Privacy laws handcuff homeless shelter's staff

BLUE rays of ultraviolet light cast an eerie glow on the half-dozen bodies curled up on foam mattresses scattered about the floor.It's late morning at the Main Street Project, a downtown homeless shelter, and a handful of people have yet to stir from the cramped refuge where they found a spot to sleep last night. On any given night, executive director Brian Bechtel says 70 people sardine themselves in this one room -- row upon row of mattresses next to mattresses -- because they have no place else to go.

The blue UV lights shine around the clock on people clustered into the emergency shelter and detox unit because the protective rays kill or inactivate TB bacteria.

Former provincial TB-control director Dr. Earl Hershfield had the lights installed as a way to protect the homeless at high risk of contracting airborne TB.

Many of Winnipeg's homeless who frequent places such as the Main Street Project and other shelters migrated from northern First Nations communities, only to find themselves without a place to stay. The same factors associated with TB in the north are present here -- poverty, overcrowding and poor health.

The UV lights are the only protection left for this vulnerable population because privacy laws now block shelter staff from helping people take their TB medication.

"We probably would rather be a little more in the loop. I think most people feel like the old way, when we were part of it, was better," Bechtel says.

"We have relationships with people who won't talk to anybody else. We take people to hospital -- they won't go unless we drive them."

Bechtel has cause to worry. The rate of TB in downtown Winnipeg and Point Douglas is more than six times the national average.

While the rate of TB is zero in parts of the city such as St. James and Assiniboine South, the rate in Point Douglas is 30 cases per 100,000, and 36 cases per 100,000 downtown. By comparison, the national rate is five cases per 100,000.

Unlike on many reserves, physician care is available in the city. But Bechtel says few people in the core have family doctors or will go to the hospital unless someone they trust from the shelter goes with them.

The tragic death of Brian Sinclair in Health Sciences Centre's emergency room in 2008 highlighted concerns that marginalized aboriginals don't always receive fair treatment from the medical system. Sinclair, a 45-year-old Métis man and double amputee, was found dead in Health Sciences Centre on Sept. 21, 2008, after waiting 34 hours to see a doctor.

Distrust of the medical system among the aboriginal population is huge, which is why it's still so difficult to get some TB patients to take their drugs.

"I believe one of the reasons tuberculosis is rampant is (aboriginals) don't want to interface with non-aboriginal doctors in the health-care system," Hershfield says. "I think it's a huge problem which I don't think is being faced by anyone."

Main Street Project staff used to give TB medication to patients who needed it because the patients' lifestyle often made it difficult for health-care workers to track them down. Some inner-city patients had trouble completing the course of their medication because of mental-health or substance-abuse issues.

But privacy laws changed, and now shelter staff can no longer make sure Joe takes his TB drugs because they're not allowed to know Joe has TB in the first place.

The Manitoba Lung Association used to screen inner-city homeless people for signs of TB at places such as the Main Street Project to catch undiagnosed cases, but that stopped, too. The province shuffled the program over to the WRHA, which doesn't conduct targeted screening for TB, even in high-risk populations.

As a result, no one knows for certain just how many people are walking around with infectious TB and don't know it.

"I think (our staff) had a lot of anxiety about it," Bechtel says. "It is a very high-risk situation, and we have all of the high-risk factors right here, in terms of proximity, in terms of population and compromised immune systems.

"It would be naive not to think that if the disease is around, it's going to show up at the Main Street Project."

jen.skerritt@freepress.mb.ca

Republished from the Winnipeg Free Press print edition November 3, 2009 A11