A Knapsack Full Of Dreams
Excerpt from A Knapsack Full Of Dreams, Chapter 9 -
Street Health’s roots went deep in the community around Sherbourne and Dundas. Homeless people themselves had come together to say they needed health care. They called themselves “the balcony crew,” as they had concocted their dream of better health care for homeless people on someone’s balcony. They were adamant they were not receiving good, if any, health care in the existing system. They identified that they were not only under-serviced, but when they accessed care, they frequently experienced discrimination. They knew they deserved better and fought for it. They approached Dilin, a nurse who was volunteering in the community. Fortunately, she was a fearless, skilled, and feisty innovator who thought out of the box when it came to health care.
The organization’s entire philosophy sprang from the principles of primary health care traditionally employed in developing countries, in sharp contrast to the medically dominant model of health care routinely provided in Canada. So, the care Street Health provided was essential, practical, relevant, accessible, street level, and looked upstream. The nursing role was expansive and pioneering for Canada. We operated regular nursing clinics and did outreach or hung out in various loca- tions where homeless people spent their time and responded to their needs.This included what is traditionally seen as hands-on nursing care (wound dressings, foot care), but it also focused on health promotion in a useful way: developing identification clinics so people could get their birth certificate or health card, obtaining funding for AIDS prevention, doing action research on homeless issues to influence public policy.
Advocacy and grassroots organizing, for example, to fight for better shelter conditions and affordable housing, were part of the job description. Speaking out at public forums, to the media, and at City Hall was expected, indeed, demanded by Dilin, who became the organization’s executive director. It was a huge learning curve, and I remember feeling a mixture of excitement and terror.
On the whole, the nurses were loved and respected by our homeless patients. I remember the sunny day that I was with my nurse co-workers walking at the corner of Sherbourne and Dundas when a homeless man across the street yelled out in a jovial manner,“Hey, Street Nurse!”That’s how the term was first coined.The title was in sharp contrast to the many titles that could describe a nurse in the community and which so often confuse the public. Street Nurse was clear, and it was definitely a compliment, as people who were homeless often referred with affection to their “street family” of friends. The term was also most definitely a political term, suggesting that homelessness had gotten so bad in this rich country that a nursing specialty has arisen called Street Nursing. I still use the term today for that reason and capitalize it whenever I can get away with it.
I have always had a strong reaction to what I see as a Street Nurse, and I can only attribute that to a simple and protected childhood. Homelessness was not on my radar at all with the exception of seeing movie images of hobos or dressing up as one at Halloween.Unfortunately, both high school and nursing school were also void of any curriculum content on current politics, economics, or social conditions.
I was stunned by what I saw as a young Street Nurse in Toronto’s down- town east end. I was also naïve, and there was a lot I didn’t understand. I had many questions.
Q: Why were there so many people with Maritime accents?
A: Just like the context in Goin’ Down the Road, during times of recession all roads lead to the big city. People migrate looking for opportunities or services not available in their small town.
Q: Why did the man I see in the clinic wearing a shirt with the name “Hank” written above the pocket say his name was something else?
A: Because he got the “Hank” shirt in the clothing donation room. Q: Why were women coming to our clinics just to ask for tampons? A: Because you had to line up for them at the shelter.
I met people who did not fit the stereotype that I had in mind for who would be homeless.They were not hobos, travelling town-to-town by jumping on trains. I met blue-collar workers, seniors, war veterans (World War II, Korea, Vietnam), professionals (including nurses and teachers) who had suffered an economic or personal crisis, and people with developmental disabilities. I was equally shocked when I heard about and then saw with my own eyes their twenty-four-hour living conditions; crowded overnight shelters, sparse daytime drop-in centres that often sheltered 400 people a day with only two toilets, church basement shelters run by volunteers with only mats for people to sleep on. I was dismayed at the resignation I saw in most homeless people’s demeanour, seemingly accepting this was their “norm” as they told me they had no hope to get into affordable housing anytime soon. This bleak picture was, in fact, an accurate prognosis of their housing options. I repeatedly encountered men and women with big personalities, lots of talent, and coping skills. More on them later.
The nursing atmosphere was mostly fun, although the work was hard. It took me a long time to get over the shock of the obvious; that home- less people had the same health problems that you or I might, and a good many more. Their foremost health challenge being they had no bed to snuggle into or stay in, no chicken soup, no medicine cupboard or first-aid supplies, and for the most part, no caregivers if they were sick. Furthermore, after a significant health event such as an operation, heart attack, or pneumonia, people were more often than not discharged back to the street before they could fully heal.There used to be the rare exception when we could convince Sister June or one of the nuns at St. Michael’s Hospital to keep a patient a few days longer; it was considered a social but necessary medical admission.
I think the day that I heard George, a homeless client, enthusiastically remark to a videographer (people were always coming in to film) that the Street Health nurses “Sure know how to do their nursing!” was the day I knew I had made the right decision to work there.
An excerpt from
A Knapsack Full Of Dreams - Memoirs of a Street Nurse
printed with permission from Cathy Crowe