Kevin “Hippie” Dobinson sits on the church step at the intersection of Dundas and Sherbourne with a black duffel bag at his side. He feels stunned, he says. A few hours before he came here he was kicked out of the detoxification centre at St. Michael’s Hospital for breaking his weeklong sobriety by smoking crack cocaine.
Now, he faces life on Toronto’s streets. Dobinson, 42, has been here before, but says this time it’s only for seven days, until he gets an unemployment cheque for $700. Then, he says, he’ll get an apartment and a job. He just has to survive one week.
Dobinson is in a dangerous place. Homeless people face far greater health risks than the general public — from immediate to chronic disease, violence, and mental illness — and getting treatment is a struggle. Health services for the homeless like Street Health, community health centres and drop-in clinics are set up throughout poverty-stricken Toronto neighbourhoods like Dundas and Sherbourne, in east downtown, desperate to help. But the economic recession has stung their budgets as private donations have dropped by as much as 40 per cent, and governments haven’t stepped in to replace those lost funds.
The new challenge facing those keeping homeless people healthy is to treat more people than ever, with fewer resources.
Toronto’s wounded neighbourhood
All three street-level windows of Street Health’s two-storey brick building are smashed in. Duct tape holds one together, while plywood sits behind the shattered glass of another. For Beric German, a health promoter at Street Health, it’s symptomatic of the neighbourhood he works in and cares for. He says the conditions at Dundas and Sherbourne, an area with one of the highest concentrations of homeless people in the country, are like the third-world refugee camps he used to work in.
“With third-world conditions at play, you get third-world outcomes,” says German.
It’s been this bad for a while. Toronto nurses founded Street Health in 1986 to care and advocate for the city’s homeless population. Street Health’s last major report came out in 2007 with findings that included:
The report made 13 recommendations, but German says few were taken, evident as the same issues still plague the streets today.
For example, one third of those surveyed in 2007 said they became homeless because they couldn’t pay the rent. Little affordable housing has been built since, and since the recession slammed Ontario, Street Health has been inundated with phone calls from people searching for places to stay. The area's shelters are already full.
Worse still, Street Health is bracing for the news that it will likely lose the 30-40 per cent of its budget (a problem shared by other social service organizations in Toronto) that used to come from private donations.
“We face a global recession, and suddenly we face it and we’ve already been wounded,” says German of Street Health and the people it serves. “We can guarantee we will have a lot more homelessness and a lot fewer services to provide to people who are already homeless.”
German says relying on donations to buoy Street Health’s efforts — nursing care, identification replacement, and provision of condoms and safer crack kits — was always a problem.
“If we look across the social service network we’re going to have to demand, like in the past, that governments pick up the slack and fill that gap,” says German.
“We see the government bailing out banks and rich folk, so naturally we say you should bail the normal folk out too.”
Treating the streets
Dr. Gary Bloch looks differently at homeless people than most when he passes them on the street. Bloch has been a doctor for five years, splitting his practice between family medicine and treating Toronto's homeless at drop-in clinics. He specializes in setting up health systems specifically designed for homeless people’s needs.
He knows homeless people have significantly higher rates of chronic diseases like diabetes and heart disease. He knows many haven’t taken their shoes off in days, and often suffer from severe skin infections. He knows mental health issues — from depression to schizophrenia — and addictions — from alcohol to crack cocaine — are almost universal amongst the chronically homeless.
Look closer and there’s more. A recent study by Dr. Stephen Hwang of St. Michael’s Hospital found 53 per cent of homeless people have suffered a traumatic brain injury in their life.
According to Street Health’s report, 41 per cent of those surveyed reported some form of daily pain, and 35 per cent reported severe pain. Compare that with the general public, where only 15 per cent report regular pain, and two per cent have severe pain.
“Generally when you see someone who’s homeless on the street and you don’t know their story I think the first thing people think are A, mental illness and addictions, then B, the obvious physical things presenting themselves … like an infection on their body,” says Bloch.
“What tends to cause the long-term health issues for the homeless are those chronic diseases that aren’t properly treated.”
Bloch says the health care system has always done a poor job of treating the homeless. Hospitals and clinics often have problems communicating with homeless who lack identification, or go by street names. The system has never been good at dealing with the mentally ill. And homeless people can be turned away from health care clinics when their Ontario Health Insurance (OHIP) expires, forcing them to use already crowded emergency rooms.
Street Health’s report found 54 per cent of those surveyed used the emergency department in the previous year, and averaged five visits. Further, 24 per cent required at least one night of hospitalization. Providing these services is a strain on hospital beds and budgets, and many homeless patients will be back.
“If there’s a revolving door of homeless people coming into and out of the system, the question is why are they out that door and then made to come back again?”
Would it be cheaper to spend money on proactive treatment, social housing and long-term care for the homeless than to keep treating them in emergency?
"Oh definitely," says Bloch.
Treatment is a big challenge for doctors like Bloch. What works in family medicine isn’t an option for the homeless. Once homeless patients are discharged, few have suitable places to recover and even changing bandages can become a life-threatening ordeal for homeless patients. Furthermore, nutrition and medication are expensive. In 2007, 62 per cent of homeless people surveyed by Street Health said they couldn’t afford medication, mainly because 63 per cent don’t have a drug benefit card.
“You always dealing with larger social issues … it’s not just disease,” says Bloch. “It’s a different way to practice medicine.”
Back in danger
Kevin Dobinson pulls out a yellow file folder, and flips through some apartment listings he printed while he was at the detox centre. Then he pulls out a police report. It’s from the last time he was on the street, a bad night.
Dobinson was beaten with fists and a baseball bat, stabbed in the hand, and robbed of his cell phone and some money. The thieves left Dobinson badly bleeding from his head. He figures they got enough to get a $40 piece of crack cocaine. He still has scars on his hands.
He’ll stay at Coffee Time on Dundas for a while, but says he’s got no plans for the night. If his cheque comes in and he spends the money on an apartment, he’ll be off the streets by March 23. If he doesn’t, Dobinson will become like the rest of the area’s homeless people — at risk.
He laughs for most of the interview, except for one point.
“I’m laughing on the outside,” he says. “But I don’t want to be out here.”
For additional information, check out:
Original field notes from Kevin Dobinson interview
"Street Health Stories" National Film Board of Canada
"Dying for a Home" Cathy Crowe, street nurse
Ontario Coalition Against Poverty
Get in touch at: jrieti@gmail.com
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