THE ADDICTION ISSUE
DR. NAHEED DOSANI: FROM A REFUGEE’S SON TO A TRAILBLAZING PALLIATIVE CARE PHYSICIAN “I GREW UP THE SON OF TWO REFUGEES who came to Canada
from Uganda in the 1970s, fleeing war and persecution. I always knew that the social determinants of health and community well-being were an important part of what it means to be healthy in a country like Canada.” That’s Dr. Naheed Dosani, the medical director of Kensington Hospice at Kensington Health in Toronto, and a palliative care physician at St. Michael’s Hospital. Most of the time, though, you won’t find him in those corridors. He’s driving around the city in his black Mazda, providing palliative care for those experiencing homelessness. As a family medicine resident at the University of Toronto he found himself caring for Terry, an unhoused man in his early 30s who struggled with mental illness and neck cancer. Terry had presented in a pain crisis at a local shelter where Dr. Dosani was working. “I got to work the next day, and found that Terry had died overnight. It was very traumatic, not only for his street family, but for me,” he said Traumatic and life-changing. “I realized there was a lot of work to do in bringing about health equity for unhoused people. That’s kind of how it all started,” Dr. Dosani said. His priority became to learn everything that was known about providing healthcare for unhoused people. He then pitched models to organizations dedicated to health justice and equity. In 2014, he founded the Palliative Education and Care for the Homeless (PEACH) program, which he still leads in Toronto. PEACH is a partnership between Inner City Health Associates, Toronto Central Health at Home and Kensington Health. It has provided palliative care for a thousand people in its 10-year history, carrying caseloads of about 120 people at any given time.
18 FEBRUARY 2025 THE MEDICAL POST
Dr. Naheed Dosani on the streets of Toronto.
“There can be harsh weather—working outdoors. There’s the emotional toll of witnessing immense suffering,“ Dr. Dosani acknowledged. But, through these hardships, he believes that when you offer unhoused people palliative care that’s trauma-informed and person-centred, care that recognizes the social determinants of health, “incredible things can happen.” That can include being able to help people get basic food and medications, housing, or income support through social assistance. PEACH does what it can to support every person with a “home” death, providing them space in a shelter, rooming house or a hospice, depending on where the person is comfortable. “We hold grief circles with the shelter community, where we gather people who are working with people who are dying in the shelter system, or have died in many cases. We gather to talk about our grief in structured spaces that are supportive.” Dr. Dosani said the memories of his patients live on in his heart. “They remind me of why this work really matters and why we need to continue to advocate for a more just and compassionate society.” He is a young physician and the father of young children. “I don’t see myself ever stepping away from this kind of work. It has defined who I am as a physician and as a human,” he said. “I would argue, though, that the work is just as (medically) rigorous and academic as traditional office-based work or academic roles.” People experiencing homelessness are 28 times more likely to have hepatitis C, he pointed out. They are five times more likely to have heart disease and four times more likely to have cancer. Average life expectancies for unhoused people in Canada range from 34 to 47 years old. “Homelessness cuts a person’s lifespan by 50% and so it goes without saying that people experiencing homelessness are arguably Canada’s sickest sub-population. And given the strength of this data, clearly and unfortunately, palliative care must be a fundamental part of any homeless healthcare system that we develop,“ Dr. Dosani said.
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of four walls we make up for in terms of the connections that we make with individuals who have been very disenfranchised. “I don’t want to glamorize this in a way that or say that it’s better than other forms of care,” Dr. Walmsley is careful to add. “That’s not it. It’s providing care for those people who have otherwise not been able to access care. And in doing so, you’re providing an open door and connecting them in a way that is not stigmatizing.“ It’s very different from working in a clinic or ER—and yet it’s not: “Most doctors know that when they are one-on-one with a patient, there’s a story,” Dr. Walmsley said. “There’s a need to listen and provide the care that’s needed at the moment. That goes whether you’re sitting in an emergency room, in a cubicle, or beside the road tending to someone who’s got, you know, a broken limb, or just (someone) struggling with an infection. It’s the patient that sets the agenda, wherever you meet them.”