Toronto Star, Apr. 24, 2003
What would Nightingale say?
What would Nightingale say?
What would Nightingale say?
By CATHY CROWE AND KATHY HARDILL
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It would shock the world's best-known nurse that some people in Toronto
cannot take the simplest measures to ward off disease
While the domain of public health may have had a reputation for being
plodding, even sedate, in comparison to the adrenalin rush of emergency room
care or the beeping, flashing, high-tech gadgetry found in critical care
units, the past weeks of the SARS crisis have propelled public health into
an unprecedented spotlight.
From our vantage point at the beginning of the 21st century, public health
strategies seem so low tech: face masks, gloves and gowns to protect
oneself, proper ventilation, meticulous handwashing, quarantine in one's
home.
Daily public health press conferences where doctors drive home the
handwashing message seem almost archaic given a media culture that includes
Chicago Hope, ER and DaVinci's Inquest.
The reality is that the basics of public health have changed very little in
the past 100 years. While some may be shocked that we must rely on these
simple practices to protect ourselves from diseases that can traverse the
globe with unprecedented speed, it may come as even more of a shock to
realize that some people cannot even do these simple measures.
Imagine, for example, that you are homeless.
If you are staying in a homeless shelter with one or two toilets and sinks
for 60 people, which may or may not have soap or towels, you will not be
able to wash your hands very often.
If you are living in a crowded basement shelter with no windows, air
circulation will be next to non-existent.
You will likely sleep less than a metre from your neighbour. There may be
anywhere between 20-100 people sleeping in the same room.
Nearly everyone has a cough
ù close to 40 per cent have already been exposed
to tuberculosis. Several days from now you may be forced to seek new
shelter. In the morning you will likely enter a nearby drop-in centre to
obtain food, or to see a nurse or to use a phone or washroom. If you should
require quarantine, where would you go?
Needless to say, poor health prevails in these settings. Shamefully, so do
poor nutrition and severe hunger.
Street nurses have seen clusters of infectious diseases and outbreaks of
disease in Toronto's shelter system for years: Hepatitis A, the Norwalk
virus, and the oldest disease known to humankind, tuberculosis.
Such outbreaks are predictable consequences of social conditions such as
overcrowding. In fact, the TB outbreak which began in Toronto's shelters in
2001 was predicted by front-line health workers as far back as 1994. Despite
the marvels of modern medicine, three homeless people died of consumption,
in the 21st century, in Canada's richest city.
As Florence Nightingale said, "Bad sanitary, bad architectural, and bad
administrative arrangements often make it impossible to nurse." As two
street nurses who have been around the block a few times, we know too well
what Flo meant.
It is exactly because of the poor sanitary and architectural conditions
(read: shelter and rooming house conditions), and administrative
arrangements (read: city officials that won't respond to documented
inadequate shelter conditions) that we struggle for improved shelter
conditions, for affordable housing, for adequately funded community based
programs such as drop-in centres.
Our work should be seen as a simple plea for help, based on the notion that
food, income, safety and housing protect people's health. Simply stated,
housing is protection from disease.
Experts are predicting that we can expect SARS or a comparable infectious
disease to raise its ugly head again. If Toronto's crusading Medical Officer
of Health, Dr. Hastings, was alive today he might well say, "Even SARS is
not merely a human disease. It is a social disorder."
In recent years, public health infrastructure has been seriously diminished
due to funding cuts. The polarization of community health activists and
public health officials has been detrimental to creating a cohesive response
to this crisis.
Surely, now, it is obvious that we must infuse public health departments
with adequate resources.
Similarly, we have an opportunity to build housing, to reduce crowding in
shelters, to restore staffing levels in our institutions to allow proper
cleaning, to put monies back into schools for soap and paper towels, to
increase welfare rates so single people and families can pay their rent and
afford to eat every day.
Let's do it
ù in the name of life and health.
---
Cathy Crowe and Kathy Hardill are street nurses who have been
working with the homeless in downtown Toronto for 15 years.
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