OMA Spotlight on Health

Understanding urban health care

December 28, 2021 Ontario Medical Association
OMA Spotlight on Health
Understanding urban health care
Show Notes Transcript

Three Toronto doctors discuss the gaps in caring for the city’s most vulnerable.

OMA Spotlight on Health – Urban Toronto Health

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis

for the Ontario Medical Association.

In this episode three Toronto doctors discuss the gaps in caring for the city's most vulnerable. Dr. Naheed Dasani specializes in providing palliative and general medical care to people experiencing homelessness and poverty.

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Dr. Naheed Dasani: This pandemic has actually exacerbated an existing homelessness issue. There are over 14,000 people living on the streets, more people living in encampments than ever before. There's the obvious components — where do people who experience homelessness keep their medication? Many of my patients require colonoscopies, for example. Where do you go if you don't have access to bathroom facilities?

People experiencing homelessness face discrimination in our health care systems. They're just treated differently. Many people who experience homelessness experience trauma at the hands of health care and that means that they don't access health care, and when they do access health care, they access it late.

During my training, I ended up providing health care for a young man in his 30s, who had schizophrenia and a widespread head and neck cancer and presented to our shelter in pain crisis. He so badly wanted to receive pain control, and went to many health facilities to seek pain control, but was turned away due to the way he presented, because of his homelessness. Unfortunately, he fell through the cracks. And so, I tried to care for him, and then I built a rapport with him, and he ended up dying due to an overdose on a combination of alcohol and street drugs. He turned to the best pain relief that he knew, and it was too little too late.

Right in our backyards, in this world-class city like Toronto with a world-class health care system and palliative care system, someone experiencing homelessness can fall through the cracks again and again and again. Palliative care is a human rights person-centred approach to health care, and it really spoke to me. And I realized that when you layer these two issues — people with structural vulnerabilities who deal with serious illnesses and then the lack of access to palliative care — there was a lot of work to do.

People who are accessing health care have experienced trauma in society and at the hands of health care. So, we treat them in a way — we support them in a way — so that we don't re-traumatize them or traumatize them more.

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Balogiannis: Dr. Jane Pritchard runs a family health group in Toronto Community Housing buildings in the city's Scarborough community.

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Dr. Jane Pritchard: I am involved very much in the sort of steering this interprofessional team — consider it a medical home, I’m trying to make a medical home for a diverse group of people. We have two nurses and a social worker; they're on site. This concept of a medical home where there is continuity of the person, health care based around a personal relationship, is the old-fashioned way of being a family doctor in a modern sector.

So, this is — amongst people who have little reason to trust others, it's very important to have that continuity of the person, to trust the person. Then it’s like a personal relationship with the patients, not just the doctor, but the other team members, the nurses, the social workers, there's actually some continuity. So, who knew that that was so important? Well, it's obvious.

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Dr. Pritchard: I have all kinds of people with PTSD on my patient list. And I can't get any psychiatric support for that because I think they're in the too-hard basket.

You'll be on a waitlist for two years to get some services. If you're a person who's experienced homelessness, it's unlikely that you're going to stay the course that long and stay on the waitlist. It's not even an option.

What I've come to understand is that for people who've experienced homelessness, most of them have been abused in childhood. And, yes, they're difficult to handle, but they have had to struggle their whole life. It's just that it's totally unfair, right?

They may well be into substance use or inebriated and that sort of behaviour, but is there — is there help for them to deal with the original problem, which was the abuse? Well, no, there isn't.

This idea of the medical home, I think, could get a lot of traction in other settings across the urban landscape — it's not only for high-risk, recently homeless people. You can build on services that are ongoing, the personnel are consistent, and

cooperating, and talking about services like counselling for help with preventing evictions, but also needed medical services.

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Balogiannis: Dr. Cindy Ochieng is a family physician at Parkdale, Queen West Community Health Centre.

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Dr. Cindy Ochieng: A lot of folks are experiencing the consequences of a system that is not made with the most marginalized folks in mind. As a doctor, we're taught to treat an infection, you give it antibiotics. You've got pain? Here's a pain medication. You treat it. But a lot of what I see in my practice is, someone doesn't have enough money to afford an air conditioner and they have asthma, and now they have to figure out, do I not eat so I can get an air conditioner?

So, it’s a lot of advocacy on my end, to reach out to the community resources that will allow folks to have the things they need to live well and live easily though the resources are finite. The access to medications is a big problem.

So, I also work at a shelter, but I also see folks at that shelter who have not seen a doctor for 15, 20 years. They don't fit into our typical idea in this society of what a “functioning adult” should be. Maybe they don't have an address, maybe they don't have the communication skills that people would expect. Or maybe they didn't grow up going to see a doctor, so that hasn't been modelled for them, and so they don't reach out for that help. And then maybe when they have in the past, they've been treated poorly. So, they have these experiences, like trauma from the medical system, and then they don't access care.

If only our system was more tailored and kept in mind these folks who are underhoused, who have addictions, who have experienced trauma, who are racialized, all of these different things. Racial issues are not separate from indigenous issues, from land issues, from homelessness, from addiction — it's all kind of related.

So, I do think that we're in a moment. That has not always been the case in medicine, and it's exciting to see. And I do hope that things come of this moment, and we're not just having a flash in the pan.

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Dr. Ochieng: Because a lot of things are being put onto family doctors, people are burning out. It's hard work. If you care, you're taking on a little bit of what people are

feeling and that can be draining in various ways. I do worry about the burden that's being put on family doctors. People need family doctors, but family doctors are feeling the burden of being needed — it's like this vicious cycle.

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Georgia Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit OMA.org

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