Doreen Littlejohn and two other nurses climbed three flights of stairs to a tiny stifling room. A man was lying in a bed with filthy sheets, flies were buzzing around, and a bucket on the floor was his bedpan. He was dying of AIDS. This was the Downtown Eastside in 1997, when Vancouver was making headlines for an HIV infection rate that was the highest in the developed world. “I could not get over the horror that this was happening in Canada,” recalls Littlejohn, who once had ambitions of nursing in a developing country. “I thought, ‘this is where I am meant to be.’” Littlejohn and her colleagues returned with morphine, sheets, and supplies, and cleaned the man’s room. She convinced him to go to a hospice and was with him two days later when he died.
Littlejohn had just started up a program focusing on the Indigenous population and other marginalized people living with HIV and AIDS in the Downtown Eastside. Her initial challenge was that her target group, with three times the risk of contracting HIV than the general population, faced multiple barriers accessing medical help. Many of them had painful histories of residential schools and had learned not to trust institutions. So Littlejohn and her team of nurses, based at the Vancouver Native Health Clinic (VNHC), took their practice to the street. Armed with packs of sandwiches and medications, they tracked down patients in parks and alleys. They called their rounds “the moccasin trail.” The man in the small room was Littlejohn’s first home visit and his death was the first of far too many. The annual death rate among her clients at that time was 10 per cent.
Since then, Littlejohn’s Positive Outlook Program (POP) has become a model admired and emulated by inner-city Native community health programs in Canada and elsewhere. Irene Goldstone was director of professional education at the BC Centre of Excellence in HIV/AIDS during this time period, and in 2010 nominated Littlejohn for an Award in Advocacy from the College of Registered Nurses of BC. “Doreen is not constrained by narrow institutional boundaries,” she said. “She’s great at forming partnerships to maximize what can be done. At one stage I figured she was raising $300,000 a year to support what I consider essential services: developing really innovative responses to Hep C, a food program, a whole range of things that helped keep people engaged in their health care.” UBC professor Colleen Varcoe is a research colleague of Littlejohn. “Doreen herself is absolutely the most dynamic advocate for people accessing care at Vancouver Native Health,” she says. “She does everything from going to someone’s hotel room to see that they’ve taken their meds, to arguing on CBC for better housing, to coming out to UBC to do a class, to analysis for her research. She just tackles all the different angles at the same time.”
Littlejohn is a former UBC adjunct professor who has trained many UBC nurses in her clinic. She grew up in Prince Rupert and, although she always wanted to be a nurse, trained as a chef out of high school. Her husband was an RCMP officer, and they eventually moved to Chetwynd. There, she worked as a community service worker, developing large crime prevention programs. In 1986 they moved to Vancouver and Littlejohn finally pursued her goal, completing the psychiatric nursing program at Douglas College. After starting her career, she went back and finished her RN. She was working as a community health nurse for Greater Vancouver Mental Health Services when she wrote a grant application for the POP at Vancouver Native Health Society.
To say that Littlejohn runs a program doesn’t quite capture what she does: the clinic is more like the busiest community centre you’ve ever seen. Located in an old building on Hastings Street, the POP space is basically a long hallway with rooms off to both sides: medical clinic rooms and Littlejohn’s office. It’s become a one-stop shop, with various medical specialists coming here to see patients. People are everywhere: milling in the hallway; chatting at the tables in the dining room at the back; preparing corn, chicken drumsticks and rice in the kitchen. They serve two meals every day to 200 people, and Littlejohn has spent every Christmas Day here since she started, using her chef’s skills to cook a turkey dinner.
Littlejohn is petite and tells stories with expressive hand gestures. People often ask if she’s Native because of her last name. She’s not, but she was given the honorary name “Niiadmagekew” (a woman who advocates for the rights of others) in 2007 by two staff from the Anishnabe Nation that worked at Vancouver Native Health. She meets the daily chaos of the POP clinic energetically, greeting people in a sing-song voice. The VNHC next door is a maze of narrow passages: the main floor is lined with medical and dental care rooms; upstairs is the office where she does her UBC work; downstairs is the counselling space and the sanctuary. Close by is a privately run pharmacy. “Everything’s crowded, nothing’s fancy,” she says, “but it works. What’s neat is that there are no high glass walls where people are barricaded from actually talking to people, no security guards.” She constantly pauses to engage with people: “I don’t see anything!” to a man outside behind the back deck, making show of hiding something he’s smoking; “Where’d you get the scooter?” to someone else pushing the vehicle around a tight corner; “How was your case conference yesterday?” to someone else in the hall. All of the volunteers here are clients themselves.
It’s hard to believe now that her first challenge was getting people to access primary care at the clinic, which now supports 1500 members with HIV/AIDS. One of the hardest to reach was a young woman who had grown up on the street with her mother, a sex trade worker. The young woman would come in every afternoon, sit down and cry. It took seven years before she would accept HIV treatment. “She would use the shower, sit outside my office and have salad. I’d always have a bag of clothes for her. But she would never engage in conversation.” One day she was outside on the sidewalk, so high that people in the clinic were frightened she would dart out onto Hastings Street. Littlejohn phoned a doctor and got a prescription for an anti-psychotic medication. “This will make your head feel better,” she promised the woman, who for the first time accepted the pill. The next day she came back and asked Littlejohn for another one. Slowly, she started seeing a doctor and taking anti-retroviral drugs for her HIV. Now she lives in stable housing, continues to visit the clinic, and has decreased her involvement in the sex trade.
Littlejohn uses this example to help UBC nursing students understand what it means to work with a “culturally appropriate lens.” Her staff provides care based on individual needs. In one case it took six months for them to help a member fill out an extensive disability form, because she was so suspicious about how the information would be used. “You have to understand that most of our clients come from trauma, and that the behaviours you’re seeing come from that history. So it’s not about blaming or judging, or even as simple as harm reduction. You’re working with people at a deeper level. So how do you actually make the connections and help people work and walk through their journey?”
Littlejohn is now trying to retire from her role as program coordinator. She’s agreed to stay on until her replacement is found, and she’s taken on a new job as health intervention coordinator for a UBC research project focusing on women experiencing violence in intimate relationships. She will be adapting an intervention for Indigenous women in an urban context, continuing a long collaboration with researchers in the UBC School of Nursing.
Reflecting back on the early years, Littlejohn feels fortunate. “In my nursing career, I’ve been so blessed. It was a very exciting time to be a nurse in terms of how you could effect change in a community. Working with Indigenous people, building a program, being an advocate, being part of the community, it’s so satisfying. I’ve done everything that I wanted to do.”
UBC in the Downtown Eastside
The Learning Exchange is a link between UBC and the Downtown Eastside. Established more than a decade ago, it is “a place of mind for thinking differently about social issues and how to build community.” The Learning Exchange welcomes volunteers to help out with different programs and initiatives.