Nursing on the Health Bus: A Place to Connect

Since the winter of 2002 I am a nurse volunteer on the health bus, a mobile outreach program in downtown Toronto.

Since the winter of 2002 I am a nurse volunteer on the health bus, a mobile outreach program in downtown Toronto. The health bus program was started in the late 1990s by the Wellesley Hospital just before its facility was closed by the Ontario Government. Today the health bus, which consists of two mobile vans, is housed by the Sherbourne Health Centre, a community health centre in the same area. In partnership with shelters and drop-ins the health bus makes weekly ‘stops’ at their locations. The outreach staff of the bus advise and counsel the clients. They also hand out some basic hygiene supplies, socks, toques, underwear and vitamins. In addition there is a nursing station on the back of the bus, staffed by a nurse, like myself. We supply some basic health care and over the counter medications. Mainly the nurses also make referrals, hooking up people with the Sherbourne Health Centre for medical and other care, such as foot care and chiropractic, as well as emergency services when needed. Mostly clients come in to get advice and to talk about their health concerns. This is how I connect with the clients on one of the stops every three weeks.

When I first started with the health bus I volunteered at an out-of-the-cold program. What an eye opener this experience has been for me! People were housed in a church basement for one night a week, (in this case Saturday night). They came for dinner and most of them also stayed the night. In a large room in the basement there were about 50 to 70 mattresses, with barely enough room to walk between them. That is where people slept. This arrangement shows the incredible needs for affordable housing, which bring people in to sleep (or at least spend the cold night) under these conditions. I doubt that it is possible to sleep much.

Once I met a whole family, a mother and father and two children in their teens. I will never forget the look on their faces, when they saw where they would spend the night. They had become homeless that very winter day. Due to a string of unfortunate circumstances, particularly one parent getting injured at work, the other becoming sick, they had both lost their low paying jobs a few months ago. While still fighting for insurance payments their savings ran out and they were unable to pay the rent. The landlord had kicked the family out that same day in the morning. By phoning around for help somebody directed them to the out-of-the-cold shelter. Despite the shock they were immensely grateful to get a warm supper and have a place to sleep as provided by this voluntary faith community. I often think about this family and wonder what became of them.

The people I meet as clients on the health bus are incredibly resilient and courageous in the midst of tremendous adversity. An immense resourcefulness is needed to survive on the streets, which most of us would not be able to handle. I have heard stories of how to create a shelter from scrap wood and cardboard boxes to keep warm outside in the winter. I will never forget how one man showed us nurses how to fix the special running shoes he needed for a medical condition with Duoderm, a thick type of adhesive covering used for wounds. He used Duoderm to create a smooth surface, preventing injury from the worn out edges of his old shoes, while waiting for a new pair which took several months. He shared his ‘invention’, so others could benefit from it. I also learned about plastic shopping bags that can be worn to keep feet dry in leaky boots and many other tips for surviving on the streets. A few years ago I had a small grant to develop a news letter for and by homeless (or formerly homeless) people. Working with five very talented persons they created two issues before the grant ran out. All five participants were very eloquent and knowledgeable regarding politics and homelessness, potential ways to improve the system, as well as resources which they shared with their readers. They showed great insights, which proved that they are the experts of their own life situations.

On the health bus I learn about the fears that homeless people face, constantly having to look over their shoulders, particularly at night, to prevent an unanticipated violent attack. There are never enough shelter spaces for all. Many people stay up all night and wander the streets and then try and sleep in the daytime, a few hours here or there, in a park or on the street, as it is safer to be off guard during daylight. But our clients also share their hopes and dreams. Most hope to get off the street someday. They hope to have their own place they can lock with a key, where they feel safe for themselves and their belongings. Most want to work and almost all state they do not want hand-outs from society. They want to belong and participate as full members in society, to be seen, heard and respected. They tell me that the worst experience for them is when people ignore them: ‘they look right through me, as if I was not there’ or when they are treated with disrespect. Many of their stories about how they ended up homeless are heartbreaking. Once on the street they face incredible barriers to get out of poverty and become housed again: lack of addiction treatment facilities, lack of resources to pay first and last month’s rent, lack of adequate income and job stability, an inability to deal with the complicated bureaucratic layers of our social support systems, and so on. Once they get housing it is often substandard and they end up back on the street. And yet, they carry on.

I feel incredibly privileged to contribute, in a small way, to the health of the courageous clients that come on the health bus. I only wish these special services would not be necessary and that all people could be participating fully in our society and use the same healthcare system. It is our loss to write off our sisters and brothers, who are down on their luck, who could contribute so much under the right conditions. I hope the day will come soon when the health bus program is no longer needed and housing is seen as a human right for all.

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