Tag Archives: Poverty

The role of street nurses in increasing access to health care for marginalized populations, by Meaghan Thumath, RN, BScN, MSc PH

The downtown eastside is a fascinating place to practice nursing with a rich history, diverse population and artistic flair. It is also a place where many people struggle daily without adequate housing, employment or support to manage substance use and mental health issues exacerbated by trauma and pain.

But there are numerous individuals who have made it their life’s work to support and encourage the community to thrive. Street nurses are some of the most forthright, committed and determined healthcare professionals in the country. They have made an enormous difference in the lives of those who are marginalized in places like the Downtown East Side, and they will continue, with minimal applause or accolades, to work with individuals who many others have simply written off.

While the history of street nursing in Canada has been largely undocumented, Vancouver appears to be an early pioneer of street nursing in Canada. Following the sexual revolution in 1960s-1970s, four nurses also known as “street nurses in blue jeans” began providing oral contraceptive pills and sexually transmitted infection (STI) treatment to youth. In 1988, the HIV/AIDS epidemic in Vancouver led to the creation of BC Centre for Disease Control’s (BCCDC) AIDS Prevention Street Nurse Program.

Much of the success of street nursing in Vancouver can be attributed to Liz James, the first nurse to be hired by BCCDC to provide outreach services. Sadly, Liz passed away earlier this year, but she has left a legacy of caring for those who are marginalized and struggling in Vancouver.

Liz

Liz James

Liz began working in Venereal Disease control in the 1970s and later found herself working in Vancouver city jail, where she found her passion for working with marginalized populations. Liz epitomized what it meant to build a trusting, non-judgemental therapeutic relationship with clients – many of the women she worked with saw her as a mother figure. With the rise in HIV/AIDS in the 1980s among men who have sex with men (MSM) and injection drug users in the 1990s, Liz worked with community members and purchased needles from a sympathetic pharmacist to begin a needle exchange. For every used needle she collected from clients, she would exchange one clean needle in return. Starting out as a program which targeting those that were at high risk of HIV and STIs such as injection drug users, and MSM, Liz’s needle exchange expanded to provide services to other marginalized populations such as sex workers, the broader LGBT community, and those involved with the correctional system. While the program’s primary mandate was to control and prevent the spread of HIV/AIDS and STIs, nurses like Liz also addressed the broader social determinants of health by providing resources to increase her client’s access to health and social services. Throughout the 1990s, street nurses such as Liz were determined activists, and were among the first to advocate for supervised injection services, bringing harm reduction services to correctional facilities, and education related to alcohol detoxification, to those who wouldn’t seek treatment otherwise.

According to “From the grey nuns to the streets: a critical history of outreach nursing in Canada” the grey nuns started public health visits for the sick poor in what is now known as Quebec. During the first half of the 19th century, the grey nuns spread all over the northern and western parts of Canada, where they founded many of the first hospitals within those regions. Moving into the mid-19th century, several prominent nursing leaders such as Florence Nightingale, Lillian Wald, and the Victorian Order of Nurses (VON) began to understand the relationship between the broader social determinants of health, such as housing conditions and income, and the need to reform policies that would improve the health of individuals.

The social reform movement during the turn of the 19th century led to the belief that introducing nurses into areas where people were at high risk of disease would reduce those risks, which subsequently led to the introduction of public health nurses across the country. However, with the dominance of the medical model in the early 20th century, many nurses were removed from health promotion activities. During the late 20th century, despite the presence of a universal health coverage model, the growing inequities in access to health care and determinants of health led to what we now call street nursing in large urban areas. Street nurses began working predominantly with individuals who were marginalized such as the homeless.

Street nursing today not only focuses on controlling the spread of infectious diseases such as HIV/AIDS and STIs, but also on the broader social determinants by connecting individuals to health and social services. Street nurses work in a variety of settings ranging from clinics to alleys and parks, to detox centres and correctional facilities, to name a few. The ability of nurses like Liz to build trusting, non-judgemental and non-threatening relationships with their clients is a significant contributor to the positive outcomes of these clients. She demonstrated the importance of the humanistic side of nursing, and that being empathetic and listening to the needs of patients is at the core of good nursing practice.2001 street nurse group in alley

If this history teaches us anything, it’s that nurses have the ability to improve the lives of individuals and communities, not only through knowledge, but by building trusting relationships, empowering patients to take control of their health and well-being, and speaking out for the needs of patients. Liz James’ passing serves as an opportunity to reflect back on the incredible individuals who have not only transformed the role of street nurses, but shifted the discussion around harm reduction and improved the health of marginalized populations by challenging inequities and refusing to succumb to the status quo. While our roles as nurses become increasingly complex, nurses like Liz will always serve to remind us that we should never underestimate our ability to be leaders and influence policy.

In the words of Liz’s colleague and former street nurse Janine Stevenson in the film Bevel Up “Nursing is a very political act. It is also, potentially, a revolutionary force that asks what kind of society do you really want to live in?”

The author would like to acknowledge the generous contributions of street nurses Caroline Brunt, Fiona Gold and James Tigcehlaar who provided valuable insight into the history of street nursing and their colleague Liz James.

meaghanABOUT MEAGHAN THUMATH,

Meaghan Thumath is a registered nurse and public health leader in HIV and drug policy. A former coordinator at Insite and leader of BC’s provincial HIV strategy she has over 10 years of clinical and health policy experience. Her research interests include drug addiction, health equity and gender.

Being Poor is Expensive – Nursing Needs to Raise its Game, by Zak Matieschyn BSN, MN, RN, NP(Family)

I live in a great neighbourhood in an amazing little town in the Kootenays. I have a chubby cat. My wife and I have professional, high profile jobs that pay us well. I eat three (and ok, sometimes more) meals every single day and if I’m hungry, I jump in my car and head to the grocery store. I have decent clothes, a warm bed and good health. And I know that tomorrow and next week and next year, all or most of these things are still going to be true.

But here’s the reality of life in B.C. for one out of every five kids… they live in poverty. They don’t wonder where their next meal is coming from because a full meal is something they have rarely experienced. They don’t worry about playdates after school because they know they need to be home to look after the younger kids and make sure dinner is ready for mom before she goes to her second job. They don’t do tradsies with the other kids at lunch because they only brought one slice of bread and butter that dad made that morning.

Since my first semester of my nursing education, I’ve been interested in the social determinants of health – things like income and social status, social support networks, education, employment, working conditions, environment, gender and culture. I have a passionate drive for social justice – the fair and just relation between the individual and society. I’m sure this grew in part from being one of those kids who lived in poverty for part of my childhood.

Throughout my nursing career, I’ve struggled with the worry that I’m not doing enough. I’m not making a difference. I’m not changing lives in a big way. I’ve always worked in direct care with patients and families and I can tangibly see the impact of my work on those I care for. Some people get better, some get healthier, others don’t – but through it all, I am connected by a therapeutic relationship to every single one of them, no matter what stage of health they may find themselves in. I am grateful for every success my patients experience, but I cannot and I should not be satisfied with that.

Nursing is more than that. Health is more than the absence of disease. Good health starts with prevention. Nurses know that determinants like income, education, physical environment, housing and gender have far more impact on a person’s health than any single interaction we might have with a patient in the course of a day.

We see it. Every single day we see it. We know there are people in our communities, who come into our clinics and our hospitals, and they are struggling. They don’t have the money to buy good, nutritious food for their families. They can’t find a decent place to live because every landlord has rejected them from bias of race or sexual orientation. They are exhausted because the bedbugs in their run-down apartment make it impossible to sleep.

The single greatest determinant of health is income. We nurses totally get this – poverty is bad for your physical and mental health. With poverty comes the difficult decisions of what to prioritize first – housing, food, clothing, etc. These are difficult decisions for a relatively healthy person, but for those whose monthly income relies on disability or social assistance, these decisions are impossible because the monthly amount they receive is much too low in B.C. As a result, they often end up purchasing the cheaper, and less nutritious options, rather than items that promote good health

Nursing knows better than almost any other profession that poverty is like slow-acting poison to health. It saps health insidiously over time. In the struggle just to survive, the opportunity to thrive is lost. Nurses come into contact with those who live in poverty at every step of their involvement with the healthcare system. We are the ones who advocate for them as they negotiate this system from sickness to health. We are experts at this. And yet, all too often, once they have achieved a measure of health, we move patients out the door without giving any thought to what is waiting for them on the other side. Or rather, we do know what’s waiting, but are powerless to change it.

Am I doing enough? Probably not. Are we as a profession doing enough? I know we are not.

We already flex our minds and our hearts every day with our patients and their families. What if the entire nursing profession flexed our collective strength to address these root causes of poverty? What if we ALL became activists? What if all 40,000 RNs and NPs in the province came forward and said “ENOUGH!”? What if we tapped into our tremendous knowledge and compassion to challenge the way things are? What if we joined with those who are in poverty and together asked “how can we come together to break this cycle”? What if we pursued evidence-informed social policy for our society with the same zeal and vigor that we strive to introduce evidence-informed practice into our healthcare system?

We owe it to our patients and their families. For our communities. For the kids.

Because when you are hungry and anxious about whether mom and dad have enough money to buy bread, you just can’t make yourself care about the war of 1812, or how to carry the 4. Because one out of every five kids living in poverty is NOT acceptable – and because we should NOT be comfortable with that statistic.

Our prime minister said it well… “Because it is 2016.”

ABOUT ZAK MATIESCHYN

Zak Matieschyn-cleanZak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.

Seniors Advocate Takes a Strong Stance on Housing for Seniors, by Kathryn Seely

Seniors Housing in B.C.: Affordable, Appropriate, Available is a new report launched May 21, 2015 by the Office of the Seniors Advocate. This document makes progressive and bold recommendations that will enable better care for seniors and should be reviewed, discussed and acted upon by all B.C. nurses.

I was pleased to join Julie Fraser, President of ARNBC, and Patrick Chiu, RN/MPH Student and ARNBC Intern, at the release of this transformative report. There was a lot of energy in the room, which was packed with engaged and active seniors, advocates and stakeholders.

The report outlines the housing issues faced by B.C’s seniors living across the continuum from independent housing, to assisted living and to residential care, and finds that seniors’ housing must be more affordable, appropriate and available.

B.C. has the fastest growing rate of seniors in Canada. Although 93% of B.C.’s seniors live independently, 50% live on an income of $24,000 per year or less. According to this report, this is not adequate to maintain independent living conditions.

Over the course of the last year, the Seniors Advocate, Isobel Mackenzie, travelled across the province and met with thousands of seniors and their families. At each consultation she attended, housing and housing expenses were listed among seniors’ top concerns.

In her report, the Seniors Advocate urges the B.C. government to implement 18 recommendations to improve the health outcomes for low income seniors. We were impressed by the boldness of some of these recommendations, and hope nurses will take this opportunity to provide comments and feedback on this important report.

Seniors Housing in B.C.: Affordable, Appropriate, Available recommends that the B.C. government help low income seniors live in their homes longer by offering a government-backed line of credit, called a Homeowner Expense Deferral Account, which would allow low-income seniors to defer paying for utilities, home insurance and repairs until after their home is sold. This would help seniors live independently, and prevent them from paying housing expenses instead of healthcare needs, such as medications, dental care, hearing aids and medical supplies. Once their home is sold, the B.C. government would recoup its money, along with a low-interest charge. There is precedent for such a program in B.C.; seniors are able to defer their property tax payments under B.C.’s Property Tax Deferment program. The Office of the Seniors Advocate crunched the numbers and a homeowner deferral program is sustainable – most seniors would still have equity in their homes after 20 years.

The Seniors Advocate also recommends that the Registered Assisted Living program be redesigned to support more flexibility in the services offered, allowing more seniors to live independently for as long as possible. Ms. Mackenzie estimates that up to 15% of seniors in residential care could still be living at home with extra assisted living.

The other recommendation that caught my attention is that the B.C government commits to ensuring that by 2025, 95% of all residential care beds in the province will be single rooms equipped with ensuite bathrooms. A private bedroom and bathroom is enormously important to seniors, who view this as preserving privacy and dignity, at a very vulnerable time in their lives.

Please feel free to access the report, read the recommendations and let us know what you think by posting your comments.

Nursing knows the impacts that the social determinants of health have on the health of seniors and is pleased to see that the Seniors Advocate puts housing at the top of the list.

At ARNBC, we look forward to working with nurses and other stakeholders to improve seniors’ health and health care for seniors. As the Director of Nursing and Health Policy, I am committed to advancing policies that will improve seniors health, and would like to hear from nurses who have interest, expertise, or innovative ideas in this area. As the Seniors Advocate stated, these recommendations can only come to life, if we all make our voices heard.

Office of the Seniors Advocate News Release

Executive Summary

ABOUT KATHRYN SEELY

kathryn2Kathryn is a former nurse and lawyer who has spent the past decade working in the area of public policy and advocacy. Kathryn believes that effecting policy change is one of the best tools we can use to improve health outcomes and looks forward to working collaboratively with stakeholders to help develop nursing and heath policy in B.C to advance the health outcomes of British Columbians.  Kathryn is ARNBC’s Director of Health and Nursing Policy.

Budget Lockup: Insights from ARNBC, by Zak Matieschyn, NP

Recently, I had the privilege of joining Joy Peacock, Executive Director of ARNBC, in the B.C. Budget Lockup. For those who are not aware, this is a secured room wherein around 200 stakeholders have an advanced preview of the details of the budget and service plans. This is also where the media interviews these stakeholders in order to get their stories aired in a timely manner following the budget speech.

This was the first time ARNBC was invited to participate in the Budget Lockup – an event that can only be attended by invitation of the Finance Minister. Beginning January 1 of this year, ARNBC entered a new phase, and is now a member-driven organization representing all B.C. registered nurses and nurse practitioners. Being invited to participate in Budget Lockup was a strong signal of how government views the importance of the Association and the work we’ve been mandated to do.

The budget itself was a relatively benign affair for healthcare. Increases to healthcare spending will be a very modest 2.9% per year. My review of the Ministry of Health service plan noted much of the same language as last year: commitments to primary disease prevention and health promotion, improving primary/community care through inter-professional teams, and improving rural healthcare to name a few. From a theoretical perspective – this is music to the ears of the nursing profession. As we know and have been educated, these points are among the mainstays of what are needed to reform healthcare. What is concerning is a lack of a blueprint of how we get there. We are talking about a fundamental shift in how healthcare is delivered to become more up-stream, integrated, and team-based. Uttering the correct words is a fine start, but such an objective will require dedicated monies to operationalize this plan, as well as an understanding that this will be a front heavy, longer term process. That is, the benefits will be slower to materialize than can fit in a single budget year or government election cycle. The other point lacking is collaboration with nursing. Registered nurses and nurse practitioners possess exactly the knowledge and expertise of a healthcare system described in the service plan. It is simply a waste of available talent, capacity and leadership to exclude nursing from the spheres of policy planning and implementation.

Also disappointing was the lack of mention of nurse practitioners when commenting on plans for improving access to full service primary care. Over the past 10 years, NPs have slowly been implemented to improve access for British Columbians to primary health care – both in urban and rural settings. Once again, new NPs find themselves without an existing hiring initiative, let alone a robust funding model, to permit them the opportunity to improve primary healthcare access to regions of the province in desperate need of help.

On the brighter side, I was pleased to observe the significant step of eliminating the clawback of child-support payments for single parents on income or disability assistance. This is a relatively low cost intervention (costing only $19 million annually but helping to lift nearly 6000 children out of poverty) which directly impacts the health of these individuals and the health of our society. Nursing has long known the impacts of social determinants on health and government would do very well to continue to explore these evidenced based health and social policy reforms.

The media scrum that occurred towards the end of lockup was a chaotic scene – throngs of stakeholders and reporters mobbing each other. I noticed a friend of mine in the crowd representing another group. “How does this thing work?” I asked. “You just grab the next available reporter and talk to them” she expertly answered. Seemed simple enough yet daunting to the novice that I am, but as I observed the goings on, there did seem to be an order amongst the madness. I did manage to speak with a few reporters about our associations’ reactions to the budget and with luck they may use the story.

I will sharpen my elbows for the next opportunity.

ABOUT ZAK MATIESCHYN
Zak

Zak’s interest in health and healing began at the early age of nine years-old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community, and societal health, as well as the social determinants of health during his nursing undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioners Association Executive and is the only Nurse Practitioner in B.C. who has been invited to sit on a Division of Family Practice Board (Interior). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education six years ago, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is president-elect of ARNBC.

Spare Some Change? by Jess Shannon, BSN Student

I run into a consistent portrait every time I head to the bank in Courtenay. A person in borrowed clothing with a head bowed in shame asks, “Can you spare some change?”

I wonder, “How can a person like me… a citizen in a democratic society filled with opportunity who eats three meals a day and can afford tuition to start a career, not spare some time to consider what other ways I can help?” Vancouver Island is not untouched from the epidemic of homelessness that rages in urban centres like Vancouver.  To date we count 300 homeless persons with an additional 3,000 at-risk individuals, right here in the Comox Valley.

A year and half ago, I was beginning my third year of nursing school. I was overwhelmed with writing papers and exhausted after my clinical rotations. My social life was taking a backseat and I felt like my life was consumed with school. One day as I was rushing to class, I noticed an advertisement for an ARNBC network meeting posted on the classroom door. My previous experience participating in committees has been disappointing with much debate occurring about issues, but rarely any action resulting from the discussion.  I hesitated, but in the end my curiosity got the best of me.

At the first meeting, I was surprised by the number of nurses present. I soon learned that the Comox Valley ARNBC Network is home to nurses from a variety of backgrounds who have taken an active leadership role in promoting positive change in the health of our local community.  Our group represents nurses working with mental health and addictions, nurse practitioners, BSN faculty and students, nurses from the local nursing centre, new graduates, and Care-A-Van/street nursing, to name a few.

During the meeting, I was flooded with the feeling that I had finally found a group of people who cared about their community and nursing issues, and who addressed serious community concerns with the intent to do something about it.  I felt inspired and invigorated.

Within the first year of attending network meetings, some of the members expressed concerns about the issue of homelessness and lack of supportive and affordable housing in the Comox Valley. As a group, we collectively identified the need to explore systemic barriers experienced by low-income and homeless individuals, and questioned how we could be involved as agents of change. We discussed how social determinants impact health, specifically homelessness and lack of housing, and agreed that nurses need to educate the general public and our local political leaders about the seriousness of the current housing deficiency for at-risk populations.

This meeting led to the development of our ARNBC Network sub-committee, which we call the Political Action Committee (PAC). That night a few core members volunteered to participate in the new initiative. I immediately felt compelled to join them, but I was nervous and unsure of myself – how could I, a third-year nursing student, possibly affect change in health and social policy?  How could I make a difference?

I didn’t volunteer to join that night, but when I got home, I couldn’t stop thinking about PAC’s intention. I wanted to learn about health policy and how nurses could participate in tackling something big like homelessness.  It boiled down to social justice. I couldn’t face another trip to the bank with the knowledge that I had the power to make a change for the person sitting on those steps: it was my responsibility to do something.

So, with much trepidation, I emailed the co-lead of our ARNBC network and volunteered.  After I sent the email, I fretted that I had made a bad decision – that the more experienced nurses might think I was being presumptuous and naïve.

Either way, I pulled up my socks and headed to the first PAC meeting.  I sat at the conference table surrounded by a group of very politically experienced nurses: individuals who established the first nursing centre in Canada, experienced nurse educators, a nurse who started a street nursing Care-A-Van, a mental health nurse eloquently versed in local politics, and a nurse practitioner experienced in health policy development. And then there was me, a student. “This is going to be embarrassing,” I thought.

But I stayed and listened.  I was completely shocked that none of the other nurses seemed surprised that I was there.  They all welcomed me like a colleague, and included me in the discussions and decision-making.  I left that meeting feeling like I had come home.  I was fully aware of my lack of experience, but I knew I wanted to be around these political powerhouses, and learn from these nurses who have already moved mountains.

Within a year, PAC had morphed and grown into a group of experienced nurses who were passionate about social justice.  The timing was right; the municipal elections were arriving in November and we wanted our message about homelessness and supportive housing to be heard by the public and local council members.  We knew there would be a question put to voters asking them how much they would be willing to contribute in taxes to ending homelessness.

We began collaborating with a social planning society who had similar goals about addressing the supportive-housing crisis. We brainstormed ways to inform the general public, and made plans about approaching local politicians. We had momentum, but we were experiencing difficulty in moving forward with a clear strategy.

Around this time, we learned that ARNBC had developed a pilot project for an issues workshop.  Our committee could participate in the pilot, which would help us develop clear strategies and a strong nursing voice to help address important health policy issues.  At the same time, we could provide ARNBC with feedback on how to strengthen the workshop so it could be rolled out to other nursing groups.  We couldn’t believe our luck; this was exactly what we needed to move forward.

PAC jumped on the opportunity and participated in the workshop. Following the session, we achieved astronomical strides in developing communication strategies to inform the general public and our local politicians about the housing crisis. We learned how to succinctly explain the importance of this issue in a way that would gain attention, and developed plans to keep this issue at the forefront of local politics.  We developed information strategies for the recent election, using the format of a community flyer, an inter-agency letter, and a health policy brief for elected council members.

When I first enrolled in nursing school, I had a romantic vision that I would pursue a career healing the sick as a sort of local Florence Nightingale. Nursing and politics together never crossed my mind.  Throughout my experience with PAC, I’ve learned that issues such as social justice, leadership, health promotion, and accountability are attributes of nursing that are essential to provide safe client care for everyone; in the society we live in, nursing and politics are not mutually exclusive.  When nurses identify social justice issues within our hospitals, clinics, and community at large, we can inform the public about positive changes that can be made.  It is also our responsibility as nurses to lobby our local governments in order to make those changes a reality.

Oh – our efforts paid off.  During the Municipal Election, voters were asked “How much annual property tax would you be willing to pay to reduce homelessness?”

The results:

  • 4425 – $0
  • 3657 – Up to $5 per year (for a home assessed at $300,000)
  • 6860 – Up to $10 per year (for a home assessed at $300,000)

ARNBC’s November Tweetchat will discuss political action and nursing with Jess and other members of the Comox Valley ARNBC Network.  Join us on Twitter, November 27 from 11-12pm!

jess2ABOUT JESS SHANNON

Jess Shannon is a 4th year BSN student at North Island College.  She has been an active member and is now a co-lead with the Comox Valley ARNBC network.  Over the past year, she has been participating in the development of an ARNBC Political Action Sub-Committee (PAC) in the Comox Valley, with a core group of politically motivated nurses who are passionate about addressing the issue of homelessness and lack of supportive housing in the region.  Upon graduation, Jess would like to find employment within her local community, integrating attributes of social justice and nurse leadership within her work, and is considering pursuing a graduate degree in public health and social policy.

Reflecting on the B.C. Budget 2014, by Julie Fraser, RN, MN, ARNBC President

Earlier today, February 18, 2014, the B.C. Government revealed its 2014 Budget along with Service Plans for each Ministry.  ARNBC has had some time to reflect on the budget, and hope that registered nurses and nurse practitioners will take an interest in reading the documentation and considering how this budget will impact their practice and Nursing in B.C.

Government has identified a 2.3% increase ($385 million) in the health budget for 2014.  While this might seem substantial at first glance, ARNBC is concerned that this modest increase in funding will not adequately cover the needs of our growing healthcare system.  Health authorities are already struggling to provide patient-centred care within limited budgets.  Nurses are growing alarmed as services and programs that support patients, families, and communities are reduced or eliminated across the province.  We are committed to working with nurses and government to raise and address these challenges.  We also recognize that changes in the budgets of other Ministries and program areas, which are unrelated to health, may have significant impact on the social determinants of health.  ARNBC believes that adequate health care funding is absolutely essential to the future of our publicly funded healthcare system and the welfare of all British Columbians.

The Ministry of Health Service Plan 2014/15 – 2015/16 was released today in conjunction with the budget. We were discouraged to see that the expertise, skills and knowledge of nurses appears to have been overlooked in this important strategic document.   Nurses and nurse practitioners are the backbone of the healthcare system and ARNBC will work with government to ensure the Nursing voice is heard and reflected in the future plans of the Ministry.

We encourage all registered nurses and nurse practitioners to review the Budget documents and share your thoughts and ideas on the impact they will have on your practice and patients.

Link to Budget 2014: http://bcbudget.gov.bc.ca/2014/default.htm

Link to the Ministry of Health Service Plan 2014/15 – 2015/16: http://bcbudget.gov.bc.ca/2014/sp/pdf/ministry/hlth.pdf

ABOUT JULIE FRASER, RN, MN, ARNBC PRESIDENT

JulieJulie Fraser is a Clinical Nurse Specialist in the area of Home Care. She has been a registered nurse for more than 15 years and has practiced in a number of different settings from residential care to acute medical and surgical care units, before focusing on community nursing, working in both clinical and educator roles.

Lessons from Guatemala: A Student Reflection on the Social Determinants of Health Following an International Practice Experience, by Daniel Leslie

Last April, 10 University of Victoria nursing students studying at Selkirk College departed the Kootenays for Guatemala on the 8th International Practice Experience.   This opportunity, which is available to students in their third year of the Nursing program, provides students with a hands-on opportunity to explore social justice issues, population and community health, primary health care, and the social determinants of health in developing countries.

It was a trip I will never forget and an experience that has given me incredible insight and inspiration for my future practice as I begin my nursing career here in British Columbia or take on opportunities around the world. Those of us who participate in this practice placement throughout the years are committed to sharing the stories and perspectives of the people and organizations we met and worked with in Guatemala. This dialog increases understanding of the current situation in Guatemala and our connection to common environmental issues such as mining and resource extraction.

Guatemala is a country sandwiched between Mexico to the North, Belize to the East, and El Salvador and Honduras to the South. It is a country with great biodiversity and an incredibly vibrant and diverse culture, and it has retained strong resilience and pride despite impacts of colonialism. The people of Guatemala have been ravaged by genocide, civil war, rampant poverty, and a political system that has been compromised by decades of corruption, greed, and injustice.

Daniel4We were accompanied by Mary Ann Morris, an instructor of nursing at Selkirk College, and Michael Chapman, community volunteer who is active in social justice issues. As the eighth group of students to embark on this practice experience, we were welcomed with genuine affection, curiosity and respect – expanding the relationship between our program and the communities in which we share this experience.  Our practice partners included individuals and organizations whose ultimate purpose is to address the health and wellness of the citizens of the country and advocate for change to a system that continues to marginalize much of the population.

One of the greatest influences on the social determinants of health for many of the Guatemalan people is the activity of Canadian mining companies in developing countries. Canadian mining companies have continued to ignore and allow the devastating effects on the people and environment of Guatemala (Zarsky & Stanley, 2011).

We witnessed firsthand many of the negative impacts on social determinants of health that often accompany mining activities in developing countries.  For example, income from employment is promised, but many jobs are lost once the initial infrastructure of the mine is complete, leaving environmental devastation with minimal positive spinoff to the community. Long-standing occupations such as subsistence agriculture and herding, are greatly compromised by the accompanying pollution. Physical environments become arid wastelands with polluted soil, air, and water at levels that would be illegal and considered unsafe in Canada. Water consumption by the mining activities leaves only the minimal supply necessary to maintain the life of the people and their animals.

One mine we visited pays nothing to use hundreds of thousands of liters of water every day for the mineral extraction process, whereas community members pay a fixed amount for water they can’t access – water they need to drink, to cook with, to water animals and to bathe. Social support networks are greatly challenged as community members opposed to mining become outcasts and experience threats and violence from mining supporters. Impacts to the social environment of a community include murders, violence, and disappearances, which in many cases have been linked to their opposition of mining (Amnesty International, 2012). Health effects from pollution include respiratory and skin infections, cancer, and increased livestock miscarriages.

Daniel1This experience has increased my understanding and perspective of international nursing, shed light on many concerns of international trade agreements, and inspired different ways of approaching health and wellness as learned from our practice partners in Guatemala who must rely on health promotion and Primary Health Care to improve health and wellness and avoid costly and often unavailable tertiary care.  

The incredible resilience and resourcefulness of the people of Guatemala inspires me to challenge hegemony and to look for ways to improve our own healthcare system. As I return to life in Canada, I continue to see the impacts of mining in Guatemala as news stories describe the violence and discontent. I also see the impacts that mining and the oil and gas industry is making in our own country, contaminating water and air and creating health concerns for people of all ages. I feel that our focus on improved primary healthcare in Canada includes addressing the environmental and individual health impacts of mining and mineral resource extraction.

Nurses in BC have a powerful voice in health policy. We can bring the health and wellness of Canadians to the table as the resource we are responsible for, working with stakeholders to ensure that Canada is among the countries with the healthiest people in the world.

References:

Amnesty International. (2012). Guatemala: Lives and livelihoods at stake in mining conflict.

Zarsky, L., & Stanley, L. (2011). Searching for gold in the highlands of Guatemala: Economic benefits and environmental risks of the Marlin Mine. Global Institute and Environment Institute, Tufts University. 

Daniel3ABOUT DANIEL LESLIE

Daniel is currently in his 4th year of the UVic BScN program studying at Selkirk College. He returned to school after many years as a ski patroller, avalanche technician, and crew-leader on forest fire suppression crews for the Province of BC. He is currently a director and member of Nelson Search and Rescue, combining his love for the outdoors, teamwork, and serving his community. Daniel has completed an associate certificate in mental health and addictions through Selkirk College and is currently pursuing his BCIT Emergency Nursing.  He hopes to work in these fields in the future as well as continue to work, volunteer, and travel.   Daniel is involved with ARNBC through the Network Leads Program. 

Better Health, Better Care: The Role of Nurses in Chronic Disease Management, by Patricia Foster RN

By Patricia Foster, RN

I have been privileged to work in a nurse led clinic for 17 years. The Comox Valley Nursing Centre began as a demonstration project, highlighting nurses working to the full scope of their practice, in partnership with the community.  Chronic illnesses and in particular chronic pain were the primary needs.

Patients and colleagues have taught us much: Continue reading

The Costs of Poverty in BC: Nurses’ Voices Matter! by Paddy Rodney RN

Registered nurses and nurse practitioners provide care for individuals, families and communities from all walks of life across British Columbia. Many of the people we encounter face complex health and social challenges—and such challenges are especially complex for those who live in poverty. The BC Office of the Canadian Centre for Policy Alternatives (CCPA) recently released a compelling report about “The Cost of Poverty in BC”.

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