Dr Mark Nowaczynski wanted was a quiet life, making house
calls to his roster of elderly patients and spending time
with his family. But by the late 1990s he was tired of
watching his housebound patients suffer the effects of
Ontario's inadequate homecare system. A long-time photography
buff, he had an idea: he asked some of his patients if
he could document, in stark black and white, their sickness,
squalor and solitude.
"Many said no because they were ashamed," says the 45-year-old
GP with a specialization in geriatrics. "Here they are
living in grinding poverty, in bachelor apartments,
in tattered clothes. I told them it was so important
to show that this is the reality in the heart of Canada's
They put their faith in their calm,
caring doctor and as a result he's amassed a sizable
body of pictures depicting their living conditions.
The photos are striking, beautifully capturing the essence
of their vulnerable subjects. One shows dapper Mr George
W, a retired postman and Second World War veteran and
emphysema/chronic bronchitis/heart disease/diabetes
sufferer. His hand is aloft in mid-speech, his cigarettes
within easy reach, his expression animated. Despite
his poor health, George was eligible for just two hours
of homecare a week.
Another photo depicts Ms Doris
A, a formidable-looking lady living with an ischemic
leg, worn out hip joint and osteoarthritis. She was
forced to make do with just four hours' help a week.
Most heartbreaking of all is Ms Constance C, a frail,
beatific 91-year-old with heart problems and dementia.
After she broke her arm, the healthcare system left
her high and dry when her six weeks of post-acute homecare
was abruptly cut off. She faced the grim prospect of
being torn away from the only life she knew and having
to give up her beloved cat, Oscar. "They were going
to put her into a nursing home," says Dr Nowaczynski,
still stunned. "She was an obvious candidate for homecare,
but she couldn't get the help she needed."
Why do these patients need advocates?
Because they don't complain, they make do. "This is
a group of people that came of age during the Depression,
and they're used to sacrificing," says Dr Nowaczynski.
"I find it a sick irony that they're being forced to
relive the privations of their youth."
ON AN EPIDEMIC
On Mother's Day 2001, Dr Nowaczynski's private concerns
about what he sees as Canada's silent healthcare epidemic
gained a powerful public platform when The Globe
and Mail published his story and photos in a three-page
spread. The piece generated tremendous public buzz and
won an award for excellence in healthcare reporting
from the Canadian Nurses Association.
Sitting in his midtown Toronto
office ? a small, cramped room overflowing with books,
plants and papers ? he looks back over the last few
years since the story appeared. Three framed black and
white photos of his patients stand out among the clutter,
frequently drawing his eyes as he speaks of his slight
discomfort at being thrust into his new, high-profile
role as homecare advocate.
The Montrealer grew up far out
of the spotlight, happiest among the test tubes and
complex experiments of his father's McGill University
lab. As a child he was the only one of six children
to take an interest in the work of their father, a scientist
and professor of medicine. Dr Nowaczynski's parents,
Second World War refugees, emigrated to Canada in 1953
The young science enthusiast planned
to follow in his father's footsteps and work as a researcher,
and completed a BSc at Queen's and a PhD in physiology
at UBC. But the climate of funding cutbacks in the 1980s
convinced him to switch to medicine; he got his MD in
1990 from UBC and two years later established his Toronto
practice. "I had originally decided to jump into family
medicine, but training in internal medicine exposed
me to various aspects of complex medical care of the
elderly," he recalls. "It didn't scare me away ? I was
quite happy to do it at their homes with minimal backup."
It helps that he has the unconditional
support of his wife, Zabeen, and their two young children,
Adam, 10 and Aliya, 8.
One vocation he's never strayed from since his youth
is photography. It's always been a passion of his ?
and now more than ever. "I realized this is a powerful
way to get at people," he says. But he admits that so
far he hasn't had much luck getting politicians to see
the social and cost benefits of increasing spending
on homecare. "Politicians are avoiding the issue of
letting people stay in their homes and providing services
to prevent institutionalization," he says. "The majority
of the homecare budget goes to post-acute homecare ?
where does this leave senior citizens who need chronic
In one happy ending, The Globe and Mail article
and Dr Nowaczynski's photography helped Constance and
Oscar bypass the queue and secure a place in an assisted-living
facility. It's also landed the doctor at the centre
of an entirely new adventure: the National Film Board
is just wrapping up shooting of a documentary chronicling
his work as well as the personal stories of three of
his patients. Called House Calls, the film is
slated to air on television sometime in the fall.
"I realized that the movie will
be an excellent vehicle to get through doors that are
otherwise hard to get through," says Dr Nowaczynski.
Meanwhile, the experience has convinced him to view
improving homecare as his life's work. "It makes sense
to me to do it full time," he says. "All of us are getting
old, and we don't want to end up like this."