Bringing equity to palliative health care
Memorial University medical school student groups host event to help people living on the margins
Two student groups from Memorial University’s faculty of medicine in St. John’s are teaming up to host a discussion this Saturday exploring ways to provide palliative care to a segment of the population that often finds health-care services to be inaccessible.
“Justice in Dying: Palliative Care for the Homeless” will bring together physicians and community workers to talk about efforts to increase health equity.
One of the guests for the event is a Toronto palliative care physician Dr. Naheed Dosani, who started a program to provide this level of health care to the city’s homeless population and those with unreliable housing.
Dosani is the son of refugees who moved to Canada in the 1970s.
The importance of social justice and community well-being were always at the forefront of his thinking growing up, and when he started studying medicine at the University of Toronto, Dosani began to think more and more about how different models of care could address health equity.
PERSONAL EXPERIENCE
While completing a family medicine residency at a Toronto shelter, Dosani took care of a young man named Terry who was in his early 30s and battling cancer.
"He had frequented various hospitals, he had gone to various walk-in clinics and he had gone to various shelters, and he just for whatever reason — due to his mental illness and chronic substance use on the street — was denied opportunities to get adequate pain control and quality-of-life medicines to support him."
Dosani was treating the man at a shelter and convinced him to try some medications that could improve his quality of life. The next day, he learned the man had killed himself.
"He had committed suicide due to inadequate pain control for his cancer," Dosani said. "This was a very traumatic story and narrative, and I started to realize there were more and more people like Terry in our city and our country and the world dealing with this issue."
In general, Canada’s homeless population is at considerably increased risk of developing heart disease, cancer and hepatitis C. Life expectancy for homeless people and those with inadequate housing is half as long as for the rest of the population.
Dosani decided to find a way to help improve the quality of life for those facing serious illness while living on the margins. With funding support from Inner City Health Associates (which already offered primary and mental-health programs for the homeless) via the Ontario Ministry of Health and Longterm Care, he founded Palliative Education and Care for the Homeless (PEACH).
Through PEACH, Dosani delivers mobile, community-based hospice palliative care to Toronto’s most vulnerable individuals. It unites housing, mental health and health-care providers to plan an individual’s care in a judgment-free manner. This model has inspired similar operations in other Canadian cities, and Dosani has brought additional attention to the issue of palliative care for vulnerable individuals through research and national media coverage.
LOCAL SITUATION
Joanne Thompson is the executive director for The Gathering Place in St. John’s and will be part of a panel discussion on Saturday.
The Gathering Place serves homeless people as well as those dealing with unreliable housing situations, and it has a clinical space where some primary health-care services are provided.
It used a model similar to what has been practiced in Ottawa and Toronto, and Thompson said The Gathering Place can continue to look to those Canadian cities for guidance in how its health-care services can best address the needs of those it serves.
According to data maintain by the organization, 65 per cent of The Gathering Place’s guests are male and over the age of 50.
"If you’ve lived an incredibly challenged life with chronic illness and addictions, 50 is actually considered senior," Thompson said. "What we have been able to determine is very few individuals here move to 65. People die young by society’s standards."
Thus, many of the people The Gathering Place serves (the organization calls them "guests") may find themselves at a critical point where issues of quality of life and pain control become even more prevalent.
Thompson says she knows of one individual who has made use of The Gathering Place and gone on to access palliative care.
"And that would have been a person who functioned at a very high level here. The other guests don’t. When you’re chronically unwell, as most (guests) are, you’re outside supports. Even hospital stays are not often realistic. That chronic illness care is a real challenge, and end-of-life care doesn’t really exist for this population, based on lifestyle."
Thompson is hopeful Saturday’s discussion will prove beneficial in bringing people together for potential co-operation in the future.
"I’m so excited the conference is happening Saturday because it really speaks to collaboration," she said. "I think collectively as a community and as service providers, we can do more, and that’s what I think the conference on Saturday really speaks to me about. Ultimately, our solutions going forward have to come through collaborative engagement."
Also taking part in Saturday’s event is Dr. Susan Macdonald, medical director of palliative care for Eastern Health, Dr. Marilynne
Sinnott and Dr. Melanie van Soeren.
Organized by the Global Health and Palliative Care student groups, it will take place from 1-4 p.m. in M1M101, the main lecture hall on the first floor of the medical school, by the atrium.
Attendees can register in the atrium. Monetary donations for the event will be accepted, but no one interested in attending will be turned away for lack of funds.