Alfred Lam, left, academic program manager at the Michener Institute with students in the Community Health and Social Medicine program, a new college certificate program for community health workers, in Toronto on Oct. 28.Photography by EDUARDO LIMA/The Globe and Mail
Shawn Pendenque grew up in an abusive household, where he was treated like a “pariah” for being gay. At 16, his father left him at a youth hostel, and Mr. Pendenque became homeless and addicted to drugs. He was eventually diagnosed with bipolar disorder in his 30s, after suffering a psychotic break and landing in a maximum-security prison.
Such biographical details aren’t typically bullet points one might list on a CV. But for Mr. Pendenque, who just turned 50, his “lived experiences” have become an invaluable asset in his job with a social services organization in Toronto, where he now helps other people facing similar struggles.
They’re also what made him an ideal candidate for the Community Health and Social Medicine (CHASM) care worker program, an innovative new college certification course offered by the University Health Network’s Michener Institute, Canada’s only postsecondary institution devoted to health sciences education.
Shawn Pendenque, a student in the program, says his ‘lived experiences’ have become an invaluable asset in his job with a social services organization in Toronto.
The course aims to provide a formal credentialing pathway for people such as Mr. Pendenque: community health workers who’ve walked in their clients’ shoes and now want to help them access a health care system that was never designed with the most marginalized in mind.
“We carry with us our stories,” Mr. Pendenque said. “I can speak to a homeless drug addict and say, ‘I’ve been there.’
“Part of where I draw my strength from, as a counsellor and community health worker, is knowing I do have that toolkit.”
“Community health worker” is an umbrella term that encompasses many titles – cultural broker, peer support worker or social medicine practitioner, to name a few. Together, they make up a critical but largely underrecognized work force dedicated to ensuring that everyone in society has equitable and culturally appropriate access to health care.
CHWs are the “future of the health care system,” said Andrew Boozary, a primary care physician and executive director of the Gattuso Centre for Social Medicine, which co-developed the CHASM program.
He says this became evident during the public-health response to the pandemic, when the most marginalized communities were the hardest hit – and also the hardest to reach.
Primary care physician Andrew Boozary says community health workers are the ‘future of the health care system.’
CHWs became the “secret sauce” in efforts aimed at supporting these communities, Dr. Boozary said. “I really see them as the trust builders in the health care system,” he says.
In Toronto’s Flemingdon Park neighbourhood, for instance, which saw some of the city’s worst infection rates, Eshra Meshkoti was a part of that secret sauce. The Iranian immigrant went door to door to ensure that everyone in the community had access to the vaccine when it became available.
When she learned of a woman whose twentysomething son was mentally ill and terrified of shots, she brought a team of nurses to their family home. After nearly three hours of the young man fleeing around the house and even locking himself in the bathroom, the team finally coaxed him into getting the vaccine.
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He was completely naked, having ripped off all his clothes at one point, but wanted to sit on Ms. Meshkoti’s lap for his shot. The elegant Persian grandmother, who likes to bedeck herself in gemstone rings and pearl bracelets, was happy to comply.
“After he got his vaccine, all of us were crying,” she recalled with a smile. “And then later we did the second [dose] for him.”
Ms. Meshkoti is now among the CHASM program’s inaugural class of 25 students, all of whom were nominated by community organizations and have their tuition covered by the United Way and philanthropist Emmanuelle Gattuso.
Eshra Meshkoti went door to door during the pandemic to ensure that everyone in Toronto’s Flemingdon Park neighbourhood had access to the vaccine when it became available.
Introducing this course was a logical next step for UHN’s social medicine centre. Since the pandemic, the hospital network has been expanding its team of CHWs and peer support workers within its hospital walls.
Now, it wants to build capacity for CHWs working in the community to support the hospital’s patient population – whether that’s helping homeless people find housing after they get discharged from the ER or advocating for patients who need access to hospital care.
From a system point of view, CHWs are a sound investment. Studies have shown that CHW interventions can reduce hospital readmissions and emergency visits. One 2021 paper found that every $1 invested in a CHW intervention saved the U.S. health care system nearly $2.50.
But from a patient perspective, CHWs are lifesaving – a bridge into a Byzantine health care system that can often seem uncaring.
Sixty-three-year-old David Gowin, the CHASM program’s oldest student, was stunned by how difficult it was to navigate the health care system and social assistance programs after he was laid off from his job a year and a half ago, shortly after suffering a stroke.
David Gowin, the CHASM program’s oldest student, says he was stunned by how difficult it was to navigate the health care system and social assistance programs after he was laid off from his job a year and a half ago.
After a 35-year career in the IT industry, Mr. Gowin now believes he is a couple of months away from homelessness. During a recent class, the only food in his backpack was a pack of dehydrated apple flakes.
But despite his ongoing struggles, he considers himself luckier than many and wants to help.
“People who don’t speak English, refugees, at-risk communities … If I’m having a hard time, what about them?” he asked. “With my experiences now of navigating the systems, I want to help other people find a path toward wholeness.”
When designing the year-long CHASM course, it was critical for community organizations and CHWs to play a role in shaping the curriculum, said Nicole Woods, the director of the Institute for Education Research, who led the effort.
“The whole point is to build an academic program that offers you full credentials of an academic institution, but preserves this really core, community-based understanding,” she said.
So far, students in the program have learned about ethics, mental health and health promotion.
Inside their classroom in downtown Toronto, students have so far sat through lessons on ethics, mental health and health promotion. On a recent afternoon, the topic of the day was physical activity and exercise.
Lifestyle interventions can be powerful medicine, explained Dr. Boozary, who guest lectured that day. Studies have shown that physical activity can reduce diabetes rates by 58 per cent, he said – more effective than any pill.
But when “prescribing” physical activity to a person who is marginalized, vulnerable or part of a minority group, there is no one-size-fits-all approach, instructor Munira Abdulwasi said. Context is key.
Dr. Boozary told the class that people have different histories and narratives. “It means you shouldn’t push a certain view of what exercise should look like,” he said.
“The work that you’re doing – trying to encourage your communities, your patients, your clients – is lifesaving. And that’s not an overstatement.”