them with their so desperately needed hits. Desperate to fund their addiction, they turn to trafficking themselves and go into the high schools creating more and more addicts to fuel the fire.

The problem, I am told, is of recent origin. Many of the mountain towns in this area were founded by the railroads for the purpose of supporting the westward movement of the railways, some time in the late 1800's. Entire towns were built for this purpose and the entire economy was dependent on the railroad. The emergence of the high reliability diesel engine which replaced the high maintenance steam engine guaranteed the loss of a lot of those jobs. Further job losses due to environmental safety concerns and robotic repair facilities left an indelible mark on the community, and the companies that once built the city, seemed to have turned their back on it, leaving the economy in a shambles.

These cities appeared to be the perfect place to build a series of drug rehabilitation facilities and halfway houses to send court ordered addicts from Philadelphia and New York. They were miles away from any large city, and surrounded by conservative Amish and Mennonite communities. It seemed the perfect way to keep these people out of mischief. The cities themselves facing soaring rates of unemployment and a faltering tax base jumped at the opportunity to bring new jobs and money into the area and allowed these facilities to be brought into what was otherwise a quiet community, one by one.

But they bit off more than they could chew. Court ordered rehab does little to solve a problem when the person ordered to treatment does not wish to change. AA members will be fast to remind you that the "geographic cure" never works as the addict has to take him/herself along. Not to mention the fact that while the city may be a few hours drive from Pittsburgh, interstates are the major route of travel of the drug traficking trade and this city is on an interstate.

I have been told that within the past fifteen years, this area has gone from a quiet working class community to one of high crime, drug gang warfare and urban blight....

to be continued