Pitching Health Care In Baltimore's Red Light District

Nov 10, 2015
Originally published on November 11, 2015 3:11 pm

Every Thursday night you can find Nathan Fields making the rounds of Baltimore's red light district, known to locals as The Block.

An outreach worker with the Baltimore City Health Department, Fields, 55, is a welcome sight outside strip clubs like Circus, Club Harem and Jewel Box.

In the early evening before the clubs get busy, he talks with dancers, bouncers and anyone else passing by about preventing drug overdoses and how to stop the spread of HIV and other sexually transmitted diseases.

Later on, he'll drop into the clubs to check on the dancers who aren't able to come outside, finding out what they might need.

Fields has credibility on The Block that people higher up in the health department don't. "I watch him walk down any street in Baltimore city, and people come up to him, and they know that he is there to serve them," says his boss, Health Commissioner Dr. Leana Wen.

The needle exchange van parks on the corner of a block that is home to numerous strip clubs.
Meredith Rizzo/NPR

It wasn't always so easy.

Seven years ago, Fields was working with the city's needle exchange program. After a spate of drug overdoses at the strip clubs, the health department brought its needle exchange van to The Block one night a week.

There were hardly any takers at first. People were skeptical.

"They were under the impression that we were giving their information to the police," Fields says. "So that's when I came on board. You know, I'm a great negotiator. Donald Trump can't beat me out."

Fields started with the bouncers. Though a Baltimore native, Fields is a huge fan of the New England Patriots and would often show up in head-to-toe Pats gear. The Baltimore Ravens-loving bouncers hated his get-up, and the football rivalry broke the ice.

Seven years ago, Fields began outreach work with Baltimore's needle exchange program on The Block.
Meredith Rizzo/NPR

Eventually, the sports talk turned more personal. Fields learned that some of the men had girlfriends dancing in the clubs who needed help – everything from condoms to drug treatment. Some women needed copies of birth certificates and other forms of ID in order to get into treatment.

Fields leaned on colleagues in the health department to get the problems solved.

Soon, the clubs doors opened for him. Once inside, Fields saw people needed even more.

"We went into one club, and there were three girls in different stages of pregnancy that were still dancing," he recalls. "We started running it up the chain: 'Hey, we need health care down here — reproductive health care.' "

So in addition to the needle exchange van, the city brought a second van to The Block, one with an exam table and a nurse. Now, every Thursday night, health workers offer needles for exchange, training in the anti-overdose drug naloxone, HIV tests, reproductive health exams, pregnancy tests, flu shots and more other basic health care services.

(Left) A Baltimore City health worker demonstrates how to use a naloxone auto-injector. (Right) Inside the needle exchange van, bundles of used needles are held in a container for disposal.
Meredith Rizzo/NPR

Fields treats each person coming into the vans like family. He remembers babies and boyfriends and other small details of people's lives.

"The Block is like living," he says. "These relationships, you've got to keep them flourishing."

Quietly, Fields also hands out pamphlets with information about drug treatment. Every so often, he'll mention a new option and encourage someone to check it out. But, it's a soft sell. He doesn't want to drive people away.

"I don't beat a person over the head," he says. "I never badger anybody for fear of them looking at me like, 'Oh, he's an elitist. He forgot where he came from.' I could never forget where I come from."

Nathan Fields (center) with his sons Hassan Fields (left) and Malik Fields on Friday, May 22. Hassan was shot and killed that weekend.
Courtesy of Nathan Fields

For nearly 20 years, Fields was a heroin addict. He sold drugs to support his habit and did time in the Baltimore City jail. "I was a predator to my community," he says.

After getting clean in the mid-1990s, he got a job as a recovery counselor. In 2004, he went to work with the Baltimore City Health Department. "The job just gives me a sense that I'm helping to build back what I tore down," he says. "You know, every time I can get somebody to even thinking different or even consider going into treatment, I feel as though I had a successful day."

In spite of those small victories, it's been a particularly difficult year for Baltimore and for Nathan Fields.

Over Memorial Day weekend, the outbreak of violence following the death of Freddie Gray claimed the life of his youngest child, 20-year-old Hassan Fields. He was shot and killed on the west side of Baltimore. His death remains an open case.

Nathan Fields struggles to understand how this could happen to him, given all he's done for the community. He had thoughts of reverting to the person he once was. Then, he came to a quieter place.

"The Block is like living," outreach worker Nathan Fields says. "These relationships, you've got to keep them flourishing."
Meredith Rizzo/NPR

"I'm sorry. I can't let this destroy me," he says. "I can't let this turn what my thoughts are about human nature — some good people with some bad people. I believe the bad people have a little bit of good in them too. It's just got to come out."

Thinking about Hassan's death has led him to reflect on his own past.

"I just have to look back on myself and say, I've caused pain. No, I've never done anything as violent as that, but I've got to keep working. I can cherish his memory, I sit down, I look at his picture and think about it, and it just makes me work harder."

NPR and All Things Considered will continue reporting from Baltimore in the coming months, checking in with Leana Wen and her team. Stay tuned for future stories.

Copyright 2019 NPR. To see more, visit https://www.npr.org.


And you do enough reporting on public health, and eventually, you will end up on an HIV testing or needle exchange van. These programs are aimed at stopping the spread of infectious diseases. And the people who run them - they're the foot soldiers of public health initiatives across the country.

LEANA WEN: They are the reason we are effective at our jobs.

CORNISH: Dr. Leana Wen is health commissioner in Baltimore.

WEN: We can't sit in our office in our headquarters here and say this is the policy that the city should follow. That's never going to work.

CORNISH: And while we've been following her the last few months to see how she faces down the city's ills, this story isn't about her. It's about a face you'd see in the background

WEN: Hi. I'm Dr. Wen.

NATHAN FIELDS: This is Dr. Wen.

WEN: Nice to meet you. I'm the health commissioner.

FIELDS: This is the health commissioner for Baltimore city.

CORNISH: OK, there - you hear that second voice?

FIELDS: Health commissioner for Baltimore city.

CORNISH: That's Nathan Fields. We met him over the summer as he was teaching people how to use the anti-overdose drug naloxone. He's 55 years old, a veteran outreach worker, and yes, he does in fact work some nights on the HIV testing and needle exchange vans. That's where we find him now.

FIELDS: So we're on the corner of Gay and Baltimore Street where all the glitter is, all the glitter and the glam. We're right in the center of it.

CORNISH: It's called The Block, Baltimore's infamous stretch of strip joints with names like Club Harem and Circus. Their neon signs flicker every night in the heart of downtown.

FIELDS: (Unintelligible), what's up?

CORNISH: Fields is just over six feet tall and towers over people like a coach. And I say coach because he's decked out in head-to-toe navy-blue New England Patriots gear. Despite being born and bred in Baltimore, he's a Pats fan. A friend once played for the team. And even this deep in Baltimore Ravens territory, his wide smile is returned by everyone.

FIELDS: I love him, Man.

CORNISH: Club owners, doormen, the dancers, or, as Fields calls them, the girls.

FIELDS: Hey. How you doing?

CORNISH: There are two vans parked around the corner from each other - white RVs staffs with health workers. One does needle exchange and anti-overdose training, the other - pregnancy tests, HIV tests, flu shots and more. And then there are the condoms - wood-paneled cabinets full. Fields estimates they'll give out some 2000 by the end of the night. Just as the staff gets organized, their first visitor runs up to the van.


APRIL: Mr. Nathan.

FIELDS: Hey. How you doing, Girl?

CORNISH: A dancer, she goes by the name April. She's wearing metallic gold 5-inch platform heels.


APRIL: Look at the shoes I just got myself.

FIELDS: Oh, cool (laughter).

APRIL: You know what I come for, though.

FIELDS: I know what you come for. I know.

CORNISH: Fields fills a brown paper lunch bag with condoms. He calls it a club bag. It's to share with the other dancers. Then he digs into another cabinet for more supplies - plastic bags of toiletries.

FIELDS: You got tampons and stuff on here?

APRIL: Can you put Band-Aids in there this time as well?

CORNISH: Before April heads back to work, Fields checks on one more thing.

FIELDS: How's the baby?

APRIL: He is awesome. Oh, my God, he's awesome.


CORNISH: He keeps track of babies and boyfriends. He arranged his own wedding date so he wouldn't miss his night offering health services to The Block. Fields is the definition of committed.

FIELDS: The Block is, like, living, so these relationships - you've got to keep them flourishing.

CORNISH: On the street, they call him Mr. Nathan. To the health department, he's Nathan Fields. At home, he's pop-pop, father of six, grandfather to 11.

UNIDENTIFIED CHILD #1: Oh, my God, there's a pumpkin in there.

UNIDENTIFIED CHILD #2: For real, you was serious.

FIELDS: OK. Go ahead to the bathroom. I thought you had to go to the bathroom.

CORNISH: We sit down at his dining room table stacked with kid-sized cinnamon rolls and cream-filled cookies and talk about building trust on The Block.

FIELDS: You know trust isn't something you just get by default.

CORNISH: He told me seven years ago when the city first decided to bring its needle exchange program to the strip clubs, there were hardly any takers. Fields says people figured they were with the authorities.

FIELDS: The police station is right across the street, so it's police milling through. And it's a cat-and-mouse game down there. But the health department know we need these services down there. They're just not sure how to do it. So that's when I come on board, and you know, I'm a great negotiator. Donald Trump can't beat me out (laughter).

CORNISH: He started with the doormen. They hated that he loved the Patriots, but it gave them lots to talk about. Soon, Fields got them talking about other stuff, personal stuff. He found out some of their girlfriends danced in the clubs and needed help - everything from rides to rehab to help getting birth certificates and other ID which turns out you need to get into rehab. Fields came through, and doors opened. And once inside the clubs, he saw the needs were greater.

FIELDS: We went into one club, and there were three girls in different stages of pregnancy that were still dancing. We started running it up the chain. Hey, we need health care down here, reproductive health care.

CORNISH: So the city brought that second van to the block with an exam table and a nurse. If Nathan Fields sounds like someone who knows how to wheel and deal, it's because, well, he used to wheel and deal. He told me that for almost 20 years, he was a heroin addict. He sold drugs to support his habit. He tells me, I was a predator to my community. Well, it took him many tries to kick his habit. In the mid-'90s, he finally did. He found work as a recovery counselor himself, and later in 2004, he was hired by the health department, a place he cannot ever imagine leaving.

FIELDS: The job - it just give me a sense that I'm helping to build back what I tore down. You know, every time I can get somebody to even thinking different or even consider going into treatment, you know, I feel as if though I had a successful day.

He, Fellas, come in for a minute.

CORNISH: And on a day like this, in a warm and comfortable home with grandbabies reaching up for hugs, he's proud of how far he's come.

FIELDS: You got a picture of me? Oh, that is so handsome.

CORNISH: This is how he recharges. He gives a lot to the city, years to the health department. Commissioners come and go. Nathan Fields stays. He lives through whatever the city lives through. In the summer, following the protests and riots over Freddie Gray, that meant living with a surge in gun violence.

FIELDS: You know, I come in every evening looking to see what the murder rate is going to be, how many people got killed over the weekend. And then when somebody calls you and say that your son is one of them - your 20-year-old son is one of them - then it changes. It's not stats and data and pie charts and - you know? It becomes personal. And wow, wow, it hits you like a bag of bricks.

CORNISH: Over Memorial Day weekend, Nathan Field's 20-year-old son Hassan was shot and killed. There aren't a whole lot of details. On Friday night, Hassan Fields went out with his girlfriend. By Saturday morning, he hadn't come home.

FIELDS: His mother actually called to say, did Hassan stay with you last night? And I was like, no, why? Was I - let me check. So you know, I walked through the house and checked and didn't see. And she was like, this not like him not to come in. And so I got up. I started running around everywhere. I went to the hospital. I went to the city jail. I went to the main police station, and I sort of thought the police station was sort of being evasive with me.

CORNISH: You know how I mentioned that Nathan Fields knows everyone? Well, he knew someone in the police department.

FIELDS: I called him and was like, Man, I need to find my son. And one of the police called me back and was like, do your son have any identifying scars or anything on them? And he has my grandbaby's name tattooed on him. And so I told them, and they say, well, we need you to come down here.

CORNISH: You've been working in this business so long and been talking with people on the street. Did you feel like, I can't believe this happened to me? Everyone knows me.

FIELDS: Right, oh, wow. It sort of hits me that you said that because that's what I said in the police station when they told me it was my son. I was like, how the hell could somebody do this to me as much as I do for the community? And guess what? It was probably that I just need to keep on working, keep on doing a little more.

I'm sorry. I can't let this destroy me. I can't let this turn what my thoughts are about human nature, you know? Some good people and some bad people, and I believe the bad people have a little bit of good in them too. It's just got to come out. And I sort of just got to look back on myself, Audie, and say, you know, I've caused pain. No I haven't never did anything as, you know, violent as that, you know? But I got to keep working. I can't let it, you know - I cherish his memory. I sit down. I look at his picture, and I think about it. And it just make me work harder.

CORNISH: Baltimore police say the death of Hassan Fields is still an open case. No arrests have been made. What we do know is that his wake was held on a warm June afternoon. By nightfall, Nathan Fields was at work on The Block. It wasn't even his normal night. But there he was, filling bags with condoms and toiletries, offering a how-are-you to the tired and sick addicts coming to exchange needles. Those addicts he often describes as being in the cold. And the ones he can convince to come in from that cold - they're his family too, and they needed him.


CORNISH: We want to thank you for listening to your public radio station. And if you want to catch up on our series from Baltimore, I want to invite you to visit our website, specifically our health blog - lots of other great reporting there. It's called Shots, and you can find it at npr.org. Transcript provided by NPR, Copyright NPR.