The head of the Canadian Medical Association says he'd like to see more medical and nursing students and doctors offering their services to homeless patients.

Dr. Jeffrey Turnbull, who for over a decade has been conducting rounds every week at homeless shelters in Ottawa, says a lack of financial incentive makes it difficult to attract medical professionals to work with the homeless across the country.

Many homeless people don't have health cards, making it hard to bill for service and make a full-time career out of the work, said Turnbull.

"A young person couldn't afford to work in this environment, unless they do it for free," said Turnbull, who serves as chief of staff at Ottawa Hospital and co-founded Ottawa Inner City Health in 1998 with nurse Wendy Muckle.

But he and Muckle say students should pursue the work for rewards that are harder to measure.


Homeless people often have complex health issues beyond a simple diagnosis. (Nathan Denette/Canadian Press)

Muckle, who serves as executive director of Ottawa Inner City Health, said medical students should devote some time to the work.

"It may not be for them and I don't judge," said Muckle. "I mean we need hip surgeons and if people want to be a hip surgeon, then good for them.

"But people should at least consider what their contribution should be. I really like the undergraduate medical students and the nursing students for that reason because it is a chance to at least have them think," she said.

Complex health issues

Each week when Turnbull makes the rounds at shelters, he makes sure he has students alongside him.

"I think it gives them a sense of what life is like in a world that they're not otherwise used to," said Turnbull, who was named a member of the Order of Canada in 2007 for his work with providing medical aid to homeless people.

"Health care is very, very different in this context as well, so they have to understand what our clients are going through."

The challenges in providing health care to homeless people are unique, said Turnbull, because many people living in shelters also have physical disabilities or mental illnesses.

Homeless people are also more vulnerable to infectious diseases. A recent study from Toronto doctors found one in five homeless people who contracted tuberculosis died within a year of diagnosis.

Turnbull said the challenges go beyond simple diagnosis.

Turnbull said one case sticks out with him in particular: a man he prescribed antibiotics to after he provided care to him in an emergency ward, but who kept returning sicker and sicker with subsequent visits. Turnbull said he asked why the man wasn't taking his antibiotics.

"He said at that point: 'You just don't understand. You know you write me a prescription; I don't have the money to buy this medication. I can't go to a family doctor. I have to leave the shelter during the day; I can't go into get and rest... You just don't understand.' And he was correct," said Turnbull.

Kathleen Kilgore, a nursing student at Algonquin College, has spent two months with the Ottawa Inner City Health program, and said the experience has been both heart-warming and heart-wrenching. But she said she is committed to the work.

"An opportunity to work with them and give them the health-care that they need and deserve was something I just couldn't pass up," said Kilgore.

With files from the CBC's Chad Pawson