White Coat, Black Art

'I'd rather sleep on the street': Homeless cancer patient scared to stay in Toronto's shelters amid COVID-19

Robert Boast, a homeless 60-year-old Toronto man with incurable prostate and colon cancer, told White Coat, Black Art that he is more frightened of catching COVID-19 than dying from cancer.

The coronavirus pandemic is not the ‘great equalizer,’ Dr. Naheed Dosani says

Robert Boast, 60, says there is no way of knowing who is infected with COVID-19 in the city's temporary overnight shelters. (Submitted by Robert Boast)

Updated Dec. 21, 2020: 

White Coat, Black Art heard from Caroline Boast who told us her brother, Robert Boast, died on Oct. 24, while receiving palliative care. His sister was by his side. "I'm lost without him," she said in an email.

Robert Boast spoke to White Coat, Black Art earlier this year about homelessness, cancer and the pandemic. Here is the original story.

Originally published on May 1, 2020

Robert Boast is more frightened of coronavirus than dying from stage four cancer. 

The 60-year-old Toronto man has been in and out of homeless shelters, and has incurable prostate and colon cancer. 

"I get the cancer thing — that's kind of inevitable — [but] it's made me more vulnerable," he told White Coat, Black Art's Dr. Brian Goldman.

He was asked to leave a downtown shelter after testing positive for cannabis and is now staying with a friend in the city's west end.

But Boast says he's in no hurry to return to a shelter, given what he's heard about the conditions during COVID-19.

"You're going into a shelter with 30 other men and you don't know who they are," he said. 

Even though the shelter is closer to the hospital where he's treated, Boast says he would much "rather sleep on the street" than go back because "at least the streets have fresh air" and he can pick and choose the people he wants to be around.

Boast, pictured here 10 years ago, says he is actively looking for a more stable alternative such as subsidized housing in order to live with his sister. (Brian Geller/Submitted by Robert Boast)

In the city's temporary overnight shelters, there is no way of knowing who has been exposed or is infected, he said. 

"They need to be tested before they even get in the building," Boast said.

Earlier in April, the province changed its guidelines to allow mass testing of homeless shelters. Provincial protocols previously did not allow for those in shelters to be tested en masse.

The number of people sleeping in shelters each night hovers around 8,000, with occupancy rates regularly reaching 100 per cent. As of April 25, the COVID-19 outbreak among Toronto's homeless population had surged, with at least 135 cases, the majority of which come from one shelter that houses refugees.

COVID-19 not the 'great equalizer' 

Dr. Naheed Dosani, one of Boast's doctors who provides health care to people experiencing homelessness, says Boast's feelings are similar to those who are still in the shelter system. 

Dr. Naheed Dosani, who delivers palliative care to Toronto's homeless, says 'that everybody has a role to play' in protecting people's health, especially now. (Grant Linton/CBC)

Many are afraid and that fear is being exacerbated after hearing about a virus that "tends to target people who live in congregate settings and the poor," he said. 

"What we know about people experiencing homelessness is that there is a strong fear of death and that many people who are on the streets are often dealing with life-limiting situations. Now 
during a pandemic these fears, concerns and anxieties are heightened."

COVID-19 is not the "great equalizer," Dosani says, noting it has impacted structurally stigmatized and marginalized communities across the world and Canada in ways that "we have never seen."

"A former CDC director in the U.S. said pandemics are like guided missiles that impact people who live in poverty, people who are experiencing housing insecurity and people who deal with medical frailty."

In New York City, the epicentre of the COVID-19 outbreak in the United States, minority populations like African-Americans and Latino were two times as likely to die as compared to their white peers, according to a New York Times report

Canada is "only just beginning to understand" data around social factors like race, housing and income status and how those conditions impact infection and death rates, Dosani said. 

What if you're told to self-isolate, and you're living in a homeless shelter?

2 years ago
Duration 0:43
Dr. Naheed Dosani, a palliative care physician providing care for homeless and vulnerably-housed people, recounts one patient's decision.

Dosani, who was recently appointed the medical director of Peel Region's COVID-19 homelessness response, said that became clear when he was assessing a patient at a regional COIVD-19 centre who needed to self-isolate. 

"He said, 'Doctor, I actually live in a homeless shelter and if the recommendation is for me to self-isolate, well, I can't do that in the shelter. So what I'll do is I'll go to the street. I'll live on the street so that my friends in the shelter don't get sick.'"

Dosani said it "brought home the idea that physical distancing is most certainly a privilege in our communities" to which not all people have access.

But he noted "a sense of resilience" among the patients he sees.

"A client of ours is an artist and working on several projects to cheer up health and front-line workers who are visiting him in the shelter. Another client of mine that I frequently visit actually gave me a chocolate bar the other day."

"My role is to be there and care for people in our communities. But that care goes two ways and you really feel that during this pandemic." 

'This is a moral gut check'

Boast says he's also trying to be an optimist during the lockdown and is actively looking for a more stable alternative such as subsidized housing in order to live with his sister.

"I'm finding I have more support now than I did when I wasn't diagnosed with cancer. It's wonderful, it's heartwarming. I thank God they didn't forget about me," he said of his family.

However, he's frustrated that his cancer treatment and ability to see his doctor has been put on hold. In an effort to extend his life, doctors at Princess Margaret Hospital are attempting to shrink his colon cancer through hormonal treatments.

"I'm going: 'Come on!' It's just frustrating, I feel like a cow …  in a big, huge line-up."

But Boast says he's grateful for the "amazing" Anishnawbe Health Toronto where he gets more personal care.

What will this say about our society if when push-came-to-shove, we weren't able to care for the most marginalized in our communities?- Dr. Naheed Dosani

Dosani says that's evidence "that everybody has a role to play" in protecting people's health, especially now. 

"We have been able to see that various aspects of our health-care system are very important for different people at different times. When people are very sick and acutely short of breath, the place you want to be in is in a hospital for access to acute medical care and maybe even a ventilator. But for people like Robert, community health organizations are equally as important."

But he says more needs to be done for impoverished Canadians like Boast and that support needs to be continued once the pandemic is over. 

"One has to wonder if he might be in a position of worsening poverty as a result of the pandemic. What will this say about our society if when push-came-to-shove, we weren't able to care for the most marginalized in our communities?"

"This is a moral gut check, a moral examination is occurring and history will undoubtedly judge us by our actions."

Written by Adam Jacobson. Produced by Sujata Berry, Jean Kim and Jeff Goodes.

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