You can’t always tell if it is a person in there, or if that person is alive or dead.

“Night Ministry!” Jeff Ayoub calls out, approaching a human-shaped pile of blankets on Lower Wacker Drive. “Night Ministry!”

The Night Ministry is the last strand of our fraying safety net. Despite “ministry” in its name, it is not a religious group, except in the sense that all religions have scripture about helping the downtrodden, edicts generally ignored by the faithful but the linchpin of this 40-year-old Chicago organization, which runs a shelter and a medical clinic on a bus that offers health care, counseling and life necessities to Chicago’s homeless.

Catrina Jones, 46, talks to Night Ministry Street Medicine Outreach worker Jeff Ayoub. | Santiago Covarrubias/Sun-Times.

Catrina Jones, 46, talks to Night Ministry Street Medicine Outreach worker Jeff Ayoub. | Santiago Covarrubias/Sun-Times

I tagged along Thursday because, one year ago, the Night Ministry began a program, where nurses carry backpacks filled with medical gear and seek out the homeless under viaducts, in fields, and other odd places where they hide.

“We were restricted with what we could do with the bus,” aid David Wywialowski, director health outreach.

They were inspired by Dr. Jim Withers and his Street Medicine Institute in Pittsburgh. So last year they visited him, observed his operation, and brought it here.

Homeless people are prone to asthma — one complained of the dust raised by cars blasting by. They have allergies from the rat feces scattered inches from their heads, difficulty filling prescriptions, early onset arthritis and undiagnosed diabetes. Not to mention the woes of addiction that cause many to fall off the grid in the first place.

OPINION

Night Ministry Street Outreach Case Manager Tiffany Green works with the homeless on Lower Wacker Drive on Dec. 22, 2016. | Santiago Covarrubias/Sun-Times.

Night Ministry Street Outreach Case Manager Tiffany Green works with the homeless on Lower Wacker Drive on Dec. 22, 2016. | Santiago Covarrubias/Sun-Times

As we moved from one encampment to another, handing out bottles of water, food, Christmas gift bags of toiletries and sweets, it struck me that homeless people do not gather randomly. They might live on the street, but they separate out into communities that reflect society. Thus you have African-Americans along one stretch of Lower Wacker Drive, while around the corner is a neighborhood of young white IV drug users.

Guatemalans live under an overpass near Chinatown, where some have jobs in nearby restaurants. And the neatly tented people living under Lake Shore Drive at Wilson and Lawrence tend to be the de-institutionalized mentally ill.

Just as in the society they’ve tumbled from, different groups scorn one another.

Felix Stettner, 26, says "I can't afford society." | Santiago Covarrubias/Sun-Times.

Felix Stettner, 26, says “I can’t afford society.” | Santiago Covarrubias/Sun-Times

“They really do,” said Matthew Sorenson, 54, a nurse practitioner at the Night Ministry. “There’s definitely an elitism among substance abusers. They separate themselves from other groups, have their own identities. The alcoholics will speak badly of the heroin users; the heroin users hate the meth addicts — everyone hates the meth addicts.”

The medical needs of addicts can be extreme. They shoot up so much their skin becomes necrotic — dead, essentially, and addicts I met shot into their torsos and necks, a dangerous, desperate thing to do. They suffer infections. Their hands are filthy and swollen. I watched three addicts in their 20s and 30s — Michael, Brittany and Andrew — smoking crack cocaine, and while I could say they didn’t care we were there, it might be more accurate to say they barely noticed.

Michael, 34, an IV drug user, said he had seizures earlier in the day. | Santiago Covarrubias/Sun-Times.

Michael, 34, an IV drug user, said he had seizures earlier in the day. | Santiago Covarrubias/Sun-Times

Among the supplies the team passed out were fresh hypodermic needles — “points” the addicts call them. It’s a controversial aspect of the program, as those unfamiliar can view it as enabling drug addiction.

“If we don’t give them the needles, that’s not going to stop them,” Sorenson said. “There are always going to be ethical debates. What are we trying to do here is reduce incidence of drug-related infections: HIV, Hepatitis C.”

They’re also building relationships.

“Then we can start to talk to people about their drug use,” Sorenson said. “With street medicine, you have to develop a trust with people you are seeing.”

Though they had invited me to see the medical program in action, on Thursday there wasn’t a nurse with us. I interviewed Sorenson later, by phone. Requests for inhalers and other treatment requests by the dozens of homeless people we met had to be deferred.

Alford Flournoy Jr., 50 and Kimberly Powell, 44 are just friends, Fournoy says. "We don't have sex or none of that." | Santiago Covarrubias/Sun-Times.

Alford Flournoy Jr., 50, and Kimberly Powell, 44, are just friends, Flournoy says. “We don’t have sex or none of that.” | Santiago Covarrubias/Sun-Times

The big difference between what the Night Ministry is doing in Chicago and Pittsburgh’s program is the lack of a Dr. Jim Withers. Their street medicine started going out only one day a week, saw the enormous need, and now goes out five, but staffing and funding is still an issue.

They are hoping to hire a part-time nurse, What they could really use are a bunch of medical volunteers — nurse practitioners who want to give back to the city, and maybe get some experience treating trench foot and scabies that they might never get at some shiny suburban hospital. Christmas is over, but the need remains, and one truth of helping such people is that the person you end up helping is yourself.