By Stephanie Mancini
Published in December 2019
At last year’s Mayors’ Dinner we focused on Person-Centred Grassroots Healthcare. In the words of Dr. George Berrigan:
“We had no bureaucratically designed program or procedural guidelines to work under. In effect, what we did was use the approach of the famous professional tennis player, Arthur Ashe, who tackled his problems using the SUD method: Start where you are! Use what you have! Do what you can! Our immediate barrier was gaining trust which took a lot of listening and attention, being adaptable, open and especially non-judgmental. We worked hard at keeping our promises. We knew our care had to be backed by consistency, respect and kindness. We accepted that even though we couldn’t figure out and solve many of their complex addiction, mental health and medical problems we could work away at lessening the harm enough at least to keep people alive. In SJK, survival is always our most immediate concern; the rest of the work is mostly finding ways to progressively lessen their suffering one on one, one day at a time.”
Our medical team is responding a-person-at-a-time to complex situations:
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A young girl ends in hospital after an overdose after an experience that builds on a series of life traumas, and we work with her and hospital staff to relieve her pain, problem-solve a situation that looks like non-compliance but is really a reaction to trauma, helping to resolve treatment, physical rehab, and housing options.
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A person from a neighbouring town is service restricted from all services, and lands in K-W for treatment; she is dying of cancer, has a partner with her helping her to cope, but he has an outstanding warrant and is rapidly arrested; leaving us as her main form of support.
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A young man who has faced many service restrictions from supports is released from jail, but can’t access shelter; he has been free of street drugs and is more coherent; after the death of a friend he ends up using, accelerating his bi-polar behaviours, damages the hotel he is in, and then ends on the street. We maintain connection, supporting the place he is in, supporting his well-being, helping him to stay connected in spite of the many connections he has pushed away.
Our medical teams walk with people through complex situations, system gaps, and the consequences of homelessness and an easily available and dangerous drug supply. Here are the thoughts of Dino, a nurse hired recently to join our team:
“When I became part of the SOS team and St. John’s Clinic, it became immediately clear that this nursing role would be a step outside of the box of what I considered to be a traditional nursing role. I became a member of an interdisciplinary team that provides wraparound care that meets the person where ever they are at—in both the metaphorical and literal sense. A predominant emphasis is placed on forming trusting, therapeutic relationships with the people we serve and identifying and offering services that can best help them in their current context. Traditionally, as nurses we may feel compelled to focus on efficiency and most of us have experienced pressure to complete tasks as quickly as possible. At the Working Centre efficiency – although important – is given less emphasis than effectiveness. We are effective when we serve the person well and strive to meet their needs.”
We are moving ahead with hiring for our Water Street house, a house that will offer interim housing for people who are active drug users. The house will offer police drop-off beds to ensure wellness; beds that will offer extended hospital treatment in a harm-reduction environment, often for rampant infections; and respite. A nurse will be available 24/7 in this creative interim housing environment, extending the dynamic health care work we are doing at St. John’s Clinic, in the SOS team, and in the wider Inner City Health Alliance partnership.
We are also extending our daytime teams to include an evening nurse/outreach team, supporting shelters, overflow, supportive housing, and hospitals to ensure that we are linking people with this deep network of supports.
We submitted a proposal to Health Canada that might also help to add some creative responses to the issues of unsafe street drugs, and drug induced psychosis. As we focus on a person-at-a-time, supporting deep relationships while we navigate complex health and mental health issues, we are learning so much. We feel the pressures of homelessness, combined with mental health issues, which are often self-medicated through street drugs. We continue to build circles of support and connection, deeply embedded in our practices of loving each person, in spite of the dislocation and substance-related numbness, continuing to creatively problem-solve.
We welcome interested nurses as we expand our team (see posting on our website)
Jean Vanier’s words take on a new meaning – “It is an attitude; it is the constant openness of the heart; it is saying to people every morning and at every moment, “come in”; it is giving them space; it is listening to them attentively.” – a person at a time, a moment at a time.
