Nikia’s funeral was last week. Poverty and neglect killed her.

Nikia was only 47 when she died. She died waiting years for Social Security to approve her for SSI and for the Housing Authority of Baltimore City to move her to a handicapped accessible unit. Nikia’s family, friends and church community are struggling with this terrible loss.

I met Nikia in the fall of 2021. She was a kind, friendly and vibrant woman, always trying to help others by telling them about resources and services she knew of. She always reached out to strangers in need.

But the resources and services that Nikia needed totally failed her. The grinding poverty she was born into she could not escape.

There were many challenges in Nikia’s life. She had a myriad of medical problems, including obesity. She couldn’t walk very far or very fast.

I don’t know too much about her early years, although she once told me every male relative in her life – her father, her stepfather, her stepbrother – had been murdered.

But she did have people – she talked about nieces and a nephew. I know she loved her family.

Despite everything she’d been through, she was a survivor.

Fair Game for Dealers

Nikia was addicted to heroin. She enrolled in programs and attended a methadone program faithfully, but had many relapses.

This was in part because she was fair game for the drug dealers – they exploited her.

She lived for years at Gilmor Homes in West Baltimore, the broken-down public housing complex where Freddie Gray was taken into custody by police in 2015.

There, people would knock on her door and offer free heroin. She had an apartment and they’d say, “Let us in your house to shoot up, and we’ll give you some.”

Mental health problems caused great difficulty for Nikia.

I admired her tenacity as I realized how government programs ostensibly established to help people like Nikia are deficient and dysfunctional.

Often she struggled with organizing her life. She missed medical appointments. Her phone was frequently lost or stolen. Completing and mailing forms or keeping appointments was a huge challenge.

There was no supermarket or decent corner store where she lived in West Baltimore. Fresh produce and other nutritious food were out of reach, both financially and logistically.

She tried very hard to pull out of all this. In physical therapy, she really wanted to get rid of her walker, to get rid of her cane.

I admired her tenacity.

She came to me at Good Trouble Church, where I volunteer, located in St. Mark’s Evangelical Lutheran Church at Station North.

But as I’ve come to realize all too often doing my work, the government programs ostensibly established to help people like Nikia are instead deficient and dysfunctional.

Nikia received benefits from the Department of Social Services – food stamps and TDAP, a totally inadequate benefit for people with disabilities who have not yet been approved for Social Security.  

But for reasons unknown, even these small benefits were frequently cut off. Nikia’s electronic benefits card was repeatedly scammed, leaving her without the means to feed herself or pay her rent.  

The staff at Social Services were not responsive or sympathetic to Nikia’s plight.

Tainted Drugs and a Revolving Door

About seven months ago, Nikia used some heroin that was tainted with xylazine (an animal tranquilizer often mixed with heroin) and other drugs.

She had a terrible reaction to it. Her skin came off in large sheets, and her wounds wouldn’t heal.

She was admitted to Bayview Medical Center’s burn unit, where she could see skin specialists. Nikia was in enormous pain 24 hours a day. She spent weeks in the hospital.

From that time on, Nikia bounced back and forth between the hospital and nursing homes. She couldn’t walk and had skilled nursing needs. She fought infection after infection.  

Her options for nursing home placement were limited to places that would accept methadone patients – most nursing homes don’t, although this is a violation of the Americans with Disabilities Act.

A lawsuit filed earlier this month by the Public Justice Center on behalf of disabled people – charging the Maryland Health Department with lax enforcement of laws to protect nursing home patients, especially those disabled – is totally on point here.

I remember Nikia calling me and saying, “I hate it here. You press the button and nobody comes.”

The nursing facilities open to people like Nikia are horrible substandard. Only 15% of local nursing homes meet new federal standards for personal medical care, putting Maryland in the bottom 15 states.

I remember Nikia calling me and saying, “I hate it here. You press the button and nobody comes.”

Earlier this month, her friends and pastor visited her in the latest nursing home and found her in an altered mental state. She was unresponsive to verbal prompting or to touch.

Alarmed, they called 911.

Nikia was rushed to the nearest hospital, where they determined that she had sepsis, and that it had spread throughout her body.  

She had emergency surgery. The hospital staff tried their best, but they could not save Nikia.

Questions Unanswered

I came home from the memorial service and sat down to write this.

I’m not quite done, I said to myself.

How many Nikias will die before we have universal health coverage like every other advanced industrial country? Before we decriminalize drugs, as has been done by Portugal, Switzerland, the Netherlands and a dozen others?

These nations have established appropriate and effective substance abuse treatment and mental health services, and they have seen decreases in overdoses. 

How many more will we lose before we have safe, decent, affordable and accessible housing for those who need it – “Half of Americans struggling to afford housing,” CBS News reported last month.

How many more food deserts will we tolerate in the middle of large urban areas – a problem that has plagued Baltimore for years?

In short, how many more unnecessary and painful deaths like Nikia’s must be suffered before we start treating our fellow citizens with the dignity and respect they deserve?

• Lauren Siegel, a longtime housing advocate and homeless service provider, teaches at the University of Maryland School of Social Work.