by PATRICK LEJTENYI

Dominique Boudreau has seen a lot in only 11 months on the job. Abscesses, STDs, hepatitis, teen pregnancies and piles and piles of discarded needles are part and parcel of what she does every week as an outreach nurse, servicing the marginalized, often ignored, street kids on the Plateau. Christmas, no big surprise, doesn’t make her job any easier.

“Well, the cold is the biggest problem,” she says. “But as nurses, we still have to go into the streets and alleys where the kids are hiding. And around Christmas, there’s a lot more problems concerning mental health. A lot of the kids are depressed or suicidal. A lot of them don’t have families, or have been abandoned by them.”

The 27 year old is one of a group of roughly 20 nurses from the Comité des infirmiers et infirmières de proximité, made up of nurses from nine CLSCs, the Montreal public health department, community groups and Médecins du monde, a humanitarian organization. Theirs is perhaps the most trying of clientele: street kids, prostitutes (male and female), prisoners, the homeless, IV drug users and new immigrants. And as if dealing with people naturally distrustful of all systems, the medical included, outreach nurses displace themselves - visiting their charges on-site, rather than waiting for them to come to a central location. That means, like mailmen, neither rain nor snow nor gloom of night keeps them from their rounds.

Outreach nursing isn’t a new phenomenon, however. “I like to compare it to programs in the 1950s in Quebec, where tuberculosis teams of doctors and nurses would travel to the tiny villages around the province and do x-rays,” says Teena-Marie Johns, a nurse with the public health department who is in charge of setting up hep A and B vaccination programs around the city. “Even school nurses are examples of outreach nurses.”

Of course, there are outreach nurses, and there are outreach nurses. Handing out syringes and dressing abscesses for junkies and hookers isn’t quite the same as examining schoolchildren for head lice. For one thing, there is a relationship that has to be built between patient and nurse that is much more difficult to achieve when dealing with Boudreau’s clients.

“With this clientele, it’s very difficult to make that link of confidence,” Boudreau says. “You make one mistake, and that link’s broken.”

“There’s a lot of bridging,” adds Johns. “It’s us going to the clientele, bringing prevention treatment with us to help with potential health-care problems.”

For all their dedication, however, both admit to a lack of resources and a lack of interest from the powers that be. Boudreau is an on-site nurse once a week at the Ketch Café, a hangout and drop-in centre for street kids on St-Denis just north of Mont-Royal. She says it’s one of maybe three resources available to her charges in the neighbourhood, something that makes her job even tougher.

“Sometimes I feel powerless,” she says. “I get the impression that we can’t do anything. But sometimes, even just talking to these kids helps them a lot.” :