Cathy Crowe on her new memoirs and what it will take to move forward in the fight for adequate housing

“My dream from the age of five was to be a nurse,” writes Cathy Crowe in her new book A Knapsack Full of Dreams: Memoirs of a Street Nurse. Growing up in Cobourg, Ontario, the longtime social justice activist and street nurse learned her earliest lessons about nursing and advocacy from her mother, an emergency room nurse. Dinner table conversations often revolved around what trauma had arrived in the emergency room, the need for patient-centred care, and the gendered politics of nursing.

When Cathy started her nursing career, her dissatisfaction with the confines of her early nursing roles and her growing interest in advocacy led her to community health centres and upstream health advocacy. Her work soon developed a focus on providing health care for those experiencing homelessness; she also began campaigning for a fully funded national housing program, as well as adequate and safe shelter. A Knapsack Full of Dreams offers an eyewitness account of the unfolding of Canada’s homelessness crisis, as well as a personal narrative of a leading activist’s inspirations, challenges, and victories.

Cathy is also the author of Dying for a Home: Homeless Activists Speak Out, as well as the co-founder of the Toronto Disaster Relief Committee. She is a filmmaker and was an executive producer in the Home Safe documentary-film series.

We spoke to Cathy about chronicling a thirty-year career dedicated to homeless health care, finding a balance of approaches to advocacy, and charting a course forward in the fight for housing for all.

Let’s start with what led you to write these memoirs and why now.

I’ve had a really long and rewarding career in nursing. I’m always reminded of that by younger nurses and other folks when they’re consulting with me on issues or when I’m teaching or speaking. And I’ve worked on a range of issues — anti-war activism, apartheid, homelessness, fighting the return of the death penalty. Their reaction always reminded me that I’ve really had some unique experiences.

When my Atkinson Economic Justice Fellowship ended — I had that twice renewed so in total for five-and-a-half years I had this absolute freedom to work on housing and homeless issues both in Toronto and nationally — I became unemployed. I use the phrase “orphaned from my nursing career,” but in many ways, throughout that period of unemployment (four years), I was fully busy. I look back at my day books from that period of time and it was constant work and activism around homelessness, with the odd bit of teaching.

During that period of time I was still being approached by younger people; they were looking to me for information and support. And I thought, “I should start writing my memoirs.” It gave me a real mission. It became a new self-employed job for me and then it grew and grew.

The book is called A Knapsack Full of Dreams. How did you arrive at that title? What does it signify?

I compare my big black knapsack, which was my nursing outreach bag, to the symbolism of a doctor’s medical bag on house calls. I have a very emotional connection to the bag, and it’s almost like a character in the book. But I didn’t realize that until the day I was part of a press conference in the press gallery at the House of Commons in Ottawa. When I pulled things out of the bag to show the media, I just started crying.

After that I wrote a story for The Globe and Mail called “My Black Bag Made Me Cry,” just describing that. My bag was a daily tool for me. It had everything from medication to bandages in it, but then every so often I would decide to add something new to the bag. For example, I would add duct tape for taping soles back on shoes or space blankets due to the lack of sleeping bags and shelter, or a camera. So, the bag, to me, had real personality.

And then, when I was going through the process of reviewing the movies that I selected to introduce each chapter, I watched a documentary about Tommy Douglas, and he was described as having “a suitcase full of dreams.” And what that meant was that he wanted health care for all, ultimately leading to Medicare, but he also cared about good roads, good schools, and good public services.

To me, that was what my bag was about. It was about health care still, and housing and homelessness, but my career was also about other things. All of those issues really are human-rights based.

So you’ve been a street nurse for over three decades now. What led you to work on issues related to homelessness in the first place? You speak about leaving a nursing job on Bay Street.

I left the job on Bay Street to become a community health nurse, or a clinic nurse. I also worked as a nurse practitioner at many downtown community health centres where the populations were diverse and interesting, many facing income challenges, ranging from Regent Park to South Riverdale. But I had no ambition to do homeless healthcare; it never entered my mind.

But I realized that at times the doctors in these organizations and the politics of the board of directors really influenced the nursing role and its scope. I even went back to school to become a nurse practitioner. And even with that there was always a nervousness around how expanded a role they would allow me to be in. So that was frustrating.

And then this little organization called Street Health got funding from the Ministry of Health. They were a small independent entity that I knew about and highly respected, and they were right downtown. They had already influenced me a little bit in terms of a small outreach clinic we ran for homeless people in Regent Park. They were hiring so I went there. I knew there would be a strong nursing role and it would be interesting.

I had many, many stereotypical ideas about what I would be doing. I had the same stereotypes that many people have — that I would only see older men, that there would be a lot of alcoholism and sore feet.

But what happened when I landed there was that everything opened up. Everything was interesting. Advocacy was expected. I saw men, I saw women, I saw teens, and it was just very, very challenging. Every day was different. It was a huge learning curve and dramatically interesting. So that’s how it happened. It was more the nursing path that led me there than deciding I wanted to be doing health care for homeless people.

Housing has been recognized as a human right at the federal level. How are you feeling about that development after years of calling for a fully funded national housing program? What do you think needs to be done next?

I worked on housing as a human right for about 8 to 10 years, meeting with Bruce Porter and others. So I fully supported that campaign and I’m pleased we’ve achieved it. And I know that in the long run it will lead to some important decisions.

But right now, I do not see housing or shelter as a right. Nothing is enacted today. Nothing is planned to be enacted in the coming months that will change the lives and experiences of people who are homeless or precariously housed. That leaves me pretty depressed actually because I think accompanying the housing decision there could have been immediate declarations across the country by city councils and provincial governments.

I know there’s been an attempt at the City of Toronto to use rights-based language, but the City of Toronto also refused to declare a state of emergency on homelessness. That could have opened up federal and provincial buildings, and could have expropriated sites for shelter and/or housing. So while I fully support the new rights legislation, I’m also aware that all the endeavour that went into that and all of the buy-in into the Housing First model has really diverted a massive amount of energies away from building “movement muscle” (as Naomi Klein would say), which we have to have to be able to move forward regardless of what happens in upcoming elections.

Could you tell me a bit more about “movement muscle”?

Movement muscle is about the mobilizing of people, about peoples’ struggles, about people coming together.

It’s about the “winds of change,” another phrase I use. It’s about enough people coming together so that an issue is on the national (and international) radar.

We need to see protests, demonstrations and a rallying cry of tens of thousands of people so that it’s on everybody’s lips. Because it’s there in their hearts, it’s there in their physical awareness in their housing circumstances or their homelessness circumstances, but it’s about bringing it all together with the leadership so that political decision-makers will be forced to respond.

You also mention two different kinds of advocacy in your book — consumer advocacy and systemic advocacy. What is the difference between those approaches and what role do you think each plays in social change?

I found that pretty much wherever I was working, my colleagues and I were very much supported to do individual advocacy or consumer advocacy, meaning the kind of special steps you would take for your patient or your client to advocate for them or with them. That could be ensuring that all the proper forms were done for eligibility for subsidized housing or various social benefits that would improve their incomes and their lives.

Sometimes within the medical system, it also meant advocating, like fighting for that person to get a second opinion if they had been turned down for something and were extremely dissatisfied. Sometimes that meant advocating with your actual coworkers saying, “Please, please, reconsider this for this patient.” And in hospitals too there’s a lot of advocacy — “Please don’t discharge this person on a Friday afternoon when he’s homeless. Don’t send them back out when there are no shelter beds.”

Systemic advocacy is looking upstream to see the conditions and policies that are creating the issues — things like ODSP rates, Ontario Works rates, the redefinition of disability this fall that’s going to happen in the province of Ontario, and obviously the lack of a national housing program. That’s the upstream, downstream parable.

Many organizations that were community-based did for a long time support their staff in taking part in systemic advocacy, for example by forming groups on different issues to try to lead up to a public inquiry.

I would say right now we’re at a very low period, where organizations are not supporting that work very much. This is due to a variety of reasons — some are fearing funding cuts, some are actually being threatened with funding cuts, and some are just swamped because they are working at the epicentre of the situation whether it be the opioid overdose crisis or the shelter crisis. Their workers are overworked, close to burnout or burned out.

I think a healthy balance of both kinds of advocacy has to take place. A long time ago a colleague of mine quoted a formula called “a third, a third, a third.” If you’re going to work on an issue, allocate a third of your time or energy to the downstream direct service (that would be individual advocacy), then a third to systemic advocacy, and then a third to even broader, stronger advocacy that is usually done by groups that don’t get any support from mainstream organizations or governments.

When you talked about organizations withdrawing support for advocacy I was reminded of what you said in the book —”I see but am silent,” a kind of prevailing philosophy around witnessing but not taking action. What do you think needs to happen to motivate people to go beyond just seeing things and taking action?

I think we have to teach how to do this; tools around advocacy have to be taught in curriculum whether that’s in social work, early childhood education, or nursing. And we have to honour it. We have to respect it and we have to allow it. We have to have managers who allow it.

People have to be able to dream and imagine creative ways to do this.

People often ask me, “Cathy, how have you done this work for so long? And, what are your personal coping skills?” I’ve always felt really awful after that question because I’ve never known how to answer it well. But now I realize that for me the answer is that with a lot of help from colleagues I always kept figuring out how to move forward and get past the barriers that were stopping me from speaking out. I think that was what helped my mental health, to be able to keep doing this.

At times — and I talk about this in the book — I had to go speak with journalists in a car or offsite or in an alleyway. There’s something very shameful about that. It can make you feel like there’s something illegitimate about the work you’re doing.

So I developed ways to survive. Now grant you, I ended up unemployed for four years and I really do feel that I was blacklisted. (Close colleagues have also told me this.) In some cases I was actually told, “We can’t hire you, we can’t bring you here because our funding would be threatened.” So there are downsides to learning how to see but not stay silent. I just feel proud that I stayed true to what I wanted to do.

What do you want readers to take away from your book?

Hope. I want them to leave the book not depressed, but with hope. I hope they see that this major issue I write about is solvable. I hope they say that they can be part, in some fashion, of what I call movement muscle and become part of the struggle. I hope that they are inspired to figure out ways to either learn some activism skills themselves or support others or groups. An elderly person reading the book for example might choose to do letter writing or to financially support groups doing that kind of advocacy.

And then, a really pleasant surprise has been having some people write to me to say they appreciate what I’ve been saying about film. Some of them are uncovering films they want to watch. To me that’s really great, especially when you think about the role documentary films can play in an issue.

If I was to recommend a film to readers on this issue, it would be Push, which features Canadian Leilani Farha, the UN Special Rapporteur on Adequate Housing.