As Winter Sets In, Infections Creep into the DTES

[Editor’s note: This story contains sensitive information about human suffering and descriptions of wounds.]

When people in Vancouver’s Downtown Eastside get an infection, it can result in death or the loss of a limb due to difficult, inadequate living conditions.

There are high rates of poverty, substance use, homelessness, stress and malnutrition and medical conditions like diabetes in the neighbourhood, which can affect a person’s ability to fight off an infection, even with the help of antibiotics.

Several clinics in the neighbourhood offer wound care, but recovering to full health can be especially challenging for people who are struggling daily to survive, The Tyee was told by several people dealing with infections themselves or caring for people with infections.

One solution is PHS Community Services Society’s Community Transitional Care Team, which partners with Vancouver Coastal Health and Providence Health Care to offer an acute care clinic in a residential setting where patients can stay to get several weeks of IV antibiotics and fully recover.

However, the clinic has only nine beds, and they’re reserved for patients whose infections have gotten into their bones, said Julie McGuinness, senior manager of programs at PHS.

Any level of infection can be dangerous, she added.

“If you have an untreated infection you can die,” she said. “You can go into organ failure and die, or absolutely need to have major surgery and amputation,” she said, depending on how far an infection has progressed.

Why people get infections

People who don’t have stable housing are at higher risk of getting sick because they’re often spending time outside during Vancouver’s cold and wet seasons.

Living in cold, wet or dirty conditions compromises a person’s immune system, which enables illness to spread through the neighbourhood, where many people live in close quarters in shelters or single-room occupancy hotels with shared kitchens and bathrooms.

Malnutrition and stress can further affect someone’s immune system, which is why colds and pneumonia are so common in the Downtown Eastside, or DTES, McGuinness said.

When an infection starts, people might not immediately notice because they’re “exposed to so much suffering” on a daily basis, or are already using drugs to manage pain and discomfort in their life, she said.

Unregulated street drugs can increase a person’s risk of developing an infection by reducing blood flow to a wound, which limits the body’s ability to fight an infection.

Stimulants such as methamphetamines, and some tranquillizers, for example xylazine, are vasoconstrictors, which reduce blood flow. Xylazine can also make you pass out while lying or sitting on a limb, further restricting blood flow, said Sarah Blyth, executive director of the Overdose Prevention Society, which offers wound care.

But drugs are not the only reason people are dealing with infections. Patients can continue to use substances while getting care through Community Transitional Care Team and make a full recovery, McGuinness said.

The main problem is that once an infection sets in, it is incredibly difficult to care for while remaining in the same conditions that allowed for it to occur.

Anthony, who asked to be identified by only his first name, told The Tyee he’s been battling infections in both of his legs for two years.

He’s been in and out of hospital for the infections and regularly goes to wound-care clinics, but he said the clinics focus on short-term care, patching him up until his next visit.

Wound-care clinics do give out extra bandages, but it’s hard to find a clean place to do wound care in the DTES, he said.

Shelter bathrooms are filthy and have time limits, Anthony said. Many people will skip showering because that would mean getting their bandages wet and needing to change them, he said.

Single-room occupancy buildings, which are common in the neighbourhood, often have dirty shared bathrooms.

Changing a bandage outside, or leaving a wound uncovered, comes with the risk of myiasis, when maggots infect a wound.

“If you’re outside and a fly lands on your wound you’ll get maggots,” Anthony said. He said that this is a common complication in the neighbourhood.

Symptoms of an infected wound include swelling, a spreading redness, red streaks, feeling hot to the touch, a fever, a bad smell, pain and pus.

Even if someone doesn’t tell you they’re dealing with an infection, you can usually smell it and check in with them, Blyth said.

When a wound smells, Anthony said, you don’t want to go on a bus or inside where people will be grossed out.

Shame is a central theme when people talk about infections.

“Unfortunately there’s a belief that if you get an infection, you’re dirty,” Nick Wells, a spokesperson for Union Gospel Mission, told The Tyee. “That’s not the case. You’re just trying to survive.”

Shame can prevent people from seeking care, even when they’re suffering.

Anthony said his wounds are “excruciatingly painful.” They often feel very raw and produce a terrible squeezing sensation. It feels like he’s being stabbed, but someone is sliding the knife in slowly, he added.

Anthony fears that his infected legs would make him more vulnerable if he were attacked. He also fears needing to have his legs amputated.

A second man, who agreed to be interviewed but not identified, told The Tyee his infected legs hurt so bad he can only stand or walk for about a half-hour.

Some days the pain throbs and other days it feels like being kicked in the shin, he said.

He pulled up one pant leg to show a raw, weeping wound that encircled his entire limb. The wound was 10 centimetres wide in some spots. He said he had picked off the scabs that morning and the surrounding skin looked angry and blistered.

The man said he knew a wound-care clinic could help but wasn’t sure when he could get an appointment. He added he trusted the care he would get at the clinic but worried about whether he would be able to remember his appointment or physically get himself there.

Anthony said wound-care clinics are not open 24-7 and sometimes it can be hard to get to a clinic while it’s open.

Blyth said she’s seen a lot of infections start on the skin from a cut, a hangnail, a needle puncture wound or a scrape. She said infected gums are also common.

Some infections will require hospital care, but staying in hospital can be challenging for people with a history of being treated poorly by health-care professionals, for people who are still using drugs but aren’t allowed to use in hospital, or for people who are taken away from their neighbourhood and isolated from their friends and family.

The Community Transitional Care Team was set up to help fully heal patients who would otherwise leave hospital early.

A patient taking antibiotics might start to feel better and still have a couple of days or weeks of treatment left. The bacteria are still usually in the body at this time, and if a patient stops taking antibiotics the infection can come back. This is why doctors say it’s important to finish a prescription.

The Community Transitional Care Team creates a comfortable place for mostly unhoused patients to stay while completing their IV antibiotic treatment, McGuinness said.

Patients stay at the Pennsylvania Hotel in the DTES and get their own room, bathroom, kitchenette, three meals a day and “a billion snacks because nutrition is incredibly important for recovery,” McGuinness said.

The care team provides medical, emotional and mental health support and helps connect patients to other services like housing or a pharmacy to go to once they’re discharged, or just helping them catch up on other health appointments like a missed colonoscopy, McGuinness said.

It’s all voluntary and patients have control over their care and treatment.

“We try to remove the paternalistic approaches that can happen in clinical settings, which can be triggering for folks who feel powerless in clinical settings,” she said.

Patients can have visitors, continue using substances and even have pets stay with them.

During their treatment people often stabilize and start expressing interest in starting opioid agonist therapy or going to treatment, McGuinness said.

The Community Transitional Care Team is very successful and its nine beds are always full. The space treats and discharges about 15 to 18 patients every two months, she said.

When people are finally discharged, they’re “very well” and have a bed waiting at a shelter or are on the list for housing, she said.

How to help

The better people’s living conditions are, the less likely they will be to get an infection, or the more likely they will be to fight it off on their own.

Having access to clean and dry socks and shoes, showers, soap, places to wash your clothes, places to get a good night’s sleep, stable housing and less stress would make a huge impact, Blyth said.

The Overdose Prevention Society can help people wash their clothes if they are infested with bugs, because bug bites are another place where infections can get in, Blyth said.

Donations of clean and dry socks, shoes and blankets are always welcome, she added, noting the items don’t have to be new, just clean.

The Union Gospel Mission also hands out donated clothing, Wells said.

McGuinness said scaling up the Community Transitional Care Team so it could offer more beds would help care for people once infection sets in. Right now there’s a waiting list and people might spend at most one month in hospital waiting for a bed to open up.