“All diseases have two causes: one pathological, the other political.”: Rudolf Virchow, 19th Century German pathologist.

By Melodie McCullough
(Originally Published August 2016)

Every week, street nurse Kathy Hardill roams the streets of downtown Peterborough with her backpack of condoms, socks, mittens, band-aids, dressing supplies – and her business card — wandering into drop-in centres or where free meals are served, reaching out to the homeless, the sex workers, the mentally ill, the drug users, and anyone else she finds in need of health care.

Kathy Hardill

It’s perverse, she says. That the nursing specialty of “street nurse” — something that has grown exponentially since the late 1980s — exists in a rich country like Canada is something Hardill finds hard to fathom.

But she knows, because it’s so desperately needed, that it’s not going to disappear any time soon. She also knows it doesn’t happen in a sparkling clean hospital or a nine-to-five doctor’s office. It deals with lonely people on the margins of society — and it can be messy.

It requires compassion, commitment and strength.

But there’s one more thing Hardill knows — it just might be the best job on the planet.

“My passion, my love, is working with the homeless people, the marginalized,” she said in an interview with JOURNEY Magazine. “It’s work I am drawn to doing. I have worked with homeless people since 1988 and it has been amazingly rewarding on several fronts.”

Hardill is the clinical director and nurse-practitioner lead of the VON 360 Degree Nurse-Practitioner-Led Clinic on Simcoe Street in the heart of downtown Peterborough, Ontario. And, she is, indeed, overflowing with the required empathy, determination and dedication to social justice.

“I love my job. I feel very lucky.”

                  “For me, health is really not about medicine and doctors and hospital It’s about access to the social determinants of health, which is political.”

Originally from Bridgenorth, Ontario, Hardill has a Bachelor of Science in Nursing, and, at present, is working on a Master’s degree in nursing at York University. She started out as a hospital nurse on trauma and intensive care wards, but got sidetracked when she began working with the downtown Toronto Street Health program in 1988. It’s where she “cut her teeth”, she said.

She’s never looked back. In 1995 she became a nurse practitioner, and worked in Hamilton, then at Toronto’s Regent Park community health centre for nine years, and then in Bancroft with a family health team. She’s been with the VON in Peterborough for four years.

Hardill has been a social justice activist since her youth, and her activism has continued to be an evolving journey, she said. As a teenager, she was involved in the anti-war movement and opposed nuclear proliferation, and in the late 1980s was involved with Nurses for Social Responsibility.

“I developed a political awareness and a worldview more and more connected to the need for social justice. For me, health is really not about medicine and doctors and hospitals. It’s about access to the social determinants of health, which is political,” she said.

Her inspiration comes from the 19th Century German pathologist, Rudolf Virchow, whom she quotes: “All diseases have two causes: one pathological, the other political.”

”Data shows the more money you have, the more healthy you are, with less illness and a longer life,” she said. “Many of the health problems we see every day wouldn’t exist if people had access to the social determinants of health.”

Social determinants – known as the building blocks of health – include adequate income, employment, nutrition, housing, education, literacy, and a violence-free environment.

In Hardill’s world, there’s a river of health care with an upstream and a downstream.

Downstream is where you find people who are already sick and where the health care emphasis is on treatment, she explained. But upstream is where you find the root causes of those downstream illnesses, and where the work can be done to prevent and alleviate them.

“My work here allows me to marry my interest in upstream advocacy with downstream needs from a social justice point of view. It’s what I learned as a young street nurse. I believe that working upstream saves a lot of downstream grief and mortality and cost.”

“I am inspired and humbled to have met literally thousands of people over the years … who have endured conditions and life events many would consider unsurvivable, and still they manage to resiliently live their lives.”

The Peterborough clinic, which opened in 2011, has a team of nurse practitioners, registered nurses, social workers, dietitians and pharmacists. It provides health care to those who are not serviced by the traditional health care system – street people who experience chaotic lives because of lack of housing, substance abuse or mental illness. These people may face stigma and lack access to traditional health care.

The clinic offers an easy downtown access point, a non-judgmental atmosphere, and provides the same services that a regular primary care family practice does. It is not a walk-in service. Clients vary from young families with children to the frail elderly. (See note below)

Some people may be wary about using the clinic, explained Hardill. Her weekly walks are a way of getting to know the street people, making non-threatening overtures, and letting them know she is an ally, but this may take months, she said. There are showers and laundry facilities at the clinic, open to anyone, which is another way of gaining trust.

There’s also a program that assesses people’s incomes and makes sure they are getting all the money to which they are entitled.

“That alone will have an impact on health intervention and do more to help than what a nurse practitioner will do in her office,” said Hardill.

The clinic takes a harm reduction approach to substance abuse that believes people who use substances do so for a reason.

“It’s a symptom of underlying emotional pain and/or trauma,” said Hardill. “It’s what people use to control their pain or feel better until they can feel better some other way. We try to work with people to figure out what’s underlying, and whenever they are ready to treat that, we will be there to help.”

If they are not at that point yet, the clinic helps them use in the safest way, she said, by letting them know what’s on the street, telling them to always use with a friend, and giving them information about overdose medicine and treatment.

“This philosophy addresses the humanity of people,” said Hardill. “It says, ‘I want to help you, but not judge, and when you’re ready, we’ll walk that journey with you. Until then, we’ll keep you safe.‘ “

“It’s a concept of compassion that says you’re an important human being and I care about you. That message is powerful and people respond to it. I’ve seen people turn their lives around who you might think would end up dead in a ditch.”

Her years of work as a street nurse have not dampened her spirit; they have strengthened it.

“I am inspired and humbled,” she said, “to have met literally thousands of people over the years going through one of the most devastating, dangerous, demoralizing situations possible – homelessness – who have endured conditions and life events many would consider unsurvivable, and still they manage to resiliently live their lives.”

Kathy Hardill is a RED PASHMINA INC. Woman of Impact nominee.

Please note: The VON 360 Degree Nurse-Practitioner-Led Clinic now has a waiting list of approximately 18 months for new patients. However, nurses from the clinic sometimes visit Peterborough’s One Roof Community Centre, and help people with medical concerns. No appointment is necessary. Contact the centre at:   warmingroom.ca/oneroof/