Toronto Community Hep C Program

Low Barrier, Accessible and Supportive Service

As part of Toronto Community Hep C Program (TCHCP), for over ten years South Riverdale CHC has offered comprehensive, group-based Hep C treatment and support to people who use substances and/or have difficulty accessing mainstream health care.

The last year and a half has seen important developments for the program. Beginning in August, 2019, all of our non-clinical programming has been delivered by people with lived experience of HCV and who are former clients of the program. In September, as one of three models of care across Canada, the TCHCP was featured in a short documentary produced by Canadian AIDS Treatment Information Exchange and the International Network on Hepatitis in Substance Users. In 2020, we published a paper on our successful peer outreach testing project; this described the delivery by 11 current/former clients of rapid Hep C antibody tests to nearly 400 people who were at risk of Hep C. We also published a study which looked at health care administration data and found a reduction in emergency department visits among women, and a decrease across all Hep C program participants in emergency department visits for soft tissue infections.

Like many other SRCHC programs and services, the Hep C program had to quickly adapt when COVID-19 hit. During the pandemic, staff has continued to offer Hep C care and support at the Health Centre. We’ve also continued to engage clients and our patient advisory board to find out what people’s needs are at this time, to continue the Hep C conversation and to figure out how we can be more responsive to current needs. Many Hep C staff have been redeployed to support other essential services (such as supervised consumption) or to new COVID-19 efforts including screening and lobby support, outbreak management for shelters/respites, and mobile COVID-19 testing in the community. Hep C staff have also been supporting the development of a safer supply program, conducting Indigenous-focused outreach and supporting homeless encampments. For many people who use drugs and live in poverty, Hep C is not the biggest priority at the moment. The overdose crisis and need for safe shelter/housing are more pressing for survival. By addressing the social determinants of health, TCHCP has always aimed to meet client needs more broadly than just Hep C.

Even as other Hep C programs have had to decrease services, the TCHCP has remained committed to providing accessible, supportive and low barrier service during COVID, with ongoing treatment initiation and support over the continuum of care. We have explored new partnerships and ways of delivering care that are responsive to the changing needs of clients. And as the pandemic continues, we will continue to meet clients where they are at. We offer what is needed most while we build relationships and partnerships. This will become the foundation for addressing the elimination of Hep C in the future.


Beach-East York Neighbourhood Voice: East Toronto’s South Riverdale Community Health Centre announces new CEO

Jason Altenberg begins his new role Jan. 16




Jason Altenberg is the new CEO of the South Riverdale Community Health Centre. He begins his new role on Jan. 16, 2020. – Jeff Speed

The South Riverdale Community Health Centre (SRCHC) has a new leader.

Jason Altenberg, who joined the centre in 2005 and has held a number of leadership roles with the organization, is the SRCHC’s new chief executive officer.

Altenberg, who for the last five months has served as the SRCHC’s co-CEO with Shannon Wiens, will begin his new role on Jan. 16.

In a Dec. 10 letter, the organization’s board of directors said it selected Altenberg after consulting with staff, community partners, and other stakeholders as well as holding a national search.

“The board believes that Jason has the right balance of knowledge, experience and expertise that make him an ideal candidate to lead SRCHC in our rapidly evolving and changing health care environment,” they wrote.

“Jason has worked for over 25 years in east Toronto and is an innovative, strategic leader who has dedicated his career to reducing barriers to access and improving health outcomes for at-risk communities.”

In a Jan. 9 statement, Altenberg said he’s “looking forward to continuing to lead South Riverdale Community Health Centre in the excellent and innovative work that this organization has been doing in the east Toronto community for over 40 years.”

“I’m excited about our recent expansions providing harm reduction outreach services on Danforth Avenue and East York, our new Harmony Community Food Centre serving East York and Crescent Town neighbourhoods, and our role as an anchor partner in the recently announced Ontario Health Team for east Toronto.,” he said.

“I am eager to move us forward to bring quality integrated care and health equity to more east Toronto communities.” East Toronto midwifery program serves vulnerable women

‘I would say it was the most wonderful experience.’: client




Shruti Madhiraju, right, with her husband Dilip Srikant and their infant daughter, Anaha. Madhiraju was a client of SRCHC’s MATCH midwifery program for the birth of her child. – Madhiraju/Srikant family photo


MATCH program midwife/co-lead Shezeen Suleman examines a client at the South Riverdale Community Health Centre. – SRCHC photo


Midwives Shezeen Suleman, left, and Jenna Bly co-lead SRCHC’s MATCH program. – Joanna Lavoie/Torstar


Midwives Shezeen Suleman, left, and Jenna Bly co-lead SRCHC’s MATCH program. – Joanna Lavoie/Torstar

1 / 4

It doesn’t matter if you’re an immigrant to Canada, a person of colour, an individual without Ontario health insurance, someone who uses drugs, is poor, queer, trans, a single parent or homeless, you can still obtain the care of a midwife in east Toronto.

Last fall, the South Riverdale Community Health Centre (SRCHC) launched an innovative program called Midwifery and Toronto Community Health, MATCH for short, that focuses on breaking down barriers for those who have had trouble accessing or wouldn’t typically seek out midwifery services.

Based in the SRCHC’s main location in Leslieville at 955 Queen St. E., the program is run by four midwives who provide clients with complete care during pregnancy, childbirth and the postpartum period (including newborn care), as well as sexual and reproductive health care. Clients, who can also benefit from a full slate of programs and services at SRCHC, can choose to have their baby at Michael Garron Hospital, at the Toronto Birth Centre or at home.

“We offer the full-spectrum of pregnancy care. We also know not all pregnancies are wanted. We recognized that’s a reality, especially for vulnerable individuals. … We want people to come and get care in a dignified way,” said Shezeen Suleman, who co-leads the program with fellow midwife Jenna Bly.

First-time mom and newcomer Shruti Madhiraju is one of the 80 clients who benefited from the MATCH program during its inaugural year.

Last spring, Madhiraju’s family physician went on maternity leave just a few months before Madhiraju was due. She was offered the services of another doctor but decided to pursue a more natural birth. At the recommendation of some friends and acquaintances, Madhiraju sought out the services of a midwife to assist in the birth of her now 4½-month-old daughter, Anaha,

The MATCH program was the first clinic to respond to her query, and after meeting with Suleman, Madhiraju and her husband Dilip Srikant, who live downtown but within the SRCHC’s catchment area, went with the MATCH program.

“We didn’t know what to expect,” she said Madhiraju, who said she really appreciated the MATCH program’s diverse environment and inclusive approach.

“I would say it was the most wonderful experience. The kind of care we got from them was really amazing.”

Madhiraju, who is originally from India but has called Canada home for two years, said she was especially impressed by the 24-7 availability of the midwives, adding the time they took to care for her and her baby was “really reassuring.”

Jason Altenberg, SRCHC’s co-interim CEO, said the centre has had a decades-long relationship with midwives in east Toronto and it only made sense to incorporate this practice into the primary-care services and programs offered at the local community health centre.

But, doing that was a challenge, because there was no money available to hire midwives and operate such a program in-house.

“The funding models that existed didn’t allow midwives to be part of our interdisciplinary team,” he said, adding that, until recently, midwives operated only in practice groups and were paid based on the number of clients they served.

Two years ago, the Ontario Ministry of Health and Long-Term Care started accepting proposals for alternative payment models for midwives. South Riverdale Community Health Centre, whose mission is to improve the lives of people who face barriers to physical, mental, spiritual and social well-being, successfully made its case to become the first CHC in Ontario to offer in-house midwifery care by salaried midwives.

“This salaried model allows us to really do a different kind of work,” Bly said during MATCH’s one-year anniversary celebration on Nov. 14.

“We’re also able to devote more time to committee involvement and research work.”

She said being a salaried midwife has given her and her colleagues more time to devote to clients, especially those with more complex cases.

Altenberg said MATCH’s first year was focused on figuring out what the program would look like, developing relationships with the other programs and services at SRCHC and in the community, and determining who were the clients who would most benefit from the care of midwives.

Going into year 2, he said, the almost-full MATCH program is now “hitting its stride” and the team is excited to keep moving forward in the meaningful work they do through the development of even more partnerships, notably with Michael Garron Hospital, and initiatives that will better serve vulnerable populations.

East Toronto Health Partners launch community response to ‘surge up’ during winter and flu season to improve care for clients and families, reduce hallway medicine

(Nov. 27, 2019) Toronto – The cold winter months and holiday season trigger a heightened demand for health and community care services, often referred to as ‘winter surge’, causing increased pressure on a system already under strain. In addition to more patients with influenza-like illness, Emergency Departments (EDs) typically see more visits for norovirus outbreaks, falls on ice and exacerbation of chronic illnesses. Hospital EDs also see an increase in visits for mental health issues, often intensified by the holidays.

However, surge is not just a hospital issue. Community services including family physician practices, shelters, walk-in clinics, home care and others, feel the same seasonal pressures. Unlike hospitals, community services are not typically part of the response to “surge”.

For the second year in a row, East Toronto Health Partners (ETHP), a prospective Ontario Health Team (OHT), is taking a community-based approach to an annual challenge. ETHP began 2019/2020 winter surge planning in August with over 30 health and community care partners; ETHP is investing $1.5-million to fund 25 surge initiatives from November 2019 to March 2020.

“This community-based approach to winter surge is one example of integrated care in action to help people in East Toronto stay well,” said Carol Annett, VHA Home HealthCare, on behalf of East Toronto Health Partners. “This enables us to wrap care around clients, patients and families, and to localize care for our most vulnerable communities and neighbourhoods, putting the needs of our community above the interests of our individual organizations.”

These 25 winter surge initiatives focus on improving access to community-based services, keeping community members across East Toronto well, supporting better transitions home from the emergency department or following hospital admission, and helping to address broader community pressures.

Some initiatives already underway include:

  • Enhanced accessed to community flu clinics for vulnerable populations: In November and December, East Toronto Community Health Centre Community Flu Clinics are offering flu shots at a number of Toronto Community Housing buildings. The initiative is organized by South Riverdale Community Health Centre, East End Community Health Centre, Access Alliance, Flemingdon Health Centre/Health Access Thorncliffe Park, VHA Home HealthCare, WoodGreen Community Services and Toronto Community Housing.
  • Mobile flu clinics for seniors: In November and December, a mobile flu clinic is offering flu shots and falls risk assessments including home screening to minimize trips and falls by clinicians from VHA Home HealthCare to Toronto Community Housing residents and WoodGreen Community Services seniors’ unit buildings.
  • Mental health and addictions services during the holidays: Enhanced access to walk-in counselling and primary care services during Dec. 23-30, 2019 will be available to individuals experiencing isolation, stress, anxiety, or food insecurity. The initiative is organized by WoodGreen Community Services, Family Services Toronto, Catholic Family Services Toronto, Yonge Street Mission and Sherbourne Health. In addition, South Riverdale Community Health Centre and Inner City Health Associates will provide enhanced primary care services in youth mental health and addictions shelters in East Toronto.
  • Increased investments in the ED: As of September, Michael Garron Hospital increased physician coverage and hospital staffing to support high ED patient volumes to improve access and timeliness of patient visits.
  • ETHP’s Home2Day program: An initiative that offers earlier transitions home from hospital for low-risk respiratory illness patients. This hospital at home model, organized by Michael Garron Hospital, VHA Home HealthCare and WoodGreen Community Services, transitions patients home after two days in hospital when their stay would typically be seven days, with enhanced supports at home, in addition to virtual care.

“The Home2Day program helped me a lot. It got me home sooner and that’s the goal,” commended a recent Home2Day patient.

In early 2020 additional surge initiatives are set to roll out to support wrap-around care for clients, patients and families in East Toronto, from enhanced primary care services, to youth mental health offerings and support for individuals experiencing substance use and addictions.

This community-based approach builds on ETHP’s response to winter surge last year; at the time, more than 10 East Toronto community partners participated in the planning and delivery of integrated, local health services. This year, with the momentum of the partnership and the OHT model, surge planning involved more than 30 partners and ETHP has more than doubled its initiatives from 11 pilot projects last year to 25 initiatives this year.

About East Toronto Health Partners (ETHP)

As an evolving network of health, community care and social service providers with a long history of delivering East Toronto solutions together, ETHP is dedicated to creating an integrated model of services that places patients, clients and families at the centre of care. ETHP anchor partners include: WoodGreen Community Services, Providence Healthcare (Unity Health Toronto), South Riverdale Community Health Centre, VHA Home HealthCare, Michael Garron Hospital Toronto East Health Network and East Toronto Family Practice Network. Read ETHP’s full Ontario Health Team application here.

About East Toronto Family Practice Network (EasT-FPN)

As an anchor partner of ETHP since October 2019, EasT-FPN seeks to engage all family physicians in East Toronto to become the voice of family practice, supporting engagement of primary care in the design and development of a local integrated model of care. As a network of self-organized physicians, EasT-FPN is the first family practice network of its kind in Ontario. To learn more, visit:

Media contacts

Erica Di Maio
Communications, Michael Garron Hospital, Toronto East Health Network
Communications, East Toronto Health Partners
Email: [email protected]
Phone: 437-993-8419

Tracey Turriff
Communications, VHA Home HealthCare
Communications, East Toronto Health Partners
Email: [email protected]
Phone: 416-565-8483

Beach-East York Neighbourhood Voice: Harm reduction services coming to the Danforth and East York

South Riverdale CHC secures funding to launch street outreach pilot project

News Oct 14, 2019 by Joanna Lavoie

From left, Rhiannon Thomas, the coordinator of SRCHC’s COUNTERfit program, and André Hermanstyne, a community health worker, hold naloxone kits, which will be distributed to people who use drugs in The Danforth and East York areas through the agency’s new street outreach project. – Joanna Lavoie/Torstar

An east Toronto agency is taking its work to reduce harm from substance abuse to the Danforth and East York.

Starting this month, South Riverdale Community Health Centre (SRCHC), which for 20-plus years has helped people who use drugs access new, sterile needles and syringes, safer crack stems, injection and smoking kits, education and referrals to a wide range of services and resources through its COUNTERfit harm reduction program, is launching a new street outreach project.

The two-year pilot is made possible through a $250,000 grant from the Public Health Agency of Canada’s $30 million Harm Reduction Fund.

The Leslieville-based organization has also received a one-year, $69,000 grant to hire a full-time community health worker and five part-time peer workers as well as host four outreach events in the community.

The new East Toronto Outreach Project will see a small team of harm reduction workers, some of whom have lived experience, hit the streets to get to know people who use drugs in the underserved Taylor Massey, Crescent Town, and Oakridge neighbourhoods as well as along the Danforth from roughly Greenwood Avenue to Main Street.

Relevant harm reduction programs and services will then be rolled out as relationships with substance users in this part of the community evolve.

Another goal of the project is to strengthen and develop new partnerships with social service and health-care organizations as far east as Warden Avenue and secure an accessible space on the Danforth.

“The initial part is about building up that trust and engaging with people then developing evidence to get more funding so this pilot project can be more permanent,” explained Rhiannon Thomas, the co-ordinator of South Riverdale’s COUNTERfit program.

The South Riverdale Community Health Centre, which serves those living in an area roughly bounded by Lake Shore Boulevard East to O’Connor Drive and from Coxwell Avenue to the Don Valley Parkway, started working to expand its harm reduction services in the spring of 2018 by hosting a community meal and paid focus groups with about 45 people from the East Danforth area who use drugs. The goal was to gauge if those surveyed wanted to see these kinds services available on the Danforth, and to determine what effective and accessible harm reduction would look like.

The organization also consulted its staff to get their thoughts on the expansion.

“Everyone very clearly said they want outreach to protect themselves and others, and to prevent overdose,” said Julia Barnett, South Riverdale’s manager of urban health and consumption services.

Leigh Chapman, a Leslieville-based nurse whose brother Brad died of a drug overdose in 2015, said providing people who use drugs with more opportunities to access non-judgmental programs and services will make all the difference.

“Those connections can absolutely be a life-saving intervention. The more people looking out for each other, the better,” said Chapman, a strong supporter of supervised consumption sites.

“(This expansion) shows how SRCHC is such a responsive organization. They’re really willing to think outside the box and be innovative.”

A former volunteer co-ordinator at the unsanctioned Moss Park overdose prevention site, she’s seen firsthand the great need throughout Toronto, including in the city’s east end, for more harm reduction services.

“There’s really nothing east of Carlaw,” Chapman said, adding harm reduction is about acknowledging drug use exists and providing people with the necessary supports.

Barnett said SRCHC has been aware of the need for dedicated harm reduction services on the Danforth and in East York for some time, but there just haven’t been resources available for expansion.

“We know there’s a high incidence of overdose in this area from EMS statistics. We know those needs are there,” she said, pointing to August 2019 data prepared by Toronto Public Health that has identified Danforth Avenue, east of Victoria Park Avenue, as a so-called hot spot for suspected opioid overdoses based on calls received by Toronto Paramedic Services.

Between July 1, 2018 and June 30, 2019, Toronto EMS responded to 4,208 calls for suspected opioid overdoses in Toronto. About eight per cent of requests for assistance came from the Danforth East/East York area. This figure is based on numbers collected by neighbourhood and intersection.

Currently, SRCHC distributes harm reduction materials and resources to people who use drugs in the east end through a mobile service.

More Photos:


A sampling of some of the harm reduction equipment that will be distributed to people who use drugs in The Danforth and East York areas through a new street outreach project by South Riverdale Community Health Centre. – Joanna Lavoie/Torstar


From left, André Hermanstyne, a community health worker at SRCHC, and Rhiannon Thomas, the coordinator of COUNTERfit program, hold naloxone kits, which will be distributed to people who use drugs in The Danforth and East York areas through the agency’s new street outreach project. – Joanna Lavoie/Torstar


Rhiannon Thomas, the coordinator of SRCHC’s COUNTERfit program, holds some of the harm reduction equipment that will be distributed to people who use drugs in The Danforth and East York areas through a new street outreach project. – Joanna Lavoie/Torstar

Leigh Chapman

Leigh Chapman, a Leslieville resident, shows off a tattoo of her brothers signature who was homeless and died after addiction struggles. – Justin Greaves/Torstar

Leigh Chapman

Leigh Chapman, a Leslieville resident, stands near a pedestrian tunnel in her neighbourhood. Her brother Brad Chapman was homeless and died after addiction struggles. – Justin Greaves/Torstar


From left, Rhiannon Thomas, the coordinator of SRCHC’s COUNTERfit program, and André Hermanstyne, a community health worker, hold naloxone kits, which will be distributed to people who use drugs in The Danforth and East York areas through the agency’s new street outreach project. – Joanna Lavoie/Torstar

Leigh Chapman

Leigh Chapman, a Leslieville resident, stands under a pedestrian tunnel in her neighbourhood. Her brother Brad Chapman was homeless and died after addiction struggles. – Justin Greaves/Torstar

Leigh Chapman

Leigh Chapman, a Leslieville resident, stands near a pedestrian tunnel in her neighbourhood. Her brother Brad Chapman was homeless and died after addiction struggles. – Justin Greaves/Torstar

Leigh Chapman

Leigh Chapman, a Leslieville resident, stands under a pedestrian tunnel in her neighbourhood. Her brother Brad Chapman was homeless and died after addiction struggles. – Justin Greaves/Torstar

East Toronto Health Partners Webinar September 23, 2019

A view of Riverdale with the city skyline.

On September 23, ETHP hosted a webinar to discuss the engagement and co-design work that is currently underway, to provide updates on primary care engagement and involvement, and to answer your questions as we work to develop a transformative health care model that wraps care and services around patients, clients and families.

The slides are available here > ETHP-Fall-Webinar-September-23-2019.

The full Webinar with audio, and including answers to questions received from participants, is available below:

Neighbourhood Voice: Toronto’s Crescent Town gets a new food hub at Harmony Hall

Toronto’s Crescent Town gets a new food hub at Harmony Hall

Facility has renovated kitchen, washrooms and main hall

New Kitchen

Chef Afrim Pristine teaches Malcom McIntosh and his sister Lily how to cut slices of cheese in the new ‘Community Food Centre’ inside Harmony Hall Centre. – Justin Greaves/Torstar

East Toronto residents of all ages will soon benefit from a new food hub in Crescent Town.

Earlier this year, South Riverdale Community Health Centre’s (SRCHC) Harmony Hall Program became a partner site of Community Food Centres Canada, a national organization that works to build health, belonging, and social justice in low-income communities through the power of food.

As a result, Harmony Hall (Centre for Seniors), which integrated with the SRCHC just over two years ago, secured $150,000 in funding, which was used to upgrade and expand its outdated kitchen and renovate its washrooms, main hall, and upstairs storage area. This money also allowed the SRCHC to hire a co-ordinator for its new community food centre, which is only the third of its kind in Toronto.

The newly upgraded and expanded kitchen at Crescent Town’s Harmony Hall -Joanna Lavoie/Torstar

“This new and improved kitchen will help us connect with the community better,” Kathleen Ko, the co-ordinator of Harmony Hall’s Community Food Centre“This new and improved kitchen will help us connect with the community better,” said Kathleen Ko, the co-ordinator of Harmony Hall’s Community Food Centre.

“Now we’re not only engaging seniors, but we’re opening the doors more to the local community … kids, families, adults. There’s definitely a need.”

Ko said they’ve also been in discussion with local schools and community groups who are interested in using the new kitchen for programming.

Shannon Wiens, SRCHC’s director of organizational health systems, said they’re excited to be able to serve more people in the community through the new food hub at Harmony Hall.

“There’s lots of need in the Crescent Town community for food-related programming,” she said.

“Basically our goal over the next year is to explore what is needed in this community and begin to implement a range of food programs. Our ultimate vision is to create empowered, healthy, and thriving communities where everyone belongs.”

Earlier this month, Harmony Hall hosted its first official event as an official community food centre: A fun children’s cooking workshop featuring chef Afrim Pristine of west Toronto’s Cheese Boutique. A small group of children from the SRCHC’s Kids Can Cook summer program were invited to take part in the special class, where they prepared a delicious European-inspired summer meal.

Avril Ancheta is impressed by a cheese and meat platter during the Kids Can Cook event at South Riverdale Community Health Centre’s new “Community Food Centre” at East York’s Harmony Hall.-Justin Greaves/Torstar

“I hope they can continue doing programs like this here. My kids were really looking forward to this class,” said East York resident Jennifer Kim, whose children Lily, 8, and six-year-old Malcolm McIntosh took part in the July 9 workshop.

“(This new kitchen) looks really great. It’s always hard to find space for community programming so it’s nice they have this space.”

As for Lily, so said she “really liked” the class in the bright, newly renovated kitchen.

“I think (the kitchen) is really nice and I really like cooking,” said Lily, who will be starting Grade 4 this September at Blake Street Junior Public School.

This fall, several food-related programs will begin at Harmony Hall, including weekly community meals, kids’ cooking classes, and gardening workshops. Programs will run at 2 Gower St., near Dawes Road and Victoria Park Avenue.

“This is the beginning stages of offering programming at the new Community Food Centre at Harmony Hall. We’re just getting started. We’re consulting with the community and more programming will be rolling out in the fall,” said Wiens, adding sponsorships, donations and strategic partnerships are also needed to offer even more programming and services at the new East York food hub.

Visit or call 416-461-1925 for more information.

Announcement: from the Board of Directors on Lynne Raskin’s Retirement Celebration

July 22 2019 – Announcement – Lynne Retirement Celebration – Sept 4 2019

July 22, 2019

The Board of Directors of South Riverdale Community Health Centre (SRCHC) would like to invite the community to join us for a Retirement Celebration of Lynne Raskin, Chief Executive Officer, from 5:00 p.m. to 8:00 p.m. on September 4, 2019 at 955 Queen Street East Room A/B. This is an opportunity to recognize Lynne’s contributions to SRCHC, East Toronto and the community health sector. Please save this date with more details to follow. Please RSVP to Julie Grgar at 416-461-3577 x 223 or [email protected].

While the search for a new CEO is underway, our Leadership Team will continue the good work that Lynne had begun and rely on our internal management resources to maintain the vision, mission and values of the organization. Our two directors Jason Altenberg, Director of Programs and Services, and Shannon Wiens, Director of Organizational Health Systems will jointly take on the role as Co-CEOs until a new CEO is chosen. On behalf of the Board, I extend my thanks to Jason and Shannon for taking on this new challenge.

Please join us in celebrating Lynne, an exceptional leader who has advanced a thriving organization over the nineteen years she has been at SRCHC.

Thank you.


Steven Little
President, Board of Directors

Toronto Star: Overdose prevention workers save thousands of lives, but who’s saving theirs?

Keren Elumir and Sarah Greig prepare injections at the Moss Park overdose prevention site. (Photo by MOE DOIRON)
Keren Elumir and Sarah Greig prepare injections at the Moss Park overdose prevention site. (MOE DOIRON)

Overdose prevention workers save thousands of lives, but who’s saving theirs?

By Sandro Contenta, Feature Writer

Wed., July 3, 2019

Keren Elumir saves lives at the Moss Park overdose prevention site in Toronto. It is relentless work: a particularly bad day saw 10 people overdose in a six-hour period.

“We were kind of joking the other day that we cleaned the entire floor of the Moss Park site with our jeans because we wrestled with so many heavy overdoses,” says Elumir, a 49-year-old registered nurse.

A bit of harmless humour helps in a job where grief and trauma are non-stop.

First responders have long had to struggle with the emotional intensity of jobs meant to save lives. But rarely have on-the-job grief and trauma been as chronic — and so lacking in supports — as on the front lines of the opioid overdose crisis.

They save thousands of lives — people were revived from overdoses 2,275 times in Ontario’s 24 federally approved injection sites in 2018. Yet they are among the most precarious workers in the labour market, many struggling with low pay and no benefits.

Burnout and turnover rates are high. Others soldier on, wounded.

[CAPTION: Keren Elumir says one of the positive aspects of her work is “we have this beautiful, intimate relationship often with people that in a way almost become family.” And the support goes both ways.  (Moe Doiron)]

“People care very deeply, so they’ll keep working even if it’s hurting them,” says Matt Johnson, co-ordinator of the overdose prevention site at Parkdale Queen West Community Health Centre, who estimates he’s revived more than 200 people over the years.

The emotional and physical toll on employees has a leading agency in the field questioning the future viability of the supervised consumption system.

“This type of model is not sustainable when we know the overdose crisis is getting worse,” says Julia Barnett, manager of supervised consumption services at South Riverdale Community Health Centre, which runs the Moss Park injection site and another in the Leslieville neighbourhood.

Trauma is the order of the day for Moss Park’s 11 workers.

In the first three months of 2019, the Sherbourne St. site was visited 6,484 times by drug users. Workers reversed 257 overdoses, usually by pumping oxygen into the victim, sometimes by injecting opioid-blocking naloxone. None of Toronto’s nine supervised injection sites saved more lives during that period.

With Moss Park open six days a week, six hours each day, workers save an average of one life every two hours.

Elumir recalls a day late last year that initially stood out because it was uneventful. Not a single person overdosed during her shift. She whiled away the down time by knitting a toque and looked forward to a Christmas concert after work, where her daughter was to play piano.

Minutes after the site closed at 6 p.m., a man banged on the locked front door begging to be let in. Elumir’s colleague, Sarah Greig, obliged. The man injected an opioid, dropped to the floor, and stopped breathing.

Elumir and Greig went to work. They injected him with naloxone but got no response. They injected him a second time and still nothing. They may have used a third shot but Elumir can’t say for sure. She once needed five shots to bring a victim back to life.

“It can be quite scary when a person isn’t responding,” she says. “If we don’t figure it out, they will die.”

They tried inserting an air tube down the man’s throat but couldn’t open his clenched jaw. Overdoses caused by fentanyl, a powerful and often deadly synthetic opioid, can make bodies rigid. So they placed an oxygen mask as tightly as possible around his nose and pumped air.

Thirty long minutes passed before the man revived.

Elumir had no time to debrief the near-death episode with her colleagues. She rushed to her daughter’s recital.

“I beat it across town to this beautiful church that was full of candles and twinkly lights,” she recalls. “I sat down and everyone around me was so happy, listening to the singing and watching the performances.

“And the contrast between this beautiful event and the hard overdose was so enormous that I could not stop crying. I cried my eyes out.”

No one has died in supervised injection sites. Yet the body count keeps rising from overdoses on the street or in private dwellings.

There were 4,460 opioid-related deaths in Canada in 2018, a third of them in Ontario. The victims are often marginalized people the workers care for daily and know well. Sometimes it’s a colleague: in Toronto, many front-line workers use drugs or did so in the past.

Who will die next is a constant worry.

Registered nurses are a small number of this largely precarious workforce. Most others are workers from harm reduction programs, which distributed clean syringes to drug users before supervised injection sites opened in Ontario in 2017. All are close to the drug-using community.

Leaving work at the office is an option few have.

“You’re seeing multiple overdoses every single day,” says Steff Pinch, a 29-year-old harm reduction worker. “You’re seeing people who are dead and you’re bringing them back to life. You’re walking in a room full of ghosts.

“And for a lot of workers, they do this as their job and then they go home and reverse overdoses. And then they walk the community and reverse overdoses. And it never ends. And then everybody dies.”

Frayed emotions are compounded by anger, a conviction that deaths would be prevented if governments cared enough to decriminalize the possession of all drugs and make safe supplies of opioids available. (The Toronto Board of Health supports both those recommendations.)

“It feels like you’re screaming into the void,” says Marissa Martins, a harm reduction worker who helps provide stable housing for drug users with Breakaway Addiction Services. “You’re saying, ‘This is what we need! This is what we need!’ and nobody is listening.”

Greig, a harm reduction worker for the past decade, says workers have no time to heal or to process what they’re going through. “How do you keep helping people without totally losing your mind?” she asks.

Few have the workplace benefits to help them find an answer.

Shoestring provincial funding keeps wages at about $15 to $25 an hour, although the few who are registered nurses can make more. Many are on short-term contracts or working part time — positions with no benefits. Workers who need counselling services, or anything else that might help manage the job’s chronic stress, usually can’t afford it.

The exception in Toronto is the downtown supervised injection service called The Works, staffed by eight full-time and unionized city employees who have benefits and higher salaries. Tor Sandberg, a spokesperson for the CUPE local representing the employees, says the city helped ensure lower job standards for others in the field by letting private agencies do the work the city should be doing.

In an attempt to help themselves, some formed the Frontline Workers Support Group, which resorts to a gofundme campaign to help access the most basic forms of self-care, including massages.

“It’s pretty messed up that it’s being crowdfunded,” says Tave Cole, a group organizer and harm reduction outreach worker, who describes on-the-job grief as a “non-stop nightmare.”

On June 10, Toronto’s Board of Health called on the Ford government to “Provide dedicated bereavement and trauma supports for frontline harm reduction workers, family members, and others impacted by the opioid poisoning crisis.”

In a written response to questions by the Star, the Ministry of Health and Long Term Care said it is “committed to supporting front-line harm reduction workers” and others hit by the crisis.

The statement, emailed by spokesperson David Jensen, noted the ministry funds the AIDS Bereavement and Resiliency Program of Ontario (ABRPO), which has expanded its work to train agencies running injection sites on “debriefing” sessions that help workers emotionally, mentally, physically and spiritually.

The government says it also plans to invest $3.8 billion over the next decade to implement a “comprehensive and connected mental health and addictions treatment strategy, including a “Centre of Excellence” to help people access “integrated and standardized” services across the province.

Provincial funding also includes $31.3 million for up to 21 sites called Consumption and Treatment Services (CTS). It’s a new harm reduction model that continues supervised injections while adding a focus on connecting drug users to treatment and rehab. Budgets for these new sites “can include funding for benefits and training for frontline staff,” the ministry states.

Reality at injection sites is generally different. Funding that rarely lasts more than a year means requests that include benefits stand little chance of ministry approval, says Barb Panter, manager of housing and drop-in services at St. Stephen’s Community House in Kensington Market, which includes a supervised injection site staffed by six workers.

“Our model is very cost-effective, but it also means our part-time and contract staff don’t get benefits,” Panter says. “That’s just a reality in the field.”

St. Stephen’s supervised site had been funded by the previous provincial Liberal government. It was one of two agencies in Toronto that failed to get renewed funding under the new CTS model. Its injection site continues to function with federal permission and private donations.

St. Stephen’s CTS application had a budget line for transit fare so that drug users could travel to the kind of rehab the ministry considers a priority.

“They said, ‘No, take that out,’ ” Panter recalls, referring to ministry officials. “And we said, ‘How are you expecting people in Toronto, where it costs $3.25 for transit, to get to the detox centre?’ And they didn’t really have an answer.

“So to talk about benefits for something as intangible as trauma and grief support doesn’t often go very far,” she adds.

Fifteen CTS sites were announced in late March, six of them in Toronto. The proposal accepted for South Riverdale’s Moss Park site would extend service to 12 hours a day, seven days a week. But the government has yet to hand over the funds, so in March, frontline workers were placed on month-to-month contracts.

“We don’t know if that financial agreement is going to be on a one-year basis or more long-term,” Barnett says.

There’s no indication the provincial government will act on the board of health’s request to fund trauma and grief supports, Barnett adds, so South Riverdale is moving on its own.

The community health centre has siphoned $20,000 from its other programs for a one-year pilot project to give its injection site workers access to counsellors, therapists or Indigenous elders, along with self-care courses in yoga or art, for example.

Gillian Kolla, a PhD candidate at the University of Toronto’s Dalla Lana School of Public Health, who is researching the impact of opioid-related trauma on health, believes funding struggles reflect a dismissive provincial attitude.

“I don’t think this would be happening with any other health issue,” Kolla says. “It is very much linked to the stigma around people who use drugs. It’s very much the idea that these people are disposable.”

Thomas Egdorf, director of the AIDS Bereavement and Resiliency Program, links the trauma struggles of workers in the opioid overdose crisis to social attitudes prevalent during the deadly height of HIV and AIDS in the 1980s.

“One of the challenges is disenfranchised grief, which is grief that isn’t supported, really, by society,” Egdorf says.

“Often, when workers reach out for support outside of their community, they get responses like, ‘Well, what did you expect? They inject drugs.’ It’s like you don’t have the legitimacy to grieve because ‘of course this person was going to die.’

“So traditional places where people could go for support — grief counselling, grief groups — don’t often work in these situations because of the judgments a lot of people attach to how someone dies,” Egdorf adds.

At the entrance to the Moss Park overdose prevention site, around a wall painting of an eagle with a syringe in its claws, are the portraits of a dozen people who recently died. Some were front-line colleagues, including Angela Kokinos, who saved lives at St. Stephen’s until her death in September 2018, and Leon “Pops” Alward, a trailblazing volunteer at the Moss Park site when it began as a cluster of tents in 2017. Others are clients the workers knew well.

“Many of the people we interact with in our work have been ostracized and stigmatized and pushed away by other people,” says Marissa Martins. “We sometimes are the only safe place for people to be authentically themselves — artistic, musical, loving, funny. So you see all these beautiful things that people are finally given permission to be.

“You grow fond of them, and then you lose them,” she adds.

[CAPTION: Says harm reduction worker Steff Pinch: “You’re seeing multiple overdoses every single day. You’re seeing people who are dead and you’re bringing them back to life. You’re walking in a room full of ghosts.”  (Toronto Star)]

For Steff Pinch, the death of 45-year-old client Rodney Rizun forced the need for a break.

Rizun, a talented musician and “born storyteller,” was shot dead in an Etobicoke residence on June 5, 2018. His unsolved murder capped a terrible four-month period when almost 20 of Pinch’s clients, friends and relatives died from natural causes, violence or overdoses.

At the time, Pinch was a harm reduction worker at the LAMP Community Health Centre in Etobicoke. LAMP isn’t a supervised injection site, but it offers drop-in services for drug users.

Pinch says clients would often inject in the centre’s washrooms or around the grounds, causing Pinch and co-workers to scramble in and out of the building saving lives. “For a while, it was every single week someone I knew was dying,” Pinch says. “It was overwhelming.”

Pinch’s only self-care option was short-term medical leave under Employment Insurance. That meant navigating multiple hoops, including finding a doctor at a walk-in clinic and paying for medical forms to be filled.

Pinch ended the EI “stress leave” about halfway through the 15-week period because the doctor would only continue approving it if Pinch went on anti-depressants.

“I refused to go on psychiatric medication because I don’t have a psychiatric problem,” Pinch says. “Everyone is dying! I make sense!”

Harm reduction workers are a tightly knit group and Pinch counts Liz Merlos, who heads harm reduction efforts at Parkdale Queen West Community Health Centre, as a supportive ally.

Merlos has spent months on a waiting list for subsidized counselling to deal with anxiety attacks. She initially called the employer assistance plan but a counsellor told her she needed more help than they could offer.

“There are many times when I’m like, I can’t go to work today, I just can’t,” says Merlos, who grew up in Parkdale and helped save her younger brother from an opioid overdose two years ago at her mother’s home. “I’m struggling with a lot of the things that my peers and colleagues are struggling with.”

She dreads extended breaks from the job — even long weekends — because “every time you come back, someone is gone.”

[CAPTION: Liz Merlos in a safe injection room at the Parkdale Queen West Community Health Centre. Merlos has spent months on a waiting list for subsidized counselling to deal with anxiety attacks.  (Toronto Star)]

Almost 900 injections were supervised at Merlos’s site in the first three months of this year. She notes the work goes much beyond reversing overdoses. She and her five co-workers often act like counsellors, listening to heartbreaking stories of childhood trauma and loss.

“You bring it home,” Merlos says. “You bring it into your relationships and your friendships. And it has a toll because it’s so overwhelming. I tell my mom things and my son things and they’re, like, traumatized and worried for me.”

Some years ago, Keren Elumir made a deal with a colleague: “Alcohol wasn’t going to be our go-to on a really bad workday.”

She began work as a street nurse in downtown Toronto in the late 1990s at a Christian charity called Sanctuary, which operates drop-in services for the homeless and marginalized.

There were moments of acute distress, like the time Elumir cut down a suicidal client she knew well from a tree in a downtown park. But she quickly developed what she describes as “this weird, beautiful intimacy” with the people she served. It felt very much like a privilege.

“We hear their stories, their fight for self-respect, their fight against shame, their fight to stay alive today,” she says. “We witness the effects of childhood trauma, of things that nobody should have ever gone through. And we’re often the receptacles of their wishes and dreams.

“So we have this beautiful, intimate relationship often with people that in a way almost become family.”

The support went both ways. Years ago, when her first child was born, serious complications kept her baby in hospital for days.

“I would come out of Mount Sinai Hospital and there was a crew of guys waiting for me to get an update on how my baby was,” she recalls.

“The ones who are still alive — a lot of them are not — feel like they have invested in my child. They’re as excited about her graduating from high school almost as much as I am.”

As clients died premature deaths — from violence, overdoses and hard lives on the streets — Elumir began a personal act of remembrance. She listed their names in a journal.

[CAPTION: Registered nurse Keren Elumir, right and harm reduction worker Sarah Greig at the Moss Park overdose prevention site. Workers like them save thousands of lives; in 2018, people were revived from overdoses 2,275 times in Ontario’s 24 federally approved injection sites.  (For the Toronto Star)]

About five years ago, the number of names rapidly grew. Fentanyl was by then commonly being used by dealers to give street drugs a more powerful high, causing a sharp rise in overdoses. In 2018, almost 75 per cent of accidental opioid-related deaths in Canada involved fentanyl.

One of the people fentanyl killed was Chris, an Indigenous man Elumir knew well. He’d greet her with a big hug and minutes later Elumir would inevitably notice one of her earrings missing.

She visited Chris one day at the Leslie Street Spit, where he camped, and saw her earrings hanging from a tree like wind chimes. “He thought it was hilarious,” she says.

Chris told her of being taken from his parents and placed in a residential school. He was maybe 6 years old. School authorities shaved his head and treated it with kerosene to make sure he didn’t have bugs.

“I don’t think he ever lost that sense of shame and fear he experienced as a little kid,” Elumir says. “He really struggled with white people. He told me numerous times that he didn’t know how to deal with wanting to hate me and wanting to love me all at the same time.”

Chris asked Elumir for help one day — his long, clumped hair was infested with lice. Combing out the bugs was impossible. Chris told Elumir to shave it off.

“He sat and cried through the whole thing,” she says, holding back tears.

Chris vanished sometime later. Rumour spread on the street that he had died. So a memorial service was held for him at Sanctuary. Chris’s street friends packed the place. In the middle of the service, a tall man walked in and asked, “Whose funeral is this?” It was Chris, fresh out of jail.

“He actually showed up at his own memorial service!” Elumir says. “It was crazy. So we used to joke that there were resurrections happening on the street.”

Three years ago, on a rainy day, Elumir found Chris lying dead of an overdose in a doorway. By then she had stopped putting names on her list of the dead. “It was too many. It was too painful.

“It’s this contrast of grief and rage,” she says. “People matter! Why can’t (governments) get that it’s not as simple as, ‘go to detox,’ it’s not as simple as, ‘go get a job.’ ”

Elumir can’t seem to shake Chris’s ghost. “I see a tall, slender, Indigenous man who walks like his feet are sore, and I think it’s him and I go to yell his name and, no …”

She needed a break after 14 years as a street nurse and joined a family health team in North York, caring for pregnant women and babies. But when tents for a safe injection site were raised at Moss Park in 2017, she immediately volunteered. And when the site moved into the Sherbourne St. building, she took a job there part time, with no benefits.

“I don’t think I really have an option,” Elumir says, when asked why she continues to do the traumatic work. “This is a community of people I love. I cannot imagine walking away from that as long as there is a need.”

By the numbers

137,711 – visits to 24 officially designated supervised drug consumption sites in Ontario in 2018

2,275 – overdoses reversed at designated consumption sites in 2018

59,257 – visits to designated consumption sites in first 3 months of 2019

1,017 – overdoses reversed at consumption sites in first 3 months of 2019

1,471 – deaths apparently due to opioid overdoses in 2018

0 – deaths at consumption sites in 2018, and first three months of 2019

Source: Ontario and Canada health ministries

Correction — July 3rd, 2019: A previous version of this story misspelled Rodney Rizun’s last name.

Sandro Contenta is a reporter and feature writer based in Toronto. Follow him on Twitter: @scontenta


© Copyright Toronto Star Newspapers Ltd. 1996 – 2019Privacy Policy Terms and Conditions