PICTURE a refugee camp:
A quarter of a million people. Ten thousand are children. There is no more room. Some people will do anything to avoid entering. Tens of thousands stay with family or friends. Another two thousand sleep rough âe” in cars, on grates, in parks, by riverbeds, under bridges, in the woods. Some are squatting in empty buildings and old factories, or building shantytowns and tent cities. They sometimes remain there for years, even during the cold, harsh Canadian winter.
Back in the camp, conditions are substandard. Common areas are filled with mats to accommodate extra people in the winter months. In some sections there are only two toilets for more than a hundred people. Staffing is inadequate and violence is rampant. Entire sections are staffed only by volunteers. Recently, one of them discovered a man dead in his sleeping bag in the morning.
Diseases and outbreaks consistent with overcrowding are the norm. The tuberculosis infection rate is four times higher than in the population not hit by the disaster. Other infections âe” diarrhea, colds, and flus âe” are rampant. During a recent outbreak of Norwalk virus, a police lockdown in part of the camp was necessary to confine healthy people who panicked and wanted out. Meanwhile, medics provided intravenous rehydration to the sick on site rather than transporting them to hospital. Bedbugs, scabies, and lice are a growing public health concern. There is even a shower room set up specifically for delousing. But for the regular shower room thereâe(TM)s a waiting list.
Some women are pregnant. Most of the children are very young. The long-term impact on them will be profound. There are people with cancer, with multiple sclerosis, with Parkinsonâe(TM)s, and diabetes. The death rate is also four times higher in the camp than outside, and each week people die. Occasionally someone is taken to hospital and dies there. People have been stuck in the camp for so long now that palliative care units have been set up.
Outside the camp, a government sign in a bus shelter reads: âeoeThere is help available for the homeless. A warm bed, a kind voice, a helping hand.âe The sign is defaced by graffiti: âeoeKill the homeless!âe Anger and hate towards the homeless has been growing. A refugee left the camp recently and was brutally murdered âe” beaten in his sleeping bag in a park.
By now youâe(TM)ve probably figured out that I am referring to the desperate situation of displaced persons âe” commonly known as âeoethe homelessâe âe” here in Canada. This refugee camp scenario describes the raw reality of homelessness in Canada. The information was taken from official reports on ten of Canadaâe(TM)s largest cities, and from my first-hand experience and work as a street nurse in Canada.
I used to call this our dirty little secret, but itâe(TM)s not so secret anymore, is it? This is the Canadian experience that tourist books donâe(TM)t mention, but tourists still see. I ask myself, how did we let this happen? How did I end up working in refugee camp conditions in a rich country like Canada?
Over the years Iâe(TM)ve been many types of nurse: a cardiac nurse, a public health nurse, a camp nurse, a nurse practitioner. One of my hobbies is a collection of Harlequin-style nurse books with titles of jobs Iâe(TM)ve never had, like Cruise Ship Nurse, Settlement Nurse, Nurse with Wings, District Nurse, Mountaineer Nurse.
But, for the last seventeen years I have called myself a street nurse. Itâe(TM)s a term coined by a homeless man who one day hollered across the street corner at Sherbourne and Dundas in downtown Toronto: âeoeHey, street nurse!âe It was a huge compliment âe” the same as a homeless man calling his close friend on the street his street brother, or sister.
I continue to use the term street nurse because itâe(TM)s so descriptive. It doesnâe(TM)t confuse the public like so many of our other nursing job titles. Street nurse âe” it tells a story of how things today are different than they used to be. It explains in two simple words that this country has a new nursing specialty âe” homelessness, and this, I suggest to you, is obscene. Iâe(TM)m not a politician, an economist or an urban planner. Iâe(TM)m a nurse, a street nurse, and what I see âeoedownstreamâe in society necessitates that I look âeoeupstreamâe to find the root of the problem. The necessity for street nurses necessitates that our nursing be about politics.
The conditions I see in my work now are not only unjust, they are cause for national shame: an old woman living and dying in a car, a senior sheltering below a bridge, another dying from tuberculosis, a young girl burned to death in her squat. A constant litany of infections and illness: frostbite injuries, malnutrition, dehydration, pneumonias, chronic diarrhea, hepatitis, HIV infection, skin infections from bedbug bites. But perhaps the hardest to treat is the emotional and mental trauma, what I call deprivation of the human spirit. Itâe(TM)s evident on the faces and in the body language of homeless people. These faces Iâe(TM)ve seen âe” barely surviving, pale, tired, despairing…hungry. How do you nurse that? How do you relieve that pain?
My experience as a street nurse has forced me to rely less on nursing theory and nursing research and more on economics, truth, power, and politics. I now prefer to think of nursing as a dance, a subtle and intricate weaving of movements that are about witnessing, attending to meaning, and when necessary leaping into the fray to grab what should be given. For if politics is about the distribution of limited resources, I learned that nothing is ever freely given. You have to fight for it.
There were always letters to the editor, articles and opinion pieces, press conferences, and tours where we took members of the media into places they wouldnâe(TM)t normally go âe” into parks, under bridges, unsafe rooming houses, basement shelters.
And there were moments of pure passion when a heated discussion with a city councillor, a mayor, or a coroner was caught by a TV camera that happened to be very close by. What all these actions share is the basic formula: witness + honesty + speaking out = the right thing to do. When I look back I realize that just about everything that homeless people have won, whether it be changes in policy, or funding, has resulted from these types of actions. Nothing was granted simply because it was the right thing to do.
This is my first book and it has a lot to do with the theme of my daughter Idellaâe(TM)s first book. She called hers The Adventures of My Blanket. She was eight and her story chronicled, with crayon illustrations, the secret life of her âeoesofty blanketâe : a shark attack (âeoeI couldnâe(TM)t believe it. My blanket saved my life!âe ); a frightening visit to the hospital for an operation (âeoeOne day my blanket got a rip.âe ); a first day at school (âeoeMy friends laughed at it âe” who ever heard of a blanket learning?âe ); and the sudden and traumatic melting of best friend snowman (âeoeSuddenly the snowman was gone, and all that was left of him was a big puddle.âe )
Her book closes with âeoeThe look on my blanketâe(TM)s face said, Anything can happen!âe No judgment, just wonder at what goes on in the world.
I felt a lot like that blanket when I realized, very early on as a street nurse, that the right to a home is not granted equally to all Canadians. This may sound naive but itâe(TM)s the truth. I was working as a street nurse in 1993 when the federal Conservative government cancelled one of our social programs, the national housing program. I hate to admit it, but I was oblivious to the decision at that time. The entire housing program was decimated. In some provinces it was a double whammy when they cancelled their provincial housing programs as well. Thatâe(TM)s what happened in Ontario in 1995, when the Conservative government of Mike Harris cut 17,000 units of housing that were already under development. Units that could have housed up to 40,000 people, including families with children.
Most of us have a softy blanket, some form of gentle protection against the scary and upsetting things that happen in life. It might take the form of family, a friend, or a lover, a talent or hobby we retreat to for comfort or inspiration like music, theatre, or even daydreams. However, weâe(TM)re all more at risk when we lose our societal softy blanket, the social safety net that ensures that when all else fails, systems and programs are in place to protect us. This became evident to me as I witnessed the aftermath of the housing cuts: longer waiting lists for affordable housing, people who were newly homeless still in shock, the increased need for blankets and sleeping bags, churches opening their basements to provide emergency shelter.
Street beds arenâe(TM)t real beds, mats on a floor arenâe(TM)t a bedroom, and sleeping bags sure arenâe(TM)t a softy blanket. Sleeping bags should not be our countryâe(TM)s national housing program.
I have met and known thousands of people who were homeless, and I canâe(TM)t think of one who deserved it, who chose it, or who couldnâe(TM)t have done just fine if the right type of housing and supports had been there. No one is hard to house; itâe(TM)s the right housing thatâe(TM)s hard to find. And it could be so easy.âe”Cathy Crowe, Street Nurse