NIGHTINGALES OF THE STREETS AND ALLEYS

In the trenches of the Downtown Eastside, health is the first
casualty.

But it is there, in needle-strewn alleyways and bug-infested hotel
rooms -- where the drug-addicted and impoverished are too busy
surviving to care -- that Evanna Brennan and Susan Giles do their work.

Like street-smart Florence Nightingales, the barely five-foot-tall duo
tote brown paper bags filled with binders, medication and first-aid
basics as they pound the pavement in search of their patients -- some
of whom aren't very happy to see them.

"It's difficult work," admitted Brennan. "It's very hard to run around
after people who tell you to f--- off."

The Vancouver Coastal Health nurses, who have both worked in the
Downtown Eastside for 30 years, have seen their clientele change from
retired labourers and alcoholics to people ravaged by drug addiction
and mental illness.

They see up to 17 patients a day. About 90 per cent have HIV/AIDS and
need a daily dose of anti-retroviral drugs, a regime that requires
100-per-cent adherence.

On a sunny day last week, the duo visit Keri, a wheelchair-bound
addict who takes 20 pills a day to treat a melange of illnesses,
including HIV, hepatitis and diabetes.

"These are my mommas. They've been taking care of me for a very long
time," said Keri, climbing on to her bed to allow Brennan to redress a
festering eight-month-old abscess on her left leg.

"This should've been done a long time ago," said Brennan, 63, using
tweezers to peel off dead skin as Giles stands beside her, handing off
antibiotic cream, gauze, bandages and scissors with the precision of a
surgeon's attendant in the operating room. While Keri is a willing
patient now, that wasn't the case when they met her four years ago.

"She was very frightened," recalled Giles, 56. "She had her moments .
. . and can be very explosive. It was a very slow process to get her
trust."

Through trial and error and their decades-long experience, the pair
has developed a new model of care designed for the hard-to-treat
population, called Action Based Care, which has garnered acclaim and
accolades in the health-care field.

The model calls for consistent and reliable care, a non-judgmental
approach and pragmatic methods.

"It means dealing with the situation right there and then, because a
lot of the time, you get one kick at the can," said Brennan.

It means treating people where they find them -- in alleys, on
sidewalks, in hotel rooms, bars or shelters.

It means wrapping her head around harm reduction and giving out clean
needles, said Giles.

It means hustling, cajoling, or even bribing patients with a loonie or
cigarettes to let them fix the hurt. Most of all, it means not giving
up on them.

"Someone will say p--- off, but that's today," said Giles. "Tomorrow
is another day."

Victories are small -- the patient takes their pills, their viral load
goes down, their hair becomes glossy again -- and happy endings are
few and far between.

"Nothing else in their life has changed. They're still using crack,
still dealing, still homeless, but those little pointers are our
successes," said Brennan.

Added Giles: "For one more day, we kept these people alive or helped
them stay out of hospital."

It's a difficult job, but the energetic pair, whose close
collaboration fends off the burn-out that's endemic in the field, has
been able to stick to it because it's their passion -- and because
they know that if they don't provide this care, their patients go without.

Back in Keri's room, Brennan finishes dressing the wound and Giles
checks to make sure Keri has taken her pills.

They pack up, quickly and efficiently, say their goodbyes and promise
to come back the next day.

"Love you, momma," said Keri, hugging them both.

"Love you, too."

Operation Phoenix is a year-long project by The Province, CKNW 980 and
Global B.C. We hope to engage the community in seeking solutions to
the issues facing our most vulnerable citizens in the Downtown Eastside.