pay it forward

Roberta Staley is a Vancouver-based author, magazine editor and documentary filmmaker.

Street medicine Helping those in need at home, here in Canada, on the streets of Vancouver’s inner city

Five 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 SR Os, as bleak, grim and Dickensian as any Victorianera London poorhouse. Others eke out a living on the street, shivering at night in sleeping bags, sheltering from the rain under eaves, spending their days scraping together enough money to buy a bit of food or the brief mental respite afforded by a hit of crystal meth or street fentanyl.

The chaotic lifestyle of thousands of marginalized DTES residents—an area referred to as Canada’s poorest postal code—often makes it impossible for such patients to organize things like medical appointments. So Burgess goes to them. She has done so since the 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, due to the closure of Vancouver’s Riverview Hospital mental health facility. Hope emerged in 1996 with the introduction 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 pavement on rounds, plans to continue her gruelling work regimen. “Once they’re in a shelter, we connect and get them help.” But the reasons they’re homeless—childhood trauma, addictions, incarceration, mental illness and paranoia and psychosis from methamphetamine and fentanyl use—can lead to errant behaviour, resulting in eviction from even the most basic shelter. “They get kicked out and you start over again and try to find them.” (Burgess also sees patients at the Downtown Community Health Centre, Kílala Lelum Dr. Susan Burgess makes her rounds in Vancouver’s Downtown Eastside

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 (CSP CP) 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 SR O 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 SR O, 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.”

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For the love o e l e p hant s

A sanctuary in Kenya rehabilitates injured and orphaned pachyderms

Dawn is breaking, spreading golden light like butter on the green and red-dirt landscape rising on either side of the highway leading out of Nairobi, Kenya. Thanks to our early start, we have eluded the capital city’s notorious traffic snarls, arriving at the Sheldrick Wildlife Trust on Magadi Road a few hours before the tourists arrive. Pulling into the quiet, empty, packed-dirt parking lot, we encounter a small family of tusked wart hogs. Surprised by our appearance, they trit-trot past, tufted tails held vertical in alarm, eyeing us with suspicion. Sheldrick Wildlife Trust is a non-profit organization that rescues injured and orphaned animals: elephants, rhinos and the occasional giraffe, and rehabilitates them for return to the wild. Founded in 1977 as the David Sheldrick Wildlife Trust (its name until 2019) by Daphne Sheldrick, David’s widow, the trust was created to honour her husband’s anti-poaching activism and work as a warden in Tsavo National Park, southeast of Nairobi. Although Daphne, an author and conservationist, died in 2018 at age 83, her daughter Angela and other Sheldrick family members continue the legacy. The trust has opened its arms to the world, inviting tourists to visit Sheldrick every day of the year from 11 am to noon, except December 25, to watch the orphan pachyderms cavort in mud or dust baths with their caregivers, who stay with the youngsters, supporting and protecting them, just as a mother elephant would. (The charge is 500 Kenyan shillings, about CDN$9, cash only.) Sheldrick Wildlife Trust’s herd of orphaned elephants range in age from a few months to about three—all rescues from various regions of Kenya. The circumstances of their rescue have usually been dire. The trust’s anti-poaching and veterinarian crews, utilizing ground and helicopter and fixedwing plane surveillance, have freed elephants from snares that have almost severed legs or trunks. While a mature elephant can be treated in situ, an injured infant is unlikely to survive, and will be flown to the Sheldrick facility for long-term medical treatment. One such baby is Enkesha, who was rescued after a snare almost sliced her trunk off. It has healed, although the hole that was left will never close. Enkesha, however, has adapted, learning to grip her trunk muscles tight to close the gap, allowing her to suck water through her trunk. Some rescued babies have suffered gunshot wounds. Others were orphaned when their mothers were slain by poachers, who hacked off the tusks for sale to the Asian ivory market. Other elephant mothers were killed for bushmeat or by farmers to protect crops, leaving the offspring orphaned. Such human-elephant conflict is exacerbated by climate change, which is linked to prolonged periods of drought so severe that Kenya has seen high mortality rates of both wild and domestic animals in past years.

Along with the company of their fellow pachyderms, and crucially the love and 24/7 attention of caregivers, who sleep with their young charges at night in the stables, most of the rescued babies survive the traumas that left them orphaned and will start to be rehabilitated into Tsavo National Park in southeastern Kenya when they are about four. Raising baby elephants isn’t easy; they have complex emotional as well as dietary needs. It took Daphne Sheldrick a decade to perfect a

milk formula that, today, is fed to the babies until they become more independent; at the Nairobi nursery they are fed every three hours, imbibing 24 litres a day, says trust spokesperson Kirsty Smith. Our early arrival, to document the work at the trust, means that we are here for the 9 am feeding, which is heralded by the soft thump of heavy round feet as the babies scurry out of the Nairobi National Park forest where they’ve been nibbling vegetation. Excited rumbles greet a wheel barrel full of freshly prepared 3.5 litre milk bottles. The elephants, with varying degrees of adeptness, grab a bottle with their trunks, suckling the bottle dry in a few minutes. Some youngsters need help from their keepers, who hold the bottles up to facilitate suckling. The amount imbibed varies; those who haven’t quite mastered the art of bottle feeding, spill much of their breakfast onto the ground.

After the feeding, the keepers accompany their charges back into Nairobi National Park to chew on branches and brush and dig up roots. When the tourists arrive, the babies are brought to the mud and dust baths for easy viewing. Such behaviour prevents the youngsters’ sensitive skin from sunburn, while mud baths—apart from being fun—also help keep them cool. All the babies have names that acknowledge the region of Kenya they were rescued from and head keeper Edwin Lusichi, who has been with the trust for 21 years, provides a history of each baby during the visit.

Visitors are also offered the opportunity to “adopt” one of the young elephants for $50 a year. Although this money is put into general operations for the Orphans’ Project at Sheldrick, the adopter receives monthly updates about their elephant, a certificate of adoption and digital copies of Angela Sheldrick’s delicate, whimsical watercolours of the babies. Giant-eared Luggard became my adoptee. Luggard was an infant when a Sheldrick helicopter pilot on anti-poaching patrol spotted him, obviously distressed, in 2016 in Tsavo East National Park in Kenya. A veterinarian crew was mobilized and Luggard caught. Only five months old, he had been shot. A bullet had shattered the knee in his left hind leg, penetrating through into the other foot. Luggard was tranquilized and evacuated via helicopter to the Sheldrick facility for intensive care. Now a four-year-old, Luggard will always limp, delicately putting just a bit of weight on the left hind foot as he walks. When it is time to reintroduce him back to the wild, he will be moved to a special place called Umani Springs in the Kibwezi Forest, one of the trust’s three reintegration units. “This is where those elephants that have been injured will be integrated into, as it’s easier, with more water and richer forest for feeding,” says Smith. In the film Larger Than Life, actor Bill Murray said, “You know, they say an elephant never forgets. But what they don’t tell you is that you never forget an elephant.” Any visitor who comes away from viewing these engaging, sweet and good-natured babies at Sheldrick Wildlife Trust will attest to that observation. Once seen, these youngsters’ remarkable stories of survival and resilience remain forever in your memory—and your heart. if you go Visitors to the Sheldrick Wildlife Trust should come on their own and make arrangements with a taxi or their hotel and driver, and ensure they have the 500 Kenyan shillings for entrance. For more info: sheldrick wildlifetrust.org.

clockwise from top left Young elephants drink 24 litres of milk daily; Each elephant has its own individual keeper; The scar from a snare can be seen on Enkesha’s trunk; Keepers protect the orphaned elephants from harm in Nairobi National Park

2020 Education

Spring Workshops: May 2-3, 2020 | Las Vegas, NV

Chelation Advanced Providers - Workshop & Certification The workshop and practicum provides in-depth training by combining the information presented in the pre-requisite webinars (Step 1) with a full course of new material. The CCT certification exam takes place on the afternoon of the second day. Visit acam.org/CAP to learn more & register.

The Science of Longevity - Stem Cell & Peptide Therapies The purpose of this intensive regenerative workshop is to critically review the large body of clinical work performed with respect to the use of stem/ progenitor cells and peptides in humans. Emphasis will be paid to new reviews of the science of repair, wound healing, aesthetics & longevity, cancer care, immune modulation and more! Email info@acam.org to learn more & register.

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Upgrade Your Education Since 1973, ACAM has educated practitioners with the mission to provide an expansive medical “toolkit”. We help you better treat patients, be more effective in treating difficult cases, and discover safe & cost-effective treatments in our signature learn-today-use-tomorrow format.

Join a Patient-Forward Community ACAM strives to encourage strong relationships. The Collaboration Cures movement is about bringing together practitioners of all fields to provide optimal patient care. That is why, for the 5th year in a row, ACAM has joined forces with AAPMD, whose primary focus is airway health & sleep medicine. Learn what a fresh perspective can do for your practice.

Be Inspired Find out why past attendees say they leave our meetings “with a renewed vitality for [their] practice” by attending our value-packed program in Seattle!

Program Topics - Neurodegeneration - Chronic Infectious Disease - Inflammatory Disorders - Cancer Care - Sleep Medicine and more!

Featured Speakers - Daniel Amen, MD - Neil Nathan, MD - Satchidananda Panda, PhD - Gregory Smith, MD, MPH - Theoharis Theoharides, MD, PhD - Simon Yu, MD