The City of Spokane's Human Services conference room looks out over the bridge under which two nursing students found Betty, a homeless Native American woman in her 50s, her "old man" asleep next to her under the blankets and tarps that served as their only shelter.

Between September 2000 and August 2001, 9,352 people like Betty lived homeless in Spokane. And those were just the documented ones.

"For a city our size we have a very high percentage of homeless," says Spokane Human Services director June Shapiro.

For six years, Shapiro's office has tracked information about Spokane's homeless population. The top five reasons for homelessness in Spokane? Poverty is the main one. After that, the biggest percentage are dually diagnosed-they are mentally ill and have substance abuse problems. Often, the latter is a result of the former, as people attempt to medicate themselves. Then come domestic violence, eviction, and relocation, in that order.

Most of Spokane's homeless-70 percent-report having lived in Spokane prior to being homeless, and another 11 percent report living in Spokane County.

"People have the stereotype that [the homeless] are transients, that they are not ours," notes Shapiro. "But our database is telling us that's not true. Most of our homeless are our people."

And many of them are children. Of the nearly 9,352 homeless persons documented, 2,731 were children within households, and another 300 were independent youths under the age of 18.

Maria Ruiz traded her Wilbur home for the streets of Spokane after her only parent-her father-left when she was 15. Now 18, she lives under Spokane's bridges, though you wouldn't guess it from her meticulously applied makeup and well-kept hair. She has a huge winter coat, a backpack with all her things, and stays wherever she can with her boyfriend, and occasionally with an uncle.

Few shelters allow men and women together. As a result, couples and families often choose to stay homeless rather than be split up for shelter. But when Ruiz's boyfriend runs errands, she's left to fend for herself.

"It's hard being alone, like sometimes when he has to go out and get food or whatever," says Ruiz while waiting with her boyfriend at the House of Charity as lunch is being prepared. Women on the street not only face more violence, but they also have unique health needs. Shyly, Ruiz admits "the monthly things" are hard.

"Sometimes you have to walk a couple of miles to a restroom. It can be really uncomfortable."

New state Medicare and Medicaid regulations and the serious budget cuts threatening state and local coffers will likely leave Ruiz and others in even worse circumstances.

More affordable housing and better substance abuse treatment and mental health care are among Spokane's biggest human services needs.

"The concern is that people with mental disabilities are falling through the cracks," Shapiro says. "Too many of them are being forced into homelessness."

Most of Spokane's $3 million human services budget consists of federal and state dollars. The amount of money Spokane budgets for human services agencies from its own general fund is embarrassingly low, given the magnitude of the problem. The City of Seattle spent 45 human services dollars per capita in recent years, compared to $12 in Tacoma, $4.28 in Bellingham, and just $2.27 in Spokane. Although the mayor and city council recently increased the amount Spokane allocates to these agencies from $430,000 to $747,000, that's still less than one percent of its entire budget.

That allows a lot of the underserved population to fall through the cracks. WSU's College of Nursing is catching a few-by educating students about community health nursing while at the same time lending a hand to Spokane's neediest.

"Health care is the biggest gap in services, so the nurses are a very valuable asset for this community," Shapiro says. "Everything we do for this population is positive. I think it is a great approach for a nursing program."

The homeless whom the nursing students reach also seem grateful that someone's looking out for them.

"Thanks for coming," says Mark Linza, 55, one of four homeless acquaintances camping together along the Spokane River. Their small fire had alerted Kate Pavlicek and Jennifer Schwarzer to their presence among the reeds and brush. "We're okay. We look out for each other."

It's not uncommon for the homeless to band together in informal support networks to avoid being beaten or harassed. They share security and moral support and sometimes help keep each other fed.

Over the fire this morning, Mark, Paul, Jeff, and Shirley are charring pastrami sandwiches that one of them had rescued from a dumpster where they know a vending machine operator throws out sandwiches past their freshness date.

These four have it better than most. They have tents, held off the ground by pallets and concrete blocks and insulated with cardboard boxes. They also have a basket of spices and food, and even a sack of cat food for a stray that also calls the riverbank home.

"I can do without," says Shirley Royer, a slight woman with kind eyes and shoulder-length hair she says she had brushed that morning. "But I need to find a job before wintertime."

Royer, 42, survives with what's given her during the day while displaying a cardboard "homeless and hungry" sign. Originally from nearby Coeur d'Alene, Idaho, Royer has been homeless on and off since 1979. But with help from local shelters where she can get clothes and a shower, she still manages to laugh and keep herself "cleaned up."

Paul came to Spokane six months ago after losing his job as a machinist in St. Paul, Minnesota. He doesn't want his full name used or his face shown in photos, because he's actively looking for work. He strips off his socks to show his feet, raw and blistered from walking in ill-fitting dress shoes.

"The reality is, we don't have an address, we don't have a phone number, and you can't put that on an application. So you just hope they hire you on the spot . . . because they can't call."

Schwarzer nods understandingly, rummages through the first aid supplies in her backpack, then gingerly applies Neosporin and bandages to his sore, chafed feet.
End

Victoria Christensen (photo) wheels up next to Don, a homeless Vietnam veteran with a heart condition. She asks him if he's on anything or if he's been drinking.

"I've been drunk since Vietnam," he barks back. She laughs and takes his blood pressure anyway.

Another man comes in extremely agitated. "I need some . . . medication!"

She offers him an over-the-counter cold medicine, but he rushes angrily out of the clinic.

A young man in his late teens or early 20s says he's had pain in his shoulder ever since a bad skateboard crash.

"Sounds like a tendon," she says, moving his arm one way, then another.

It's early morning at the House of Charity, a shelter that provides meals, showers, counseling, health services, and emergency winter sleeping quarters. Men, and a few women, are standing in a long line as a meal is about to be served.

Christensen and another Intercollegiate College of Nursing student, Amy Bevins, staff the small clinic within the shelter.

Christensen has been confined to a wheelchair since a car accident in 1994 left her paralyzed from the waist down. She completed a WSU degree in biological sciences in 1998 and decided to go to nursing school on the advice of her favorite professor, Douglas King, who passed away in 2001.

"He was absolutely blind to my wheelchair," she recalls. "He said, 'Victoria, go to nursing school.' "

Now, as she's preparing to graduate and take the nursing boards, Christensen is blazing a trail for other people with disabilities who want to be nurses and must battle stereotypes as they seek internships, apply for jobs, and attempt to get a nursing license.

"The biggest question I get is, can she be safe, is the patient going to be safe?"

"Patient safety is of course paramount," she says. "My disability is a societal problem for you, not for me. I'm here sitting in a wheelchair taking care of people who walk-disability and health are not necessarily connected."

In fact, Christensen and her service dog, Maverick, lead an extremely active life. She camps, bikes, and has a pilot's license. On finals day last year her classmates duct-taped her to the back of a motorcycle so she could try that too. She loved it.

"People's attitudes, and steps. Those are the barriers," Christensen says. "The College of Nursing at WSU has been very supportive. They have set the tenor for me. I just hope it works for the other people like me across the country who are going to nursing schools."