By Paul Gallant, Toronto Star, May 7, 2015
Nurses at shelters and on the street know that homelessness and poor health are intertwined.
A client of the Regent Park Community Health Centre had been homeless for years, going to emergency rooms almost daily for a variety of health problems. Nurses at the health centre, working together with other community agencies, decided on an intervention to help the man get back on his feet – starting by diagnosing conditions that hadn’t been addressed in the emergency room, helping him taking his medication regularly and, at long last, finding him supported housing.
“It’s transformed his life,” says Laura Hanson, a nurse with the Regent Park team. Though their clients include downtown residents of all income levels, many are struggling to get by. “Acute care is one aspect of health, but there are so many other factors that go into making you well or not well. Health is not something that’s just biological. Poverty is one of the biggest indicators of health, which really influenced the kind of work I decided to do.
” Research shows that, unsurprisingly, people who can’t afford housing and nutritious food are far more likely to be unhealthy. The grind of being poor, often combined with mental health issues, can make it hard for some people to even access health care services. Many nurses who take prevention to heart have made addressing poverty and homelessness central to their work. Eight months after the provincial government announced it would redouble efforts to achieve its poverty reduction targets, Ontario nurses remain on the front lines of that battle.
“I’m very passionate about health equity,” says Jessica Hales, who works with Toronto Street Health, a four-nurse team dedicated to improving the health and wellbeing of homeless and underhoused people in downtown Toronto. With more than 5,000 clients, some of whom visit regularly and others whose visits are more erratic, Street Health has adopted a model of health care that treats people more holistically. “The longer I’m in health care, the more I realize that being healthy really extends beyond what medical services can offer,” she says.
Hales started her nursing career in a hospital, where she realized that the increased reliance on technology was extending the lives of some people, but not necessarily helping those most in need. She started volunteering at Street Health and five years ago accepted a position with the team. In April she became Street Health’s first nurse practitioner, a designation which, among other things, allows her to prescribe medication and order diagnostic tests. Now she can offer more intensive care to people who have trouble accessing mainstream health-care services.
Hales’s commitment to getting at the root causes of poor health extends to advocacy outside work hours. Last November she and four other community workers were charged with mischief for staging a sit-in at a city housing office after the city failed to fund a proposal for a 24-hour drop-in shelter for homeless women. (Women in crisis often can’t make the curfews of traditional shelters.) Hales says the charges were dropped in March and the city has agreed to provide funding for two 24-hour dropin shelters, the first opening in mid-May. “Hopefully it will reduce the rates of sexual and physical violence and will give women a safe place to go if they’re trying to leave unhealthy relationships,” she says.
Not all nurses fighting poverty work so close to the street. As a professor of nursing and psychiatry at Western University, assistant director at the Lawson Health Research Institute and a member on Ontario’s new advisory panel on homelessness, Dr. Cheryl Forchuk comes at poverty and homelessness from an academic angle. But she takes a seriously grassroots approach, improving health-care systems by talking directly to the people who most need help.
The obstacles are not always what the experts think. In one of her studies, Forchuk interviewed homeless veterans. The American literature suggested that post-traumatic stress was a major factor in veteran homelessness, but the Canadian veterans had mostly not served overseas and considered their military experience to be a highlight of their lives. Their military service had not given them post-traumatic stress, but harddrinking habits emerged as serious drinking problems later in life. The pilot project that came out of the study employed a peer-supported approach that echoed the structure of military life – something that would not likely have worked with post-traumatic stress patients. Of the 56 men who took part in the program, all but one have remained housed.
For Forchuk, listening to patients is at the core of nursing. So is collaborating with other professionals whose decisions about social assistance and housing can be the major factor in how healthy a person is.
“If we’re all in our own corner trying to come up with solutions in a fragmented way, it’s simply not going to work,” Forchuk says. “Addressing homelessness is not at all stepping away from nursing. It’s looking at nursing in a different environment.”
Our Comment
Would that more economists and politicians shared the insight, commitment and the “passion for equity” of nightingales like those cited in these articles highlighting Nursing Week!
During the Occupy movement in Toronto, I had an opportunity to get to know such a nightingale and that experience made me realize how indebted we all are to an army of angels, out there dealing with the collateral damage of our failing system. But, as Joyce Rankin makes clear, that’s not enough – it “lets [politicians] off the hook.” And it’s just a finger in the dyke!
Making connections like that between poverty and health, between healthy individuals and healthy communities, recognizing the need to go beyond symptoms and deal with the root cause, accepting responsibility for a holistic approach that addresses the systemic nature of problems – finding it morally repugnant that, “in a country as wealthy as ours, someone can freeze to death in a bus shelter,” accepting the need to fight the cause as well as the affliction…. If only we could elect to public office politicians who brought this level of thinking and caring to the task! If only we could educate economists to rethink their concept of “externalities”!
Poverty is not an economic problem. It’s a political crime!
When we want to end poverty the way we wanted to end smallpox, it will happen. – Dr. John Hotson
Élan
