By Tony D’Amato Stortz
Published in March 2019
Dr. Chris and Michelle Steingart have matching T-shirts.
One says ‘Harm Reduction Works.” The other, “I <3 people who <3 drugs”. It’s a long way from their past lives as a middle school science teacher and the Head of Infectious Disease at Grand River Hospital.
It may seem surprising, but it shouldn’t be. Chris and Michelle are people who embrace change.
The two met as students at the University of Waterloo, but when Chris got into University of Calgary Medical School, they moved west to take advantage of the opportunity. Michelle got a degree first in Science and then in Education and began working as a teacher while Chris finished his studies.
She has more degrees than Chris, and teases him for it. He didn’t finish his undergraduate degree before going to medical school.
Moving back to Waterloo Region, Chris became increasingly aware of lack of care for those suffering with Hepatitis C. He began seeing patients one day a week out of an office in Guelph, but it wasn’t enough. Eventually he told Michelle that he wanted to quit his job and open up a Hepatitis C clinic to meet that need. The couple had two young kids and Michelle was working as a substitute teacher.
It was not long after that, with trepidation, Michelle quit her job to administer the clinic, and Sanguen was born.
Sanguen is the province’s first charitable Hepatitis C service organization, but it has grown to do so much more than just treat Hep C. Sanguen has a dedicated team of nurses, social support workers, outreach workers, and peer support workers to meet the needs of the marginalized population they serve. They also run community health vans that go out, meeting people where they are, and providing primary care, clean needles, and even fresh socks. The WINS team also goes out to retrieve used needles they find in the community and dispose of them safely.
These incredible programs just scratch the surface of Sanguen’s good work in our community, and they come, not from a top-down approach of how to solve the opioid crisis, but from the grassroots. They see the problem and do what they can to reduce harm on the ground, where it benefits those who need it most. Their vision is a combination of compassionate medical care for those with Hepatitis C as well as innovative programs to meet the many other important needs of their patients, who suffer from diseases similar to HIV without the same level of support.
Before starting Sanguen there weren’t the same options for support for Hepatitis C patients.
“If an HIV patient came in, I couldn’t set them up with housing, addiction counselling, mental health support, etc. If a Hepatitis C patient came in, they had nothing.”
The scale of the problem is also much bigger.
“There is an order of magnitude – more people are living with Hepatitis C than HIV.”
And Hepatitis C is a terrible disease to live with. Often undiagnosed, it causes the patient to feel tired, unwell, lose their appetite, experience muscle and joint pain, and even depression. Eventually it causes severe liver damage and even death.
“It’s a horrible way to die,” Michelle says, shaking her head.
It is, however, treatable and the medication has gotten much better in the past few years.
“Back in 2011, Hepatitis C treatment was like chemotherapy,” Chris recalls.
It involved weekly injections, a mountain of pills, and nasty mental and physical side effects.
“Now treatment is a single pill a day for 12 weeks. A 95%+ cure rate.”
But the improvement in the medicine does not remove the burden of this disease, especially for those who are already marginalized.
“It’s simple, but not easy. For people who are not housed, nothing is easy.”
And with this change in the treatment method, Sanguen changed as well. It is now less of a specialized Hepatitis C clinic that treats patients through the established medical system. It has changed to become more of a health-focused outreach organization that meets people where they are and walks their health journey alongside them.
“When you help people with Hepatitis C, you’re helping people with addictions, homelessness, poverty, and people who are new to Canada … I don’t think we’re a Hepatitis C organization anymore – we’re just trying to meet the needs of people with complex needs.”
One way Sanguen does this effectively is through the use of their Community Health Van. This initiative, which has become central to the organization, was suggested by one of their Outreach staff, Violet. She saw the need for a van that could go out and meet people where they were. They had to be there physically as well as mentally.
The first night, the van provided service to 11 people. A week later there were 25. The week after that, there were 40. Now, the van can reach up to 400 people on a night in Waterloo Region alone. They also have services in Guelph, and are expanding into Palmerston.
“Now, people will be lined up, waiting for the van.”
And as the van’s reach grows, its services do too. It distributes clothing, toiletries, and even a hot drink on cold winter nights. It can be the bridge that re-connects someone to the healthcare system. Only then can you move to treat a chronic health condition like Hepatitis C.
“It’s just giving folks a sense of worth (…) Right now we’re trying to keep people alive, meet them where they’re at. We’re trying to help people to be safe and healthy. Because that’s what they deserve.”
Chris and Michelle are adamant that the credit for the incredible work done at Sanguen belongs with the staff working on the ground every day.
Tracy and Amanda are the Nurses administering care. Garilynn is a Nurse Practitioner. Kim is an Outreach Worker. Simone and Aislinn are van coordinators. Violet is the Manager of Outreach, Education, and Prevention. Colin is the Program Director for Guelph/Wellington & Waterloo Region. Pete, Rene, and Alice are the Social Support Coordinators for Waterloo Region and Guelph. Johnny, Paul, Jen, Jason, Barb, Charlotte, Steph, Moira, Paul, Yanna, and Craig are Peer Workers. Dr. Chittle is the PrEP Clinic Physician.
Chris recalls looking over at members of the team while they were providing service and thinking “wow, they know how to do things I don’t have a clue about.”
“It’s the team” he says.
Michelle agrees. When asked about her favorite part of the job, she immediately jumps to the Monday morning meetings they have with everyone to get on track for the upcoming week.
“I love Monday mornings,” she said with a smile.“How many people can say that?”
Sanguen is the province’s first charitable Hepatitis C service organization, but it has grown to do so much more than just treat Hep C: it has changed to become more of a health-focused outreach organization that meets people where they are and walks their health journey alongside them.
With a dedicated team of nurses, social support workers, outreach workers, and peer support workers Sanguen works to meet the needs of the marginalized population they serve. Their community health vans go out, meeting people where they are, and providing primary care, harm reduction support, and even fresh socks.
These programs come, bring a grassroots approach to the opioid crisis. They see the problem and do what they can to reduce harm on the ground, where it benefits those who need it most. Their vision is a combination of compassionate medical care for those with Hepatitis C as well as innovative programs to meet the many other important needs of their patients including mental health, addiction, and housing support.
