5.4.2008

If gang violence was an infectious disease, how would you stop it? A Chicago epidemiologist thinks he has the answer.

LAST SUMMER, MARTIN TORRES WAS WORKING AS A COOK IN AUSTIN, Tex., when, on the morning of Aug. 23, he received a call from a relative. His 17-year-old nephew, Emilio, had been murdered. According to the police, Emilio was walking down a street on Chicago’s South Side when someone shot him in the chest, possibly the culmination of an ongoing dispute. Like many killings, Emilio’s received just a few sentences in the local newspapers.

Torres, who was especially close to his nephew, got on the first Greyhound bus to Chicago. He was grieving and plotting retribution. “I thought, Man, I’m going to take care of business,” he told me recently. “That’s how I live. I was going hunting. This is my own blood, my nephew.”

REUBEN COX FOR THE NEW YORK TIMES

Zale Hoddenbach, center, once a gang member, now a CeaseFire interrupter. He trades on his street credibility to diffuse violence before it happens.

Torres, who is 38, grew up in a dicey section of Chicago, and even by the standards of his neighborhood he was a rough character. His nickname was Packman, because he was known to always pack a gun. He was first shot when he was 12, in the legs with buckshot by members of a rival gang. He was shot five more times, including once through the jaw, another time in his right shoulder and the last time — seven years ago — in his right thigh, with a .38-caliber bullet that is still lodged there. On his chest, he has tattooed a tombstone with the name “Buff” at its center, a tribute to a friend who was killed on his 18th birthday. Torres was the head of a small Hispanic gang, and though he is no longer active, he still wears two silver studs in his left ear, a sign of his affiliation.

When he arrived in Chicago, he began to ask around, and within a day believed he had figured out who killed his nephew. He also began drinking a lot — mostly Hennessey cognac. He borrowed two guns, a .38 and a .380, from guys he knew. He would, he thought, wait until after the funeral to track down his nephew’s assailants.

Zale Hoddenbach looks like an ex-military man. He wears his hair cropped and has a trimmed goatee that highlights his angular jaw. He often wears T-shirts that fit tightly around his muscled arms, though he also carries a slight paunch. When he was younger, Hoddenbach, who is also 38, belonged to a gang that was under the same umbrella as Torres’s, and so when the two men first met 17 years ago at Pontiac Correctional Center, an Illinois maximum-security prison, they became friendly. Hoddenbach was serving time for armed violence; Torres for possession of a stolen car and a gun (he was, he says, on his way to make a hit). “Zale was always in segregation, in the hole for fights,” Torres told me. “He was aggressive.” In one scuffle, Hoddenbach lost the sight in his right eye after an inmate pierced it with a shank. Torres and Hoddenbach were at Pontiac together for about a year but quickly lost touch after they were both released.

Shortly after Torres arrived in Chicago last summer, Hoddenbach received a phone call from Torres’s brother, the father of the young man who was murdered. He was worried that Torres was preparing to seek revenge and hoped that Hoddenbach would speak with him. When Hoddenbach called, Torres was thrilled. He immediately thought that his old prison buddy was going to join him in his search for the killer. But instead Hoddenbach tried to talk him down, telling him retribution wasn’t what his brother wanted. “I didn’t understand what the hell he was talking about,” Torres told me when I talked to him six months later. “This didn’t seem like the person I knew.” The next day Hoddenbach appeared at the wake, which was held at New Life Community Church, housed in a low-slung former factory. He spent the day by Torres’s side, sitting with him, talking to him, urging him to respect his brother’s wishes. When Torres went to the parking lot for a smoke, his hands shaking from agitation, Hoddenbach would follow. “Because of our relationship, I thought there was a chance,” Hoddenbach told me. “We were both cut from the same cloth.” Hoddenbach knew from experience that the longer he could delay Torres from heading out, the more chance he’d have of keeping him from shooting someone. So he let him vent for a few hours. Then Hoddenbach started laying into him with every argument he could think of: Look around, do you see any old guys here? I never seen so many young kids at a funeral. Look at these kids, what does the future hold for them? Where do we fit in? Who are you to step on your brother’s wishes?

THE STUBBORN CORE of violence in American cities is troubling and perplexing. Even as homicide rates have declined across the country — in some places, like New York, by a remarkable amount — gunplay continues to plague economically struggling minority communities. For 25 years, murder has been the leading cause of death among African-American men between the ages of 15 and 34, according to the Centers for Disease Control and Prevention, which has analyzed data up to 2005. And the past few years have seen an uptick in homicides in many cities. Since 2004, for instance, they are up 19 percent in Philadelphia and Milwaukee, 29 percent in Houston and 54 percent in Oakland. Just two weekends ago in Chicago, with the first warm weather, 36 people were shot, 7 of them fatally. The Chicago Sun-Times called it the “weekend of rage.” Many killings are attributed to gang conflicts and are confined to particular neighborhoods. In Chicago, where on average five people were shot each day last year, 83 percent of the assaults were concentrated in half the police districts. So for people living outside those neighborhoods, the frequent outbursts of unrestrained anger have been easy to ignore. But each shooting, each murder, leaves a devastating legacy, and a growing school of thought suggests that there’s little we can do about the entrenched urban poverty if the relentless pattern of street violence isn’t somehow broken.

The traditional response has been more focused policing and longer prison sentences, but law enforcement does little to disrupt a street code that allows, if not encourages, the settling of squabbles with deadly force. Zale Hoddenbach, who works for an organization called CeaseFire, is part of an unusual effort to apply the principles of public health to the brutality of the streets. CeaseFire tries to deal with these quarrels on the front end. Hoddenbach’s job is to suss out smoldering disputes and to intervene before matters get out of hand. His job title is violence interrupter, a term that while not artful seems bluntly self-explanatory. Newspaper accounts usually refer to the organization as a gang-intervention program, and Hoddenbach and most of his colleagues are indeed former gang leaders. But CeaseFire doesn’t necessarily aim to get people out of gangs — nor interrupt the drug trade. It’s almost blindly focused on one thing: preventing shootings.

REUBEN COX FOR THE NEW YORK TIMES

THE VISIONARY: Gary Slutkin saw a connection between violence and disease.

CeaseFire’s founder, Gary Slutkin, is an epidemiologist and a physician who for 10 years battled infectious diseases in Africa. He says that violence directly mimics infections like tuberculosis and AIDS, and so, he suggests, the treatment ought to mimic the regimen applied to these diseases: go after the most infected, and stop the infection at its source. “For violence, we’re trying to interrupt the next event, the next transmission, the next violent activity,” Slutkin told me recently. “And the violent activity predicts the next violent activity like H.I.V. predicts the next H.I.V. and TB predicts the next TB.” Slutkin wants to shift how we think about violence from a moral issue (good and bad people) to a public health one (healthful and unhealthful behavior).

REUBEN COX FOR THE NEW YORK TIMES

THE FRONT END: James Highsmith tries to stay plugged in to Auburn Gresham, a Chicago neighborhood, where he can track brewing conflicts.

EVERY WEDNESDAY AFTERNOON, in a Spartan room on the 10th floor of the University of Illinois at Chicago’s public-health building, 15 to 25 men — and two women — all violence interrupters, sit around tables arranged in a circle and ruminate on the rage percolating in the city. Most are in their 40s and 50s, though some, like Hoddenbach, are a bit younger. All of them are black or Hispanic and in one manner or another have themselves been privy to, if not participants in, the brutality of the streets.

On a Wednesday near the end of March, Slutkin made a rare appearance; he ordinarily leaves the day-to-day operations to a staff member. Fit at 57, Slutkin has a somewhat disheveled appearance — tie askew, hair uncombed, seemingly forgetful. Some see his presentation as a calculated effort to disarm. “Slutkin does his thing in his Slutkinesque way,” notes Carl Bell, a psychiatrist who has long worked with children exposed to neighborhood violence and who admires CeaseFire’s work. “He seems kind of disorganized, but he’s not.” Hoddenbach told me: “You can’t make too much of that guy. In the beginning, he gives you that look like he doesn’t know what you’re talking about.”

REUBEN COX FOR THE NEW YORK TIMES

THE BACK END: Charles Mack the victim of a gunshot wound. His goal: to prevent retaliation.

Slutkin had come to talk with the group about a recent high-profile incident outside Crane Tech High School on the city’s West Side. An 18-year-old boy was shot and died on the school’s steps, while nearby another boy was savagely beaten with a golf club. Since the beginning of the school year, 18 Chicago public-school students had been killed. (Another six would be murdered in the coming weeks.) The interrupters told Slutkin that there was a large police presence at the school, at least temporarily muffling any hostilities there, and that the police were even escorting some kids to and from school. They then told him what was happening off the radar in their neighborhoods. There was the continuing discord at another high school involving a group of girls (“They’d argue with a stop sign,” one of the interrupters noted); a 14-year-old boy with a gang tattoo on his forehead was shot by an older gang member just out of prison; a 15-year-old was shot in the stomach by a rival gang member as he came out of his house; and a former CeaseFire colleague was struggling to keep himself from losing control after his own sons were beaten. There was also a high-school basketball player shot four times; a 12-year-old boy shot at a party; gang members arming themselves to counter an egging of their freshly painted cars; and a high-ranking gang member who was on life support after being shot, and whose sister was overheard talking on her cellphone in the hospital, urging someone to “get those straps together.

These incidents all occurred over the previous seven days. In each of them, the interrupters had stepped in to try to keep one act of enmity from spiraling into another. Some had more success than others. Janell Sails prodded the guys with the egged cars to go to a car wash and then persuaded them it wasn’t worth risking their lives over a stupid prank. At Crane Tech High School, three of the interrupters fanned out, trying to convince the five gangs involved in the conflict to lie low, but they conceded that they were unable reach some of the main players. Many of the interrupters seem bewildered by what they see as a wilder group of youngsters now running the streets and by a gang structure that is no longer top-down but is instead made up of many small groups — which they refer to as cliques — whose members are answerable to a handful of peers.

REUBEN COX FOR THE NEW YORK TIMES

SMALL STEPS: CeaseFire field office in Chicago's Humboldt Park.

For an hour, Slutkin leaned on the table, playing with a piece of Scotch tape, keenly listening. In some situations, Slutkin can appear detached and didactic. He can wear people down with his long discourses, and some of the interrupters say they sometimes tune him out. (On one occasion, he tried to explain to me the relationship between emotional intelligence and quantum physics.) But having seen a lot of out-of-control behavior, Slutkin is a big believer in controlling emotions. So he has taught himself not to break into discussions and to digest before presenting his view. The interrupters say he has their unqualified loyalty. Hoddenbach told me that he now considers Slutkin a friend.

It became clear as they delivered their reports that many of the interrupters were worn down. One of them, Calvin Buchanan, whose street name is Monster and who just recently joined CeaseFire, showed the others six stitches over his left eye; someone had cracked a beer bottle on his head while he was mediating an argument between two men. The other interrupters applauded when Buchanan told them that, though tempted, he restrained himself from getting even.

When Slutkin finally spoke, he first praised the interrupters for their work. “Everybody’s overreacting, and you’re trying to cool them down,” he told them. He then asked if any of them had been experiencing jitteriness or fear. He spent the next half-hour teaching stress-reduction exercises. If they could calm themselves, he seemed to be saying, they could also calm others. I recalled what one of the interrupters told me a few weeks earlier: “We helped create the madness, and now we’re trying to debug it.”

IN THE PUBLIC-HEALTH field, there have long been two schools of thought on derailing violence. One focuses on environmental factors, specifically trying to limit gun purchases and making guns safer. The other tries to influence behavior by introducing school-based curricula like antidrug and safe-sex campaigns.

Slutkin is going after it in a third way — as if he were trying to contain an infectious disease. The fact that there’s no vaccine or medical cure for violence doesn’t dissuade him. He points out that in the early days of AIDS, there was no treatment either. In the short run, he’s just trying to halt the spread of violence. In the long run, though, he says he hopes to alter behavior and what’s considered socially acceptable. Slutkin’s perspective grew out of his own experience as an infectious-disease doctor. In 1981, six years out of the University of Chicago Pritzker School of Medicine, Slutkin was asked to lead the TB program in San Francisco. With an influx of new refugees from Cambodia, Laos and Vietnam, the number of cases in the city had nearly doubled. Slutkin chose to concentrate on those who had the most active TB; on average, they were infecting 6 to 10 others a year. Slutkin hired Southeast Asian outreach workers who could not only locate the infected individuals but who could also stick with them for nine months, making sure they took the necessary medication. These outreach workers knew the communities and spoke the languages, and they were able to persuade family members of infected people to be tested. Slutkin also went after the toughest cases — 26 people with drug-resistant TB. The chance of curing those people was slim, but Slutkin reckoned that if they went untreated, the disease would continue to spread. “Gary wasn’t constrained by the textbook,” says Eric Goosby, who worked in the clinic and is now the chief executive of the Pangaea Global AIDS Foundation. Within two years, the number of TB cases, at least among these new immigrants, declined sharply.

Slutkin then spent 10 years in Africa, first in refugee camps in Somalia and then working, in Uganda and other countries, for the World Health Organization to curtail the spread of AIDS. During his first posting, in Somalia, a cholera epidemic spread from camp to camp. Slutkin had never dealt with an outbreak of this sort, and he was overwhelmed. The diarrhea from cholera is so severe that patients can die within hours from dehydration. According to Sandy Gove, who was then married to Slutkin and was also a doctor in the camps, infection rates were approaching 10 percent; in one camp there were 1,000 severely ill refugees. “It was desperate,” she told me. Slutkin drove a Land Cruiser two and a half days to an American military base along the coast to the closest phone. He called doctors in Europe and the United States, trying to get information. He also asked the soldiers at the base for blue food coloring, which he then poured into the water sources of the bacteria, a warning to refugees not to drink. “What Gary is really good about is laying out a broad strategic plan and keeping ahead of something,” Gove told me. There were only six doctors for the 40 refugee camps, so Slutkin and Gove trained birth attendants to spot infected people and to give them rehydration therapies in their homes. Because the birth attendants were refugees, they were trusted and could persuade those with the most severe symptoms to receive aid at the medical tent.

After leaving Africa, Slutkin returned to Chicago, where he was raised and where he could attend to his aging parents. (He later remarried there.) It was 1995, and there had been a series of horrific murders involving children in the city. He was convinced that longer sentences and more police officers had made little difference. “Punishment doesn’t drive behavior,” he told me. “Copying and modeling and the social expectations of your peers is what drives your behavior.”

Borrowing some ideas (and the name) from a successful Boston program, Slutkin initially established an approach that exists in one form or another in many cities: outreach workers tried to get youth and young adults into school or to help them find jobs. These outreach workers were also doing dispute mediation. But Slutkin was feeling his way, much as he had in Somalia during the cholera epidemic. One of Slutkin’s colleagues, Tio Hardiman, brought up an uncomfortable truth: the program wasn’t reaching the most bellicose, those most likely to pull a trigger. So in 2004, Hardiman suggested that, in addition to outreach workers, they also hire men and women who had been deep into street life, and he began recruiting people even while they were still in prison. Hardiman told me he was looking for those “right there on the edge.” (The interrupters are paid roughly $15 an hour, and those working full time receive benefits from the University of Illinois at Chicago, where CeaseFire is housed.) The new recruits, with strong connections to the toughest communities, would focus solely on sniffing out clashes that had the potential to escalate. They would intervene in potential acts of retribution — as well as try to defuse seemingly minor spats that might erupt into something bigger, like disputes over women or insulting remarks.

As CeaseFire evolved, Slutkin says he started to realize how much it was drawing on his experiences fighting TB and AIDS. “Early intervention in TB is actually treatment of the most infectious people,” Slutkin told me recently. “They’re the ones who are infecting others. So treatment of the most infectious spreaders is the most effective strategy known and now accepted in the world.” And, he continued, you want to go after them with individuals who themselves were once either infectious spreaders or at high risk for the illness. In the case of violence, you use those who were once hard-core, once the most belligerent, once the most uncontrollable, once the angriest. They are the most convincing messengers. It’s why, for instance, Slutkin and his colleagues asked sex workers in Uganda and other nations to spread the word to other sex workers about safer sexual behavior. Then, Slutkin said, you train them, as you would paraprofessionals, as he and Gove did when they trained birth attendants to spot cholera in Somalia.

The first step to containing the spread of an infectious disease is minimizing transmission. The parallel in Slutkin’s Chicago work is thwarting retaliations, which is precisely what Hoddenbach was trying to do in the aftermath of Emilio Torres’s murder. But Slutkin is also looking for the equivalent of a cure. The way public-health doctors think of curing disease when there are no drug treatments is by changing behavior. Smoking is the most obvious example. Cigarettes are still around. And there’s no easy remedy for lung cancer or emphysema. So the best way to deal with the diseases associated with smoking is to get people to stop smoking. In Uganda, Slutkin and his colleagues tried to change behavior by encouraging people to have fewer sexual partners and to use condoms. CeaseFire has a visible public-communications campaign, which includes billboards and bumper stickers (which read, “Stop. Killing. People.”). It also holds rallies — or what it calls “responses” — at the sites of killings. But much research suggests that peer or social pressure is the most effective way to change behavior. “It was a real turning point for me,” Slutkin said, “when I was working on the AIDS epidemic and saw research findings that showed that the principal determinant of whether someone uses a condom or not is whether they think their friends use them.” Daniel Webster, a professor of public health at Johns Hopkins University who has looked closely at CeaseFire, told me, “The guys out there doing the interruption have some prestige and reputation, and I think the hope is that they start to change a culture so that you can retain your status, retain your manliness and be able to walk away from events where all expectations were that you were supposed to respond with lethal force.”

As a result, the interrupters operate in a netherworld between upholding the law and upholding the logic of the streets. They’re not meant to be a substitute for the police, and indeed, sometimes the interrupters negotiate disputes involving illicit goings-on. They often walk a fine line between mediating and seeming to condone criminal activity. At one Wednesday meeting this past December, the interrupters argued over whether they could dissuade stickup artists from shooting their victims; persuading them to stop robbing people didn’t come up in the discussion.

LAST DECEMBER, at the first Wednesday meeting I attended, James Highsmith came up to introduce himself. At 58, Highsmith is one of the older interrupters. He wears striped, collared shirts, black rectangular glasses and often a black Borsalino, an Italian-made fedora. He reminded me that I had mentioned him in my book, “There Are No Children Here,” about life in a Chicago public-housing project in the late 1980s. I wrote about a picnic that some Chicago drug kingpins gave in a South Side park. There was a car show, a wet T-shirt contest and softball games for the children. About 2,000 people attended, dancing to a live band while the drug lords showed off their Mercedes Benzes, Rolls-Royces and Jaguars. Highsmith was the key sponsor of the event. He controlled the drug trade on the city’s South Side. He owned a towing business, an auto-mechanic’s shop and a nightclub, as well as a 38-foot boat. In January 1994, he was sentenced to 14 years in federal prison on drug-conspiracy charges; he was released in 2004. Highsmith was just the kind of recruit CeaseFire looks for: an older man getting out of the penitentiary who once had standing on the streets and who, through word of mouth, appears ready, eager even, to discard his former persona. “I’m a work in progress,” Highsmith told me.

One evening we were sitting in Highsmith’s basement apartment when the phone rang. It was Alphonso Prater, another interrupter. The two had a reunion of sorts when they joined CeaseFire; they shared a cell in the county jail 34 years ago. Prater’s voice is so raspy it sounds as if he has gravel in his throat. He told me that he became permanently hoarse after a long stint in segregation in prison; he had to shout to talk with others. When Prater called the night I was there, all Highsmith could make out was: “There’s some high-tech stuff going on. I need you to talk to some folks.” Highsmith didn’t ask any questions.

We drove to a poorly lighted side street on the city’s West Side. Empty beer bottles littered the side of the road. Prater, who is short and wiry and has trouble keeping still, was bouncing on the sidewalk, standing next to a lanky middle-aged man who had receded into his oversize hooded sweatshirt. Highsmith, Prater and another interrupter joined the man in a parked car, where they talked for half an hour. When they were done, the car peeled away, two other sedans escorting it, one in front, the other in the rear. “Protection,” Highsmith commented. Apparently, the man in the hooded sweatshirt, whom I would meet later, had been an intermediary in a drug deal. He had taken an out-of-town buyer holding $30,000 in cash to a house on the South Side to buy drugs. But when they got there, they were met by six men in the backyard, each armed with a pistol or an automatic weapon, and robbed. The out-of-town buyer believed he’d been set up by the intermediary, who, in turn, was trying to hunt down the stickup artists. In the car, Prater, who knew the intermediary, had worked to cool him down, while Highsmith promised to see if he could find someone who might know the stickup guys and could negotiate with them. The intermediary told Prater and Highsmith, a bit ominously, “Something got to give.”

After the intermediary drove off, Prater joked that there was no way he was getting back in a car with him, that he was too overheated and too likely to be the target or the shooter. “I’m not sure we can do anything about this one,” Highsmith told Prater.

RELYING ON HARDENED TYPES — the ones who, as Webster of Johns Hopkins says, have some prestige on the streets — is risky. They have prestige for a reason. Hoddenbach, who once beat someone so badly he punctured his lungs, is reluctant to talk about his past. “I don’t want to be seen as a monster,” he told me. Hoddenbach’s ethnicity is hard to pinpoint. His father was Dutch and his mother Puerto Rican, and he’s so light-skinned his street name was Casper. He has a discerning gaze and mischievous smile, and can be hardheaded and impatient. (At the Wednesday meetings, he often sits near the door and whispers entreaties to the others to speed things up.) Hoddenbach’s father had an explosive temper, and to steal from Slutkin’s lingo, he seems to have infected others. Two of Hoddenbach’s older brothers are serving time for murder. His third brother has carved out a legitimate life as a manager at a manufacturing firm. Hoddenbach always worked. He did maintenance on train equipment and towed airplanes at a private airport. But he was also active in a Hispanic street gang and was known for his unmitigated aggression. He served a total of eight years in the state penitentiary, the last stay for charges that included aggravated battery. He was released in 2002.

In January, I was with Slutkin in Baltimore, where he spoke about CeaseFire to a small gathering of local civic leaders at a private home. During the two-hour meeting, Slutkin never mentioned that the interrupters were ex-felons. When I later asked him about that omission, he conceded that talking about their personal histories “is a dilemma. I haven’t solved it.” I spent many hours with Hoddenbach and the others, trying to understand how they chose to make the transition from gangster to peacemaker, how they put thuggery behind them. It is, of course, their street savvy and reputations that make them effective for CeaseFire. (One supporter of the program admiringly called it “a terrifying strategy” because of the inherent risks.) Some CeaseFire workers have, indeed, reverted to their old ways. One outreach worker was fired after he was arrested for possession of an AK-47 and a handgun. Another outreach worker and an interrupter were let go after they were arrested for dealing drugs. Word-of-mouth allegations often circulate, and privately, some in the police department worry about CeaseFire’s workers returning to their old habits.

Not all the interrupters I talked to could articulate how they had made the transition. Some, like Hoddenbach, find religion — in his case, Christianity. He also has four children he feels responsible for, and has found ways to decompress, like going for long runs. (His brother Mark speculated that “maybe he just wants to give back what he took out.”) I once asked Hoddenbach if he has ever apologized to anyone he hurt. We were with one of his old friends from the street, who started guffawing, as if I had asked Hoddenbach if he ever wore dresses. “I done it twice,” Hoddenbach told us — quickly silencing his friend and saving me from further embarrassment. (One apology was to the brother of the man whose lungs he’d punctured; the other was to a rival gang member he shot.) Alphonso Prater told me that the last time he was released from prison, in 2001, an older woman hired him to gut some homes she was renovating. She trusted him with the keys to the homes, and something about that small gesture lifted him. “She seen something in me that I didn’t see,” he told me.

Though the interrupters may not put it this way, the Wednesday meetings are a kind of therapy. One staff member laughingly compared it to a 12-step program. It was clear to me that they leaned on one another — a lot. Prater once got an urgent call from his daughter, who said her boyfriend was beating her. Prater got in his car and began to race to her house; as he was about to run a stop sign, he glimpsed a police car on the corner. He skidded to a halt. It gave him a moment to think, and he called his CeaseFire supervisor, Tio Hardiman, who got another interrupter to visit Prater’s daughter. Not long ago, three old-timers fresh out of prison ruthlessly ridiculed Hoddenbach for his work with CeaseFire. They were relentless, and Hoddenbach asked to sit down with them. But when it came time to meet, he realized he was too riled, and so he asked another interrupter, Tim White, to go in his place. “I was worried I was going to whip their asses, and wherever it went from there it went,” Hoddenbach told me. “They were old feelings, feelings I don’t want to revisit.”

Recently I went out to lunch with Hoddenbach and Torres. It had been four months since Torres buried his nephew. Torres, who looked worn and agitated (he would get up periodically to smoke a cigarette outside), seemed paradoxically both grateful to and annoyed at Hoddenbach. In the end, Hoddenbach had persuaded him not to avenge his nephew’s murder. Torres had returned the guns and quickly left town. This was his first visit back to Chicago. “I felt like a punk,” he told me, before transferring to the present tense. “I feel shameful.” He said he had sought revenge for people who weren’t related to him — “people who weren’t even no blood to me.” But he held back in the case of his nephew. “I still struggle with it,” he said. On the ride over to the restaurant, Torres had been playing a CD of his nephew’s favorite rap songs. It got him hyped up, and he blurted out to Hoddenbach, “I feel like doing something.” Hoddenbach chided him and shut off the music. “Stop being an idiot,” he told Torres.

“Something made me do what Zale asked me to do,” Torres said later, looking more puzzled than comforted. “Which is respect my brother’s wishes.”

When Slutkin heard of Hoddenbach’s intervention, he told me: “The interrupters have to deal with how to get someone to save face. In other words, how do you not do a shooting if someone has insulted you, if all of your friends are expecting you to do that? . . . In fact, what our interrupters do is put social pressure in the other direction.”

He continued: “This is cognitive dissonance. Before Zale walked up to him, this guy was holding only one thought. So you want to put another thought in his head. It turns out talking about family is what really makes a difference.” Slutkin didn’t take this notion to the interrupters; he learned it from them.

ONE JANUARY NIGHT at 11 p.m., Charles Mack received a phone call that a shooting victim was being rushed to Advocate Christ Medical Center. Mack drove the 10 miles from his home to the hospital, which houses one of four trauma centers in Chicago. Two interrupters, Mack and LeVon Stone, are assigned there. They respond to every shooting and stabbing victim taken to the hospital. Mack, who is 57 and has a slight lisp, is less imposing than his colleagues. He seems always to be coming from or going to church, often dressed in tie and cardigan. He sheepishly told me that his prison term, two years, was for bank fraud. “The other guys laugh at me,” he said. LeVon Stone is 23 years younger and a fast talker. He’s in a wheelchair, paralyzed from the waist down as a result of being shot when he was 18.

Advocate Christ has come to see the presence of interrupters in the trauma unit as essential and is, in fact, looking to expand their numbers. “It has just given me so much hope,” Cathy Arsenault, one of the chaplains there, told me. “The families would come in, huddle in the corner and I could see them assigning people to take care of business.” Mack and Stone try to cool off family members and friends, and if the victim survives, try to keep them from seeking vengeance.

The victim that night was a tall 16-year-old boy named Frederick. He was lying on a gurney just off the emergency room’s main hallway. He was connected to two IVs, and blood was seeping through the gauze wrapped around his left hand. Mack stood to one side; Stone pulled up on the other.

“You know, the most important thing is —” Mack ventured.

“You’re alive,” Stone chimed in.

Stone then asked Frederick if he had heard of CeaseFire. The boy nodded and told them that he had even participated in a CeaseFire rally after a killing in his neighborhood.

“We try to stop violence on the front end,” Stone told Frederick. “Unfortunately, this is the back end. We just want to make sure you don’t go out and try to retaliate.”

The boy had been shot — one bullet shattered his thigh bone and another ripped the tendons in two fingers. Nonetheless, he seemed lucid and chatty.

“My intention is to get in the house, call my school, get my books and finish my work,” he told Mack and Stone. He mentioned the school he attends, which Mack instantly recognized as a place for kids on juvenile-court probation. Frederick told his story. He was at a party, and a rival clique arrived. Frederick and his friends sensed there would be trouble, so they left, and while standing outside, one of the rival group pulled a gun on them. Frederick’s friend told him earlier he had a gun. It turned out to be braggadocio, and so when his friend took off running, so did Frederick, a step behind. As he dashed through a narrow passageway between buildings, he heard the shots.

“Can I ask why you’re in the wheelchair?” Frederick asked Stone.

“I got shot 15 years ago,” Stone told him. Stone didn’t say anything more about it, and later when I asked for more detail, he was elusive. He said simply that he had gotten shot at a barbecue when he tried to intervene in a fistfight.

“You doing good,” Stone assured him.

“You got shot. You’re here. And you’re alive. What you do when you get out of here?” “You got to stop hanging with the wrong person, thinking you’re a Wyatt Earp,” Frederick said, speaking in the third person as if he were reciting a lesson.

At that point, Frederick’s sister arrived. She explained that she was bringing up her brother. She was 18.

“He just wants to go to parties, parties, parties,” she complained. “But it’s too dangerous.” She started to cry.

“Don’t start that, please,” Frederick pleaded. Mack left a CeaseFire brochure on Frederick’s chest and promised to visit him again in the coming weeks.

LAST MAY, after a 16-year-old boy was killed trying to protect a girl from a gunman on a city bus, Slutkin appeared on a local public-television news program. He suggested CeaseFire was responsible for sharp dips in homicide around the city. Slutkin, some say, gives CeaseFire too much credit. Carl Bell, the psychiatrist, was on the program with Slutkin that night. “I didn’t say anything,” he told me. “I support Slutkin. I’m like, Slutkin, what are you doing? You can’t do that. Maybe politically it’s a good thing, but scientifically it’s so much more complex than that. Come on, Gary.” Last year, CeaseFire lost its $6 million in annual state financing — which meant a reduction from 45 interrupters to 17 — as part of statewide budget cuts. One state senator, who had ordered an audit of CeaseFire (released after the cuts, it found some administrative inefficiencies), maintained there was no evidence that CeaseFire’s work had made a difference. (The cuts caused considerable uproar: The Chicago Tribune ran an editorial urging the restoration of financing, and the State House overwhelmingly voted to double CeaseFire’s financing; the State Senate, though, has yet to address it.)

It can be hard to measure the success — or the failure — of public-health programs, especially violence-prevention efforts. And given Slutkin’s propensity to cite scientific studies, it is surprising that he hasn’t yet published anything about CeaseFire in a peer-reviewed journal. Nonetheless, in a report due out later this month, independent researchers hired by the Justice Department (from which CeaseFire gets some money) conclude that CeaseFire has had an impact. Shootings have declined around the city in recent years. But the study found that in six of the seven neighborhoods examined, CeaseFire’s efforts reduced the number of shootings or attempted shootings by 16 percent to 27 percent more than it had declined in comparable neighborhoods. The report also noted — with approbation — that CeaseFire, unlike most programs, manages by outcomes, which means that it doesn’t measure its success by gauging the amount of activity (like the number of interrupters on the street or the number of interruptions — 1,200 over four years) but rather by whether shootings are going up or down. One wall in Slutkin’s office is taken up by maps and charts his staff has generated on the location and changes in the frequency of shootings throughout the city; the data determine how they assign the interrupters. Wes Skogan, a professor of political science at Northwestern (disclosure: I teach there) and the author of the report, said, “I found the statistical results to be as strong as you could hope for.”

BALTIMORE, NEWARK and Kansas City, Mo., have each replicated components of the CeaseFire model and have received training from the Chicago staff. In Baltimore, the program, which is run by the city, combines the work of interrupters and outreach workers and has been concentrated in one East Baltimore neighborhood. (The program recently expanded to a second community.) Early research out of the Johns Hopkins Bloomberg School of Public Health shows that in the East Baltimore neighborhood there were on average two shootings a month just before the program started. During the first four months that interrupters worked the streets, there had not been a single incident.

“My eyes rolled immediately when I heard what the model was,” says Webster of Johns Hopkins, who is studying the Baltimore project. Webster knew the forces the interrupters were up against and considered it wishful thinking that they could effectively mediate disputes. “But when I looked closer at the data,” Webster continues, “and got to know more about who these people were and what they were doing, I became far less skeptical and more hopeful. We’re going to learn from it. And it will evolve.” George Kelling, a Rutgers professor of criminal justice who is helping to establish an effort in Newark to reduce homicide, helped develop the “broken window” theory of fighting crime: addressing small issues quickly. He says a public-health model will be fully effective only if coupled with other efforts, including more creative policing and efforts to get gang members back to school or to work. But he sees promise in the CeaseFire model. “I had to overcome resistance,” Kelling told me, referring to the introduction of a similar program in Newark. “But I think Slutkin’s on to something.”

Most of the police officials I spoke with, in both Chicago and Baltimore, were grateful for the interrupters. James B. Jackson, now the first deputy superintendent in Chicago, was once the commander of the 11th district, which has one of the highest rates of violent crime in the city. Jackson told me that after his officers investigated an incident, he would ask the police to pull back so the interrupters could mediate. He understood that if the interrupters were associated with the police, it would jeopardize their standing among gang members. “If you look at how segments of the population view the police department, it makes some of our efforts problematic,” Baltimore’s police commissioner, Frederick H. Bealefeld III, told me. “It takes someone who knows these guys to go in and say, ‘Hey, lay off.’ We can’t do that.”

Like many new programs that taste some success, CeaseFire has ambitions that threaten to outgrow its capacity. Slutkin has put much of his effort on taking the project to other cities (there’s interest from Los Angeles, Oakland and Wilmington, Del., among others), and he has consulted with the State Department about assisting in Iraq and in Kenya. (CeaseFire training material has been made available to the provincial reconstruction teams in Iraq.) Meanwhile, their Chicago project is underfinanced, and the interrupters seem stressed from the amount of work they’ve taken on.

THE INTERRUPTERS have certain understandings. At the Wednesday meetings, no one is ever to mention anyone involved in a dispute by name or, for that matter, mention the name of the gang. Instead they refer to “Group A” or “Group B.” They are not investigators for the police. In fact, they go out of their way to avoid knowing too much about a crime. When Highsmith and Prater left me the night of the failed drug deal, they began working their contacts. Highsmith found someone who knew one of the stickup men and who, at Highsmith’s request, negotiated with them. Highsmith’s contact persuaded the robbers to return enough of the money to appease the drug-buyer’s anger. When I met with the intermediary a few weeks after things were resolved, he was still stirred up about the robbery. “I was mad enough to do anything,” he told me, making it clear that he and his friends had been hunting for the stickup guys. “This could’ve been a hell of a lot worse than it was.” To this day, neither Highsmith nor Prater know the identities of anyone except the intermediary — and they want to leave it that way.

The interrupters often operate by instinct. CeaseFire once received a call from the mother of a 15-year-old boy who wanted out of a gang he joined a few weeks earlier. The mother told Hoddenbach and another interrupter, Max Cerda, that the gang members chased her son home every day from school threatening to beat him. They had shot at him twice. Hoddenbach found the clique leaders and tried to talk sense to them. If the boy didn’t want to be in the gang, he told them, he’d be the first one to snitch. The gang members saw the logic behind that but insisted on giving him a beating before releasing him. Hoddenbach then tried another tack: he negotiated to let him leave the gang for $300 — and no thrashing. The family, though, was only able to come up with $50, so Hoddenbach, Cerda and another interrupter came up with the rest. At their next Wednesday meeting, some interrupters were critical of Hoddenbach for paying what they considered extortion money.

“It was kind of a messed-up way, but it was a messed-up way that works,” Hoddenbach said. It was nearly three months before Charles Mack could find time to visit Frederick, the young shooting victim. Frederick had since moved in with his great-grandmother in a different part of town. In his old neighborhood, he told Mack, “there always somebody who knows you. And I had a reputation.” He complained to Mack that he had never been interviewed by the police but then declared he would never identify the person who shot him anyway. “I’m going to leave it alone,” he said. As is so often the case, Frederick couldn’t remember the genesis of the disagreement between his clique and the other. Mack promised to stay in touch, and as we dropped him off, Mack turned to me and said, “I think he’s going to be all right.” It sounded like both a proclamation as well as hopeful aside.

Not long ago, I stopped by to visit with Hoddenbach at the Boys and Girls Club, where he holds down a second job. It was a Friday evening, and he was waiting for an old associate to come by to give him an introduction to a group of Hispanic kids on the far North Side. Apparently, earlier in the week, they bashed in the face of an African-American teenager with a brick. From what Hoddenbach could make out, it was the result of a long-simmering dispute — the equivalent of a dormant virus — and the victim’s uncle was now worried that it would set off more fighting. As we sat and talked, Hoddenbach seemed unusually agitated. His left foot twitched as if it had an electric current running through it. “If these idiots continue,” he told me, “somebody’s going to step up and make a statement.”

Hoddenbach also worried about Torres, who had recently gone back to Texas and found a job working construction. Hoddenbach says he originally hoped Torres would stay in Chicago and establish some roots, but then decided he’d be better off in another town. “I kept him out of one situation, but I can’t keep him out of all of them,” Hoddenbach said. This may well speak to CeaseFire’s limitations. Leaving town is not an option for most. And for those who have walked away from a shooting, like Torres, if there are no jobs, or lousy schools, or decrepit housing, what’s to keep them from drifting back into their former lives? It’s like cholera: you may cure everyone, you may contain the epidemic, but if you don’t clean up the water supply, people will soon get sick again.

Slutkin says that it makes sense to purify the water supply if — and only if — you acknowledge and treat the epidemic at hand. In other words, antipoverty measures will work only if you treat violence. It would seem intuitive that violence is a result of economic deprivation, but the relationship between the two is not static. People who have little expectation for the future live recklessly. On the other side of the coin, a community in which arguments are settled by gunshots is unlikely to experience economic growth and opportunity. In his book “The Bottom Billion,” Paul Collier argues that one of the characteristics of many developing countries that suffer from entrenched poverty is what he calls the conflict trap, the inability to escape a cycle of violence, usually in the guise of civil wars. Could the same be true in our inner cities, where the ubiquity of guns and gunplay pushes businesses and residents out and leaves behind those who can’t leave, the most impoverished?

In this, Slutkin sees a direct parallel to the early history of seemingly incurable infectious diseases. “Chinatown, San Francisco in the 1880s,” Slutkin says. “Three ghosts: malaria, smallpox and leprosy. No one wanted to go there. Everybody blamed the people. Dirty. Bad habits. Something about their race. Not only is everybody afraid to go there, but the people there themselves are afraid at all times because people are dying a lot and nobody really knows what to do about it. And people come up with all kinds of other ideas that are not scientifically grounded — like putting people away, closing the place down, pushing the people out of town. Sound familiar?”

Alex Kotlowitz teaches writing at Northwestern University and is a regular contributor to the magazine. His last article was about illegal immigration.

Copyright 2008 The New York Times Company. Reprinted from the New York Times Magazine of Sunday, May 4, 2008.