Pushing aside stigma, a street nurse reaches out to Cape Breton's vulnerable

A nurse in Sydney, N.S., who seeks out and treats vulnerable people reluctant to get medical attention is doing important work, according to advocates and patients who want the position made permanent in Cape Breton.

Sharon MacKenzie began working as an outreach street health nurse nearly a year ago. She works under the umbrella of the Ally Centre of Cape Breton, a harm reduction centre that services the Cape Breton Regional Municipality. 

Many people in the CBRM who experience mental health and addictions may not seek help in an ER because of past experiences or long wait times that mean they go into drug withdrawal before being seen. That's where MacKenzie comes in.

"People that really weren't accessing health care, people that ... had infections that went for a prolonged period of time without any type of intervention, people with mental health and substance use disorders that really weren't accessing treatment," said MacKenzie.

"When people say they're living rough or they're precariously housed or whatever the descriptor may be, when you actually see it visually, it's really deplorable."

MacKenzie's job is to meet vulnerable people where they are, instead of having them come to her. She provides wound care and tests people for HIV, hepatitis C, sexually transmitted infections and COVID-19. She often operates out of the Ally Centre's mobile clinic in communities throughout CBRM.

Her position, which was created after several previously unsuccessful attempts by the Ally Centre to secure funding, is currently funded through the provincial health authority, but only until early next year.

The work she's doing is very much needed, according to those using her services. Fliss Cramman, a peer outreach worker with the Ally Centre, said she prefers to see MacKenzie instead of going to the emergency room or a clinic.

"Stigma ... is the biggest reason why people do not go to the ER.," said Cramman. "There's no stigma at all with [MacKenzie]. There's no judgment. There's no nothing. She's just the best new recruit we've got for the Ally Centre."

Cramman carries MacKenzie's cards with her so when she encounters friends on the street she can encourage them to see and trust MacKenzie.

Funding for position

Janet Bickerton, who co-ordinates health services for the Ally Centre, said this type of work is just as needed in CBRM as it is in the Halifax Regional Municipality, where there is a team of people that do street health work there. The CBRM, said Bickerton, "has all the big city problems."

"We know the level of substance use is really high, we gave out over 700,000 needles last year. That's like five needles per Cape Bretoner," said Bickerton.

Bickerton said the CBRM has higher rates of hepatitis C as a result of sharing needles and many people suffer from mental health problems.

Last year, a provincial group that helps fund the centre, provided the $106,000 needed for the year-long pilot to hire MacKenzie. The centre applied to various funding streams for the position for years but this was the first time they succeeded.

Now the position has been extended from September to March 2022 through the provincial health authority's primary health stream.

Bickerton hopes the centre can make the case to have that funding become a permanent fixture. Cramman wants to see the program not just become permanent but be expanded. She believes a psychologist or counselor would be a big boost for the vulnerable population of CBRM.

"That would be even better," she said.

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