Posted by Paul Manly

Executive Director

Nanaimo Unitarian Shelter

It is not unusual for staff at the Nanaimo Unitarian Shelter to experience the loss of people they know who were guests at the shelter or clients of the shower program. I get regular reports from staff about unhoused members of the community who died for one reason or another. What is shocking is when one of their colleagues dies and that death was completely preventable.

In 2023, Sophia, one of the shelter's dedicated team of professionals, died. Sophia’s death was a shock for me and for the staff at the shelter. She was young, 23 years old. She had graduated from the VIU Community Mental Health Worker program and started working at the shelter in September, 2022.

Bright, compassionate and dedicated to her work at the shelter, Sophia was well liked by staff and guests. She worked hard and did her best to ensure that shelter guests were comfortable and felt at home. In her last self-evaluation she outlined her ambitions and how she wanted to do more to assist people in our community who were marginalized and struggling. Sophia was one of our rising stars, with a bright future ahead of her, set to make an impact doing good things to assist others.

Last summer Sophia started having health complications and wasn’t able to work at full capacity. Staff members were expressing concern for her. I met with her and she acknowledged she was having trouble so we agreed that she should take a medical leave of absence. We worked with her as she struggled to find a doctor who could provide a diagnosis and the letter we needed to ensure that she could keep her benefits active. Occasionally we would get reports but then suddenly we were notified that she had died.

In late January, I received a letter from her mother outlining what had happened. I read it in shock, sadness and anger. For months Sophia’s health had been deteriorating. She did not have a family doctor and struggled to get into the only walk-in clinic in town where people line up at 6 a.m. in the hope of seeing a doctor when it opens at 8 a.m.

Sophia was finally able to get an appointment at a Youth Wellness clinic. They diagnosed her as having an eating disorder. They told her that she would be put on the waiting list for the eating disorder clinic. Sophia was adamant with her mother and the professionals that she didn’t think it was an eating disorder and she wasn’t intentionally not eating. She continued to visit the clinic in an effort to get a doctor's note for work. It took months before they requisitioned a blood panel but they didn’t request it back and it was supposed to be forwarded to the Eating Disorder clinic. Sophia trusted the professionals and assumed they knew what they were doing.

On Thanksgiving weekend Sophia’s mother took her to the emergency department at NRGH. The doctor who saw her was dismissive and gave her a prescription for a cream for what he diagnosed as hemorrhoids. It turned out that it was much more than that. Sophia’s health continued to deteriorate, her hair was falling out and she was losing weight.

Her mom took her to the hospital again on November 16, she was anemic and needed a blood transfusion. This was when it was revealed that Sophia was not on the Eating Disorder clinic patient list. On November 24 the diagnosis came in, she had a compromised immune system and had an internal infection. Nanaimo Regional Hospital realized this was beyond their capacity and had her transported to St. Paul’s hospital in Vancouver for further care. But sepsis had taken hold and she died three days later.

The immunodeficiency was treatable if diagnosed properly but it made her susceptible to infections. Working at a homeless shelter exposes workers to a range of active infections and pathogens that members of the homeless population are struggling with. It is very possible that Sophia contracted an infection at work.

At the shelter we get regular calls from the hospital for patients who are being discharged who do not have homes. We try to keep two beds open for emergency purposes like this but we have to set a hard line with the hospital because our staff are not trained for patient care and the shelter is not an appropriate environment for people with serious health challenges. We have had people show up at our door with serious infections that we have sent to the hospital and then refused to have come back to the shelter. Homeless shelters should not be a dumping ground for homeless patients but we are.

Our healthcare system is in a deep crisis. Our hospital consistently runs over capacity, staff are overworked, there are not enough doctors and patients are suffering the consequences. In this case we lost a compassionate worker, and a mother lost her child. What is even more brutal is that Sophia’s mother lost her only other child in 2020 due to deficiencies in our healthcare system. This is beyond unacceptable and demands action from the federal and provincial governments. This is what tax cuts for the wealthy and austerity and program cuts in the 1990s and 2000s have resulted in today, people living on our streets due to a housing affordability crisis and the preventable deaths of people trying to help the homeless because our healthcare system is failing.

Condolences to Sophia's family and friends.

Addendum

Here is some information to help provide context to this tragedy.

There are 20,000 people without a family doctor in Nanaimo and only 1 walk in clinic to serve them. Health Minster Adrian Dix acknowledges that more than 880,000 people in BC are without a family doctor. This makes it extremely difficult for people to get the care they need and deserve. If you are sick and feeling weak you shouldn’t have to wait for hours outside in the cold first thing in the morning to see a doctor.

The Nanaimo Regional General Hospital NRGH was built in 1963 when the city had a population of 15,000 people. There have been additions since then but the Nanaimo region has grown rapidly and has the highest percentage of seniors over the age of 75 per capita than anywhere else in Canada. This is the age when people need the most health care services. This region is a retirement destination and the NRGH will continue to serve a growing and aging population.

NRGH consistently runs at over 120 per cent capacity, there’s room for 344 beds but often 425-450 beds are full with people sleeping in the hallways. The NRGH emergency room is the busiest ER on Vancouver Island. The hospital staff are overworked and under incredible strain, which creates risks for staff and patients. There is an urgent need for a major expansion of NRGH including a new patient tower and cancer ward. This need has been known for decades.

The April 2023 Nanaimo Point in Time count identified 515 people as homeless. The data collected from BC Housing and a number of BC government ministries estimates that the number is closer to 800-1,000 homeless people. There are 69 year-round emergency shelter beds in Nanaimo with an additional 35 added in the winter time for a total of 104 beds. Of the 515 people identified in the homeless count 78 per cent of them had no access to shelter. In comparison only 15 per cent of the homeless people in Victoria and 30 per cent of the homeless people in Vancouver have no access to shelter. 78 per cent in Nanaimo!

The impacts on the health outcomes of people who have no shelter are horrific. The unhoused population struggles with preventable illnesses, infections and parasitic outbreaks (lice, scabies). This creates an incredible strain on our health care system, just visit the NRGH ER to see for yourself. It also creates a risk for shelter workers, such as Sophia who had an undiagnosed weakened immune system.

The Canadian health care system is in crisis. It’s really a sickness care system that is failing. We would be far better off if the system focussed on keeping people healthy rather than just reacting when people are sick. Following Maslow’s hierarchy of needs is a good start by making sure people have food, water, shelter (warmth and a place to rest), clothing, security and safety followed by psychological needs that can be met through social prescribing and community connection. After these needs are met people can reach their full potential and we will all be far better off.

Sophia’s mother Melonie asked me to help amplify Sophia’s story so that Sophia’s death would result in change. We can do better, we must do better - we owe it to each other.