When Ignacio Ramos caught the flu, he got the same advice doctors give other influenza sufferers: Bed rest and lots of fluids. But for Ramos and at least six other homeless patients in Juneau, bed rest isn't an option.
When you're homeless and sick with the flu, room and board are unavailable in Juneau.
"It's terrible, it's that much harder," the 28-year-old said. "Not having a quiet place, even a bed to lay down on, makes it that much more difficult."
Ramos and at least six other homeless patients sought treatment for the flu or flu-like symptoms and were released to recover at home. Several, including Ramos, have tested positive for the H1N1 swine flu, which is highly contagious but typically isn't lethal.
Mariya Lovishchuk said the sick individuals have been coming to her at the Glory Hole, a 39-bed homeless shelter downtown where she's the executive director. Two that visited her Friday complained of flu symptoms and requested a place to lay down. They weren't sick enough to be hospitalized, but still needed somewhere to sleep.
The problem is, she can't house them either.
"When people think homeless in Juneau, they think Glory Hole and call us," she said. "But there's no place for quarantine or for separation."
Lovishchuk said the Glory Hole can't risk spreading the illness to healthy patrons, though she wishes she had staff and space to do more.
The Glory Hole has two primary rooms with bunk beds lining the walls and just a few feet of separation in between, the perfect environment for an infection to spread.
"It would be horrible if, of the 70 people here, they all got sick," she said.
When someone needs bed rest, but has no bed, what are they to do? That's the question Lovishchuk, community leaders, and city and hospital officials are trying to answer. They met last week and will convene again Friday to discuss options.
United Way director Brenda Hewitt described the dilemma as "one of the gaps in our social network."
'No other option'
Some of the homeless flu sufferers went to Bartlett Regional Hospital for treatment, and in most cases they were treated on the spot and released. The flu alone isn't reason enough to hospitalize a patient, however, Bartlett spokesman Jim Strader said.
"Coming to the hospital with the flu isn't the best course of action anyway, but these people have no other option," he said.
The hospital doesn't turn anyone away - it will eat $7.6 million in uncompensated care this year - but it doesn't treat the homeless population any different than other patients, which means they're discharged.
"It's a question of keeping them until they are able to be released," he said.
Strader said the 62-bed hospital has limited space, though he sympathizes with those whose only cure is to "sleep it off."
Ramos eventually got a hospital room to himself, but only after going back to Bartlett three days after his initial visit when his flu led to pneumonia. He was put in an isolation room Monday for observation, and was still there recovering as of Tuesday.
"I'm sick enough to meet their standards to be admitted," he said.
No simple solution
Tom Mattice, Juneau's emergency programs manager, is among those looking for answers. He contacted agencies in Anchorage, Fairbanks, Ketchikan and Seattle, only to find that those cities have the same problem.
He suggests the Glory Hole begin housing the ill. Building a shelter is another option, he said, but that would cost hundreds of thousands of dollars and require constant staffing and would only serve a small percentage of the population. And it would take time, which is running out. Flu season is approaching.
Bartlett infection control specialist Jan Beauchamp said flu specialists are predicting a "significant surge as fall comes." Most flu cases tested at Bartlett are the H1N1 virus, she said.
Ramos described his symptoms as "flu on steroids."
"It hurts more and your body feels worse, and it takes much longer to get rid of," he said of his case.
Adding more room at the hospital is another possible solution by offering minimal care, Hewitt said.
"The homeless population, for the most part, is a very vulnerable population," she said. "When the flu hits them, it hits ... harder."
No one to count on
Ramos came to Alaska from Seattle looking for work. He took a job in Petersburg at the fish processing plant, but said the physical demands were too much and he had to quit. An hour later he was officially homeless.
A charity in Petersburg bought Ramos a ferry ticket to Juneau, where he began working as a day laborer to save money to return to Seattle. Ramos said he was "doing pretty good" for a while, eating three meals a day at the Glory Hole and staying there at night. It wasn't until he got sick that the reality of being destitute sank in.
"It didn't really hit me until I got this sickness," he said. "Getting swine flu ... has changed my whole perspective on being homeless. I have no one here to count on."
Charles Westmoreland can be reached at 523-2265 or at firstname.lastname@example.org