Taking It to the Streets

VICTORIA'S STREET NURSES HELP THE PEOPLE SOCIETY IGNORES

When Victoria's street nurses trek down the city's urine-doused and
blood-speckled back alleys or underneath its musty bridges, they don't
see the prostitutes, druggies or the crazies that many people in society do.

They see people -- individuals like any other -- trying with their own
sense of dignity to survive the best they can.

"Those are not terms we use -- druggies, junkies or hookers -- because
people are people," said Tanya, a street nurse for more than four
years with the Vancouver Island Health Authority. But she hears the
derogatory terms all the time.

"They're just trying to survive, to get by to live another day and
we're trying to make that a little easier for them," she said.

Loaded down with backpacks, soft-sided cases, vaccine coolers and
sometimes rolling suitcases, Victoria's three female street nurses --
referred to here on a first-name only basis for VIHA security reasons
- -- take to the pavement in teams of two, five days a week.

The nurses, two full-time and one part-time, find, test, and treat
people who often won't seek health care until it's too late.

Some live under bridges, in parks and in doorways, while others are
tucked away in shelters, rooming houses, motels or cheap apartments.
If the nurses can't find them on the streets, they find them during
regular rounds to shelters, drop-in centres, recovery houses and
needle exchanges. They can be found sitting in the PEERS mobile home
for sex-trade workers or the YW-YMCA's youth outreach van.

On the spot, the nurses are equipped to: take blood tests for HIV,
hepatitis A, B, and C; swabs and urine tests for sexually transmitted
infections such as gonorrhea or chlamydia; administer vaccines such as
those to prevent pneumonia or tetanus; give out antibiotics for
obvious infections; and take sputum samples for tuberculosis.

A tough-talking Rhonda Campbell, eating a piece of pork with two
knives at the Our Place drop-in centre on Johnson Street, says she's
seen a street nurse treat a man covered in weeping abscesses -- a man
others wouldn't go near. "She just looked after him as if he were her
child," Campbell said.

According to VIHA, the nurses see up to 40 clients a week and
administer about 11,600 different types of services a year. Weldon
Lee, 39, said he often just needs something as small as an Aspirin.

In extreme situations, the street nurses can administer the drug
narcan to reverse or prevent an obvious drug overdose.

"Our street nurses take the service to the client," said Audrey Shaw,
VIHA manager of communicable disease programs.

The mandate of the program is to deliver harm-reduction and prevention
health-care services to marginalized populations that would be at high
risk for infection or transmission of HIV, hepatitis C and other
blood-borne diseases.

Murray Fyfe, VIHA medical health officer, said the street nurses
prevent diseases and serious infections in a "really hard to reach"
population.

"The cost of three street nursing salaries [is nominal] compared to
the hundreds of thousands or millions associated with care in hospital
or the emergency room for problems once they get out of hand," Fyfe
said.

In a lifetime, one person with HIV costs the health-care system about
$250,000 in drug, hospital and physician costs, according to VIHA. A
hepatitis C patient costs about the same, said Fyfe. There are about
50 new HIV cases and up to 600 new hepatitis C cases on Vancouver
Island each year, Fyfe said. VIHA has a plan in place to cut that
number of new infections in half.

However, before street nurses can immunize or test people who partake
in high-risk activities, they must first establish trust and develop
relationships.

"Some people have never known what it's like to be cared about," said
Janice, a VIHA street nurse for the last 10 months.

She's worked in hospital intensive care units and as a public health
nurse, but it was her most recent stint in a primary care clinic in
Vancouver's Downtown Eastside where she developed a calling for
"taking care of people who don't take care of themselves.

"The work we do is not about getting them to that one day that the
person lives in a house, has two children and a job," Janice said.
"It's about giving these people a reason to live ... to say 'we in
society care about you.' "

If she convinces a sickly person to receive medical treatment, treats
a superbug infection before it gets into the bloodstream, gets an
addict a spot in a detox program or simply convinces someone to get a
vaccine or a blood test, "to be honest, that's a big success."

However, Janice admits the sad stories outweigh the happy ones. It's
the individual tales that bother her as much as the totality of all
the deaths.

"It's very rare for a week to go by where one of our people haven't
died," Janice said. "That part is very difficult for me -- the amount
of death in our population, people usually younger than 55."

Rev. Al Tysick of Our Place, which houses and serves the street
population, said about 1.5 street people died on average every week in
2007, up from about one person each week the year previous.

"I bury them, I know," said Tysick. He presides over their services
and keeps records of every death. The average age of the dead is
dropping to the mid-30s from the mid-40s, he said.

The pain for the street nurses, and all front-line workers, said
Tysick, isn't even so much counting deaths, as watching the dying.

"The street nurses have more intimate knowledge of that, what their
records are and what the person is dying of," Tysick said. "It's hard
on them."

Also upsetting, said Janice, are the judgments from the public. Some
critics question why the health authority seems to care more about
drug addicts than law-abiding citizens.

But Janice, with a masters degree in nursing, said no one is more or
less deserving of her health know-how. She would no more judge or turn
away a wound-infested person in need of antibiotics on the street than
she would turn away an obese smoker in need of emergency bypass
surgery in hospital, she said.

"I don't think it's ethical to ignore human suffering," Janice said.
"I don't like to wake up cold so I can't imagine what it's like to
wake up on the streets and being hungry and having to find food and be
worried about just surviving."

But despite the sometimes desperate circumstances of this population
- -- some who have been sexually or physically abused or fell in life
and didn't get back up -- many would rather go without help than trust
a stranger offering it.

Dan MacDonald, 50, living on a disability benefits for mental health
issues, doesn't mince words about the health-care system: "It sucks.
It fails miserably."

MacDonald said he would rather seek out a peer's health advice first
than be looked down upon by the city's doctors and nurses in hospitals
and clinics, whom he says discriminate against the homeless and drug
users.

"Royal Jubilee is the worst," he said. "People are hesitant to go
there. They're too professional, too official," he said, mocking what
he perceives as their snobbery. "They are part of the enemy."

But MacDonald's been poked and prodded, without complaint, by street
nurses administering vaccines or testing for diseases. "The street
nurses out here are pretty good," he admits.

Campbell agrees. She has empathy for the nurses.

"They see more bodily fluids and don't look twice at anyone," she
said. "Others, they don't want to smell us or deal with us or look at
the clothes we can't afford."

The nurses know they're appreciated. They say they receive more
thank-yous on the street than they ever received working in hospitals.

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THE COSTS ADD UP

Every time a street-entrenched person is prevented from having to
visit a hospital emergency room or receive treatment in hospital, the
cost savings, based on what the province bills a foreign visitor, the
only figures available, are:

acute care or maternity ward bed: $3,000 per day

acute care intensive care unit bed: $4,300 per day

ER or treatment room visit: $500 per visit

additional cost of physician for ER visit: $200

ambulatory clinic visit: $500 per day

FINDING A NEW WAY

Sometimes street nurses must be creative in their ways to get people
on the street -- many of whom are extremely vulnerable to infection
- --into clinics for prevention services such as immunization and testing.

On March 12 the street nurses hosted a testing night for infectious
diseases, followed by a vaccination night on March 25.

On April 18 they will host a women's night at AIDS Vancouver Island
where the street nurses will provide testing for sexually transmitted
diseases and adult immunization for a host of diseases, while other
agencies will volunteer massage, hairstyling, makeup, manicure and
other services and activities.

INFECTION BY THE NUMBERS

(From a 2005 survey of 250 people living on the streets in
Victoria)

12.5 per cent, or 30 people, tested positive for
HIV

74 per cent, or 177 people, tested positive for hepatitis
C

12 per cent tested positive for both HIV and hepatitis
C

On Vancouver Island each year there are about 50 new HIV infections,
from a mix of unprotected sex and injection drug use, and up to 600
new hepatitis C infections, mainly from injection drug use.

Source: I-Track survey, a national program conducted with VIHA