pay i t f o r w a r d
r o b e r ta s ta l e y Roberta Staley is a Vancouver-based author, magazine editor and documentary filmmaker.
Street medicine
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ive days a week, Dr. Susan Burgess, 10-kilogram backpack full of medical supplies slung over her slight shoulders, traipses—or sometimes drives—along the streets of Vancouver’s Downtown Eastside (DTES) on her rounds. Some of her patients live in single resident occupancies, or SROs, as bleak, grim and Dickensian as any Victorianera London poorhouse. Others eke out a living on the street, shiverDr. Susan
mid-1990s, when she first came to the DTES from Ontario via the Northwest Territories where she delivered healthcare in Aboriginal communities. Upon her arrival on the west coast, Burgess began working with Vancouver Native Health, a place that supported outreach care. It was an overwhelming time, with soaring rates of HIV/AIDS, syphilis, tuberculosis and hepatitis C that were exacerbated by intravenous cocaine and opioid use and a growing population of people with psychiatric illnesses, Burgess makes due to the closure of Vancouver’s her rounds in Riverview Hospital mental Vancouver’s health facility. Hope emerged Downtown in 1996 with the introduction Eastside of Highly Active Antiretroviral Therapy (HAART). But it would be the early aughts before HIV/AIDS was under some control. Burgess was part of this achievement, being the lead study physician with the BC Centre of Excellence in HIV/AIDS, researching the effects of directly observed therapy, or DOT. Burgess, a palliative care physician, is still trying to keep a lid on HIV, which she says is now increasing among younger DTES residents. She describes one patient—a homeless man in his 20s whose HIV had gone untreated for months. With the help of a social worker, the man was finally placed in a shelter—a key first step in helping street people establish some order in their lives and link with a variety of supports, such as drug treatment and HAART. Providing care to such individuals “is often difficult,” says Burgess who, despite 27 years spent pounding the paveing at night in sleeping bags, sheltering ment on rounds, plans to continue her from the rain under eaves, spending their gruelling work regimen. “Once they’re in days scraping together enough money a shelter, we connect and get them help.” to buy a bit of food or the brief mental But the reasons they’re homeless—childrespite afforded by a hit of crystal meth or hood trauma, addictions, incarceration, street fentanyl. mental illness and paranoia and psychosis The chaotic lifestyle of thousands from methamphetamine and fentanyl of marginalized DTES residents—an use—can lead to errant behaviour, resultarea referred to as Canada’s poorest ing in eviction from even the most basic postal code—often makes it imposshelter. “They get kicked out and you start sible for such patients to organize things over again and try to find them.” (Burgess like medical appointments. So Burgess also sees patients at the Downtown goes to them. She has done so since the Community Health Centre, Kílala Lelum
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Just For Canadian doctors Spring 2020
Clinic and the Vancouver Coastal Health Home Hospice Palliative Care service.) Burgess’s tireless work in the DTES resulted in her being given the Canadian Society of Palliative Care Physicians (CSPCP) Humanitarian Award in 2017. She was surprised by the recognition and hopes that it raises awareness of the challenges DTES residents face. “That award was an opportunity to highlight our commonalities. Everyone is a human being and deserving of the same human rights. We’re all born; we all die. That has to be acknowledged.” It’s in between birth and death that can be so dramatically different, with some people facing their final few years, months or days in an SRO with only Burgess and an outreach nurse by their side. She has many patients with advanced HIV/AIDs—virtually all her patients are HIV positive—while co-morbidities, such as heavy addiction and psychiatric illnesses, are factors in inconsistent HAART treatment, leading to high viral loads. “It’s heartbreaking,” says Burgess. Distressing, too, is the loneliness. “The worst thing for folks is when there’s nobody. They don’t have family; Joe down the hallway, maybe he’s sort of a friend.” Despite enormous hardships, the residents of the DTES are proud, lacking self-pity. Burgess remarks that, with some patients, she will have to visit them numerous times before they agree to be looked at or treated. One patient, psychotic from drug abuse, who slept on a towel on the floor of his SRO, refused to allow Burgess into his room. After five separate “knocks on his door” from Burgess, he finally relented, which allowed her to finally initiate an HIV regimen. Eventually, after detoxing during a long stint in hospital, his psychosis diminished and the man, a gifted visual artist, now supports other HIV patients and helps train nurses and physicians. Burgess calls him “amazing.” Burgess doesn’t expect all her patients to be so successful. And that’s OK. “We’re just walking alongside these folks, whatever happens to be their path. They’re beautiful and troubled—they are my teachers. It’s a gift to be able to do this.”
Tallulah Photography
Helping those in need at home, here in Canada, on the streets of Vancouver’s inner city
