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TB In Canadian Shelters

By Kathy Hardill

The last century saw more medical advances than ever before in the history
of humankind: CT scanning, magnetic resonance imaging, microvascular
surgery – a dizzying list. Which makes it at all the more ironic that, even
as we claim more superiority over the human body, it is the ancient plagues
that now threaten to kill us off in droves.
The World Health Organization tells us to expect the currently mutating
avian flu to deliver a long overdue pandemic predicted to threaten millions
of us.
Drug-resistant bacteria thrive, as if to thumb their cellular noses at what
begins to look like puny medical advances not providing much protection
after all.
Predictably, it is our cities which act as gigantic petri dishes, incubating
viruses and bacteria old and new.
These tiny organisms seek out ideal growing environments, which they find in
poverty – among our shelters, rooming houses and squats. Like hungry wolves,
they wait for the opportunity to attack first those animals at the edge of
the herd weakened by illness, malnutrition, stress.
We have seen, recently, a virulent norovirus sweep through a Calgary
homeless shelter, and sky-high rates of HIV infection among Vancouver’s
poorest citizens.
And now in Canada’s largest city, more than three years after a tuberculosis
outbreak began in its shelter system, we have a beleaguered public health
department scrambling to locate the source person whose undetected TB has
infected two shelter workers with active TB. So concerned are health
officials that they have begun the laborious process of testing as many as
4,000 homeless individuals across the city.
You know what they say: Every time you repeat history, it gets more
expensive. More than 100 years ago, New York City’s commissioner of public
health, Hermann Biggs, said: “Public health is purchasable. Within natural
limits, any society can determine its own death rate.”
Biggs would no doubt be dismayed to see how few lessons have been learned a
century later.
Public health officials knew more than a decade ago that almost half of
Toronto’s homeless population was infected with latent TB.
City officials have known for at least as long the public health risks
associated with their policy of cramming homeless people into an overcrowded
shelter system and forcing them to constantly move from place to place.
Toronto officials gambled on that risk, and now the pound of cure is proving
very expensive, indeed.
The 2001 shelter TB outbreak cost Toronto Public Health more than $500,000.
It cost three homeless men their lives. Last week, another homeless man died
of TB in Toronto. The current case-finding strategy has pulled public health
staff from many other departments and the financial costs are as yet
And so now, if I am homeless in Canada’s largest city, these are my choices:
Try to sleep outside, where I face rain, snow, disrupted sleep, violence,
frostbite, hypothermia and police harassment.
Or, try to get into a shelter where I face noise, crowding, disrupted sleep,
violence, influenza, tuberculosis, and bedbugs.
Or, try to get a mat on the floor of a church basement where I face noise,
poor air quality, even more crowding, disrupted sleep, influenza,
tuberculosis, the burden of carrying all my possessions with me wherever I
go, and the exhaustion that accompanies travelling from place to place every
night. A Hobson’s choice if ever there was one.
Perhaps I will be among the 40 per cent of unlucky homeless people who
contract latent TB infection. If I am even unluckier and develop active TB,
how long before I am diagnosed? How will my movements or my contacts be
The lessons repeat, over and over, and always the price climbs. But never,
apparently, is it ever cheap enough, cost-efficient enough, timely enough or
anything enough, to just offer people housing they can afford and let them
live there – sleeping in their own beds, within their own walls, breathing
their own air, looking after their health.
Even with a record-setting financial surplus, the federal government balks
at spending money on a national housing program. Even after signing an
agreement to spend $366 million on affordable housing, and promising 35,000
new rent supplements, the Ontario government drags its feet.
What if SARS had entered Toronto’s shelter system? Where would you
quarantine homeless people? Has anyone got a plan for that?
During the 1918 flu pandemic, Toronto city officials shut down theatres and
all congregate facilities, in order to try to stop the spread of the virus.
Now, we have about 5,000 weakened, stressed-out men, women and children
crowded into more than 60 shelters.
In an epidemic, where will these people go? In a pandemic, where will they
go? Does anyone have a plan?
Sadly, little has changed since Hermann Biggs’ time, except that now we have
microbes that are drug-resistant, and a bigger population.
How ironic it will be if the refusal of governments to improve social
conditions ends up fuelling a cataclysmic pandemic that will change society

Kathy Hardill is a Toronto street nurse who has worked with the homeless for
16 years.