What’s
Love Got to Do with it? …Everything!
Health Issues of Homeless and Marginalized Women (Part two)
By Margaret Anne McHugh
How the 416 Drop-In works
The 416 Drop-In Centre focuses on service
delivery rather than advocacy. They
offer services - including health and medical services - to women who attend
the daytime drop-in. What they are able
to provide is limited: they can usually obtain some welfare, an OHIP or drug
card for anyone who is a legal resident in Canada. There are, of course, some
issues for refugee claimants and those without status. Even for their legal resident clients, there
are issues and barriers to encouraging them to seek and receive service.
About 90% of the women who frequent the 416
have mental health problems. Often,
they also suffer from addictions to alcohol or other substances. The drop-in works with the women on their needs rather than trying to make
them “fit into the system.” The women they serve tend to be
“non-compliant” with medical advice and tend to want a quick fix. That results in two problems: they will not
sit and wait for service in locations like a hospital emergency room; and they
will not follow medical advice unless it seems to solve an immediate
problem. For example, they will use an
inhaler when they are wheezing, but not on a regular basis to avoid an attack.
The women using the 416 Drop-In often do
not want to admit to having a mental health diagnosis. As I said earlier, they see it as a
stigma. They tend to deny their mental
illness and may, therefore, refuse medication.
For these women, living on the street or on the margins of society, they
may not see their health problems – whether physical or mental – as their
priority problems. Ironically, this may
be their easiest access to service.
In order to try and get women to deal with
problems before they become severe, the 416 staff watch the women for signs
that they may need, for example, some health care service or adjustment in
their medication. They would inform
Lynn Hemlow. Lynn’s job is to try and
get the women to seek and accept appropriate healthcare. This takes skill. Once Lynn gets a woman upstairs (into the clinic area) she has to
establish trust. For example, in order
to get a woman to provide a urine sample to check for a bladder infection, she
promises to let the women dispose of the unused urine herself (because she may
be worried about drug testing). Lynn
also gives out cigarettes and coffee, so that she can keep a woman around long
enough to do a Pap test, a blood test and so, on in order to identify any other
health problems that the woman may have.
She says that she may only get them “one time”, so she has to try to provide
as much service as she can. (On the
other hand, there are some women who would happily seek medical care on a daily
basis just to have a private chat with her, sometimes to get some drugs, or to
complain about aches and pains because they didn’t get their “medication” - AKA street drugs – that week).
Each woman at the 416 is dealt with as an
individual: each has her distinct needs.
The 416 also acts as the trustee for 180 women who pick up money and
medication there on a daily or weekly basis.
Many women also use the drop-in as an address for receiving mail
including cheques. It is a place that
many women trust, and where many women feel safe.
The
influence of crack
Joy and Lynn say things have changed a lot
in the past 20 years. The primary reason
seems to be crack cocaine. There was a
time when the women were kinder and gentler: they helped each other and would
never steal from each other. Now,
because so many women are seeking money for crack, they often steal from each
other and manipulate each other rather than working together, or helping each
other out.
Psychiatric
facilities – what’s the problem?
There are systemic problems with the
admittance procedures to psychiatric facilities:
It is difficult for those who are “on the margins” to get admitted:
institutions have some problems separating mental health from other issues like
addictions and homelessness.
The health care system in general does not want the “non-compliant
group” in hospital.
People who are “never going to recover” but who just need their
medication adjusted are not among those that they will admit to hospital.
Treatment-resistant patients are unwelcome: because the hospital
expects no improvement, they don’t want them “on the books.”
Young
women’s issues
Francine Small works in Hamilton at Planned
Parenthood, as a Community Services Coordinator. She works with young people on the street dealing with sexual
health issues, as well as other health issues.
She identifies the needs for young women as distinct. If you are “underage” and home is untenable,
when you leave, you tend to become visibly
homeless immediately. So, specific
issues for young women include:
·
Access to housing
Finding safe, affordable housing is problematic. Some landlords will not rent to youth. They end up staying in abandoned buildings, often without running water, which creates its own health issues. Money is an issue – they cannot get first and last month’s rent. Even if they find an apartment, they can’t afford to furnish it.
Welfare
It is difficult to access workers and to get an independent cheque.
·
Gangs (or wannabe gangs)
You need a
“family” to protect you. Gangs may seem
attractive; sometimes, they are just coercive.
Some gang initiations can cause injury.
Some initiations are not voluntary and may involve forced sex and/or
branding.
·
Identification
Often kids on the street have run away from home and cannot access
their identification.
·
Appropriate shelter
It is often
unavailable. When there is space, youth
have issues with curfews and age limits.
Like their adult counterparts, they also worry about theft and bed bugs.
·
Education
This is an issue
for a lifetime – kids on the street usually cannot stay in school. If they try, they may get “kicked out” for
absence or illness.
·
Health
They have no money for prescriptions. They may not be able to access the health care system because of discrimination, lack of ID, undiagnosed mental health issues or survival sex - forced prostitution.
Homelessness is a trauma
According to Ase Hallgren, we should treat
homeless and marginalized women as trauma survivors. She works for AIS, an agency for the mentally ill. Ase says of a local lobby organization, “we
don’t call it the Toronto Disaster Relief
Committee for nothing!”
Trauma has an impact on how a woman sees
the world and how she acts in it. It
also has an impact on how the world reacts to her. Although she acts like
a woman who has experienced trauma, she is treated
like someone who is not cooperative or compliant.
Some women end up in the street because of
an initial trauma in their past or in their family. She may leave home initially because of it.
Once you are on the street, it is not a
safe place. Women are regularly beaten
and sexually assaulted or used. Both
Francine and Ase mentioned women who felt “grateful” after an assault: “at
least he didn’t kill me”. Apart from an
initial trauma, being homeless – on the street – is enough of a trauma for
anyone. Being cold, wet, hungry and
unsafe for a sustained period of time puts a person in the same league as those
who experience war or violence as their social norm.
If health care workers were trained to
recognize the signs and stages of trauma in the street people that they treat,
they might be less judgmental and paternalistic in their caregiving. Moreover, care might become more accessible
to those women who are treated in institutional settings like hospital
emergency rooms. For example, some
street people’s affect seems “flat”. That flatness
is part of the stages of trauma. If you
block everything out - you don’t feel much and don’t react too much – then you
have less pain.
The economics of homelessness
The Toronto Disaster Relief Committee looks
at homelessness as a disaster and the people who are homeless are the victims
of the disaster. So why don’t we treat
them like victims of disaster? Is there
some societal benefit to maintaining a certain level of homelessness? A cynic might argue that in the same way
that capitalism requires a certain level of unemployment to function, the
corollary would be if you are not manageable as a worker, you will be end up on
the street, so “keep your nose clean”.
According to Jack Layton, national leader
of the NDP, in a speech made in December 2003, 60% of women who pay in to
unemployment insurance are not eligible to collect it. That puts them on welfare or on the street if
they can no longer afford their housing.
It appears to be integral to the way the system functions.
If you weren’t mentally ill before you
found yourself sliding into hidden or visible homelessness – you will likely be
mentally ill after. At the very least,
you would probably turn to substances – either legal/prescription or illegal
drugs. The general system response is:
you cannot have a home, but you can have these
drugs; they will, at least, making being cold, lonely, and in danger, feel
tolerable.
Often using medication or even street
drugs keeps people on the street alive.
It can be a way of coping. You
take a drug (one that eliminates pain, creates euphoria and allows for escape)
that dulls the pain of the trauma to keep yourself alive long enough to find
the solution.
Problems
and solutions
To summarize:
Specific identifiable issues with the
funded health care system for marginalized women include:
fragmented services
lack of appropriate services
Non-covered Ontario Drug Benefit Plan (ODB) drugs, vitamins, minerals and other
supplements, which are not covered
rules – For some agency staff, they feel that some agencies are more
concerned about their staff than the clients – public health “red zones”
certain places: workers don’t go there because it isn’t deemed “safe”. Yet people in those locations need their
services.
wait-time - Some agencies make people wait for a long time. This creates difficulties, especially for a
woman who is extremely restless because of the drugs she is taking.
health card - Some agencies won’t see anyone without a health card.
Solutions for all homeless women include:
Access to a variety of housing to fill a variety of needs:
supportive housing that is more communal in style.
housing where services are available, but without too many rules
recovery housing for women addicts
After detox and after rehab, without
long-term recovery housing, a woman
ends up in her old neighbourhood with her drug-using friends. Her old substance of choice is what keeps
her pain-free. This is especially true
if she cannot afford any psychotherapy to deal with the root causes of her
issues.
A lot of housing needs to be repaired. Renovations at Moss Park, for example,
improved the look of the outside of the building (keeping the neighbours
happy), but not the inside. Many women
appear to be housed, but they live in buildings with apartments functioning as
crack houses. The women are terrorized
by drug dealers, noise and threats, especially at night. In some places, garbage litters the halls or
balconies. No one is responsible for
getting it picked up.
Good therapy, psychotherapy and counselling – not just psychiatry,
which tends to be focussed on medication
An infirmary and hospice for women who live on the street
A place for post-operative patients
Even if they live in a room, some isolated women need help to stay well after hospital discharge.
One final note about health care
issues. Ase mentioned that she knows
people on the street who have died and adds that the subsequent autopsy was
unable to indicate a cause of death.
She suggests that they died of a “broken spirit”. So, I am left sadly humming…
What the world needs now is love,
Sweet love
It’s the only thing
That there’s just too little of
What the world needs now
Is love, sweet love
No, not just for some,
But for everyone
Announcements: 416 Fundraiser March 31st at the Great Hall ( Bloor and Dovercourt)
.
Tickets are $50-$75
-$100 based on ability to pay. For more information or to order
tickets -- mamchugh@sympatico.ca.
Received….
From Women’s Health Matters
In the news:
* Many men would rather cope with STDs than condoms
* Silicone implants may interfere with mammography interpretations
* Fetus size may be more important than blood sugar in gestational diabetes
* Most women feel birth control is up to them
* Those with eating disorders more likely to abuse substances
* Women ‘dis’
their competition most when fertile
* Kidney disease on the increase in elderly women
* Lifetime stroke risk higher for women
* Many men would rather cope with STDs than condoms
To read these and other news stories, please go to the Women’s Health Matters
News page:
http://www.womenshealthmatters.ca/news/index.cfm
Health Care for Black Women
Black women and women of colour are concerned about the same health issues as
other women. Sometimes though, due to cultural differences, socioeconomic
factors and racial intolerance, these women have to work harder to stay
healthy:
http://www.womenshealthmatters.ca/facts/quick_show_d.cfm?number=485
Morning Sickness, or Something Worse?
Not all nausea during pregnancy is normal. In fact, it may be a sign of
something called Hyperemesis Gravidarum (HG). Read more:
http://www.womenshealthmatters.ca/facts/quick_show_d.cfm?number=484
Sunnybrook & Women’s Doctor’s
Response to Cancer Society’s Position on HRT
Read Dr. Jennifer Blake open letter to the media:
http://www.womenshealthmatters.ca/news/news_show.cfm?number=310
February Highlight on Sexual Assault
Sexual violence is a prevalent and devastating problem, and it can be very
difficult to know where to turn to get the help you need. Find help here: http://www.womenshealthmatters.ca/resources2/Feb04picks.html
Bladders problems
Urinary incontinence is a subject most people would rather not discuss.
However, it is an important one for women to think about early, as it affects
as many as one in four women at some point in their lives: http://www.womenshealthmatters.ca/facts/quick_show_d.cfm?number=488
Endometriosis, Pain & Infertility:
Treatment Options
Endometriosis is a disease that causes pain, but its impact doesn’t stop
there. Read the coverage of a
presentation at the 2004 Women’s Health Matters Forum + Expo:
http://www.womenshealthmatters.ca/facts/quick_show_d.cfm?number=487
Answers to Questions on Breast Health
Dr. Sandy Messner’s answers to readers’ questions about Breast Health:
http://www.womenshealthmatters.ca/le_club/expert/q&a.cfm
Story of the Month: The Day My Life Ended
One woman’s experience with sexual assault led her on a journey of depression,
then healing, and finally, a decision to help others.
http://www.womenshealthmatters.ca/le_club/stories/index.cfm