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You don't have to go to Rio to witness a public health catastrophe

Picture of Seaton House shelter.

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You don't have to go to Rio to witness contaminated water, food shortages and opportunistic diseases and infections.

We have it all here in Canada. According to research by the Council of Canadians, there were at least 1,838 drinking water advisories in Canada as of January 2015. Of these, 169 were in 126 First Nation communities.

Food shortages, hunger and food insecurity have only worsened in Canada. I was astonished to witness the around the block line-up outside Toronto's Allan Gardens Food Bank on the fourth day of the month. I naively thought those kind of queues would only be on the last half of the month when people on social assistance or living only on their Old Age Security had run out of money.

Even during a heat alert, people had braved the sun and humidity to get what food they could. Many were elderly or frail, leaning on canes, walkers or bundle buggies. In what can only be described as a cruel public policy knife in the back, on that same day, the City of Toronto opened its seven cooling centres for people who are vulnerable, however, citing its own impoverished budget, without staff, water, juice or snacks.

Then there is the burden of ill health that public health nurses, primary care physicians, social workers and street nurses like myself see first hand.

I know that disease will always be with us but I also know that our medical system, our psychiatric system, our pharmaceutical industry will not produce the real changes needed in people's lives and health.

In many cultures there are legends about pestilence, stories of the opportunistic nature of diseases that take advantage of people who are denied the basic social determinants of health. In Russia it was the Pest Maiden who carried disease throughout villages causing peasants to fall dead before her. After a visit from the Pest Maiden, funeral processions clogged the streets. Occasionally a peasant would fight the Pest Maiden off and she would go back into the forest to wait for another day and another opportunity to attack.

Andrew Nikiforuk uses imagery like this in his book The Fourth Horseman. A Short History of Plagues, Famine and other Scourges to describe the cyclical nature of plagues, scourges and emerging viruses (think Zika) that erupt when social disasters like overcrowding, hunger and homelessness devastate a country. He describes the Fourth Horseman as one of the riders of the Apocalypse, who is both pestilence and death, riding into our lives with epidemics, pandemics and death.

If we are to have third world conditions in our cities, be it Rio de Janeiro or Toronto, we will have third world results and we can expect disease outbreaks like tuberculosis, conditions of hunger and homelessness and children who are expected to fail.

I've seen the disease outbreaks first hand. In early 2001, an active case of tuberculosis was identified in Seaton House, Canada's largest men's shelter. In June 2001, Toronto Public Health identified the situation as a micro-epidemic but they waited until November to hold a press conference to announce the outbreak.

Fifteen men developed active TB. Three men died and there was an inquest because no one should die of tuberculosis. This outbreak was a marker, nationally, of the declining health status of our poorest citizens. The "Pest Maiden" -- in this case, the persistent mycobacterium tuberculosis -- took advantage of conditions of overcrowding, malnourishment and immune-compromised health to destroy.

Few lessons seem to have been learned from this tuberculosis micro-epidemic, Toronto's SARS crisis or the pandemic potential of new and emerging influenza viruses. We still contain homeless people in over-crowded sleeping arrangements ranging from homeless shelters to volunteer faith-based "shelters." In Toronto, the 30-year old, volunteer-run Out of the Cold program means people sleep close together on mats on the floor, shelter standards don’t apply and there is a forced nightly movement from basement to basement. We still build shelters dormitory style and we are still not building enough affordable and supportive housing.

So, it is perhaps no surprise that the Pest Maiden paid another visit. A new outbreak, has surfaced in a Toronto homeless shelter taking advantage of the same conditions of persistent poverty, overcrowding and immune-compromised health. Yes, in Seaton House.

It's an outbreak of Group A Streptococcus bacterium (GAS for short) that was declared in March. At this time it is known that 37 people have been infected. Five homeless men suffered the invasive group A strep variety, which can lead to septicemia, flesh-eating disease or meningitis and had to go to hospital. One man is known to have died.

Toronto Public Health has now undertaken a mass screening of close to 200 homeless men and all staff. Yet, they have once again, inexplicably, waited to inform the public and the dozens of agencies that work with people who are homeless. It was only in early August, after City TV and The Toronto Star exposed the outbreak that Toronto Public Health officials spoke publicly.

Toronto Public Health's own website claims that "close contacts (for spread of GAS) include: people living in the same household as the sick person, people sharing sleeping arrangements with the sick person." 

Yup, the definition of a day drop-in or night shelter.

There's a reason AIDS activists chose and relied on the famous slogans: SILENCE=DEATH and ACTION=LIFE. Information is power and in this case the outbreak is yet another reminder of the horrific conditions of homelessness in this country that must be seen and exposed.

The solutions are obvious and should be on the table and acted on: expanded homeless infirmary care, expansion of shelters with a best practice model of one person per room, immediate transitional housing with high level of supports including harm-reduction and home care, and you've heard me say it before: a national housing program.

Photo: Cathy Crowe

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