StarPhoenix, March 15, 2016 - Dr. Naheed Dosani still remembers Terry, the man who inspired his passion to improve palliative care for homeless people.
They met when Dosani was doing an inner city rotation at St. Michael’s Hospital in Toronto during his residency five years ago, which included working at a homeless shelter.
Dosani admitted Terry to the shelter’s infirmary; the man’s head and neck cancer was causing him great pain. He had lived on the street for more than a decade, and had a history of intravenous drug use and schizophrenia.
“Unfortunately due to his addictions history, his mental health issues and lack of housing, he was bounced around and called all sorts of names. A user, an abuser of the system, an addict,” Dosani said.
Over time, he built a rapport with Terry and had him agree to a pain management plan.
“I remember going home one night saying, ‘Yes, we’ve charmed him,’ and I got to work the next day and I couldn’t find him in his room, I couldn’t find him in the cafeteria, couldn’t find him anywhere. And I learned he had gone into his room, spoken to his roommate, saying ‘I want to die.’ ”
Terry had overdosed on a mix of alcohol, opioids and benzodiazepine.
“What I thought at that moment was, ‘How, as a society, do we allow this to occur to our weakest, our most vulnerable in the context of a universal health system?’ ” Dosani recalls.
The Toronto palliative care doctor, who specializes in treating the homeless, was in Saskatoon Wednesday for a health innovation conference at the University of Saskatchewan. Terry’s story highlights a gap in the system that homeless people fall through, he said.
“For some perspective, this was a sample size of one — but it quickly turned into an obsession of mine and I started to realize this was a worldwide problem.”
Many health care providers now see homelessness itself as a terminal diagnosis, he said. Homeless people are 28 times more likely to contract Hepatitis C and four times more likely to have cancer. The life expectancy of a homeless person in Toronto is 34 to 47 years of age, he said.
“It’s quite a burdensome disease. And when you throw in life-threatening illness on top of that, this population falls through the cracks.”
Shaun Dyck, executive director of the Saskatoon Housing Initiatives Partnership, said Saskatoon does have some need for similar services. He noted the opening of Sanctum, an AIDS hospice, last year.
“Do we have a great handle on that right now? It’s something we’re actually looking at. When Sanctum came to us regarding this, we knew there was that issue,” he said.
“What we really are grasping now is the extent of the health needs of the homeless population.”
Dosani has hope. He’s part of a new intervention called PEACH, Palliative Education And Care for the Homeless. It provides a mobile palliative service — literally, him and a coordinator out on the street in a Honda Civic — for people who are homeless or vulnerably housed.
“We go to where people are, whether that’s a street, under a bridge, in a shelter, in a hospital,” he said.
Proper palliative care doesn’t just mean an end-of-life hospice stay — it should start at the point of diagnosis, Dosani said. It can both improve quality of life and extend it.
“It’s a question of what is a life worth? Is your life worth the same as mine, is your life worth as much as a patient on the street, is my life worth as much as a patient on the street? I’d like to think we live in a country where everybody’s life is worth the same,” Dosani said.
“My hope is that at least at the end of life, we can derive some sort of equity for all people, so there is true dignity for all Canadians from all walks of life.”