The Bronx Ink

The Civic Engagement Commission (CEC) opened submissions for its “People’s Money” initiative Wednesday, allowing New York residents to propose community-focused ideas that could be implemented by the city and funded by a $5-million portion of the mayoral budget.

Members of the CEC plan to gather ideas until Nov. 9, which will then be voted on by New Yorkers through April to ultimately be implemented in June. Residents of all five boroughs above the age of 10 will be eligible to vote and submit ideas.

“Is this $5 million going to change the world? Probably not,” said Wendy Trull, a member of the CEC. “But it’s a start towards getting New Yorkers involved and engaged in their communities and exposed to what volunteerism can do. If someone proposes an idea and sees that idea become real, that’s inspiring.”

Proposals are meant to be local and grassroots in nature. Sarah Sayeed, another member of the CEC, said its intention is to fund projects that are “closer to food and clothing drives than building a new public park.” The initiative’s website specifies that no proposal requiring construction or renovation is eligible for funding.

The CEC kicked-off the initiative with a morning of festivities at Roberto Clemente Plaza in Mott Haven’s business district, which included speeches from Bronx Borough President Vanessa Gibson and other elected officials.

One hour into the event, ten proposals had already been submitted in-person, ranging from broader concepts like “community building” to tackling specific causes like gun violence against Muslim women.

Some attendees were less optimistic about the initiative than its organizers, including Johnny Chavarria, the event’s DJ.

“It feels a bit performative if I’m being honest, like the city is trying to check off a box of their agenda,” Chavarria said. “I’m an activist myself but I believe less in the government funded programs.”

The People’s Money concept has been in the works since November 2018, when New Yorkers voted through a referendum proposed by the Charter Revision Commission mandating a new participatory budgeting process.

The specific plan to distribute the money geographically gets complicated – while proposals can be for any neighborhood around New York City, funding will be allocated based on poverty density, with preference given to TRIE neighborhoods, the 33 neighborhoods the city deemed most negatively impacted by the pandemic, nine of which are in the Bronx. 

The $5 million represents just a small fraction of the mayor’s $101 billion annual budget. Since participatory budgeting was added to the city council’s agenda in 2011, $200 million has been spent on projects voted on by residents, according to the city’s website.

For all his skepticism, Chavarria still plans to submit his own proposal to fund an event that focuses on bringing more music to the community, a cause he’s passionate about.

“For the music, it’s worth a shot,” Chavarria said.

In a dimly lit room at Lincoln Recovery Center in the South Bronx one September morning, six middle-aged men were sound asleep, five needles poking out each of their ears. Meditation music played from a 1990s cassette recorder.

This was acupuncture therapy, the first on the center’s agenda every weekday at the East 142nd drug treatment location. Next comes group therapy and reiki sessions.

Nearly a decade ago this center was a thriving community service hub and a crucial therapeutic refuge for those afflicted by rampaging heroin addiction in the South Bronx.

But two weeks ago, a dozen chairs in the acupuncture room remained empty. Apart from the occasional banter between patients, the waiting room was eerily quiet throughout the day.

“The center used to be more community-based,” said Angela Torres, the clinic’s supervisor and senior addiction counselor. She has been working for the program for 24 years. “We tried to keep it in the community, but there have been more regulations from the hospital.”

Lincoln Recovery Center began as a grassroots organization, developing into a core neighborhood service treating drug addiction with experimental holistic methods. But, the treatment center has since disappeared from the heart of the community, and its patient census continues to decline.

In December 2011, Lincoln Hospital administrators relocated the center from a four-story building on East 140th Street, to the basement of the Segundo Ruiz Treatment Center half a mile away. Since then, the center has seen fewer patients every year. This current August, clinicians had 21 patients, less than a quarter of its monthly average of approximately 120 before the move.

Yet, opioid overdose rates have been increasing over the last decade, particularly in the South Bronx, which has become the epicenter of a growing supply of prescription opioid drugs.

In 2018, the borough had the highest rate of overdose rates in New York City. Nearly 400 residents died, up 9% from the previous year, according to a recent report by the NYC Department of Health and Mental Hygiene. Mott Haven-Hunts Point had the second highest rates in the borough.

Lincoln Recovery Center was established as part of a community activism in the 1970s to combat an epidemic of drug addiction in the area. At the time, the New York Times reported 20,000 drug addicts were roaming the streets of the South Bronx. The activist and militant groups of the Young Lords and the Black Panthers made headlines by marching into Lincoln hospital and taking over the sixth floor to implement a drug program that became known as “Lincoln Detox.”

“The detoxification program came out of desperation because the healthcare was substandard and there were no drug programs to help addicts in the Bronx,” said Carlos Alvarez, who started working for the program when it began.

Activists began treating patients with holistic practices and methadone, a synthetic opioid receptor that is prominently used today in medication-assisted treatment (MAT) to reduce opioid withdrawal symptoms. Concerned about the addictive nature of methadone, counselors began to experiment with acupuncture after hearing about the work of Dr. H.L Wen in Hong Kong, who found that acupuncture combined with electrical stimulation could relieve opioid withdrawal signs in addicts.

Conflicts between the program and hospital administration resulted in the unit being shut down in 1978 by city hospital officials from NYC Health and Hospitals, led by then-Mayor Ed Koch. It was then relocated to an abandoned 21,000 square-foot building on East 140th Street, which the corporation bought for one dollar.

Acupuncture became the center’s main treatment method, pioneered by Dr. Michael Smith, founder of the National Acupuncture Detoxification Association (NADA). The association set the protocol known as “acudetox,” a non-verbal therapy approach, often set in a group setting that involves the gentle placement of five small, sterilized, disposable needles into specific sites in the ear.

The acupuncture association estimates that approximately 25,000 people have since been trained in this method worldwide, which continues to expand as a modality within addiction and behavioral health treatment, including prisons, military medicine and disaster relief.

Nancy Smalls began working from the program in 1973.“It was like a big family affair, it was wonderful,” she said. The center had a game room, a big backyard and would run weekly activities and trips.  “We had clients coming out of the woodwork. The acupuncture had to be doing something.” 

Smalls also launched the Maternal Substance Abuse program as part of the centre’s services in 1987. “No one was handling the drug treatment of women,” she said. “We found out that acupuncture worked even better for pregnant women who were withdrawing. It removed the want to get high.”

Studies on the science behind acupuncture remain varied and often inconclusive.

“Acupuncture can be helpful to any type of withdrawal, simply because it calms the sympathetic nervous system related to the fight or flight response,” said Pooja Shah, doctor of integrative and family medicine and a licensed acupuncturist. “It’s hard to research the effects, because there is a lot of variability that can change the outcome, such as the group dynamics and the relationship between the patient and the practitioner.”

A 2012 systematic review concluded that after 35 years of research by both Asian and Western scientists, the efficacy of acupuncture in the treatment of opiate addiction had not been established. A 2017 study on NADA protocol states that is not a standalone intervention as a treatment for substance abuse.

Research into acupuncture’s mechanisms is currently being conducted in Brigham Young University. “Right now it can only be used as an adjunct therapy, but it has potential,” said Scott Steffensen, professor of cognitive and behavioral neuroscience. “If you activate certain receptors in the body without using drugs, you can modify the whole nervous system in a way that it could be used to reverse the craving associated with opioid withdrawal.”

The relocation of the Lincoln Recovery Center in 2011 came as a shock to the local community and former employees. The building has been abandoned since then but is still under the ownership of NYC Health and Hospitals. 

“They said the rent was too high,” said Angela Torres. “We could all have chipped in to pay a dollar.” 

After the women’s program was closed down in 2013, Nancy Smalls retired. “Everybody we serviced, we made a difference in their lives,” she said. “I just don’t understand why they are not using that building. The city did a huge disservice to the population when they got rid of Dr. Smith.”

Numerous attempts to reach the communications department at Lincoln Hospital in person and by phone were unsuccessful.

Currently, 22 recovery services across New York offer acupuncture, according to the 2019 National Directory of Drug and Alcohol Abuse Treatment Facilities.  Lincoln Recovery Center is the only facility listed in the Bronx.

Activist group South Bronx Unite has since been campaigning for the hospital agency to hand the building over to the local community. On September 7, plans were showcased to transform it into a H.E.A.R.T (Health, Education and the Arts) Center to house local non-profit organizations and a mural was unveiled on the side of the building.

The Lincoln Recovery Center has changed from a community hub to a more structured medical service.

“It used to give people somewhere to be, it had a homey kind of atmosphere,” said Dorine Seabrook. “Now it’s much more appointment driven, we are required to people in and out of treatment faster.” 

Patients at the Lincoln Recovery Center are now referred by the Consult for Addiction and Care Team in Hospitals team (CATCH) at Lincoln hospital, the courts, or by the city’s Human Resources Administration.

Dr. Mark Sinclair is Medical Director of the CATCH program and the Lincoln Recovery Center. “We try to encourage patients who need treatment to go there,” he said. “The services at the Lincoln Recovery are great but they need to be more integrated here in Lincoln Hospital with the other patient’s healthcare needs.”

Patients are referred depending on their needs, either using the center as their sole service or on top of their methadone program.

But employees cite the location as the main reason for the lack of patients and their frustration with the administration.

“Our biggest problem is that the program is a mile away from Lincoln hospital,” said Program Director Christina Laboy. “I have pushed to set up a transportation service. People don’t end up coming here.”

“We need exposure,” said Serge Ernandez, the licensed acupuncturist at the center. “No one knows we exist here anymore.”

Charles Aviles, a 36 year-old Bronx resident, will always remember his mother’s childhood friend Ronnie when he thinks about growing up during the 1980s. Ronnie had treated Aviles like a son, helping him with things like tying his sneakers.

“He had one of those million-dollar smiles, like nothing ever bothered him,” he said.

But when Aviles was just 10-years-old, Ronnie passed away suddenly. That was when Aviles first became aware of AIDs. The global epidemic continued to rage throughout Aviles’s childhood years and into the early 1990s.

HIV and AIDs rates have decreased globally since the peak of the epidemic in the 1980s, and earlier this month, New York Gov. Andrew Cuomo announced that the number of HIV diagnoses in the state had declined by 28 percent since 2014. But that doesn’t mean progress is evenly spread: just as the Bronx was disproportionately affected during the crisis’s peak, today it is one of the Center for Disease Control’s 45 HIV hotspots across the country.

There are several factors that feed into the “invisible crisis” of HIV in the south Bronx, according to Dr. Vincent Guilamo-Ramos, director of the Center for Latino Adolescent and Family Health. HIV rates are higher among Latino and African American populations, which disproportionately populate the borough. There are also generally higher rates of HIV among men under 25 years old, particularly those who are gay and bisexual. The Bronx also has the largest youth population of any of New York’s five boroughs. Language and cultural differences also play a role.

Both government and non-profits have been trying to address the issue with outreach programs tailored to specific demographics.

For example, hair care professionals were one of the groups identified by the CDC as potential partners for its Business Response to AIDs initiative, which began in 1992. The program partners with businesses, health departments, community based organizations and government agencies to provide public education on HIV. As barbers in New York are already required by state law to receive training on contagious disease transmission associated with their professional duties, training centers for hair care professionals were an obvious group to incorporate into the program.

Aviles, who is training to become a barber at the Beyond Beauty & Barber Academy in the Bronx’s Westchester Square neighborhood, is also being trained to talk to people about HIV. For Aviles, it’s important not just to have practical knowledge about safe barber practices – sanitizing equipment, taking care with pimples and open wounds – but also about how the community provided by space can facilitate difficult talks.

“Barbershops are the places where you let loose, where you want to be able to talk sometimes and at home you can’t really have certain conversations,” he said. “But when the fellas are around, it’s a great environment to have certain conversations.”

But despite efforts like the CDC’s, there are several reasons that HIV rates remain high across the Bronx today.

There are fewer health services in the area than elsewhere in the city, and Latinos and African Americans are disproportionately uninsured, or have inadequate coverage. For many, that means that PrEP, a highly effective antiretroviral drug, often isn’t available to them. Bronx residents generally have lower incomes than in other parts of the city, Dr Guilamo-Ramos said, and other expenses might seem more urgent than medication for a chronic health condition.

People also feel scared about going into formal spaces like hospitals or clinics to take an HIV test test, said Daniel Leyva, the Latino Commission on AIDs’s press secretary. This discomfort can be especially prevalent among Latinos and people of color, who can feel socially and culturally excluded in places like sexual health clinics.

“It’s really sad to see that a lot of people in our community are still dealing with so much stigma,” said Ivan Ribera, a community engagement specialist at Latino Pride Center whose daily work involves approaching people to talk about HIV prevention.

All of this has grave consequences for the Bronx. The borough’s rate of premature deaths from HIV was twice as high as the New York City average in 2018, according to Community Health Profile data., which put the Bronx’s rate at 12.3 deaths per 100,000 compared to Brooklyn’s 6.4 and the New York City average of 5.9. In total, the Bronx saw 792 premature deaths from HIV last year.

Moreover, the South Bronx itself is a pocket with much higher HIV death rates than anywhere else in New York City. Morrisania, Mott Haven and Hunts Point were among the worst-affected areas.

Dr. Guilamo-Ramos has piloted a number of pioneering outreach and education programs in recent years, but described youth infection rates as a “raging epidemic”. As a result, two of the programs he runs – Families Talking Together and Fathers Raising Responsible Men – target teenagers and work with families to communicate on the issue.

Ribera said he talks to approximately eleven people a week on an individual basis as part of his outreach work, and that much of it involves trying to get people to use condoms. “There’s this idea that NYC condoms don’t work,” he said, alluding to rumors that condoms issued by the city’s Health Department are faulty. “So we try to push condoms, to eliminate those patterns.” In addition to approaching people in the street, Ribera and the Latino Pride Center produce discreet boxes filled with a range of differently-sized and -flavored condoms and leave them in places like barbershops.

Churches are another space being leveraged to offer a culturally-specific outreach service, due to their standing in minority communities and the close personal relationships they often cultivate in areas such as the Bronx.

“Churches are becoming a mediator between communities and its services people who are nervous about seeking services somewhere else,” said Leyva, adding that they can be particularly important for people who don’t see themselves as a part of at-risk groups or who don’t realize the breadth of health services they are entitled to use. “At the end of the day, it’s about promoting safe spaces for people to discuss sensitive issues.”

In Aviles’s mind, the necessary outreach work to combat HIV in the Bronx shouldn’t pose as many challenges as it appears to. “It doesn’t mean you got the cooties or anything like that. You’re just a normal person,” he said. “Things happen.”

At 6 a.m., the sky began to light up as Perla Medina darted around a line that had already formed at the mobile vet clinic that wouldn’t arrive for another hour at St. Mary’s Park in the Bronx. It was Thursday, and the clinic’s monthly visit to the park.

Medina wore a gray hoodie and held a loose sheet of lined notebook paper and a pen. As people arrived, the 13-year-old took their name and asked how many pets they had with them.

It was Medina and her sister, Daniella Estevez’s, third time at The American Society of Prevention of Cruelty to Animals mobile clinics and after two unsuccessful trips they wanted to make sure their two cats get a spot in line. Medina was taking names so that when the clinic arrived, the veterinarian technicians would know who’d been in line first. She didn’t want the others to wait unnecessarily if there was no hope for them to be seen.

The first time, she and her sister waited for two hours, according to Estevez, a 17-year-old high school student. The second time they happened to be number 26, out of 25 served.

“We could get there as early as we want, but we were always one behind the last person taken,” Medina said. . 

The ASPCA currently has  four ASPCA Mobile Spay/Neuter Clinics located at rotating locations throughout New York City, but can only accommodate up to 25 animals per day, according to ASPCA Media and Communications.

A community veterinary center  is expected to open in the South Bronx next spring to improve access to veterinarian services for lower income people. The American Society for the Prevention of Cruelty is spending $45 million on three new facilities. Each will provide free care to to cat and dog owners who have proof of public assistance or public housing, and subsidized services for others.

The center will be the first of its kind in New York City, followed by others scheduled to open in Brooklyn and Manhattan in 2020 and 2021 respectively, according to an ASPCA press release. 

The cost of pet care is rising – with pet owners spending more than $18 billion on veterinary care last year, a billion-dollar increase over the year before, according to American Pets Project Association. 

The communities that use the ASPCA mobile clinics hope the new centers will be able to address some of the issues with the mobile clinics such as long wait times with the risk of not being seen. 

Waiting to be seen

While Medina and her sister were lucky on their third trip and were able to have both of their cats Oreo and Storm seen, it was not the case for everyone.

While mobile clinics arrive at their rotating locations throughout the boroughs at 7 a.m., owners are recommended to arrive in advance, according to the Bronx September ASPCA calendar. Customers of ASPCA said they regularly arrived as early as 4:30 a.m. to guarantee a spot on the list.

Medina and Estevez arrived at 5 a.m. and were the sixth people in line for the 7 a.m. clinic. 

More Animals Served

Not a morning person, Emilia Rodriguez held her cat carrier and bounced up and down, trying to stay awake. This was her fourth visit to the mobile clinic as she got her last cat Little Bit, a stray from a funeral home, fixed.

“The clinics around here charge $100-$200 and here getting pets fixed is free,” said Rodriguez, a cashier at Family Dollar. “It’s really awesome for low income people. I have nothing bad to say about this truck. I’m serious. This truck is a god send.” 

On average, people spend $1,300 per dog and $900 per cats every year, according to a study by TD Ameritrade. But, the monthly average spent on pets in New York at $157 is higher than the national average, according to a study by Opploans.

The clinics are open every Tuesday through Saturday, with at least one clinic in each borough, and with two clinics in the Bronx every Tuesday and Friday, according to the ASPCA website. 

The ASPCA declined to cite how many animals were served in New York City in a year, but said it was in the tens of thousands. 

Once the three community centers are open, ASPCA expects to provide an additionally 30,000 spay/neuter services every year. The centers won’t replace the clinics, but will supplement their services. 

Expanded Services

Samantha Arroyo held her small grey and white splotched cat in a pink carrier close to her. It was her second time in line at the mobile clinic. Arroyo was called in, but soon after she was sent back out again.

The clinic couldn’t fix her cat because it had pus in his mouth. She’ll have to go to another veterinarian and come back again. She had been turned away for the same reason the last time she was at there.

With the new community centers, it is possible that Arroyo could have had her cat treated and fixed at the same location, instead of visiting another vet, according to the ASPCA press release. 

Currently the clinics offer spay or neuter surgeries, vaccinations, nail trims and microchip placement, according to the ASPCA spokesperson. The community centers will expand their services, but it is unclear what additional services the clinics will offer and ASPCA declined further requests for information, including why the center opening was delayed. It was originally slated to open this fall.

A lifelong resident of the Bronx Marty Rogers walked his familiar route on September 10 down Third Avenue to the Hub at 149^th Street, the unofficial shopping and transit heart of the South Bronx. Rogers regularly visits this area dotted with orange plastic pieces of discarded syringes, neon lights alerting to all too familiar problem for the community. 

Knowing that students from 10 surrounding schools pass by all this danger and debris every day broke his heart. 

“The subliminal message is just killing our kids,” said Rogers, 64, leader of a local grassroots movement called Take Back the Hub focused on bringing attention to this issue. “It wires our kids to become an addict of some kind.” 

The message, he said, is that drug use like this is a big part of what’s inevitable for these children.

On two separate days the week of September 10, a walk through the five block area fanning out from 149^th Street and Third Avenue found nearly 1,000 pieces of needles and 200 intact syringes. The area observed by The Bronx Ink, included Patterson Playground and Lincoln Medical Center. 

In this same area are a total of 10 schools, spanning elementary to high school, both public and charter schools. 

The scope of the drug crisis is nothing new to residents of Mott Haven. The neighborhood has the third highest rate of overdose deaths in the city at a rate of 49.2 deaths per 100,000 citizens, according to Epi Data Brief by New York City Health.

“The rates of overdoses in the South Bronx are exceptionally high and if the the South Bronx was its own state it would have one of the highest rates in the country,” said Michelle Nolan, senior epidemiologist for the New York City Department of Health.

This data was gathered using death certificates and information from the medical examiner’s office, which is consistent with the Centers for Disease Control standards, according to Nolan. 

What is no longer tenable to the local grassroots activists is how the city’s repeated neglect. The members believe that a lack of quality services, such as police, sanitation and healthcare, is to blame for the opioid problem and the number of discarded syringes. 

Rogers calls the area a “zone of neglect.” 

Residents can report discarded syringes to 311, according to Dina Montes, Press Secretary of the New York City Department of Sanitation. 

“The Department of Sanitation of New York investigates reports of syringes on a City public street or public sidewalk. If any are found, our Environmental Police Unit will collect them and ensure their proper, safe disposal,” said Montes in an email. “Our Environmental Police Unit found and removed 16 syringes with sharps attached in that area of East 149th Street on Tuesday, September 10.”

The committee is not interested in “demonizing” those suffering from addiction, according to Rogers. 

“They are our brothers and sisters,” he said. “They had a very sad situation because they’re addicted, but the real victim is the child that has to walk past the needles and the defecation. That is the victim.”

Roger’s collection of neighbors aren’t the only ones concerned. Antonio Merced, a volunteer at Brilla Middle School at Courtlandt Avenue and 148^th Street, regularly uses his cane to bend syringe needles and gather them in a pile on the block before the students enter and leave the school.

“This is what it comes down to: parents, volunteers and guys getting paid who swept the needles up,” Rogers said. “I would challenge anyone to walk three blocks around this area and not find a cap or evidence of drug use.”

The movement plans to hold a vigil every Tuesday in The Hub, at 149th Street and Third Avenue  to bring attention to the number of improperly disposed syringes. 

“The people who join in, we have to keep reminding them, this isn’t one time,” said Francine Rogers, Marty’s wife. “We have to keep going.”

The office of Bronx Borough President Ruben Diaz Jr. is aware of the situation, according to John DeSio, director of communications.  

“Our office is aware of the situation, and have been in regular contact with agencies, the police department, local businesses, non-profits and other stakeholders in the area to develop solutions moving forward,” DeSio said in an email. 

Meanwhile, the members of the committee are waiting for the political officials to call a rally and organize to end this problem. 

“I think it’s fair to say that the community is more on top of this issue than the political officials,” said Rogers. “I’m not saying they’re not trying but they’re failing.”

MOTT HAVEN–Walking through the streets of the South Bronx one afternoon in July, Tino Fuentes, 53, said he sensed trouble across the street.

“You get this little gut feeling like something’s not right,” Fuentes said.

He found a man on the ground, unresponsive, drawing faint, shallow breaths. Bystanders said the man had been unconscious for several minutes, and his breathing was getting weaker as time passed. Amidst the chaos, a woman leaned over and whispered, “He did a bag.”

Fuentes, who knew she meant the man was likely overdosing on heroin, said he sprung into well-rehearsed action. An ambulance had already been called, but in the case of an overdose, every second matters. An injection of the drug Naloxone can reverse the effect of opioid overdose, but the success rate depends on rapid response.

Fuentes had a Naloxone kit across the street. After retrieving it, he removed the orange top of the vile, filled the syringe with its contents, and plunged the two-inch needle into the sinewy part of the man’s shoulder. Fuentes said he was rolling the man over to begin rescue breathing when he came to — brought back by the medication Fuentes injected.

“It’s such a selfish feeling, but I feel great. I just saved someone’s life,” Fuentes recalled.

Fuentes claims to have saved more than 75 lives with Naloxone since 2006, though he said he has lost count. He is not an EMT or doctor. He just makes sure he always has a kit on him when he is walking around New York.

“I do this because I came from these streets,” Fuentes said. “I gotta find a way to give back, you know?”

Fuentes serves as the co-director of the Syringe Exchange Program at St. Ann’s Corner of Harm Reduction in the South Bronx, where he also trains other people to administer Naloxone. Under New York State law, anyone can carry the medication after undergoing the twenty-minute training and earning a blanket-prescription.

“There is really no reason not to get trained,” Fuentes said. “We’re reaching out to try to train everybody.”

https://www.instagram.com/p/BJ3QDvmDpBV/

Between 2014 and 2015, Mott Haven and Hunts Point had the highest rate of heroin overdose in New York City by a significant margin. The death rates have steadily increased in recent years. Joyce Rivera, founder and executive director at St. Ann’s, said socioeconomic status and race cause people to ignore this public health crisis in the Bronx.

“The only people who really pay the price for using drugs are poor, working class people,” Rivera said to a crowd on National Overdose Awareness Day at the end of August. But she said harm reduction programs and Naloxone are saving lives in marginalized communities. “Every life matters. Who’s life is expendable?”

Across the country, heroin is becoming increasingly deadly. New reports confirm that heroin is now commonly cut with prescription Fentanyl, a drug 100 times stronger than morphine, causing users to underestimate the potency of what they inject.

“[Dealers] put whatever they put in heroin to stretch it out, to make more money,” Fuentes said. “Not too many people know what’s being put in there.”

According to Fuentes, the man he saved in July was a frequent user, injecting up to five bags a day. The day he nearly died, he was only on his first bag, which he had sniffed rather than injected. Since those are not the conditions that generally lead to overdose, Fuentes said he suspects Fentanyl was present in the mixture. Naloxone is still effective against Fentanyl-laced heroin though experts say in those cases it might take more than one dose to revive the person.

Since the Naloxone program began at St. Ann’s in 2006, awareness around heroin overdose has increased dramatically in New York. Now, all police officers in Mott Haven carry Naloxone. Overdose response trainings are being held in local prisons. Laws around prescription to carry have changed to give easier access to the life-saving medication.

Organizers at St. Ann’s say the shift in awareness and action was influenced by the changing demographics of heroin use and abuse throughout New York State. In 2013, more white New Yorkers than black or Hispanic New Yorkers died of overdose statewide.

“The progress we have made, the general tipping point we have passed, has to do with all of the white people who have overdosed,” said Bill Matthews, clinical director at St. Ann’s.

For Fuentes, it’s frustrating to believe nobody cares about the Bronx. But he said the most important thing is that progress is finally being made, and it’s helping people and saving lives.

“This is hurting everybody,” Fuentes said.

It’s hard to hold your breath for 108 days.

At Save Our Streets South Bronx, which launched in January 2013, a whiteboard in their Mott Haven office read “107” on Oct. 13 and “108” on Oct. 14. They dread when that tally of days without a shooting in their 20-block territory must go back to zero.

Save Our Streets, or simply SOS, originated in the Crown Heights section of Brooklyn in 2009 and has since expanded to 15 sites across the city. The City Council along with the Robert Woods Johnson Foundation, the largest U.S. charity devoted to public health, have pumped millions of dollars into this unconventional anti-violence initiative modeled after Chicago’s CeaseFire program. Now called Cure Violence, the program was celebrated in the award-winning 2011 documentary “The Interrupters.” Cure Violence has been emulated in roughly 50 cities worldwide since its inception 15 years ago.

The cornerstone of Cure Violence is the work of “violence interrupters,” “credible messengers” and “outreach workers” who patrol the streets and nurture relationships with at-risk individuals, typically young people, in an effort to undo a culture of violence of which they themselves were once byproducts. A job flier for SOS South Bronx (they’re hiring) describes such responsibilities for violence interrupters as identifying youth who are gang members or at-risk for joining, finding tips on potential conflicts, mediating with those parties involved to prevent retaliations and diffusing “hot spots” where shootings are likely to occur.

The credibility of these paid staffers is rooted in empathy.

“What I like about Save Our Streets is it’s composed of staff and volunteers who are former gang members or drug abusers themselves, or people who have been incarcerated,” said City Councilmember Vanessa Gibson, a Democrat who represents neighborhoods such as Morrisania and Melrose. “The best person you can get to really understand what a young person is going through is someone who has been in that situation before.”

Gibson allocated $5,000 of her discretionary funds for the 2015 fiscal year to SOS South Bronx. Democrat Robert Cornegy of Bedford-Stuyvesant and northern Crown Heights set aside $9,000. The Council voted earlier this year to expand SOS efforts from three neighborhoods to 15, including new posts in the 44th, 46th and 47th precincts in the South Bronx.

Jeffrey A. Butts, director of the Research and Evaluation Center at the John Jay College of Criminal Justice, echoed Gibson’s assertion that knowing the streets is key for SOS employees. “They have to have some connection to the community that doesn’t make them seem like an outside meddler or do-gooder,” explained Butts. Researchers at his school are currently evaluating the Cure Violence model and its implementation in Crown Heights and the South Bronx. “Some of the programs have successful employees who’ve never been arrested, but they might be the son of a well-known gang leader,” he said.

SOS is guarded about disclosing details on its organization. An SOS staffer said the program’s parent organization, the Center for Court Innovation, clamped down on news media access after The Mott Haven Herald published the criminal record of an SOS interrupter. Robert Wolf, director of communications for the Center for Court Innovation, denied that claim but said “everyone is tied up here” and would be unavailable for interviews indefinitely. SOS staffers have been instructed not to participate in interviews without approval from the Center’s Midtown Manhattan office.

Butts, whose center at John Jay received more than $1 million from the Robert Woods Johnson Foundation and $750,000 from the city council to study Save Our Streets through 2016 in conjunction with the Center for Court Innovation, explained the concern over public scrutiny.

“These programs do get very skittish. There have been lots of stories about some of the dominant political infrastructure forces running to the media to explode the situation when something goes wrong,” Butts said.

“Cure violence does not conform with the dominant political culture surrounding public safety,” he added. “So when you’re talking about crime and violence in a public policy arena, people immediately think of policing, prosecution and punishment. This program does not fit that model, so you start off with immediate opposition from the people who think conventionally about public safety.”

In the South Bronx, SOS outreach workers are unarmed and identifiable by their red T-shirts. Although sanctioned by the city, they operate in communities where cooperating with police work is a serious taboo. Despite often being privy to criminal activity, SOS explicitly refuses to have contact with police.

“You have a disconnect with a lot of young people who don’t trust the police and don’t think police are there to serve the public and to protect them,” Councilmember Gibson said.

This wall of separation between law enforcement and social workers is not unusual.

“I was visiting some police departments in Washington, D.C., and they said they keep in touch with outreach workers at these types of programs, but only at the highest level,” Butts said. “They might hear, ‘Things are really heating up in this neighborhood’ or ‘We’re getting rumors that something is about to go down between this crew and that crew,’ but no individual names, no tip-offs and certainly no post-incident information to help the investigation find a perpetrator. As soon as you do that, word gets out and the whole program is dead.”

SOS South Bronx employs three interrupters and three outreach workers, all middle-aged, to engage a territory composed of four public housing complexes and about 20,000 residents. They work full-time Tuesday through Saturday, with shifts running as late as 2 a.m.

In Crown Heights, interrupters underwent 40 hours of training in direct consultation with Cure Violence experts in Chicago, according to a 2011 report from the U.S. Department of Justice’s Bureau of Justice Assistance. SOS South Bronx is also in frequent contact with Chicago, allowing for a uniform implementation of the model.

Crown Heights had a homicide rate for those aged 15 to 24 nearly four times the city average in 2011, at 41.9 homicides for every 100,000 people in that age bracket, according to a report by the Department of Health and Mental Hygiene. (The department is now an advisor to SOS.) Fordham / Bronx Park and High Bridge / Morrisania in the South Bronx were also in the top-five neighborhoods most plagued by youth gun violence. Whereas SOS Crown Heights developed a successful “Youth SOS” program driven by student volunteers, efforts to duplicate that youth engagement in the South Bronx have foundered.

“The youth are disempowered and basically have no opportunity. One of biggest frustrations from a social work perspective is when you’re not addressing the core causes behind these issues,” said Markus Redding, a professor at the Columbia University School of Social Work who has worked extensively in non-violent conflict resolution. “It’s going to be very similar to what we do in the court system, which is reacting to what’s there but not getting at root causes like better education.”

The Crown Heights program reported recruiting 96 community members between January 2010 and May 2012 to participate in the SOS mission. All but one of these recruits was male, 94 were black and two were Hispanic. An SOS South Bronx official said his team has fostered about 25 such relationships.

Researchers led by Butts have interviewed roughly 200 people about gun violence in neighborhoods with and without SOS programs, and they are analyzing shooting data in these test and control areas. Butts would not give any tentative findings — their work began in February 2014 and will conclude around August 2016 — but he did outline basic variables that impact Cure Violence:

“To what extent are public institutions well-coordinated? Do social services people talk to the schools? Do law enforcement know their own community? How do neighborhood residents feel about their access to necessary support? Are police seen as an outside occupying force?”

SOS South Bronx has struggled to form alliances with institutions in the area. An exception is the Bronx Christian Fellowship, a church in Mott Haven where Rev. Que English has collaborated closely with SOS efforts. English reiterated the need to solve violence through means outside law enforcement.

“There’s an idea in these communities that if a cop kills us they’ll get away with it,” she said. “It’s circulated throughout generations. I once heard a 5-year-old say, “I don’t like cops.’”

Religious figures are a core component of the SOS strategy, according to literature distributed at the program’s Mott Haven office. One form reads, “Faith-based leaders are encouraged to preach against gun violence from their pulpits.”

What would it take for programs such as SOS to thrive in the pastor’s community?

“My first thought is a miracle,” English responded. “If we had a wish list, it would be ongoing community awareness and a lot of media coverage because we need to get the word out on violence to turn the tide.

“It’s going to take a while, and there’s no quick answer,” she added.

Anti-violence initiatives are not new in New York City. In 1979, Curtis Sliwa founded the Guardian Angels, whose red berets and jackets became trademarks of the amateur pseudo-police force that patrolled the subway amid a rash of violence. That operation was controversial for its vigilante approach, instructing volunteers to make citizens arrests and even providing them training in martial arts. The Guardian Angels do not accept volunteers with gang affiliations or serious criminal records.

But Redding and Gibson support the inclusion of ex-convicts in SOS South Bronx.

“With the prison industrial complex — we have more people incarcerated in the United States than any other country in the history of the world — there’s such labeling and the stereotyping of anyone who has committed a crime,” Redding said. “That lack of a second chance is very frustrating.”

In areas of Chicago where Cure Violence has been implemented, shootings are down 75 percent, according to cureviolenge.org. Crown Heights saw a 6 percent drop in shootings from January 2011 to May 2012 — the first year and a half of SOS activity — while comparable Brooklyn neighborhoods saw increases of 18 to 28 percent in that period. Experts say it is premature to conclude a cause-and-effect relationship between SOS efforts and diminished shooting rates, but they point to these data as cause for optimism about the efficacy of Cure Violence.

Still, Chicago is far from eradicating its gun epidemic or the culture behind it. The city has suffered 329 homicides in 2014, the Chicago Tribune reported, following 440 in 2013.

Lil Bibby, a 19-year-old at the forefront of the hardcore rap movement in a city nicknamed “Chiraq,” spoke in January on New York’s HOT 97 hip-hop radio station about gun violence in his hometown.

“In the last couple of years everybody got guns now, man. There ain’t no more fist fighting or arguing anymore, just guns,” Lil Bibby said. “Guns come out right away. There are kids, 13 or 14, playing with guns, and there ain’t no big homies telling them, ‘Stop this.’”

Several months later, HOT 97 debuted “Hot N—-” by the then-19-year-old from East Flatbush, Brooklyn, named Bobby Shmurda. The song is now ubiquitous on New York street corners, and it was blaring on repeat from a stereo across the street from the SOS South Bronx office on the day the whiteboard showed No. 95.

“Hot Boy,” as it’s called on the radio, reflects a pervasive gun culture that SOS staffers are fighting desperately to reform. Seven of the song’s first 10 lines, and most thereafter, draw on boastful anecdotes dealing with guns.

Although experts such as Redding note the peril of discounting underlying political causes behind crime, Save Our Streets is premised on changing a cultural mentality — as Butts put it, “accepting violence as normal behavior.”

“It’s not an easy thing or a quick thing, but I think it’s the only way you fix this problem,” he said. “If we continue to see community-level violence through the lens of a war on crime, it will just be a war on crime forever. It takes someone bold enough to say maybe there’s a new way to think about this problem.”

To keep urban shooting tallies like the one on the Mott Haven whiteboard low, must interrupters patrol violent street corners indefinitely?

“The foundational idea behind this model is that you implement it for three years or 10 years  — some period of time  — and you slowly shift away the social norms in support of violence, then you’re done,” Butts said. “There’s no need for people to be constantly funding programs to stop cigarette smoking: that cultural shift has already happened in this country. It’s the same thing with violence.”

A Staten Island couple set up their own sting operation in Mott Haven on Wednesday night by posing as customers interested in remote control cars they saw on Craigslist. The rare cars they tried to buy had been  stolen from them the previous week.

Christian Lugo, a granite and marble installer, saw the posting on the website and arranged to meet the seller on Third Avenue to exchange $1,200 for the two custom-built hobby cars. Lugo and his wife Tabitha feigned interest in one of the rare model Baja 5B for just a moment before pulling out the remote controls that correspond with the car.

“This is my car,” Lugo said three times to the would-be seller. Tabitha then texted the police, whom the couple had alerted in advance. Officers who were waiting nearby then escorted the seller to his Bronx apartment to retrieve the second car. The young man claimed to have bought the cars from a drug addict for $150 and said he did not know the hobby cars were stolen.

“I am disappointed that I lost the money I spent on buying them to not get anything for it,” said the seller in a text message. He declined to give his name. “I knew the value so I wanted to resell them.” The Lugos did not press charges and were just happy to have the cars back. The young man was released without charges. “He spoke politely,” Tabitha said. “I told him, ‘But you are in possession of stolen property.’”

The Lugos have put a lot of custom work into the aluminum cars, which Tabitha claimed were worth about $3,000 each. The remote control Baja 5Bs are one-fifth the size of a real car and sell for $1,600 on the RC Superstores website. Lugo is an avid collector and builder of remote control cars and Craigslist is a go-to site for buying, selling and trading parts.Lugo estimates he has anywhere from 40 to 50 remote control cars on top of the hobby planes and boats he collects.

Two weeks ago, Lugo left the two Baja 5Bs at the Staten Island home of a friend, also a collector. Two days later the friend said the cars  had gone missing, but not the remote controls.  While searching Craigslist the following week, Lugo spotted his Bajas for sale. “He was ready at 8 o’clock last night to run over here and get the cars,” Tabitha said in Mott Haven, after they had retrieved their property. The couple had called the phone number posted on Craigslist and made an offer, setting a meeting place near the 40th police precinct on Third Avenue and 138 St. The Lugos alerted police of their plan. “I’m not from around here,” Lugo said. “I didn’t know if he had a gun.” The seller was unarmed and appeared to be about 18 years old.

Selling stolen property on Craigslist is against the company’s policies, although doing so is difficult to detect and impossible to prevent. Selling stolen property is prevalent enough that the Internet stolen property database site, stolen911.com, has a special page through which victims of theft can search for their property on Craigslist.