Caring: Bernie Pauly’s personal approach to research and the homeless

Photography by HÉLÈNE CYR

As a registered nurse, Bernie Pauly’s life was all about access to health care services. As a professor and community-based researcher, she turns to the broader picture and imagines a day when people don’t have to sleep on concrete beds. Here’s how academic research and street- level realities are combining to take on homelessness in the capital region, beginning with the simple act of Caring.

One snowy Sunday morning last December, a homeless man and three women sought warmth inside the Victoria church that happens to be attended by Bernie Pauly. Pauly is a nurse, a professor, and a community-based researcher concentrating on the best ways to find an end to homelessness in the capital region. After the service, the congregation gathered for a pre-Christmas lunch. Things were wrapping up when Pauly and the minister realized the man and his friends had nowhere to go but back into the cold streets.

“Everybody in the street community would have known this, but there’s a gap on weekends,” Pauly says, recalling the incident. “There’s a gap for food, and there’s a gap for shelter.”

In the end, a group of service providers for the homeless pulled together funding and made sure a drop-in place was open on every wintry weekend. “I loved it,” says Pauly. “I was hearing all of these people’s stories, we were talking. It just reminds you that research can be so one-dimensional, when this is so rich.”

1,500 men and women.
In recent years, homelessness has rarely been far from the local headlines. There was the controversial needle exchange closure. A bitter legal battle over camping on public property reached the BC Supreme Court. A young homeless woman lost her life after she was allegedly pushed in front of an oncoming bus. An estimated 1,500 men and women live on the region’s streets, in extreme poverty. About half of them are mentally ill or addicted to drugs or alcohol.

For Pauly, PhD ’05, homelessness is as much an ethical issue as it is a social issue. She looked up from her doctoral research on homelessness and access to health care, and began to ask: what would it take to maintain the health of people from the streets instead of treating preventable illnesses over and over again?

“I went from looking exclusively at access to health care services, to looking at those things that impact health like housing, food, and income,” she says. “I don’t want to keep fixing people up when they come into the emergency ward (with) street feet from walking, and their feet are raw and tender and sore. I want to deal with the reason they have street feet.”

Since completing her PhD and joining the faculty of the School of Nursing, Pauly’s remained directly involved in homelessness: leading community-based research projects that engage community groups; playing an instrumental role in developing public policy, primarily through former mayor Alan Lowe’s 2007 Task Force on Homelessness; and currently as chair of the research and evaluation working group of the Greater Victoria Coalition to End Homelessness, which aims to end homelessness in the region by 2018. Without action, the coalition says, the homeless population would increase four-fold within five years.

Would you translate that?
“Everyone thinks of this as an unsolvable problem. Research says it isn’t,” says Victoria Mayor, and coalition co-chair, Dean Fortin, MEd ’97.

“The work that Bernie does is fundamental to the work of the coalition,” adds coalition program manager Robert Mitchell. “(It) happens at the working group level.”
In one example, Pauly and fellow UVic researchers are employing a “knowledge mobilization” strategy to determine whether “housing first” strategies (that move people from the streets or shelters into permanent housing) are the best approach in every case, before treating addictions, mental illnesses, or other challenges.
“[Academics] sit around and read peer-reviewed articles, but that’s not necessarily what other people do. That’s what I think we can contribute,” Pauly says. “As researchers, we can translate what we know and develop research that fills the gaps.”

In a related study, Pauly and Anthropology Prof. Margo Matwychuk conducted surveys to assess the effectiveness of a transition house operated by the Cool Aid Society.
“Intuitively, looking at housing first information that’s out there, one would think [it’s] probably not (effective), and we don’t need to have that interim step (of transitional housing),” says Cool Aid executive director Kathy Stinson.

But early findings from the survey suggest that transitional shelters do have some benefits, partly because the level of care helps people deal with multiple health concerns, Pauly says. Another key finding, she says, lies in the difficulties that study participants say they experience in just trying to navigate the housing system.

Images, first person.
At the core of her approach to research Pauly tries “to understand the solutions from the perspective of people who have experienced homelessness. Because they have lived it.” A new community-based research project that she’s initiated — Street Stories — aims to do exactly that.

A group of people who are, or have been, homeless will use photography and videotape to document their experiences and, essentially, create their own research data. Pauly hopes it will empower them to communicate the everyday challenges of being homeless.

“The value is in the process,” says Pauly. “But the value is also that (the images) will get presented to people who make decisions” about policies on homelessness.

Rose Henry, a Victoria homelessness activist who has been homeless herself, shares Pauly’s vision for Street Stories. “My hope is that we can educate housed people about how valuable homeless people are,” Henry says, adding that people with valuable skills can wind up in the streets. She challenges the mainstream stereotype that all homeless persons as addicts or alcoholics with mental illness.

Pauly says Street Stories has already proven the point. She was surprised to discover how many participants had prior photography or video experience, and how many different talents they bring to the table.

“Bernie will be the first to admit that she’s never been homeless and she has to rely on other people to reach into (that) world,” says Henry, who views Pauly as a valuable liaison between the homeless and policymakers.

“It can be fixed.”
The answers she began seeking during her PhD research still propel Pauly’s academic work. “It’s so simple,” she says. “It’s just so simple. People need houses to live in. People need food to eat. They need money to survive.

“One of the primary issues is that there’s no affordable housing,” she says, calling for a national social housing policy. In the interim, rent supplements are key to ensuring people are housed, she says. Third, it’s vital that people accept that “in a society as wealthy as ours, nobody should have to live without basic things they need to survive.”

Near the end of our conversation, she opens up about her motivations behind her work.
“I’ll tell you the two things that drive me. One is, that [homelessness] is simple, and it can be fixed.”

She pauses, and her voice catches a bit.

“The other thing that keeps me going is knowing that every night when I go to bed, there are other people who don’t have a bed. You know, when you get into bed, and it’s all warm and cozy and think, oh my god, somebody is lying on the cement. I can’t live with myself if I’m not actively trying to change the community I live in, because [homelessness] isn’t fair.”

Bernie Pauly and fellow School of Nursing researcher Joan MacNeil were reviewing AIDS Vancouver Island practices in 2008 when AVI’s 20-year-old needle exchange was evicted, replaced by a mobile service.

Their research took on a whole new direction.

“I approached Bernie and said, this is a research opportunity. We need to document what happens when a needle exchange of this size closes,” says AVI communications coordinator Andrea Langlois, BA ’01. The site on Cormorant St. had a higher volume of clients than sites in cities three times Victoria’s size, like Edmonton or Ottawa.

In a collaborative research project with AVI, Pauly and MacNeil interview 33 people who used needle exchange services on Vancouver Island to find out how access to exchange services could be improved.

The resulting report drew national media attention. University research “illustrating some of what, anecdotally, we could articulate as having seen on the street” had a major impact on AVI’s ability to communicate what they saw happening after the exchange closed, Langlois says.

“It brought forward the fact that closing the exchange meant less access, not just to needle exchange services, but it meant less access to health and social services,” Pauly says.

The needle exchange was a gateway to other services. And the study also revealed that the rates of reusing needles or unsafely disposing of them rose dramatically.

“Bernie and I have done presentations about it,” Langlois says. “It was like the ground kind of shifted in the middle of their research.”


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