The Poor Will Always Be With Us? Not If nurses have a role!
Keynote to Family Practice Nurses Conference
Toronto June 16, 2006
Nurses were singled out by the Ontario Government’s television and newspaper
advertisements in the weeks preceding 2006’s Nursing Week.
In fact the government and the sponsoring nursing organizations seemed to
celebrate the notion of street nursing, almost suggesting that homelessness will
always be with us and this specialized form of nursing is here to stay.
some of the copy from the newspaper ad which depicts a nurse bandaging the leg
of an apparently homeless man on the street:
nurse Diane, RN, is but one example of the varied and vital roles that nurses
are playing in
nurses are highly qualified, doing far more than you might think.
Nurses – a key part of the team strengthening health care in
you will see, I do celebrate nursing and the power of individual nurses to make
real and lasting differences, but I can not celebrate the idea of the Street
Nurse. Many of us, who call
ourselves Street Nurses, use that term to describe the obscenity of needing that
kind of nursing specialty in such a rich country – we are nursing people who
are homeless. It is not dissimilar
to nursing in a refugee camp, which is usually set up as a response to a natural
disaster or war. So, let’s
not call homeless people couch-surfers, or ‘chronics’, street people,
hard-core, or hard-to-house. People
who have been de-housed remain so much longer today than previously, and it is
not by choice or through their personal fault.
1998, when conditions reached a breaking point, a group of us came together and
formed the Toronto Disaster Relief Committee and declared homelessness a
national disaster. The State of Emergency Declaration was taken to the
United Nations in
Committee is gravely concerned that such a wealthy country as
three weeks ago, the United Nations Committee on Economic Social and Cultural
Rights released their latest report on
The Committee reiterates its recommendation that the federal, provincial and
territorial governments address homelessness and inadequate housing as a
national emergency by reinstating or increasing, where necessary, social housing
programmes for those in need, improving and properly enforcing
anti-discrimination legislation in the field of housing, increasing shelter
allowances and social assistance rates to realistic levels, and providing
adequate support services for persons with disabilities. The Committee urges the
State party to implement a national strategy for the reduction of homelessness
that includes measurable goals and timetables, consultation and collaboration
with affected communities, complaints procedures, and transparent accountability
mechanisms, in keeping with Covenant standards.
it is critical that you as nurses know where our political ‘leaders’ stand
on this question.
Liberal government, elected in 1993, was equally bad on their housing policy
during the 1990s. Further cuts were
made to housing funding, most national housing programs were downloaded to the
provinces and territories in 1996, and the role of Canada Mortgage and Housing
Corporation was further eroded in 1998.
is now represented as part of the status quo.
There are government ads about street nursing.
We have federal and provincial homelessness funds to help agencies deal
with homelessness. We even had a
Minister Responsible for Homelessness. Yet, we do not have a national
is widely accepted that housing is a social determinant of health.
Or, another cleaner, simpler way to say it – you can’t get healthy or
stay healthy without a home.
want to present to you a summary of where we’re at today:
conditions in most of the country by and large remain totally inadequate for
human living. In some cases shelters
continue to break the United Nations Standard for Refugee Camps, for example by
not providing 3.5 square metres per person for sleeping space and a separation
between beds of .75 metres.
living remains as a forced choice for many, and it remains fraught with dangers
related to climate, violence and quality of space.
higher mortality rate is now noticed in many communities –
remains a threat following a series of outbreaks in shelters that were
responsible for homeless deaths. Poverty,
malnutrition, long-term congregate living, lack of proper ventilation, and lack
of prevention or screening measures led to those deaths.
feel we have learned little from SARS when we continue to keep people crowded in
shelters – and a pandemic will pose a serious threat for homeless people,
seniors, people living in poverty – look at the effect a simple power blackout
a few years ago had on those communities.
– are the new scourge causing people both physical and mental anguish.
and children remain the fastest growing group of people who are becoming
homeless. By and large, every
community I have visited over the last 3 years has not had sufficient emergency
shelter spaces for families with children. In
many cases, smaller cities and towns do not even have a designated family and
children’s shelter and rely on contracts with motels.
is now reported as the Number One concern of Street Nurses and nurses working in
the inner city health centres. Hunger is exacerbated by the harsh provincial
climate of welfare cuts, more onerous criteria for obtaining disability
assistance and recent restrictions to the Special Diet Allowance, as well as
increasing hydro rates and a lack of affordable rents.
discrimination and prejudice are growing. We
seem to be following the
have witnessed an unprecedented growth in all of the above in recent years and I
predict that these things will only get worse.
The first and foremost solution to this crisis is not even in the policy
mix at the federal or provincial levels. Housing.
an expression “the poor will always be with us” and that line of thought has
often led to a charity response to problems, or an institutionalized response
like food banks, shelters, Out of the Cold programmes.
number of years ago I became inspired by the words and work of paediatrician Dr.
Helen Caldicott, who campaigned against the nuclear arms race and formed
Physicians for Social Responsibility. She
is profiled in the fabulous movie ‘If You Love This Planet’.
In fact, her energy inspired me to form Nurses for Social Responsibility.
I discovered that nurses, speaking out on social justice issues were
warmly embraced by the public far and wide.
I was later inspired by Norman Bethune, by Philip Berger, by Michael
Rachlis…..all doctors. They
challenged the ideas that war and military build-up was inevitable, that we
should be an enclave to ourselves, that discrimination against people with AIDS
for example was acceptable, that privatized health care was a given.
inspired by these physicians, I later discovered that many of the social reforms
I take for granted originated with nurses and I had a lot to learn from their
want to show you how some nurses from our past (and one whose practice is
history in the making) decided to challenge the assumption that “the poor will
always be with us”. Sometimes
it’s helpful to look at our past to feel inspired for our future.
Cohen, my nursing student, assisted with much of this historical research.
the first lay nurse in North
founded the Hôtel-Dieu de Montréal – it was built in 1645.
between Rue St-Paul and Rue St-Sulpice, the modest wood building measured 60
feet long by 24 feet wide, with six beds for men and two beds for women.
It was surrounded by a stockade and a trench.
This hospital served
was to be the hospital's administrator until her death. In the event of her
death, a community of nurses was to be established to serve the poor without
charge. In 1659, several years before her death, three nurses from La Flèche
began health care for the poor in
1737, Marguerite d’Youville and three companions shocked
the same time they
erased the Hospital's debts by sewing everything from lingerie to tents, selling
building materials, and managing a cartage business.
The order she established was the Grey Nuns; they continue her work to
1747 she was allowed to take over the administration of the Hospital
General--including its large debt. D’Youville
and her companions restored the buildings,
and provided a combination veteran's hospital, nursing home, orphanage, mental
asylum, VD clinic, reformatory for prostitutes, and overflow ward in case of
as a teacher, ‘nurse’ and social reformer.
is perhaps best known for her role in the American Civil War where she convinced
skeptical military officials that women could nurse the wounded.
She was often at odds with doctors over their drinking habits and neglect
age 19 she ran a free evening school for poor children – one of the first in
spent more than 20 years working for improved treatment of people suffering
prison reformer – after visiting a jail where she observed “prostitutes,
drunks, criminals, retarded individuals and the mentally ill ….all together in
unheated, unfurnished and foul-smelling quarters...” She took the matter to
the courts and after a series of battles won major reforms.
Muir Edwards (1849-1931)
1893, Henrietta Muir Edwards, together with Lady Aberdeen, founded the National
Council of Women, and for nearly 35 years served as chair for Laws Governing
Women and Children.
1897, again with Lady Aberdeen, she founded the Victorian Order of Nurses.
Edwards championed many of the accomplishments of different feminist
organizations and was an avid supporter of equal grounds for divorce, reform of
the prison system, and allowances for women.
Edwards’ major contribution to the review of provincial and federal laws
relating to women earned her a reputation for knowing more about laws affecting
women than even the chief justice of
1927, she joined forces with Emily
McKinney and Irene
Parlby to sign a petition requesting that the Supreme Court of Canada
reinterpret the law concerning the term "person" in the British North
America Act. It was not until
Lillian Wald (1867-1940)
Lillian D. Wald was a practical idealist who
worked to create a more just society. Her goal was to ensure that women and
children, immigrants and the poor and members of all ethnic and religious groups
Shocked by conditions she saw in overcrowded
With nurse and friend Mary Brewster she founded
the Henry Street Settlement and the Visiting Nurse Service.
Although Wald achieved international
recognition, her efforts were always grounded in the belief that the world was
simply an expanded version of the culturally diverse neighbourhood.
Wald actively supported efforts to improve race
relations and made sure that her settlement houses not only provided services,
but also employment, for members of all racial and ethnic groups.
She insisted that
became an influential leader in city, state, and national politics, championing
the causes of public health nursing, housing reform, suffrage, world peace, and
the rights of women, children, immigrants and working people.
Her tireless efforts to link the health of children with the health of
nations made her a model of achievement, caring, and integrity throughout her
Isabel Hampton Robb (1860
A Canadian nurse who moved to the
Johns Hopkins nursing training school opened in
1889 under Robb.
Robb, a national leader and visionary in the
nursing profession, believed that nursing extended beyond caring for the sick
and included reforming the conditions that caused the illness.
Palmer (1908 - ?)
was actually a social worker.
provision of birth control information and contraceptive materials in
led the movement for a women’s right to choose in
Ross was hired to be the head nurse of the Mount Carmel Clinic in 1948, building
on and expanding the clinic's services to a changing community.
A NFB movie ‘Rebel with a Cause’ profiles her work.
was challenged and inspired by some of the people she saw in the neighbourhood -
those who lacked food or a steady income, people who lacked parenting skills,
those living in situations of domestic abuse or neglect. Not only did she
realize that the health needs of the children were aggravated by the
socioeconomic needs of the families, she was able to earn the confidence and
trust of the poverty-stricken parents.
1969, the federal government finally passed a bill which legalized contraception
and reformed the law on abortion, making therapeutic abortions legal in order to
preserve a women's health, with each case reliant on the recommendation of a
hospital review committee. As a response to the new law, Mount Carmel Clinic
developed the Pregnancy Counselling Service. This service was provided to the
many women who began requesting abortions, ensuring that each would receive
accurate information concerning all her options, along with contraceptive
information and follow-up, regardless of the patient's decision to continue with
or terminate the pregnancy.
ensured that clinic services were all encompassing, including a woman’s right
not finish nursing school (Ottawa Civic) – she remained frustrated with the
hierarchy, the disparity in resources between the private patients and public
– she could not conform to regulations she felt were unjust.
a stint in
was most famous for her prisoner
justice work and whistle blowing.
Ann Walpole (1933 -2006)
a nursing student in St. Michael’s Hospital Emergency – she wondered where
did the homeless women come from? Where did they go when they left Emerg?
a drop-in for women in 1965 in an unused beverage room of an old hotel.
at inquests, frequent speaker with the media calling for proper conditions for
Ann founded both Street Haven and Joubert House.
Oleson (1978- )
28 year-old nurse and activist who has been tireless in her fight to protect the
health and human rights of some of the most vulnerable residents of
in helping to establish a safe injection site in 2003.
part of her work at the Safe Injection Site, Megan supervised injections, taught
drug users about safe injection practices, and referred individuals to available
services. Megan also helped advance nursing practice within the site by
developing a protocol for accommodating individuals who require assistance with
injections. She would often spend
over an hour with individuals requiring assistance with injections, teaching
them how to self-inject safely.
has spearheaded various direct action measures that address an array of issues
ranging from lack of access to appropriate harm reduction measures and housing
to poverty and police brutality.
motto of the Mack School of Nursing in
it has been nurses who, after witnessing injustices spoke out.
They responded with words, with research, with action, with the
development of programs, with legal action and with new policy proposals.
this brings us to the notion of the Street Nurse.
This unusual specialty originated, in part because of the lack of
responsiveness of mainstream health care agencies and other institutions to poor
people’s needs. However,
upon closer inspection our homelessness crisis originated with the destruction
of our national housing programme.
main point is this – we once fought for a national health care program in this
country. We know that story very
well – many of you saw the Tommy Douglas story on television and many of you
have been active in recent years in campaigns to save Medicare as members of
RNAO or ONA.
is forgotten, is that we once fought for a national housing program – vets
after World War II were part of that fight, joined by women’s groups and
church groups, among others. They
won a national housing programme that led to hundreds of thousands of housing
units built all across this country.
housing programme was taken from us in 1993 and we have to get it back.
of you can obviously care for people who are homeless in your nursing practice
but my bigger hope is that you will engage in a more intentional way for the
real solution – housing.
idea that it is wrong to discriminate against someone based on the colour of
their skin is now common sense, but it was a fight that took well over 300 years
and that fight continues. The idea
that it is wrong to discriminate against women is also common sense, but that
fight took well over 100 years and that fight continues.
Nurses were part of all of these fights.
The idea that it is wrong to discriminate against someone based on their
poverty or their circumstance is no less an equally common sense idea.
Nurses must play a role in this fight today.
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