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TRANSCRIPT:
Kwadwo: 00:43 welcome back everybody. Super excited about episode nine year with Jeffrey Turnbull. But first I want to tell you about our sponsor. Better help. This is a group of amazing online online counselors that provide online counseling via audio calls, via, via chat, via messaging, and it's affordable. It is timely, it's on your schedule. And these guys are great. They reach out after hearing episodes with dr Adrienne Matheson and dr Tamina Eapen. And um, I think they do amazing work. So if you want to sign up, you get a 10% discount using discount code solving healthcare. There are better help.com and uh, I highly recommend these guys. Okay. A couple of housekeeping things. We've been busting out episodes every week. And for the sake of my marriage, we're going to be extending that to every two weeks. Now that we've have a few episodes out. Now we're also going to explore different format.
Kwadwo: 01:51 We'll call them mini casts, where you get 10 to 15 minute episodes of, of innovative things that are happening within healthcare that, you know, there might be quite niche, but the idea is that it could be scalable, it reduces spending and provides better care. And so, um, that's another format we're going to explore. Okay. I'm going to tell you about our next guest, dr Jeffrey Turnbull. This guy is a walking angel and as far as I'm concerned is a hero. He works with the homeless population. Okay? He's done this throughout his career and his whole motivation is to give them a voice, humanize them, provide them with care that they should be receiving in a setting that is optimal for them. So he is the medical director of the Ottawa inner city health program, which provides full range of care to the hump homeless population, including safe injection sites, um, manage alcohol program.
Kwadwo: 03:01 And even palliative care and I got to work with him about 10 years ago in that environment. And it was truly, I don't even know what to what the word is. It was just eyeopening. It was humbling. It was, it was fantastic. The work that they're providing and it was a real, a true honor to have him on the show. And this guy, let me tell you, he's a baller. Okay. Like when I tell, let me list off some of his accolades. Order of Canada, order of Ontario queen Elizabeth, the second diamond Jubilee medal. I don't know exactly what that means, but that sounds proper. He's been the president of the CPSO, which is a college of physicians and surgeons of Ontario, president of the Canadian medical association, president of the medical council of Canada. And honestly, the other thing that's amazing about Jeff is he's truly a nice guy and he's held all these leadership positions. And I've always thought to be, you know, up there, you need to be, you know, you need to be a hard ass. You gotta be that militant leadership approach. And he is the opposite. He's been a true inspiration in terms of leadership styles and I it, he's amazing. So without further ado, Jeffrey Turnbull,
Kwadwo: 04:24 Jeffrey Turnbull, I got to tell you, it's a privilege man. A privilege is all mine. Oh, thanks for doing this. This is amazing. We are in, where are we actually?
Jeff : 04:35 So this is our office facility. So we're in the basement of that. Right beside you. Over there is a nursing station where we draw up injectable hydromorphone for the opioid substitution program. And above all, the next two floors are administrative and where our nurses work and set a, when they're not out in the shelters.
Kwadwo: 04:58 Wow. I mean we're going to get into this, but I know say right out of the gate, this stuff that you're doing is stuff that angels do. And I, it really is an honor to be here and it's, uh, it's been an honor to work with you in the past. Um, I want to ask you the day in the life of Jeffrey Turnbull in 2019 cause you, I mean if you look at your resume, it's pretty ridiculous. Uh, what is like not like for you?
Jeff : 05:28 So a very, very different, so it's not involved in the hospital and it's not involved in Toronto. So I'm not flying back and forth commuting. Um, I'm here and I've devoted my, my week now to the homeless. Um, today began with picking up eggs and at the farm and, uh, doing some farm work and then bringing Charlie to my youngest son to school. And then from there I
Jeff : 05:58 came down for our meeting, which is, I was actually in this boardroom where we go through the list of clients that we have at any one time. It's about 280 to 300. And they're in all of the facilities around us and we discuss each case and we have the care providers, but we also have housing people and social workers and addiction specialists, uh, that join us and mental health specialists. Wow. And we all go through each one of those cases about how we're handling them and what are the challenges that we're facing.
Kwadwo: 06:33 And I, I can't imagine that these challenges aren't, uh, many. So maybe give us a sense of if you had this magic wand to, to, to fix some of the issues that you see, like some, what are some of the major concerns that you come across dealing with the homeless population?
Jeff : 06:54 Well, the, the homeless, like many other vulnerable or disadvantaged populations, um, because of their circumstances, the poverty that they live in, the mental health or addictions, lack of education, concept of health, all of those things bring them to this environment, but it's this environment that prevents them from getting meaningful, reasonable care and moving away from homelessness. So, um, if I had a magic wand, as you said, what would I do? Uh, um, the, I think we really have to address all of those factors that bring people into a world of homelessness, addictions, mental health, and those are the upstream factors. So those are the things like, um, early childhood development, poverty reduction strategies, education, employment, um, uh, intact family structures, um, not having residential school systems, et cetera, et cetera. However, the, my life now is drinking from a fire hose and I just can look at only the complications of that. And so the 300 people that I'm looking after today, um, what's the best thing for them? It's improved public health policies. It's, um, better addictions management. It's better mental health treatment. Um, and it's bringing care that is traditionally hospital focused or primary care, uh, in a residential setting into their world on their terms, which is very, very different than what you and I've ever experienced before.
Kwadwo: 08:39 Can you, can you, can you paint that picture? Like what, what is it like to be taken care of such patients?
Jeff : 08:49 Well, um, can I tell you about a patient from this morning discussion? So he is, um, a guy who came to us yesterdays overdosed three times and the last two weeks, um, had to be resuscitated on two of those three times. The third time just woke up somewhere. Um, and his, when you talk to him, you know, you begin by saying, you know, how much, what's your addiction like? Well, he's taking, um, um, not only does he take a Dick, he's addicted to benzodiazepines. He's also addicted to, um, Nissan, a gram of Kadian every day, his thousand milligrams. He takes, uh, about two grams of what we call purple, which is, um, fentanyl mostly or all other stuff. So two grams. If you think about that, that's fentanyl's a hundred times more potent than morphine. So you can do the math. This is massive doses. And he has this history of mental health.
Jeff : 09:57 Uh, he's been institutionalized. He was, um, a product to the child welfare system. He was orphaned at a very young age. He's had a history of abuse and trauma. He has behavior management problems, um, violence and aggression has been in jail. And um, he's 38 and probably will not see 40, um, probably won't see three, four more months. And so the challenge for him is how do you actually, you know, turn the clock back for him? How do you start to treat his mental health? Well, he doesn't have a place to stay. He squats, um, and winter's coming. How do you treat his addiction? It's massive. You couldn't give him enough opioids to control that. And his impulses are such that whenever he has something, he takes it. And so he's at very high risk of overdose death. And so we were trying to think about could we put him in a housed environment, start treating as mental health, then make inroads on his addiction. Um, and all of these things are, you know, a constellation of impediments for him that will likely lead to his desk.
Kwadwo: 11:16 That's, that's it. That's incredible. Like the thing that breaks my heart is, you know, we, the general public, you know, we, we see people in these circumstances, they're on the street, they're asking for money and we're like, Aw man, get a job. Get that gate, get yourself cleaned up. You know what I'm saying? And just as you alluded to at the beginning, it's like, think about the factors that got them there. You know, it's like we say like, you know, getting like, get control of your life and do these things. But you got a question when you go through such trauma as you just described, this gentleman going through, is it like how much of his fate is in his hands? You know, like,
Jeff : 12:08 yeah, so, so very little at this point. If there was inroads earlier on when he was six, when he was not abused in foster care or when he was, um, uh, early on developing signs of, um, disordered mental state and, uh, struggling with his trauma. Um, if we had to intervene then in a more supportive environment, wrap services around it, it might've been different. But now I have a 38 year old and I have a 38 year old that's on massive doses of opioids who's overdosing, who can't control behaviors, is unemployed and lives in a world of poverty and doesn't have a place to stay tonight. I can't even find this guy, you know, like, it's not as if he's got a, an address. He can't get the usual entitlements. He doesn't have a health card, you know, all of that. So there's so many other built in obstacles for him to get care that it makes it almost impossible for him to get care. And yeah. You know, what happened to those people that, you know, we, we see, we attend many memorials obviously because of so many people dying. Um, in this context. And almost always there is a young seven year old in a cowboy outfit, a pitcher, you know, that their parents have brought and something happened between that seven year old in keloid pads and a couple of hat to that person who is 25 who just overdosed and died on King Edward and Marie,
Kwadwo: 13:45 you know, and this is something that I try and remind our healthcare team is, you know, that patient that we're seeing that got themselves in this situation, I'm doing this and they're doing air quotes. That's somebody's son. That's somebody's brother. Yeah. And you know, I almost wondered if Jeff didn't like the work you guys are doing is, is, is truly amazing. I wonder how much, like are there stories that you've come across or have seen where this has made a difference? Are they too far gone because of all the stuff that has happened? You know,
Jeff : 14:26 so no, there are, they are never too far gone. You can, you can always have an impact on their lives. So are there circumstances where we've taken, we've seen somebody who's on the streets, um, and return them to lives that you and I would think are normal employment, paying taxes, you know, um, they're not many stories like that, but there are, and so in fact that's, you know, keeps us going a lot. But on the other hand, those people who you see on King handwritten Murray that are in veteran alcoholics are injection drug users. Um, you know, who've been doing this for many years, you can improve the quality of their life very dramatically just by simple support, housing care, treat their HIV, treat their Hep C, um, treat their underlying mental health issues, support them, build trust, and do it in a, uh, in a, an environment that allows them to have control of their health outcomes. You know, the, that you may say, well that's palliative care, but that is in fact we're taking people and making their lives better, even though they have an underlying problem that probably they will never recover from.
Kwadwo: 15:49 Yeah. And the one thing, I mean, I got a chance to work with you over a decade ago and one thing that really stuck to me was how appreciative they are of the care. And I that it's always stuck with me when I, when I, you know, when you're, and when we were working, it was in the palliative setting, but when you're there to, uh, support their medications or that they hear, hear their story, it's, there was always a thank you. There was a genuine look in the eye and saying how appreciative they were.
Jeff : 16:29 And they are, they're enormously appreciative. And when you bring care to them on their terms, suddenly there's a new trust that's built. Um, you don't see them in a hospital environment. This is foreign for them. Where authority has always been a challenge for them. You say, Oh, you got a quote, can't go out for a smoke. Um, you know, and, and that, that bad series of behaviors that we see in a hospital environment are so predictable, but they disappear when you deliver care here. And they are charming, nice collegial people. I mean, they have their moments. There's no question about it. And they make terrible decisions sometimes, but frankly, nobody ever taught them how to make good decisions. And that's the world that they live in. And uh, um, it's not for me to judge what's right or for wrong. Um, my job is to pry and try and improve the quality of their life as best I can.
Kwadwo: 17:31 And I, the one thing I think that must be amazing for them too, and I don't want to put words in their mouth, but that non judgemental environment in here, like they are treated like human beings, like the way they should be treated, which unfortunately I don't think it's all, there's always the case everywhere. They're everywhere they go, you know?
Jeff : 17:55 No, and they're not. And you know, it's...
