This article first appeared on the CATIE website.
Une version française est disponible ici.
If healing to a large extent means making people feel whole again, then looking at the whole person may be the most effective way to heal. That is the idea behind some innovative Canadian programs that are addressing the needs of people living with or at risk of contracting hepatitis C.
Toronto’s South Riverdale Community Health Centre (SRCHC) is one such place where caring for a client means attending to all of their needs with respect for their situation. As the Hepatitis C Program Coordinator at SRCHC, Zoe Dodd has been working with patients living with hepatitis C for eight years and acknowledges discrimination sometimes denies people the care they deserve: “I can’t think of another disease where people have to prove that they’re deserving of life.”
Some of Canada’s most vulnerable populations represent 50 to 70 per cent of the quarter million people currently living with hepatitis C. While these are people of any age who inject drugs, are in prison, and are living on the street, they are predominantly youth.
In order to reach these populations, South Riverdale and two other organizations are embracing this thought: When we feel most vulnerable and our well-being is at stake – no matter the reason or cause for our ailment - being treated with respect can go a long way to addressing our needs and, ultimately, yield some very positive results in our health and well-being. Using unique methods, all three organizations employ an approach towards their clients that is neither judgmental nor authoritarian, but rather grounded in developing a mutual trust and rapport, and taking into account the broader context of their clients’ lives.
In Vancouver, Insite operates on a ‘harm reduction’ model, embracing the non-judgemental philosophy. Known broadly as the only legal supervised-injection site in Canada, Insite, which receives up to 1000 visits per day, actually fully engages clients in treatment and care and moves them away from chronic drug addiction, by showing them a sense of worth.
"she began to recognize Insite as a place of warmth and caring, a place where she could trust to ask for help with housing . ."
A prime example of this approach, says Darwin Fisher, Coordinator at the facility, is the case of one woman who, toughened by life on the street, initially showed hostile behaviour. Gradually, she began to recognize Insite as a place of warmth and caring, a place where she could trust to ask for help with housing. Today she has drastically increased her health and has even taken initiative to reconnect with her children; a prime indicator, says Fisher, of a “new-found sense of self-worth.”
As an initiative of the Portland Hotel Society (PHS) Community Services, Insite is “designed to be as low-barrier as possible for its users, recognizing that for the most at-risk users, accessing health care in a clinic or ER can be fraught with difficulties,” adds Fisher. “The detox space allows participants individual rooms with en-suite bathrooms. [It’s] a small, but significant detail in terms of dignity and privacy,” particularly for participants who are living on the street.
Insite’s measures of success include any “visit to detox or any other move towards wellness, no matter how brief, which further reflects their non-judgemental philosophy to hepatitis C care.”
On the opposite side of the country, Halifax-based Hepatitis Outreach Society of Nova Scotia (HepNS) embraces the principle of developing a mutual rapport and trust with clients with a ‘peer-based model.’ Through the ‘Spread the Word’ project, the Society’s peer facilitators – people who have first-hand knowledge of some of the realities facing their clients – equip clients with accurate information, so they can in turn spread the information forward, in order to attract at-risk populations to get tested, and to engage people living with hepatitis C.
"clients invariably agree that the ‘first hand’ accounts of the peer facilitators are especially valuable...."
In workshop settings, peer facilitators discuss the importance of testing and the benefits and difficulties of treatment. The information is initially provided in a structured setting, but clients invariably agree that the ‘first hand’ accounts of the peer facilitators are especially valuable. It is through “the informal discussions that peer facilitators develop a mutual rapport with the clients, and gain their trust,” says Adam Dolliver, a workshop facilitator at HepNS.
“Your information is great, but you don’t know what it’s like living my life, while a [peer facilitator] does,” explained a participant at a recent HepNS workshop. The peer counseling not only encourages engagement with treatment recommendations, but also increases the client’s attendance, which is crucial to success.
In Ontario, multidisciplinary clinics have proven to be highly effective in treating people living with hepatitis C by offering a ‘one-stop shop’ that provides clients ongoing care in every aspect of their lives. By taking into account the broader context of a patient’s life, multidisciplinary clinics such as the one at South Riverdale CHC “recognize that there are certain things that impact a person’s health, such as poverty or homelessness,” explains Dodd, emphasizing how at South Riverdale, “we even provide wound care, foot care, chiropractic care or cooking lessons.”
Unlike other hepatitis C treatment centers, South Riverdale not only provides treatment from a harm reduction perspective, but also addresses the other needs of a patient such as needle exchange, housing, group support, or advocacy. In one case, the Centre welcomed an individual who had been denied treatment by his specialist due to his continued use of crack cocaine. Upon accessing care, all of his needs were identified and addressed from the onset, and the patient was able to finish his treatment and clear the hepatitis C virus. He is now working in the community as an advocate for people living with hepatitis C.
These various approaches to patient treatment and counseling are successful because they are grounded in one basic concept, says Fisher, “We need to make health care fit the participant rather than the other way around.”
For more information on hepatitis C, or for a listing of World Hepatitis Day events happening in your region, visit www.hepCinfo.ca and click on the World Hepatitis Day logo.