As the child of refugees who struggled to access healthcare in Toronto, Dr. Naheed Dosani always knew he wanted to inspire social change through a career in medicine.
But he can pinpoint the exact moment he chose to dedicate his life to health justice in the field of palliative care.
During his residency, he found himself caring for a man named Terry who was experiencing homelessness, substance use, and a serious mental health condition. Terry had also been diagnosed with terminal neck cancer.
“He hadn’t been able to get the care he needed, and he died a very agonizing, painful death in the shelter,” says Dr. Dosani. “That experience changed me forever.”
Although the health system has long recognized the importance of palliative care, Dr. Dosani—who is now a palliative care physician and researcher at St. Michael’s Hospital—says that people experiencing homelessness often lack access to it.
“Palliative care can be a really beautiful thing that enables a peaceful passing for those who receive it. But shelter-based palliative care is not something our system is able to deliver,” he says.
“This means that when they’re dying, people in the shelter system can experience significant pain, existential distress, and frequent transfers to the emergency department.”
Yet they are also far more likely to face life-threatening health issues and die prematurely.
Unhoused people are five times more likely to have heart disease and four times more likely to have cancer compared to the general population. And their average life expectancy is just 34 to 47 years old.
“We have to do a lot better if we truly believe in a human rights-based approach to palliative care,” says Dr. Dosani.
Leading change
For more than a decade, Dr. Dosani has been working to improve access to compassionate end-of-life care for people on the margins of society.
In 2014, he launched the world’s first mobile palliative care program for unhoused people with just his own car and the support of a street nurse.
Called PEACH, or Palliative Education and Care for the Homeless, the program now has a network of mobile clinics across Canada. It’s also been replicated in the United States, Australia, and other countries around the world.
“PEACH is a partnership between a number of different organizations that have come together in recognition of its urgent need, including Inner City Health Associates, Kensington Health, Ontario Health’s Toronto Central and Downtown East, and Unity Health Toronto,” says Dr. Dosani.
He’s also leading groundbreaking research as an investigator with the MAP Centre for Urban Health Solutions at St. Michael’s, Canada’s largest research centre focused on health equity and social determinants of health. A significant portion of the work taking place at MAP is funded by donor dollars.
“At MAP, we’re looking at how we can create models of palliative care that support equity for the unhoused population, the issues and gaps faced by community workers in connecting individuals with palliative care, improving guidelines around this work, and much more.”
He says that MAP has provided a truly innovative space for this work to happen.
"MAP is the pinnacle of anything and everything related to equity-focused solutions for complex health issues impacting vulnerable people,” he says. “Not only are we asking incredibly important questions at MAP that don’t get asked elsewhere, but it’s being done with expertise and care for the populations we’re working for.
And as co-chair of Improving Equity in Access to Palliative Care, an initiative funded by Health Canada, Dr. Dosani has overseen the delivery of $2.3 million to 23 projects across Canada focused on improving equity in palliative care.
“This work is really changing how we do things in the world of palliative care right across Canada, from mobile-based programs like PEACH to changes in paramedic practices to harm reduction approaches and beyond,” he says.
A more just and hopeful future ahead
As he pursues his vision of health justice, Dr. Dosani is driven every day by the stories of the people he’s cared for.
“I think of Pandora, a young woman who was struggling with substance use and dying of heart failure. Our team was able to allow her to die in a place where she was comfortable and cared for, surrounded by her street family,” he says.
There was Richard, an Indigenous man who was able to engage in his passion for soap sculpting before he passed away.
And Archie, a former engineer who found himself living in a men’s shelter before being diagnosed with terminal cancer. He loved to do the daily crossword at Allen Gardens, so the team would provide care for him in the park with his consent.
“I’m reminded that we must always remember to acknowledge the full dignity of each person beyond the stigma of their marginalization,” says Dr. Dosani.
Now, when he thinks of the future of palliative care in Canada, Dr. Dosani is optimistic.
“We’re seeing action and change. Public and philanthropic dollars are being invested in this work, and there’s recognition across the health system that this is important,” he says.
“I’m hopeful that in the future, people will face fewer structural barriers to care. They’ll live longer lives. And we’ll be a better and healthier society because of it.”
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