Intensivist Hugo Touw doesn’t have to think long about which collaboration partner he wants to go “into the field” with to illustrate his commitment to good health and well-being: Wendy Broeren, who is responsible at the regional GGD for caring for people who are forced to live on the streets.
Working toward a sustainable world is not about sprinting
Working on health is more than just making people better. It is also - above all - about ensuring that people can live on a healthier planet. With that idea in mind, researcher and intensivist Hugo Touw is working toward better and more sustainable healthcare. “We see people in the intensive care unit who have waited far too long for help.” Touw goes out into the field with Wendy Broeren, who works daily at the regional public health service (GGD Gelderland-Zuid) providing care for people forced to live on the streets.
Touw and Broeren meet under the Waal Bridge, one of the areas where Broeren makes her rounds to give attention to “her” people. At the far edge of the open space beneath the bridge, she notices a sleeping bag. Is someone still lying under it? “That’s actually not allowed,” Broeren says. “When it gets light, homeless people have to leave their sleeping spot. Otherwise, the police will move them along.”
She goes to take a look and finds a man under the sleeping bag. She knows him - his name is Adam - just as she knows all the homeless people. After a short conversation, she can add a task to her to-do list: Adam shouldn’t be lying here, but he no longer has access to the daytime shelter due to a four-month suspension following a violent incident there. “Four months is quite long,” Broeren says. She decides to check with the shelter whether that period is correct. “Maybe it’s only four weeks and Adam misunderstood. If that’s the case, I’ll let him know as soon as possible. You can’t just lie here all day.”
Hugo Touw joins Adam and Broeren. He doesn’t need to provide medical care right now, but he takes the opportunity to see the person behind the patients he usually only encounters lying in a bed in the intensive care unit. The Radboudumc regularly offers homeless people such a bed, even if they are uninsured and such care is extremely expensive. Touw reflects on a man who lived on the streets and is currently occupying an ICU bed. “Often, someone like that stays for several weeks. They usually avoid care, or sometimes they don’t know that they can still receive help from general practitioners or from our hospital even without insurance. By then it’s too late, while a timely course of antibiotics could have prevented a lot of suffering.” For Touw, it is important to once again see with his own eyes where “his” patients come from. “I want to go back to the source. This is exactly where we need to solve the problems. There is so much suffering in the system.”
For a while, Broeren becomes a guide through the world of homelessness, leading the way past places familiar to her. During her shifts near the bridge, she scans the Ooijpolder with binoculars, searching for tents. On the slope near the entrance to the Waal Bridge, she points to an open spot, invisible to the many indifferent passersby. “There’s often a tent there - the woman isn’t there right now.” Touw looks more closely and points to a chair in a clearing in the vegetation. “Does someone live there too?” It’s unhealthy, he concludes. Yes, someone does live there, Broeren confirms: she knows her people and knows the numbers - Nijmegen alone counted 180 people on the “rough sleepers list” at the end of 2023.
Accessible healthcare
Touw and Broeren take a broad view of healthcare. In other words: it is more than just making people better. Broeren is particularly drawn to the goal of “universally accessible healthcare and development.” “I was trained with the value that care should be the same for everyone, regardless of who you are or where you come from. Everyone should be able to receive the care they need.” Life on the streets is a downward spiral: “Recently we saw a child born to parents living on the streets. How can you grow up healthy, eat well, in those circumstances?”
Touw agrees: it aligns exactly with what he means by tackling healthcare at its root. “Treating problems early prevents escalation in treatment, and that should apply to everyone. It prevents suffering and saves money.”
Statistics show that worldwide, one billion people suffer because they do not have adequate access to healthcare. These are also the people who must live in environments that actually make them sick, such as the homeless people under the Waal Bridge.
Good care not only helps these individuals get better but also reduces problems in society. Touw points to public nuisance and theft. “If the basics are in order, you can prevent this. Everyone should have enough money and opportunities for a roof over their head and to eat healthily. Even in this country, children go to school without a proper breakfast. That’s unfair.”
“The neglect of these people is also a loss of potential,” says Broeren. “You should want to empower everyone. Even people who seem confused have their own qualities.”
Hope and perseverance
Health problems are so intertwined with systems, climate, and social justice that there seems to be little room left for hope. “It sometimes feels like mopping up with the tap running,” Broeren says during the walk past tents and sleeping bags near the Waal Bridge. Still, she reflects on meaningful moments - like helping a man she found on the street with persistent headaches. She guided him through the healthcare system, where a fatal brain tumor was diagnosed. Later, with help from a cooperative housing association, she found him a home. “They had a small senior housing unit available, and he was able to live there with dignity for three more months.” Only two people stood at his grave: Wendy and the man’s daughter. “Sometimes you can make a huge difference, and that’s what I think about when the work feels difficult.”
For Touw, hope is connected to self-awareness and an understanding of the complexity of the issue. This awareness helps prevent self-inflicted disappointment, he says: “Working toward a sustainable world is not about sprinting - it’s a marathon. It requires perseverance.”
From the book: 'De kracht van verbinding' (in Dutch)
This article is a shortened version of a chapter from the book Dekracht van verbinding.
Melting polar ice, rapidly declining biodiversity, heatwaves and floods, and persistent poverty and injustice in many parts of the world. Is it too late to turn things around? Quite the opposite. De kracht van verbinding, published by Radboud University, shows students, teachers, and professionals how they can contribute to a more sustainable planet from within their own fields of expertise.
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