A doctor’s journey from privilege to compassion
Dr. Stephen Hwang had never met a poor person before he attended university. He grew up in a privileged enclave in Southern California where no one was hungry or homeless.
It came as a shock when he arrived in Boston for pre-med studies to see vast disparities in wealth. Harvard Square, where the university was located, was pleasantly upscale, but neighbourhoods such as Roxbury and South Boston — in which poverty was deeply entrenched and had been for generations — opened his eyes and his mind. “I volunteered at (homeless) shelters and food banks,” he recounted. “These were real people who had dignity and strength and gave me more than I could give them”
Hwang’s concept of Christianity also changed. His exposure to the predominantly African-American Christian Fellowship on campus convinced him that “the gospel calls us to lives of social justice and caring for the poor. I finished medical school knowing I wanted to serve marginalized people.”
On Canada Day 2015, Hwang, now equipped with three degrees — one as a biochemist, one as a doctor and another as a specialist in public health — plus 20 years of experience as a physician and researcher working among the homeless, became director of the Centre for Research on Inner City Health at St. Michael’s Hospital.
Founded in 1998, CRICH is Canada’s only hospitalbased research organization that explores the links between poverty and illness and finds ways to reduce health inequities. Hwang puts it in simpler terms: “We want to improve the lives of people who are marginalized. That’s our North Star, our guiding principle.”
He moved to Toronto 19 years ago. He had done his internship and residency here, but returned to Boston to join Health Care for the Homeless, a nonprofit organization that serves people living on the streets and in emergency shelters. “I learned how to be a physician for people who are homeless and discovered I had a knack for doing research that complemented my clinical work.”
St. Michael’s Hospital recruited him to combine the two. The downtown hospital, which serves Toronto’s homeless and underhoused, patients living with HIV/AIDS, newly arrived immigrants and refugees, urban aboriginals and people struggling with mental illness and addictions, offered Hwang an opportunity to join its medical staff and investigate the root causes of its clients’ poor health.
“The arc of my research is the same as the growth of the (research) centre,” Hwang explained. “It started as a tiny enterprise, just me doing little projects. A researcher’s first impulse is to look at a problem and describe it: the (elevated) death rate among the homeless, their lack of access to mental health care. But research has to make a difference in people’s lives.” That can be done in three ways, he said. The most direct way is to develop interventions that work, such as Chez Soi (Housing First) which proved through rigorous research that the best way to help homeless people with mental disorders and addictions is to house them, then start treating their problems.
The second way is by putting issues such as violence against women in the public eye. When the health consequences are spelled out clearly and the impact of intervention is demonstrated, it gives the issue legitimacy as something society needs to deal with.
The third way is to provide the evidence governments need to design effective policies. They sometimes — in fact frequently — ignore it, Hwang acknowledged ruefully. “The victories are small and few. We have to be determined and persistent.”
He is the fourth director of CRICH. Over its 17-year history it has grown from a handful of doctor-scientists into a multidisciplinary team of physicians and researchers housed in the Li Ka Shing Knowledge Institute, a modern facility attached to St. Michael’s Hospital. “We share a common philosophy,” Hwang said. “We want to create a fairer, more just society. We think preventing poverty and illness is a highly effective way to invest in health.”
After an intensive initiation in management, administration and strategic planning, he hopes to spend one day a week running the centre and split the rest of his time between his clinical work (he is a physician at Seaton House, Toronto’s largest homeless shelter for men and an internist at St. Michael’s) and his research.
His colleagues don’t know how he’ll keep up that pace. He isn’t sure either. What he can say with certainty is that he’ll never lose sight of the mission of the centre: to lift up the poorest, least healthy members of society. Carol Goar’s column appears Monday, Wednesday and Friday.