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After a day spent on the streets of Hamilton, outreach coordinator for HAMSMART Marcie McIlveen, right, updates Dr. Tim O'Shea and fellow outreach worker Dani Delottinville.​Glenn Lowson/The Globe and Mail

Tim O’Shea sees his first patient of the day in a parking lot behind a downtown community health centre.

The man, who is homeless, has an eye infection so bad that both eyes are nearly swollen shut. He’d been treated in hospital and discharged with antibiotics, outreach worker Marcie McIlveen explains to Dr. O’Shea – but lost them shortly after, when his backpack was stolen on the streets.

On this hot Thursday afternoon in Hamilton, Ont., Dr. O’Shea kneels beside the man on the pavement, retrieving an iPad from his own backpack to email a replacement prescription to a nearby pharmacy.

Each week, Dr. O’Shea, a member of Hamilton’s Social Medicine Response Team (HAMSMaRT), makes the rounds with Ms. McIlveen. Together, they provide some of the city’s most marginalized people with access to health care.

Over the past year and a half, the havoc wrought by the pandemic upon Canada’s hospitals has made constant national news headlines. But the intensive care unit that the HAMSMaRT team operates in is an invisible one, outside institutional walls.

Dr. O’Shea, an infectious-disease specialist, started HAMSMaRT as a side project with a colleague in 2016, and now splits his time between it, a variety of hospital appointments and his duties as an associate professor at McMaster University. The program is independent from any hospital networks and relies on grants. Its goal is to provide care to people poorly served by the traditional medical system.

Today, in addition to Dr. O’Shea and Ms. McIlveen, the team includes two other local doctors and a midwife. They focus their efforts on patients affected by homelessness, poverty and substance-use disorders. Medical consultations can happen in city parks, in local shelters, along train tracks or in nooks of the city’s escarpment – wherever their patients are.

The discrimination and stigma that homeless and marginalized people have experienced in hospitals have left many wary of the system, reluctant to seek care. Dr. O’Shea knows that to many people he is just as intimidating as a police officer. To build trust with his patients, he relies on the assistance of Ms. McIlveen.

“I’d be useless without Marcie,” he says.

McIlveen and Delottinville chat with Andrew Stevens at a small tent encampment inside Tweedsmuir Park on June 29, 2021.Glenn Lowson/The Globe and Mail

Ms. McIlveen, 39, has been homeless. She has been in jail. She struggled for many years with addiction, and, she says, she sold drugs. She seems to understand, on a visceral level, what life is like for the people she helps. Now, having been sober for almost seven years, she says she is thriving in a role that finally allows her to give back.

On this day in the parking lot, Ms. McIlveen notices a man eying Dr. O’Shea curiously as he treats the patient with the eye infection.

“He’s a doctor,” she explains, introducing them.

The man tells Dr. O’Shea that he has been thinking about going on methadone, an opioid drug that is often used to treat addiction to other opioids, but isn’t sure he has the documentation needed to register with a clinic.

“We can do that right now,” Dr. O’Shea says. He casually discusses what drugs the man uses as he writes up an e-mail to send off to a colleague.

The HAMSMaRT team has forged connections with clinics and pharmacies that are willing to work with them to ensure access to medical care for people who might not have proper ID or can’t afford transportation. A doctor might send a photo of a patient to a pharmacy, vouching for their identity, or provide a patient with bus tickets, or a taxi.

This flexibility is the crux of the team’s harm-reduction mandate. A rigid system simply would not work.

When they finish in the health clinic parking lot, Dr. O’Shea and Ms. McIlveen carry on east toward an encampment in downtown J.C. Beemer Park.

For the past year, city councils in many Canadian cities – Hamilton included – have been debating whether encampments should be allowed in public spaces.

It’s a political fight the HAMSMaRT team found themselves in the middle of last summer, when they, in a joint action with other organizations and a local law firm, won a court injunction that ultimately prevented the city, for several months, from tearing down a large encampment.

Although that fight led to the negotiation of a protocol that offered certain protections for encampment residents, Hamilton’s city council voted on Aug. 10 to do away with that protocol come September. This will allow the city return to what it calls “pre-pandemic enforcement of camping bylaws.”

Dr. O’Shea and other members of HAMSMaRT maintain that the encampments are necessary, because of a lack of other viable housing options.

Most shelters do not allow couples, Ms. McIlveen says. Others don’t allow pets. There are health and safety concerns, especially during the pandemic.

“We have seen people be restricted because of drug abuse,” Dr. O’Shea says. “If they have drug paraphernalia, they can get restricted. If they overdose, they can get restricted.”

Even when more stable housing options are offered, Ms. McIlveen says, they often do not come with the necessary supports. She has seen countless people finally make their way through housing waitlists, only to be swiftly evicted. From a health care perspective, Dr. O’Shea and Ms. McIlveen say, encampments at least allow social workers and doctors to connect with people with some consistency. As soon as encampment residents are uprooted, that work starts from scratch.

“Our sense is that a lot of time the rhetoric is aimed more at the visibility of homelessness than actually tackling homelessness. I don’t think this is a good solution. People staying in tents is not a good solution. But obviously, for some people, it’s the best solution that we have available,” Dr. O’Shea says, waving his arm at the J.C. Beemer encampment.

When a pregnant woman steps out from one of the tents, Ms. McIlveen introduces her to Dr. O’Shea.

The woman tells him she has been meaning to see a doctor since discovering she was pregnant a few months earlier. But she wanted to get into a methadone program first.

“We can do that right now if you want,” Dr. O’Shea says, pulling out his iPad. She doesn’t have ID, she warns, as they discuss a few of her options. That’s not a problem, he assures her.

Within minutes, he has forwarded a methadone prescription to a local pharmacy, and has jotted down information for an appointment the following day with a doctor who specializes in treating pregnant women with substance-use disorders.

McIlveen provides aid to a man being detained by police at a small tent encampment.Glenn Lowson/The Globe and Mail

The woman gives Ms. McIlveen a hug, thanking her for being someone she can talk to.

Ms. McIlveen gives the woman’s shoulder a squeeze before she and Dr. O’Shea head off to their next stop.

Homelessness is not an easy issue to solve, Dr. O’Shea acknowledges, and HAMSMaRT’s work is not magic. Replacing someone’s antibiotics, for example, is a helpful service, he says – but one that’s unlikely to change the recipient’s life.

But people shouldn’t have to be success stories to be deserving of care, Dr. O’Shea and Ms. McIlveen argue. And so, one barrier at a time, they keep chipping away.

“It’s hard to have success stories, because sometimes we’re spinning our wheels,” Dr. O’Shea says. “Sometimes it feels like you’re just sort of keeping people’s heads above water.”

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