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Right Place, Right Time

Meeting clients’ needs on their own turf

Sometimes you need to meet the needs of a community right where those needs are, both figuratively and literally. That’s exactly why this program supported by Calgary Foundation was created—to bridge gaps in wellness services, bringing help to two very different communities in our city.

CAMPP: End-of-life care for the homeless

Having a terminal illness is stressful for anyone, but when you have nowhere to live, the last days, months or years of your life can be devastating and lonely. Nurse Rachael Edwards and Dr. Simon Colgan, a palliative-care physician, set out to change this in 2016 by forming CAMPP—Calgary Allied Mobile Palliative Program—to help connect terminally ill homeless people with services, and to act as advocates during end-of-life care.

“As long as I have worked out in the community, I’ve seen folks end up dying these isolated deaths in hospital or sent to hospice to die alone without their community around them,” Edwards says.

“Dr. Colgan noticed he’d get these terminally ill people in the hospital, and everything would be easy from a medical perspective. He’d get them stable, then get them out to where they came from and the wheels would come off again.”

For Edwards, a typical day as a “street nurse” can involve travelling distances in search of occasionally elusive patients. She identifies people who may be terminally ill, helps get them diagnosed and connected to primary care services, assists in navigating the system and engages with health-care workers to help them understand her patients’ challenges and needs.

Many homeless people don’t have cellphones to make appointments or stay connected with health providers. It can also be a challenge to get compassionate care for someone who is actively using drugs and alcohol.
CAMPP advocates for care with the philosophy of harm reduction rather than total abstinence, and a right to comfort and dignity regardless of what actions someone is taking in their life. The organization also takes

the view that the process of dying is a social experience, not a medical experience, says Sonya Jakubec, an adviser for CAMPP

“We look at a whole, compassionate community approach that addresses their trauma and need to make important connections,” Jakubec says. “Whether they’ve been homeless for long or short periods of time, they may be disconnected from family but have a street-level ‘family’ that can be involved. Our healthcare systems don’t always fully understand these needs. We have all these protocols and rules as to who can have

Systemic change Understanding that traditional palliative settings among the general population are not ideal for people who have spent decades on the street, Edwards and Colgan are pushing for
systemic change. They believe it is important for the terminally ill homeless to die without stigma, where their final journeys are supported in creative and flexible ways.

Edwards shares an example of how the current system can be difficult with a story about one of her first patients, a homeless man who was dying. He had been set up with a warm bed and food and reconnected with family. One of his street-family members—who was also a blood relative— spent two weeks detoxing so he’d feel comfortable visiting the hospice.

“He missed seeing him by a half hour. He died a half hour before he got there. I had to say ‘Oh my God, you’re too late,’” Edwards says. “From a systemic point of view, what does that do to the community? Their loved ones go to the hospital and they never come back. They don’t know what’s happening. People don’t fill them in. They are in the dark. There is no place to memorialize them.

“So these are the things we are advocating for, over and above the care we do.”

Story by: Karen Rudolph Durrie

Photo by Leah Hennel, courtesy Calgary Herald