Journalist: Haleema Ahmed
Haleema: Hello everyone and welcome back to SciSection. I'm Haleema, your journalist for this week and today we are delighted to have Dr. Naheed Dosani. Dr. Dosani is a palliative care physician, professor and lecturer at McMaster and the University of Toronto respectively, and a prominent TikTok star. Thank you for joining us Dr. Dosani.
Naheed: Hi Haleema, it's so great to connect with you. Thanks for having me on.
Haleema: Sure. So right now you're a palliative care physician. How did you know that medicine was for you and what did your path look like to getting to where you are today?
Naheed: Well, I'm actually the son of two refugees who came to Canada, in the 1970s from Africa. So I grew up in the immigrant experience, the refugee experience and knew very early about what community wellbeing was really about. And it was about the social factors you know family income, housing, food, education, social supports and so I knew that I wanted to get involved in the community in that way. And I had originally, you know, wanted to work internationally with like Doctors Without Borders and do work like that. But then during my residency actually ended up finding myself in providing healthcare to people experiencing homelessness and had a really tragic, really sad event happened. Can I tell you about it?
Naheed: So I was providing health care at a local men's shelter in downtown Toronto during my residency first year. And I came across a man that I was providing healthcare to. And he presented in a pain crisis. He was rising, shaking, curled into a ball, and I, I examined his mouth and I could see that he had a widespread head and neck cancer. He had a severe mental illness and he was a person who used drugs as well. And he was diagnosed with that cancer a year before. And when he started because of his mental illness, he wasn't able to follow up for his appointments. And so he did what any one of us would do. He tried to access care in ERs and walking clinics, and he was denied access because he was homeless. I provided healthcare to him that day and he, we built a bit of a relationship. And then the next day I tried to provide care for him again. And I had learned that he had actually overdosed on a combination of alcohol and street drugs. So he had actually died by suicide in terms of the best pain relief that he knew. This was actually a very important moment for me. It's when I started to realize that there are huge gaps, right in our backyard. There are people who don't have access to healthcare and healthcare is a human right. And I also learned about palliative care.
Haleema: I know you must've been super duper bittersweet because here you are now helping so many people who are homeless, who are vulnerably housed, but then you also had to do that experience as well. So it's heartbreaking to say the least. I think palliative medicine many assume is just a depressing kind of end of life care that you mentioned actually in one of your TikToks. As a physician who supports these critically ill patients. What do you think is a large misconception that somebody like me might have about your line of work?
Naheed: Yeah, you know, I think one of the biggest myths that people believe around palliative care is they think palliative care is end of life care. And it's just about dying. It's just about death. And that's actually the furthest thing from the truth. Palliative care is an approach to care, which emphasizes quality of life for anyone experiencing a serious life limiting illness. And actually in good palliative care, people accessing palliative care should have access to it right at the time of diagnosis and have it throughout their disease journey. It does encompass end of life care or what we often refer to as hospice care, but palliative care is actively doing something, it is not giving up. And what I love about it is it's not just a medical specialty. It's actually, it's, it's a societal thing. And actually palliative care encompasses spiritual care, social work and social support, rehabilitative sciences, medical, sciences, nursing and a whole community of support around a person - it's really that whole - whole person centered kind of care. That really speaks to - the probably all of healthcare should be speaking to.
Haleema: Is that kind of why you love it so much because it's so all encompassing because I think many of us think medicine is just biological, but I think from just looking at your content, I understand that it's so much more than that. It's sociological, it's psychological, there's so much to it. Right. So do you think that's why you love it so much because it's just so all encompassing?
Naheed: You got it Haleema. That's one of the reasons I fell in love with palliative care.
Naheed: And we often have the saying that palliative medicine is, is easy, but palliative care can be very hard, right? And that's because once you start to throw on all the bio, psychosocial factors in conjunction with the medicine itself, that's when things get challenging and the interesting things about palliative care, we don't just treat the person we're caring for. We take into account the entire caregiving unit that means supporting caregivers you know loved ones children and friends and family, and supporting them through loss grief and even bereavement. The palliative care journey continues all the way into the bereavement phase.
Naheed: And I find that it's a very holistic specialty, holistic area of healthcare.
Haleema: I think many of us, myself included have many misconceptions about the homeless, which is an area of palliative care that you work with specifically. How has your perception over the years changed regarding the homeless population regarding people who are vulnerably housed and what do you want people to know about your patients?
Naheed: You know, I think the public, you know, falls into traps around the stigma, around people of homelessness. There's an unfortunate misunderstanding that, that people who are on the streets or have precarious housing are in these situations because they get it to themselves. And that could be again, further from the truth. I've never actually met someone who wanted to be in the situation they were in, particularly as it relates to living in poverty or, or experiencing homelessness. You know, people who are on our streets and experiencing homelessness are in the situation they're in due to various intersecting factors, including trauma, a weakening social safety net as it comes, when it comes to housing and, and social assistance and downright discrimination. And so, you know, when you think about what I want people to know, I want people to know that people don't choose to be there. So people experiencing homelessness in Canada are arguably the sickest population in this country. Haleema, do you know, kind of about like how sick people experiencing homelessness are?
Haleema: In all honesty, I think just from my own experience, I don't really involve myself with the homeless population. And I now understand, like, from your content, how large the issue really, really is. From what I understand, I think in one of your, in one of your posts or something along those lines, you talked a lot about how, like, a lot of these people they're dying on the streets and they're not dying because they want to, they're dying just because that's the state that they'd be left in. And so I think that's sort of, from what I understand.
Haleema: Yeah. I mean, absolutely, but even just down to our like healthcare outcomes. This is a population that's 28 times more likely to have hepatitis C, five times more likely to have heart disease, four times more likely to have cancer. And the average expectancy for people experiencing homelessness is 30 to 47 years old. We know that housed people in this country live generally 77 to 82 years old. So homelessness actually actually cuts the lifespan by half. And so that's as bad as a serious illness, the kind of illness that a palliative care doctor would see. Right. So, you know, these, the, the, the disease of a lack of housing or precarious housing has significant consequences.
Haleema: That's definitely very, very eye opening. It's not something I don't think I've ever learned about. I think with COVID-19, we've seen how rapidly the government can put together policies and packages and things for people who are struggling due to the crisis. How, how, how have you been as I guess, a homeless care doctor seeing how quick the government can respond to other crises when there's such a long standing problem within the homeless population, especially in Toronto?
Naheed: You know, it's, it's very interesting, and it's a great point that you make. I mean, one of the things that comes to light in, and we literally a colleague and I published about this in the CBC today, about how we've seen, you know, multiple levels of government act with urgency to respond to COVID-19 in our communities. And, and actually we have seen some really positive action towards people experiencing homelessness. I'm not sure if you're aware, but insurance protections across Canada, we have seen COVID recovery programs set up. And, and there have been approaches which actually support having people supported in temporary accommodations like hotels and motels, but as we move towards the fall and the winter, there's a greater kind of discussion happening about what do we do next, right? And we're certainly at a crossroads and and begs the question of how we hope to actually see the change in our communities. And in the article that we put out today, which is entitled access to housing is not just a political issue COVID-19 has made it a matter of life and death, we argue that we've seen all the levels of government work together, work collaboratively to make change. They can also make that change to end homelessness. And, you know, for those who are interested in listening, the Canadian Alliance To End homelessness has a six point plan that they'd call recovery for all. We talk about that in the article, and I think that's a great opportunity for us to take a step forward. You know, it's, it's clear that, you know you know the government has had the ability to develop and implement a prescription for dealing with COVID-19. They now also have a deal, a prescription that they can fill for the end of homelessness in Canada, and the time is now.
Haleema: Absolutely. And as you mentioned, you know, you've been a frontline worker during the pandemic. I would obviously like to thank you so much for all of your service. How have you seen palliative care and treating the homeless population change during the pandemic? Has it become like much, much more difficult? What has it been like?
Naheed: I think one of the things that was really important about palliative care early on was, was what role were we going to play in terms of being a palliative care community and, and our colleagues as well. And how are they going to provide palliative care and this is already a specialty that has a significant identity crisis in the sense that a lot of people don't understand what palliative care is. And we were just talking about that a few minutes ago. So I think the first step was recognizing the role of palliative care which involved really early on, there was a lot of conversations about, do we have enough ventilators, right. You know, what does withdrawal of support look like? You know, palliative care really facilitated during the pandemic, a lot of conversations around advanced care planning, shared decision making, and actually what a lot of people don't realize is all throughout COVID, you know and even before COVID there, there are, there are, there are hundreds, if not thousands of people in our communities who are receiving palliative care at home, through home and community care and home palliative care, and those people were there before the pandemic. And they were there during the pandemic and the home care workers who are often underpaid nurses, PSW care coordinators, and other staff were still going out to see these people, it's supporting people at home. So we had an existing type of care infrastructure that we had to support and continue to serve. Right. which is really, really important as well. So, you know, it goes without saying that palliative care is a huge part of, of any pandemic response. And actually it's a significant part of a casualty response planning and large, mass casualties response, finding, you know, from people who are interested. There's a an article that a colleague and I wrote in Maclean's Magazine called the coronavirus palliative care crisis. And it's a good resource to learn more.
Haleema: And how do you kind of see post pandemic palliative care? Do you see it kind of becoming, or not even palliative care, the government becoming better prepared for something like this, again, especially in terms of palliative care where so many of the patients who are who are suffering from COVID-19 end up in some similar to that, where they're on like ventilators or they're away from their families, how do you hope, or how do you see the government will become better prepared for this, something like this in the future?
Naheed: Yeah, it's a, it's a really it's a really good point. I think one of the things that we need to remember is that in 2018, the federal government through Health Canada came out with a palliative care, the palliative care framework, which is a 2018 document that really gave a real sense of what the future of palliative care. And it should, and could look like in our communities and with COVID-19 we've now we've now better understood the, the, the importance from our hospitals to our communities, to long term care, which has gotten a lot of discussion, right. During the COVID-19 and, and of course home care along the spectrum, palliative care plays an important role. So the COVID-19 reminded us of how important this is as we move through the pandemic. And even after it's going to be the palliative care community to continue to advocate for quality palliative care, but also governments to work together, to actually be able to deliver a comprehensible continuity of care that, that really people who need palliative care deserve in our communities. And I think that's a really key concept to think about at this time and, and something to really consider as well.
Haleema: 100%. And I guess segwaying now more into some of your social media work, because that's something I would love to talk to you more about. You have a really, really large following on social media, especially being TikTok, which I think I've seen so many doctors take over that's where I've found most people. On your platforms (laughs), on your platforms, you often cover some challenging topics in all honesty about palliative care and about the overwhelming presence of racism in healthcare. Definitely there's probably been a spectrum of responses to your content. What has that been like?
Naheed: Yeah. You know, I mean, that's a really great point. I, I, when I ventured out to start the journey on social media, you know, be at Twitter, Instagram, or TikTok, the journey was really about providing education around palliative care and supporting people experiencing homelessness as time has gone on, you know, COVID has brought about a lot of inequities that I was already talking about before, I guess people were more interested in them. But then, you know, incidents happen in the United States here and around the world as it pertains to systemic racism. And I, and I know I I've, I've always felt, and I often have talked about the importance of discussing racism as not just as a societal issue, but as a public health emergency.
Naheed: And it most certainly is. And so whether you look at the, the, the healthcare outcomes for black and indigenous people in our communities and other people of color and health inequities that exist there, or the differences in pain management.
Naheed: For example, for people who need palliative care, where we see that, you know black people and people of color receive much less dosing of pain medicines as compared to their white counterparts, or even the public health crisis of systemic racism, police brutality, and the outcomes of that, I've taken to social media to try to bring forth that these are real issues. And these are healthcare issues. Sometimes there's a - a competing narrative where people are, you know, stay in your lane. This is not for you to discuss, but actually you can see it through COVID-19 and Ontario, we had you know, systemic racism right here in our province of Ontario around how the government was dealing in in their support of migrant workers who were not being supported at all. It's a, it's a real issue. And I'm glad I've been able to speak about it in terms of the response by, and large has been very positive here and there though, you've you, you know, I've gotten responses from people who are not so positive that some emails from accounts to my personal email account, and it's been, it's been tough. But all in all, it's been a really great experience and I continue to look forward to continuing to support this journey.
Haleema: Absolutely. And I definitely look forward to continuing to follow your content as well. And you mentioned this, this concept of systemic racism, and I think the death of, wel not even the death, the murder of George Floyd really, really exasperated all of these issues. Right. And so from that, we've seen so many educational institutions such as the University of Toronto, you know, allowing a record number of black medical students to join into the program. How do you kind of see these kinds of advances continuing? And do you hope obviously that none of this is like performative and this stuff can continue. How do you think educational institutions and even like on the individual person basis, we can keep this kind of momentum of eradicating structural racism, continuous, I guess?
Naheed: I think, you know, it's having conversations like this and keeping the pressure on you know, my, I really, you know, I really been talking to a lot of colleagues and, and, and, and in my talks and like my discourse on social media, trying to talk about the fact that it's not good enough to be non-racist, we need to be anti racist with every action with every word.
Naheed: And that if we know that, you know, racist - racism is, is a huge determinant of health outcomes, then practicing anti-racist healthcare is a political - political act rooted in justice. And we will only achieve equity and health equity in our communities. If we keep the practice of it being anti racist at the forefront of our minds and our hearts and our souls. And so that's that sentiment. We need to get people to agree on that, which I think more people are agreeing on that concept with that concept than ever before. The next step is how right. And so, you know, being an ally, how for black and indigenous communities for me has meant being very active or using the platform that I have that we're talking about to, to have these and engage these conversations and you know, being creative and, but being clear about it, it's also you know, actually providing anti racism training or where possible, and being - used my platform and privilege to support communities that needed and, and be an ally. And for me, that's also meant joining and being a cofounder for the organization, Doctors for Defunding the Police. As you know, as I've mentioned, you know, systemic racism and police brutality is also a public health crisis and pleasure of joining over 600 doctors who signed an open letter thing for not police reform, but actual defunding of the police - A change of the use of force laws by Toronto police and I'm actively advocating around that. And they're just examples of, of many others that so many others I know are doing as well, but some, some that are more personal to me.
Haleema: Absolutely. And you also mentioned indigenous health care, and I guess the overwhelming presence of racism within that as well, for many of us who live in areas like Toronto, or even more like Southern than that who live away from indigenous communities, how do you think we can connect to those communities? I guess, like, how could we connect with them?
Haleema: I mean, so, you know indigenous people live in urban and rural areas. So, you know, as a palliative care doc, it's healthcare, it's people experiencing homelessness. I actually do provide healthcare to a significant proportion of people who identify as indigenous and we know shelter system that there's a higher rate of representation of people who are indigenous than the people who are, you know, living in the community. For example, here in Toronto but it's not having - being able to meet indigenous people, allows us to have that change. It's reading around topics. So reading about residential schools and the 60s Scoop and better understanding our history, learning about the origins of some people that we kind of put on pedestals, not kind of really, in fact, John A MacDonald and the colonial bloodstain past. It means we're learning about missing murdered indigenous women - #MMYW, you know, so you don't have to necessarily meet people who are indigenous or who are of indigenous backgrounds to understand these issues. One could, could, could learn - could learn by reading, and then it's a digital world. There's lots of opportunities. And I'm lucky to work in a community of very inspiring indigenous physicians, scholars, academics, and activists, who I learned from each and every day. And, you know, they're, you know you know, from Dr. Lisa Robertson to (inaudible) to you know, many others who inspire me on, you know, and are available and you can follow them on social media and attend events and, you know, buy their books and read their writings. I mean, I think these are ways that we can connect to be really informed to better take on issues that are addressing our communities.
Haleema: Absolutely. That's really, really well said. And I think lastly, I wanted to ask, how do you think social media has and can continue to be used to foster a lot of the societal change and remove a lot of the prejudice within, you know, our very own Toronto, but really global communities?
Naheed: Yeah, I think on one hand, it's, it's really opened up the, the, the world for people to be able to have a better sense of, you know issues and social justice issues that are existing in our communities. More than ever, you can have insight into who's doing what, saying what, when, why, how, you're getting up the minute and updates on protests on, you know elections. And I think there's great power in that we've seen, you know, literally social justice movements start from a seed and, and, and grow within minutes and hours and weeks and months and then we've seen that around the world. On the flip side, you know, I would not say that social media is the, is the reason that the whole world is gonna be great and we're, we're gonna get rid of all of our problems soon, cause that's not true. It also has created, you know, a real divide between, you know, what I think, but some, some call armchair activism versus you know, out there (inaudible) activism, right? And so, you know, it's one thing to advocate for issues online, but we must take steps that are, you know are actually active in making change. And part of that is using our social media platforms, but it's also asking people to give up their power privilege and, and, and, and resources as well. And once, you know, for example, in being, anti-racist one of the calls to action to actually being anti-racist is actually to give of your own privilege and that's you know, really an essential, essential piece. Right? And if you're not doing that, then, you know, you're really missing out. Right so, you know, I think we have to consider that - that social media is a tool and it, we can use it and we can definitely use it. But if we don't use it to give up our privilege or give up of our power, then what are we really doing? Right. And so I, I think it's important to differentiate that, but I - I think it's an important part of, of, of activism nowadays, for sure.
Haleema: Absolutely. And on that note, thank you so much, Dr. Dosani for joining us today and providing us with this really insightful insight, not only into palliative care to homeless and systemic racism, a lot of the pressing issues today. Be sure to follow him on TikTok, Twitter, Instagram, to support his fantastic content and also learn a lot from the educational information that he's putting out there. Thank you so much, Dr. Dosani.