The lyrics to Ray Charles hit R&B tune “I Don’t Need no Doctor” are just as valid today as they were in the 60’s. Men do not like to go to the doctor.
While more than 11.5 million women had contact with a physician in the past year across Canada, the number of men who did so was considerably lower. According to a 1999-study published in the Journal of Family Practice, “men are less likely than women to actively seek medical care when they are ill, choosing instead to ‘tough it out’.”
The reasons for not being engaged with their own well-being vary, from men conforming to an expected social role of being strong, almost immune to any physical threat, to other barriers like having to disclose their vulnerabilities to a third person, or having difficulties keeping up with appointments.
In marginalized populations, the phenomenon worsens. That’s why the team that coordinates the Positive Outreach Program at Vancouver’s Native Health Society launched an initiative called Downtown Urban-knights Defending Equality and Solidarity.
The program, better known by its acronym Dude’s Club, tackles Downtown Eastside’s men’s health by approaching them in an informal setting.
Six out of every 10 people living in Vancouver’s Downtown Eastside are men, and most of them are considered low income.
Health problems related to poverty abound among these men. According to the Downtown Eastside Local Area Profile 2013, released by the City of Vancouver, life expectancy for them is of 74 years, almost five years below what’s expected for all Canadian men and 11 years lower than what is expected for female residents of the area.
“Within Vancouver, the Downtown Eastside has the highest rates of nutritionally related disease including colorectal cancer, diabetes, and diseases of the circulatory system,” said Christiana Miewald, PhD in her 2009 report Food Security and Housing in Vancouver’s Downtown Eastside.
HIV is another major problem that people living in the DTES face, especially men. According to Vancouver Coastal Health’s report Community Health Area 2: A Health and Social Profile, 47 males out of 100,000 people were diagnosed with the infection in 2010/2011 within the health area where the Downtown Eastside is contained. The rate for their female counterparts was of 11 out of 100,000 people.
Most of the infections are from the exchange of contaminated syringes. The DTES hosts some 4,600 users of intravenous drugs and even though it’s difficult to track them to know their demography with certainty, the fact that 73-per-cent of those who attend the safe injection clinic InSite are men is an indicator of the consumer’s profile.
Robert McMillan fits into that profile. Twenty-five years ago he was diagnosed with HIV, moved from Alberta to the Downtown Eastside and, as many men, was reluctant to access health care services.
“When I first started coming to the Dude’s Club, I was a screwed-up Downtown addict who thought the world didn’t give a shit,” he said. However, once he started to receive proper medical attention, and connect with other men going through situations similar to his own, he began to break down the barriers that had previously stopped him from taking better care of himself.
Besides facing physical health issues, a high proportion of men living in Vancouver’s Downtown Eastside also deal with mental and emotional struggles, like substance abuse and psychosis.
Coping with loneliness is another challenge. According to the Downtown Eastside Local Area Profile 2013, 45-per-cent of the residents of the area live alone and many of them reside in single room occupancy units. Eight out of 10 SROs dwellers are men.
Even though many of these men find connections in public spaces, like the always-crowded Pigeon Park on Hastings Street, they eventually return to the isolation of their dorms. “Mostly, when we do our focus groups, they talk about loneliness and a sense of disconnection from community, and how that further isolates them from an already stigmatizing, marginalizing kind of situation,” said Dr. Paul Gross, the medical director of the Dude’s Club.
For the men living in the Downtown Eastside, having no one to share their feelings or concerns with affects more than their mental and emotional health; it also affects their physical well-being. According to the Journal of Family Practice’s study, “men appear to get most of their support for health concerns from their female partners. Their pattern of seeking support tends to be indirect rather than straightforward.”
A traditional family
Male loneliness in the Downtown Eastside is part of a larger trend in the city, according to a 2012 report issued by the Vancouver Foundation. To lessen it, Dude’s Club’s organizers have worked with the members to build a sense of family within the group.
The creation of that atmosphere is also influenced by the Vancouver’s Native Health Society, which hosts the group. Clients are encouraged to try to understand each other as members of the extended families that are prevalent among First Nations.
Besides promoting those traditional ways, supported by the presence of the Musqueam Elder Henry Charles, the aboriginal approach also stresses the importance of food as an essential part of each gathering. “Because when you feed the body you also care for the spirit, mind and emotions,” states the Club’s mandate.