Solutions gain traction as problems persist
This Urban Health Media Project story was reported by Richard Wright Public Charter School students Grace Reed and Kamaia Bexley, UHMP intern Pam Rentz of Florida A & M University and Georgetown University’s Master’s in Global Health program students Mary Kate Fogarty, Andrew Lizon and Maria Cordero. Principal writing by Richard Willing, UHMP.
The members of the Harris family of Southeast Washington don’t need to be told that public transportation is a big problem in the most distant and least prosperous neighborhoods of the nation’s capital.
The Harris home is more than seven miles from the nearest Metrorail station. Bus stops are closer, but were magnets for violence even before COVID-19 eliminated some routes and made for lengthy waits on many others. Ride sharing services such as Uber and Lyft were already pricey; then rideshare rates were driven higher by pandemic-related demand and the elimination of the UberPool sharing option. Even before COVID, residents said it would be hard to find drivers willing to work in Wards 7 and 8.
Deirtra Harris, the family matriarch, said her family often pays ridesharing’s high prices to avoid the danger and uncertainty of Metro buses. Harris and her two grown sons suffer from anxiety and post-traumatic stress disorders stemming from domestic violence that left them homeless for a time. And Harris’ former work as a home health aide dramatically worsened her arthritis and back problems, which along with her mental health diagnoses, has prompted her to apply for Social Security Disability Insurance.
“(Public transportation is) better than it was 20 years ago, but in certain areas I think they should beef up security and they don’t,” said Harris. “And there’s a communication problem” aboard buses that only got worse when social distancing rules reduced seating.
For instance, drivers can be too quick to heed passengers’ requests to leave potential riders waiting at stops. “Don’t pick her up! Don’t pick her up,” Harris said she’d hear people yell as crowded buses pass stops.
Even before the pandemic struck in March 2020, poor public transport combined with higher levels of poverty and low rates of private vehicle ownership to create a “transportation desert” across the 17 square miles of Wards 7 and 8. DC government data tell part of the story:
Only five of the city’s 40 Metro stations are located there. There are no Slug lines - the casual carpools organized by commuters in other parts of the region - in Ward 7 or Ward 8, and only eight Zipcar locations, far fewer than in any of DC’s other six wards.
The pandemic has only made things worse. The Washington Metropolitan Area Transit Authority reported 17 bus routes serving Southeast DC lost at least half of their average daily riders between the onset of the pandemic in early 2020 and 2021. Three lines lost nearly all of their usual riders.
But at the same time, three projects that aim to change the face of public transportation in the District, and especially in Southeast, have taken root during the pandemic and appear to have staying power. A neighborhood-based ride share service, an expansion of Uber for maternity and other patients and a pilot project to bring self-driving cars to the District were all in process before the pandemic began. But each has gained traction and expanded during the shutdown, in spite of — or, in one case, because of — limitations that the health crisis imposed.
Community ride-share at local grocery store expands
About 35 years ago in the parking lot of a Safeway supermarket on Alabama Avenue Southeast, a store security guard noticed how many shoppers were struggling to get their groceries home without reliable public transportation. With his encouragement, a few residents began offering rides home for shoppers. An informal public service — eventually dubbed “Community Courtesy Drivers”— began to catch on.
Passengers are not charged fees, though drivers gladly accept offerings of any amount, including simple “thank yous.” A voluntary supervisor began to recruit new drivers, verify insurance coverage and vet safety records, and make out schedules that were flexible enough to accommodate drivers but that covered Safeway’s busiest times.
Drivers were issued badges to display in their vehicles. Once a month, each was expected to donate $10 to a local church.
The service, and the drivers themselves, were enormously popular: One supervisor, known simply as “Mr. Shorty,” became a beloved community figure whose recent funeral drew a large crowd of former customers and admirers.
The service fills a gap, said regular customer Mable Carter, left by a sometimes unreliable Metro system that still can leave long walks and commercial ride sharing services such as Uber whose prices are beyond the reach of many neighborhood shoppers and have only risen in the wake of the COVID pandemic.
If anything, the current health crisis has helped increase Community Courtesy Drivers’ footprint in the neighborhood. Routes have expanded, to meet the increase in passenger needs. In addition to the Safeway run, the service carries passengers to and from BJs, Walmart, local laundromats and medical appointments.
Charles Valentine, the service’s current supervising driver, said a team now regularly picks up shoppers from their homes and delivers them to Safeway on a daily schedule, then brings them home and helps them unpack. Local young people who may not yet qualify as drivers have been drafted to serve as grocery loaders.
In response to the pandemic, vehicles are sanitized daily, and drivers and passengers are advised to wear masks.
“Folks in the neighborhood know transportation is out there,” said Valentine.
Valentine said he has heard of similar programs that operated for a period of time, but none that have had the staying power of the Alabama Avenue Southeast service. He stands ready, he said, to share his team’s experience with any individual or group that is interested.
“If anybody came and asked me, I’d do it,” Valentine said.
Missed doctor appointments fuel growth of Uber Health
As an undergraduate at Northeastern University in Boston, Lauren Steingold developed an interest in the social determinants of health. Steingold, the founder and former director of strategic initiatives for Uber Health, has made access to transportation a career focus.
Uber Health aims to bring Uber’s by now familiar model of ride sharing to patients who need transportation to doctor’s appointments and scheduled hospital visits. Uber research, Steingold said, echoes the observation of experts about the impact of uncertain transportation at health care providers. Each year, Steingold said, “six million Americans miss a doctor’s appointment because they lack a reliable ride.”
Uber Health, Steingold said, begins by recognizing that patients are not typical Uber riders, and that those without access to reliable transportation may also lack
smartphones or credit cards. So Uber partners with hospitals and doctor’s offices to schedule for an Uber Health ride at the same time a medical appointment is made. In Wards 7 and 8, social workers often help out by coordinating appointments with patients. Patients are notified via text message when Uber Health vehicles are en route to a pickup. Patients whose mobility is compromised are connected to parallel services such as Uber Assist or Uber WAV (wheelchair accessible vehicle).
Uber Health bills doctor’s offices or hospitals, who may pay the charge or bill public or private insurance, or the patient. Uber Health charges ordinary Uber rates for its rides.
Drivers are drawn from the city’s fleet of regular Uber drivers. To protect patient privacy, drivers are not informed that their customer is an Uber Health client.
Uber Health was introduced in July 2018, but gained momentum during the pandemic, especially in the District’s most underserved neighborhoods. A Boston Medical Center study has already shown that Uber Health reduces costs to hospitals by decreasing the number of no-shows, Steingold says.
Patient visits to medical appointments continue to account for the bulk of Uber Health’s rides. The pandemic, Steingold says, has driven demand even higher in many areas where access to public transportation has become even more complicated.
In DC and elsewhere, Uber Health has partnered with community organizations to provide vouchers for rides to patients to COVID-19 vaccination appointments.
Ride sharing services such as Uber and Lyft have already come under fire for undercutting the taxis, trains and buses that make up the traditional urban transportation system.
In Steingold’s view, the criticism is misplaced. The market for patient rides, in the District and elsewhere, is big enough for competitors such as Uber Health.
“There are far too many people missing doctor’s appointments, so there is space for plenty of players,” she says.
“The more we can get people to care, the better.”
Self-driving vehicles may add options in future
While their regular use is still years away, a partnership between the DC government and the Ford Motor Company to bring self-driving cars to the District should also help improve transportation access, proponents say.
Such vehicles, Mayor Muriel Bowser said, represent the “cutting edge” of a technology that promises to be both innovative and “inclusive.’’
The project, launched in 2018, was put on hold during the early pandemic and has pushed back some of its projected completion dates, but is still moving ahead, says Brittany Pauley, Ford’s lead on the DC project.
From a warehouse on B Street NE in the Fort Lincoln neighborhood, two-person teams continue to drive test cars along city streets, mapping intersections, alleys and stop signs and other roadway features to build a “geofence” within which the cars, also known as Autonomous Vehicles (AVs), can operate safely.
“We listen to what we are hearing” from city officials and ordinary citizens who see the test cars on the street,” Pauley says. “We want to be part of a ‘mobility ecosystem’ that can be built upon, (including) getting people in Wards 7 and 8 to Metro stops.”
Fans of the technology say it’s full of promise, including for underserved wards, if cars are deployed there as part of a city ride sharing service.
“Intelligent transportation carries the promise of how we can help so many people who don’t have the ability to go out and buy an expensive vehicle with all the new technology and special features,” said Northern Virginia resident Nicole Nason, who headed the National Highway Traffic Safety Administration in the mid-2000s and the Federal Highway Administration until January 2021.
Returning to government after a 15-year absence, Nason was disappointed by how little progress had been made on autonomous vehicles or “connected car” technology, which allows cars to communicate with each other and the roadway through short-wave radio signals. Drivers receive notifications and alerts of dangerous situations, which would reduce crashes - including for self-driving cars - and ease congestion and air pollution.
Now chief safety officer at Cavnue, a company that combines technology and road mapping to “unlock the full potential” of connected and autonomous vehicles, Nason believes the technology has strong potential to improve both safety and convenience for lower income communities and others who want to become less reliant on car ownership. Connected vehicle technology is also less expensive to install than radar and camera equipment in vehicles. This will enable it to become standard equipment in the future on practically all vehicles, not just luxury cars.
But will DC residents use AVs if they are made available? Safety is a concern, especially in light of reports of crashes in self driving cars and recent videos of drivers losing control of them.
Harris, for one, is skeptical.
“What if something goes wrong?” she said. So is her mother, Laurice Mason, who asks “how do you get off if you need to?”
Most self-driving cars currently in production are not completely autonomous, permitting or in some cases requiring the involvement of a human driver to oversee driving functions, including acceleration, braking and obstacle avoidance.
With that in mind, cars that are part of the DC pilot project are sent out with teams of two drivers. One keeps hands hovering over a set of controls at all times. The other carries a 3D laptop capable of noting unusual features encountered along city streets in sharp detail.
Pauley says Ford is addressing skepticism head-on by being transparent about safety features that are being implemented and conducting virtual tours to demystify the technology.
“Misconceptions can result in a lot of fear,” Pauley says. “The answer is to keep (the public) completely informed about the technology.”
Beyond safety, opposition to AVs has arisen from those who fear the new vehicles will eliminate jobs for taxi and ride sharing drivers and for Metro and Metrobus operators.
Pauley acknowledges their concern, but suggests that self-driving cars, like most new technologies, will create new jobs even as they lead to the elimination of others. Acknowledging this, the Ford-DC pilot project includes a training program designed to prepare DC residents for AV-related jobs.
“Young people in particular are interested in autonomous vehicles,” she says. “I think we (AV related industries) are the next generation of technology jobs.”
For Julie Reiff, who moved to Washington in 2018 to complete a master’s in health administration through Washington Hospital Center, these and other solutions can’t come fast enough to parts of a city that she found could be “almost impossible” to navigate using public transportation.
The then-Johns Hopkins University graduate student was thoroughly dismayed how patrons of facilities like Washington Hospital Center, located in Ward 5, and people in Wards 7 and 8, fared.
“There was no way to get to work without a car,” recalled Reiff. “No bus line and no Metro stop nearby, and it was a 20-minute walk to the Red Line stop. It took me more than an hour to travel two miles (from 18th St NW) to work by public transportation.”
Transportation and lack of it posed a critical public problem for many patients.
“So much of health care is empowering people,” says Reiff.” “But how do people take control of their health care” (without) “access to care?”
UHMP founder and former USA TODAY health policy reporter Jayne O’Donnell contributed to this story.