Canada: Homeless and Pregnant, Women Afraid to Seek Care

Edmonton's needle exchange program, Streetworks, on some days looks more like a prenatal clinic. Since 2005, Alberta has logged 14 congenital syphilis cases from an outbreak that also affects many potential Streetworks clients.

"We're the needle exchange program, but we work with the crowd that this was affecting, those that are involved in drug use, those who are involved in the sex trade, so we decided to do a project," said Marliss Taylor, program manager for Streetworks.

Using a $95,000 (US $76,700) grant from the Public Health Agency of Canada, Streetworks is able to target syphilis and other STD services to homeless pregnant women. The grant funds a part-time nurse position and two outreach workers who scour downtown, hop buses along 118th Avenue, and check places such as Kindred House and Hope Mission. So far, outreach workers Karen Turner and Laurie McDermott have found 50 pregnant women, including five who either had syphilis or were antibody-positive from a previous infection.

At Streetworks, nurse Amber Krasowki and Dr. Rubeena Ahmad also give women Pap smears and draw blood for testing. The small back room is fitted with an examination table donated by the Royal Alexandra Hospital (RAH). Krasowki counsels the women about breastfeeding, drug use, and their babies. Many of the women are reluctant to visit regular medical facilities, lacking an established address and fearful their babies will be seized by Children's Services.

In March 2009 the federal grant runs out, but Taylor hopes to find more funding. Streetworks has started a program to train health professionals about working with street people. Krasowki has been invited to speak with nurse practitioners at RAH, and she hopes to accompany new physicians on their rounds there. The program is developing a booklet on healthier pregnancy and living on the streets, and Taylor wants to create DVDs to educate the women.

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