By Joe Mancini
Published in December 2017
Every weekday at St. John’s Kitchen, the doors open at 8:00 am as a breakfast of breads, jams, peanut butter and coffee is served. Soon after, in the open kitchen, the preparations begin for the meal to be served by 11:00 and 11:30. This routine has been going on without a break for over 30 years. On January 15th the kitchen will mark its 32nd year. All the people involved, giving of their time and energy, ensure that a daily meal is served for free in the downtown.
When we moved to 97 Victoria Street North in 2006, we were fortunate to build a medical clinic at the top of the stairs as you enter St. John’s Kitchen. This is also the area where we built showers and a place for laundry. We are always grateful for the support of the Lyle S. Hallman Foundation and the KW Community Foundation for helping to establish the medical clinic. Dr. Neil Arya was the founding doctor offering time one day a week.
In 2008, we received an offer from Dr. George Berrigan to work up to 30 hours a week to serve the population of St. John’s Kitchen. Dr. Berrigan had recently retired from his family practice. He committed to learning this new field of medicine through his own reseach and taking courses on addictions and mental health. As a retired family doctor he had already gained vast experience dealing with regular health problems.
It was already obvious that the people at St. John’s Kitchen were in poor health. Dr. Berrigan’s role was to work with the outreach workers and nurses to create conditions to ensure that the St. John’s Kitchen medical clinic became a helpful support. He learned that there is great distrust of the medical system and that for many reasons people who are suffering major illnesses either refuse to be treated or cannot find a way to navigate the bureaucracy of health care.
It is now 10 years later and the St. John’s Kitchen medical clinic has a roster of some 1000 – 1200 people who are associated with supports at the clinic. In all over 2400 individuals have registered for care. Registration has been limited to those who have either experienced or are at risk of being homelessness. This is the size of a decent medical practice that has all the elements of a mini-family health team.
Evelyn Gurney is a nurse who worked with Dr. Berrigan at his old practice. She has offered a similar role at the St. John’s clinic through her hugely friendly hospitality from the front desk and her ability to negotiate and build relationships with medical specialists. Through the development of the Psychiatric Outreach Project and now Specialized Outreach Services (funded by the LHIN through CMHA), the clinic has benefited from three outreach nurses. There is also a host role for the clinic and a counsellor. Street Outreach and Streets to Housing workers are also a key component (funded through the ROW and the LHIN). They accompany and give context to the issues people face as they walk through the medical system offering support.
St. John’s Kitchen has cobbled other supports such as the two fulltime outreach workers who are available to support people in the dining hall and an at-home outreach worker that supports ill people who have some shelter. The Hospitality House provides 6 beds for those most acutely and without a home. Community Dental is a new project that is providing dental support for this same group.
Dr. Berrigan understands the work he does as harm reduction. “This is how we do our work, doing the best you can, this is the reality of medicine in these circumstances. Just doing the right thing is the priority. It is the only way to be helpful. It is not aiding the problem, the problem is already there, there is no big solution but there are hundreds of small things that can be done to be helpful.”
This configuration of services is the result of independent and cooperative energy dedicated to ensuring that those left out get access to support. To make this possible the clinic has a person-centred approach. There are no appointments; it holds together because of a commitment to build on small connections. The ecology of care takes place through conversations, being available to help out someone who is ailing. The best kind of attention is meeting people where they are, in their own space.
Dr. Berrigan, Dr. Rebecca Lubitz and psychiatrist Dr. Robyn Fallen are always busy working in an environment where hospitality is the message that underlines the care offered. This work is complemented by the village of supports that have evolved at St. John’s Kitchen such as the showers, laundry, the public phones, the daily meal, food pantry distribution, the daily community interactions, the grieving process through hosting memorial funeral services, and the opportunities for work and volunteering.
As Dr. Berrigan works towards his second retirement we have been actively helping the wider community to understand the importance of this configuration of services that has evolved at St. John’s Kitchen. In the midst of the opioid crisis, St. John’s is a first line of support for those dealing with addictions.
As part of our discussion both the LHIN and the Grand River Hospital talked to us about possibilities of support. In September, we were thrilled to learn that the LHIN and Grand River Hospital had come up with a plan. Malcolm Maxwell, CEO of Grand River Hospital has made it possible to transfer a Nurse Practitioner role from the hospital to be a full time role at the St. John’s Kitchen medical Clinic.
The development of medical supports over the last 10 years adds a dimension of support offered through St. John’s Kitchen that ensures primary care is available, supporting people where they are at. This work of solidarity, walking with those most left out, gives substance and hope to the common good.
