Newsletter No. 1, July 2004
Iíve been a street nurse in Toronto for 15 years. In the spring of 2004 I received the Atkinson Economic Justice Award which permits me to pursue, for up to three years, my passions for nursing and working on homelessness and housing issues. In this newsletter I hope to both report on my activities and create a link to a broader group of individuals who care about these social issues. Further information about subscribing to the newsletter is found below.
Many people thought that the Severe Acute Respiratory Syndrome (SARS) outbreak in Toronto in 2003 would create enough concern about communicable and infectious diseases that major steps would be taken to lessen their incidence. While procedures were put in place in hospitals and airports for SARS, itís frustrating to see that more basic and long term steps have not been taken to protect vulnerable people, such as reducing crowding in shelters and providing housing. I thought SARS would be a wake-up call, but that hasnít been the case.
My concern here is with another communicable disease, tuberculosis. Tuberculosis of the lung is spread when an infected person coughs, and its spread is considerably enhanced when people are crowded together. After many years of this disease being relatively rare in the western world, TB is on the rise in Toronto and in other cities.
For these reasons I spent several months in the early part of this year as a member of the Tuberculosis Action Group (TBAG), a coalition of health and social service agencies, which was involved in the inquest into the death of Joseph Teigesser. Mr. Teigesser was one of three homeless Toronto men who had contracted tuberculosis during a TB outbreak in 2001 and died. A total of 15 men all developed the same strain of active TB during this outbreak.
Mr. Teigesser was of Eastern European origin, was 64, and had been homeless for at least a decade. He stayed for various periods of time in Seaton House and the Salvation Army hostel on Sherbourne Street. When very ill, he was taken to St. Michaelís Hospital where he was diagnosed with two different strains of TB. The disease had spread from his lungs to his throat, and his last few weeks were undoubtedly very painful. He was a quiet man, who kept to himself. By the time he went to hospital he had wasted away. He clearly suffered a very horrible death.
TBAG had standing at the coronerís inquest, which meant that our lawyers, Peter Rosenthal and Jackie Esmonde, had the right to play a formal role in proceedings. The City of Toronto also had standing, as did a number of physicians, the Salvation Army and a coalition of aboriginal agencies.
The hearing was very frustrating for us. We wanted to take the coronerís jury (it consisted of five individuals) on a walking tour, a "homeless 101 tour" to familiarize them with the places someone like Mr. Teigesser would spend his days and nights. We wanted to present evidence about the severe crowding in shelters, the poor air quality and the constant movement of homeless people to find food and shelter, in order to show how easy it is for communicable diseases to be passed on. We wanted to present evidence about how providing permanent housing would begin to address the causes of TB and reduce the opportunity for any communicable disease to spread . We hoped to call Professor David Hulchanski (of the School of Social Work, University of Toronto) to provide expert testimony on housing issues and the rent supplement solution. We also wanted to call Amber Kellen from the John Howard Society since a number of the 15 men who were ill in 2001 had spent time in correctional facilities Ė they are at least as crowded as shelters.
Sadly, we were prevented from presenting this kind of evidence to the jury. The coroner, with advice from his crown counsel, would not agree to allow any of this testimony. Thus, while days and days were spent sifting through the treatment given Mr. Teigesser at St. Mikeís, and dissecting his medical charts, no time was spent on how overcrowding, poor air quality, and shared sleeping quarters lead to the spread of the disease to begin with.
After months of struggle, we were able to come to a common agreement with the other parties on a list of 26 recommendations Ė at the top of which was the need for permanent affordable housing. This was submitted to the jury. But on the last day of the inquest the crown attorney argued that the jury, to do a credible job, should only propose recommendations about matters on which they heard substantial evidence. Our lawyer, Peter Rosenthal, argued strongly against that approach Ė after all, we had not been permitted to present evidence on these key issues.
The jury spent months at this inquest and seemed interested and sympathetic. Coroner's jury recommendations only require a majority vote of the jury (not like a criminal trial where the jury must be unanimous), so we remained hopeful. But the juryís final verdict and their 13 recommendations dealt mainly with public health and treatment, not with prevention. It proposed more funding for public health, a centralized TB program, and measures to improve ventilation standards. These are ideas we donít quarrel with, particularly since Torontoís public health department is overloaded and is unable to implement the provincially recommended TB testing of high risk groups such as the homeless on a regular basis (that testing is however done in Ottawa). There were no recommendations about the need for permanent affordable housing, reduced crowding or increasing social assistance rates. Not dealing with issues of prevention means that not much will be done to prevent TB spreading.
During the five months from the beginning of the inquest in December 2003 and its end Ė it was delayed when the crown attorney was appointed a judge and a new crown attorney had to be found - tragically three new cases of TB were found.
We believe a Coronerís inquest is an appropriate and effective forum to raise issues of homelessness and to demonstrate how the lack of adequate affordable housing has severe negative health outcomes. Coroners' juries should be presented with evidence about how social conditions exacerbate and cause illness and death. Since we were prevented from presenting such evidence in the case of Mr. Teigesser, we will be asking for a judicial review for a continuation of the inquest.
Itís sometimes discouraging to find so little public interest in the causes of homelessness, the poor health of the homeless, and how these problems can be addressed effectively. Too often the political process shows little concern about these matters. But I believe it is important to press these issues with health care professionals, since in the past 150 years this group has been so effective in bringing about public health policies that have been beneficial to society.
As well, all the indicators point to more instances of communicable and infectious diseases occurring that will severely affect society: not just TB, but SARS, the Norwalk virus, and others of which we are not yet aware. These diseases are devastating, especially to people who are homeless with compromised immune systems, who must rely on crowded shelters and daytime drop-in centres. One shudders at imagining what could happen if a disease like SARS finds its way into the homeless community. Thatís why we need to adopt strategies to avert this disaster before it occurs. For more information on tuberculosis please see TB or not TB. There is no Question at www.tdrc.net
A number of us have been working with homeless people for many years. Weíve gotten to know many of the homeless well, and to know their friendships within the community. When those people die, we know them and those who mourn them.
Weíre noticing two worrisome trends: the death rate in the homeless community is increasing, and many of those who die are in their 30s and 40ís.
In December 2003 Leo Cyrenne died. He was a homeless man in his 50s who spent many days in the vicinity of the Church of the Holy Trinity (by Eaton Centre) and slept sometimes outside St. Michaelís Hospital. His friend James Kagoshima, who mostly lived in Seaton House, was so upset at Leoís death that he organized a well-attended funeral at Holy Trinity.
Two months later, in February, James died. On the night James entered hospital he was to have joined me as I took newly elected Mayor David Miller on a tour of homeless shelters. Ryck, his street brother, spoke at James' funeral and then two months later in April, Ryck died. Itís as though everywhere we look itís happening. Leo, James and Ryck frequently attended TDRC events, including press conferences and rallies and often spoke to the media, calling for better conditions and housing. Sadly, they will not benefit from their work.
The Toronto Disaster Relief Committee holds a monthly service at the Church of the Holy Trinity (the second Tuesday of every month, at 12 noon) where homeless people who have died are remembered, and their names are read out and added to the memorial. In December we recorded seven deaths, in January four; and last month in May ten more names were added.
Many of these deaths are a result of chronic illness, and the deaths occur in shelters, on the street and in hospital. The City of Ottawa has established a hospice for the homeless so that palliative care can be offered in a reasonable manner. We forget about the injustices of homelessness: in Toronto, some individuals actually receive chemotherapy in shelters and out-of-the-cold programs Ė because they donít have a place called home.
Deaths of the homeless receive attention when they are spectacular Ė freezing to death, or being caught in a fire in a shack Ė but the majority of homeless deaths donít attract much attention. These deaths are just "normal" and even though some reporters are sympathetic their editors arenít interested in another story of a homeless death.
One recent death sent shivers through those working with the homeless. Joey Chakasim, a native man in his 40ís, was found dead one morning in January on his mat on a church floor in an Out-of-the-Cold program. This death stunned the homeless community and the volunteers at the Church. It was a reminder that no place was safe if you were homeless, no matter how caring.
When Drina Joubert, a homeless woman, froze to death in a truck in 1987, the coronerís jury recommended that the coroner begin tracking the deaths of the homeless. In the 1996 "freezing deaths" inquest the coroner admitted this was not being done. Since then, the coroner is tracking deaths, but only those that qualify as a "coroner's case". Dying of a chronic or an infectious disease is often not considered a coroner's case, so the coronerís record isnít full or complete. As well, for what the coroner's office claims are privacy reasons, those who die are often not publicly identified, but labeled ďJohn or Jane Doe.Ē Many in the homeless community are angry at these practices.
I have been very fortunate to receive this award from the Atkinson Foundation. It provides me with a stipend for a three year period, significant enough to provide me with an income and a budget to assist my work. There are virtually no restrictions on what I can do during this three year period. Two others who have also been given the award are Armine Yalmizan, a social policy researcher, and Roy Romanow, who completed the report on medicare for the Federal government in 2002.
I have terminated my position with the Queen West Community Health Centre. I feel especially fortunate to have established a relationship with the Sherbourne Health Centre which has a demonstrated and positive history of homeless health care and "upstream" work. The Centre has kindly agreed to provide office space and logistical support. My phone there is 416-324-5069, and email email@example.com (I can also be reached at the Toronto Disaster Relief Committee, 416-599-8372.) You can always find updates and great reports on the TDRC's web site www.tdrc.net
I hope to spend the next three years fighting for a national housing program. This will involve my continuing efforts on local issues here in Toronto with the Toronto Disaster Relief Committee, as well as visits to other Canadian communities to both learn about their issues and to support their fight for a national housing program.
For personal support I have organized a group of advisors with whom I meet regularly, and I hope this newsletter will both force me to write down and analyze whatís occurring on a week-by-week basis, and to make good connections to the larger world.
I plan to publish this newsletter regularly. If you receive this newsletter directly, then your address is already on our mailing list. Otherwise, to subscribe or unsubscribe, send a note to firstname.lastname@example.org. For more information on my work including this and other editions of my newsletter please visit my web page at www.tdrc.net/cathycrowe.htm .
There is no charge for this newsletter. Please forward it to your friends and others who you think may be interested in it. You can contact me at email@example.com or c/o the Sherbourne Health Centre, 365 Bloor Street East, Suite 301, Toronto, ON, M4W 3L4.
Photo Credit: Michelle Vella Photography
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