In South Philadelphia, a community of tight neighborhoods and strong traditions, a long-hidden opioid crisis is starting to reveal itself.
At Broad and Snyder Streets, next to a booming restaurant row and a major transit hub, Destinie Campanella makes her rounds. She lugs a bag full of Narcan, the overdose reversal drug, and water bottles to the corner where a few people in addiction sleep on cardboard mattresses. It's a sight familiar a few miles away in the open-air heroin scene of Kensington, but not here.
Campanella was born and raised in South Philly, where the drug crisis mirrors the intimacy and the insularity of the neighborhoods. The overdose death rate is skyrocketing, emergency rooms are filling up, and everyone knows a family affected.
But hardly anyone is comfortable talking about it.
Six years ago, when Campanella's uncle died of a heroin overdose, her family didn't want to talk about it either — even insisting his toxicology results were wrong.
The stigma of drug use here is so strong, mothers ask Campanella if she can spare a dose of Narcan in case they need it to save their children. They'd rather not be seen in line at the pharmacy, they tell her.
The people she visits on the corner are the most visible signs of an epidemic that usually kills in bedrooms and living rooms, hidden from the public eye.
On Broad Street last week, Campanella met a woman with a dangerously infected abscess from a botched injection.
Later, she got yet another lesson in how tight this community is: She realized the woman had gone to her South Philadelphia high school.
While the opioid crisis is most acute by far in Kensington, overdose deaths in South Philly increased by 41 percent from 2016 to 2017. All told, 132 of the city's 1,217 overdose deaths last year were in the community. Jefferson Methodist Hospital's ER on South Broad Street had the city's third-highest volume of overdose patients in the city in 2016.
"The only difference between Kensington and South Philly is location," said Sam Santiago, a city outreach worker who has worked with homeless people in addiction all over the city. "If you look hard enough, you'll see it."
Campanella, a mental health advocate, and a handful of other harm-reduction advocates and city outreach workers are among the few engaging with the homeless in South Philly.
"There's a gap in services that's happening here, in South Philly, in West Philly, in the Northeast," said Elvis Rosado, an outreach worker at Prevention Point, the city's only needle exchange, who stopped by the Broad Street camp on a recent night after holding a Narcan training for campus police officers at Methodist.
The needle exchange, which also offers wound care, addiction treatment, and other social services, sends a van to South Philly from its Kensington headquarters with clean needles once a week.
A man named Rick, homeless on Broad Street for a year, told Rosado the block can use more medical services, especially Narcan. He pointed to the alley behind the Wendy's on Snyder: he reversed an overdose there, with donated Narcan, a few weeks back. "Then there was Phil, in the schoolyard," he said. "And Jerry around the corner." And Carmen, who overdosed outside Wendy's last week and took four Narcan doses before paramedics found a pulse.
"And then I had a couple die," he said.
At State Sen. Larry Farnese's office at Broad and Moore, Dominic Simirglia, who handles constituent services, has become an unexpected concierge for families in search of drug treatment.
There are few treatment options in the neighborhood, but even going across town is a hard sell for people deeply attached to their community.
"For most kids in South Philly, detox is on mom's couch," said Anthony Curci, in recovery from a pain-pill addiction himself, who runs a number of recovery houses in the neighborhood.
Even those sleeping on Broad Street were mostly born and raised in the neighborhood, or have lived there for years.
Like Rick, who has lived in South Philly just for a decade but won't leave the center of his community, his friends, and his living — selling pretzels and water outside the stadiums on game days.
Priya Mammen, an emergency-room doctor at Methodist, said she often has a hard time persuading her patients to seek help outside the community.
"Sometimes they don't even want to go up to our Center City campus," she said. "Prevention Point is a phenomenal resource that I would love to link any number of people to. But they're like: 'That's Kensington. I don't go there. I'm not that person.' The stigma goes in all directions."
From his famous cheesesteak shop on Oregon Avenue, Tony Luke Jr., has stepped up to combat that stigma.
"People still believe it's a choice. They still look at addiction as an annoyance, as someone who is just choosing to destroy their lives and everyone around them," he said. "I used to be that guy on the corner going, 'Just stop using drugs.' "
Then his son, Tony III, developed a heroin addiction.
"He was looked at as a loser and a weak-minded individual, and he truly was none of those things. My son suffered from depression. And I didn't know it, and I didn't realize it, and I didn't treat it like I should at first," he said. "Thank God I learned [to treat addiction differently] while he was still alive."
Tony III died of an overdose last year.
Now, parents from the neighborhood who have lost children seek out Tony Luke on social media and in his shop. They ask him, tentatively, if he can talk to them — at their homes, rarely in public.
"They're carrying this guilt as if they caused the death," he said. "Most of the time, honestly, we just hug each other and cry, and we just say that we're all in the same club that nobody wants to be in."
Eight years ago, when he kicked his Percocet habit, Curci said, no one in the neighborhood wanted to hear about the swelling opioid crisis. As the death toll mounts, that is changing.
"Now, my grandmother, who's never left Sartain Street, knows about the heroin crisis" because her friend has a grandchild in rehab, Curci said.
Campanella's work takes her all over the city.
Working in South Philly, "I worried that people weren't going to be receptive to me because they knew me, and they were ashamed of themselves," she said.
But now, when she runs into her old classmates on the street, their shared histories are her way in.
Like the woman with the dangerously infected abscess, who feared going to the hospital and finding out just how bad her situation was.
Campanella saw she wasn't budging, at least not yet. But she also knew she was the woman's only source of help right then.