By Tony D’Amato Stortz
Published in March 2019
Dr. George Berrigan is the physician at St. John’s Clinic, the primary care clinic located within St. John’s Kitchen in Downtown Kitchener. Together with longtime Registered Nurse, Evelyn Gurney, and a dedicated team of healthcare and outreach workers, they care for the over 2,000 people in the clinic. Dr. Berrigan is the family doctor for many people experiencing homelessness in our community. Evelyn is often their link to specialists and advocates for people throughout the healthcare system. Together they offer care with kindness and a unique understanding of the health issues associated with homelessness and addiction.
Evelyn and Dr. Berrigan have been doing this work since they retired from their family practice ten years ago. Together, they are being honoured at the 32nd Annual Mayors’ Dinner for their dedication to grassroots healthcare and outstanding contribution to the community.
Their patients have a unique set of needs. Addiction and mental health concerns are often present, but they are further compounded by dental issues, skin infections, and poor nutrition as a consequence of living on the street.
Many have also had negative experiences with healthcare before and come in ready for a fight. In these situations, Dr. Berrigan and Evelyn emphasize kindness in response to antagonism.
“What you need is a non-confrontational approach. Take the hostility and throw it out the window. Evelyn is the master of that.”
She is. As the host nurse at the St. John’s Clinic, Evelyn has walked this journey too. She is the practical, welcoming presence for those who find letting their guard down and showing vulnerability uncomfortable.
The relationships that form under these circumstances can be far deeper than in a regular healthcare setting. Evelyn recounts grateful patients coming in with small gifts to express their thanks for the care they received.
Through the strength of these relationships, Evelyn can facilitate access to healthcare, both inside the clinic and outside. She knows the patients well, but also knows the specialists, pharmacists, and other gatekeepers in the healthcare system. She uses these relationships to get her patients the care they need, often vouching for them and working behind the scenes to make things happen.
Emotion, perception, and judgement are also a huge part of Evelyn and Dr. Berrigan’s work. Their patients are often so quick to get labelled as an addict, mentally ill, or just another homeless person.
They try to throw these labels out the window too.
“We said no – what we have here is a person. He’s human, and he may have schizophrenia, ADHD, or a drug addiction, but first and foremost he’s a person” said Dr. Berrigan, with conviction. “Respect and kindness shouldn’t be something you add on when you have time for it. You have to start from there.”
Beyond creating a welcoming space and rejecting labels within their office, getting patients to follow through with treatment can be a challenge. This population has a high level of traumatic brain injuries which can make them forgetful and high incarceration rates which interferes with care. This, alongside so many other challenges, can lead to missed appointments and lost medications.
In many of these situations, Evelyn in conversation with the Outreach team, is the advocate who gets them another appointment, a new bottle of medication, and encourages them to continue with treatment. It is a vital and challenging role in light of the massive challenges faced by this group.
“Homeless healthcare is so much more complex… you have social problems contributing to the medical ones.”
Berrigan spoke of a situation which demonstrated the barriers to healthcare this group faces.
“A patient with severe heart failure came in, and I said they needed to go to the hospital right away. It turns out the taxi wouldn’t take them. They didn’t have any bus tickets. They had to walk from Victoria Street to Grand River Hospital, stopping to rest every five steps. It took them two and a half hours.”
These are a long way from the issues Dr. Berrigan and Evelyn faced in their family practice. They have to go beyond treating just the disease; they must treat the entire situation.
“Housing, education, employability – these determine health.”
But Dr. Berrigan also is candid about the barriers to effective treatment within this population.
“The mental health or medicine isn’t the problem. The barrier is the addiction … (and) the real payback is in prevention.”
As for his existing patients, Dr. Berrigan emphasizes a harm-reduction approach to care.
“Harm reduction is about making a big problem less, so it doesn’t become a disaster. I need to keep them alive, increase quality of life, and help them get better and safer.”
“Addiction is a very big complex problem without a simple soultion. It’s a problem that will take a bunch of hard work from all levels.”
But George and Evelyn do not appear to have lost hope or become cynical about the issues their patients face.
“[They’re] funny, silly, sad, clever people who are, at the moment, homeless. No better, no worse than us. I want to talk about who they are.”
St. John’s Clinic supports access to primary care, mental health and addictions services for people who are homeless/ at risk of homelessness with a commitment to helping people to be as well as they can be.
We follow an outreach philosophy that responds to complexity, meeting people in our clinic, on the street, in supported housing, in other organizations, in Mental Health and Drug Treatment courts, responding within a wider circle-of-care supports.
Partnerships with Sanguen, CFFM, and KDCHC help to enhance this work.
We collaborate in the interest of the person, with housing resources, police, courts, EMS, hospital and other agencies to creatively problem solve the best response for the person we serve.
