Unhealthy wait

When Pauline Kononovich got a phone call from a homeless sex worker who needed surgery, she had no idea she was about to become involved in a two-month long battle to find the young woman a place where she could recuperate after the operation.

Kononovich, the HIV and AIDS educator at the Toronto prostitute project Maggie’s, says that the woman’s doctor wouldn’t perform the procedure unless she had a clean, safe place – with access to a private bath – where she could rest and heal.

To Kononovich’s dismay, all the hostels she called were unable to meet those criteria, nor did they know of anywhere else that could. Finally, working with the woman’s physician, Kononovich found a place and the woman had her surgery.

Stories like this aren’t uncommon among street-involved people in the downtown south-east core. Uncomfortable with hospital bureaucracy and often without access to physicians, street folk often live a third-world existence as far as medical care is concerned.

The Sherbourne Health Centre (SHC), is designed for people who need health assistance, but not through conventional means. Its mandate also targets gay, lesbian and trans people who also make up a big part of the downtown core.

The centre was originally supposed to open by the end of this year. But there have been delays, resulting in conflict between the Ministry Of Health And Long-term Care and the centre’s administration.

“There is no clear commitment to operating dollars,” says the centre’s CEO, Suzanne Boggild. “It seems like there are delays upon delays. We have given them [the ministry] detailed planning documents. And there is a year ahead of renovations. It seems that the community is more interested in service delivery than the government.”

The government is pointing its finger in the other direction.

“The ministry is waiting for SHC to provide additional info that was to come by the middle of October. There is a definite commitment to the project,” says ministry spokesperson John Letherby.

Though there’s dispute over who’s fault is the delay, most everyone can agree that Toronto’s downtown needs something just like it.

First there’s the growing number of street-involved people in the city.

The City Of Toronto Report Card On Homelessness published some startling data: Between 1988 and 1999, there has been a 40 percent increase in the total number of people staying in emergency shelters, with a 545 percent increase (that’s not a typo) in the number of two-parent families using the shelters. In October 2000, Toronto’s rental vacancy rate was 0.6 percent, meaning that of every 1,000 rental units, only six were available for rent and the average rental unit was priced at $900 a month.

Coupling these issues with the province’s predilection for closing hospitals and you’ve got a mandate for some alternative to hospital-based medical care in the area.

Residents of downtown south-east, including its gay inhabitants, were vocal in their displeasure when Wellesley Hospital was closed. It was taken over by St Michael’s in 1998 and then closed as a hospital in 2000. The Wellesley was seen as gay-positive and progressive. With its demise, there was a feeling that the downtown was losing a vital non-judgmental health service.

Anna Travers, the client service leader responsible for developing programs at the SHC that would provide services to the gay, lesbian and trans people, says these populations require more sensitivity from their health care providers. There are lots of studies that say so.

“There is a combination of transphobia and homophobia that people deal with in conventional medical settings,” says Travers. “A lot of transgendered people, for instance, don’t attend to routine healthcare because of rudeness and ignorance. We do need safer sex info, etc, but don’t reduce everything to that.”

Kononovich agrees. “The problem in this city is that when sex workers go into hospitals or agencies with, for example, a medical complication, once the doctor hears they’re a sex worker, they assume you’re having intercourse and that you’re high risk.

“A lot of places [like the city’s hostels] aren’t set up to deal with cross addictions or behavioural issues. We need places staffed with people who are sensitive to all issues and supportive.”

Christina Strang, coordinator of the Meal Trans Program, which provides meals to trans people at The 519 Church Street Community Centre, says something like the SHC is urgently needed.

“Street active people’s needs are different from most people’s,” says Strang. For example she says transsexual youth are reluctant to seek healthcare because they’re afraid they’ll be judged or they won’t be given appropriate services.

“A lot of people who run agencies are so impatient and will bar people from the services because of mental health/social issues. Many places assume that people are going to meet them on their level and, if they act up, they’re barred for life,” says Strang.

Says Robin Silverstein, homelessness and anti-poverty coordinator at The 519: “Many physicians won’t prescribe meds to HIV-positive homeless people. They may as well be living in a third world country. HIV and hepatitis C co-infection are exploding. TB, of course, has always been there. It goes through the homeless (population) really fast.”

The provincial Health Services Restructuring Commission, through research and a series of interviews, was convinced that a more progressive, grassroots approach was needed. When the commission suggested that the old Central Hospital, at 333 Sherbourne St, be turned into a centre, the seeds of SBC were planted.

The commission studied the downtown core and found that it was underserved. Feedback from the community suggested an interest in a one-stop approach to medical care and as little bureaucracy as possible.

“We are committed to developing shared partnerships with other agencies,” says Boggild. “Already, we have a chiropractic clinic, associated with Memorial Chiropractic College.” They’ve also hooked up with the Canadian Working Group On HIV/AIDS.

Travers explains that Sherbourne will insist on a holistic model. That means not just thinking that all that makes the queer community different is a concern for safer sex, AIDS prevention or hormone therapy for transgendered clients.

“The needs of the whole client will be addressed,” says Travers.

Travers cites the 8th And 8th Health Centre in Calgary as a good role model. It provides walk-in care for problems not likely to require hospitalization, public health nurses, mental health counsellors, a needle exchange for IV drug users, home care and outreach to the urban Aboriginal communities and downtown ethnic communities.

SHC will offer walk-in care, too, available 18 hours a day, seven days a week. It will also provide infirmary/recuperative care for up to 30 people at a time. Its focus will be homeless and underhoused people, following an acute care hospital stay or as a preventative measure to avoid a hospital admission. Infirmary care will include medical care and treatment as well as access to the full range of therapeutic and primary care services offered by the centre.

Corry Thomas, another of the planners at SHC, estimates that 50 percent of people in St Michael’s emergency department don’t need to be there. Their needs could be served by a nurse, a counsellor or just more support in their day-to-day living. Translated into dollars, a well-run centre could produce significant savings. He also says that the SHC is estimating that they will be seeing 100,000 outpatients a year.

Silverstein is impressed with SHC’s outline for care. The Health Bus, which SHC will be taking over, sees 80 to 100 people in the two hours when it’s parked outside the 519 each Sunday, which she says is a good way to provide services.

The homeless, she says, “don’t do well in emergency room situations. If the SHC is willing to treat them like patients, I for one will be jumping up and down for joy when they open.”

Which takes us back to the question of when.

At the ministry, Letherby expresses some frustration with the centre’s administration; he says the still haven’t offered up their cost analysis.

“The ministry has provided $2-million for the initial stages of development for 2001 and 2002 and the first four months of 2002/2003,” says Leatherby. “This is, in addition to $3-million provided to SHC for the first three years of development [from 1998 to present].” He says the ministry has provided more than $8-million for the (still in negotiation) purchase of 333 Sherbourne St building from the Wellesley Central Hospital Corporation, now run by St Mike’s. (After long negotiations, the SHC board and St Mike’s decided earlier this year not to co-manage the centre.)

Boggild says the centre has already provided everything needed by the ministry. She’s concerned about the length of time the government takes to make decisions.

“I realize how difficult it is for such a large bureaucracy to move as quickly as we would like,” she says.