IT IS 18 DEGREES CELSIUS below freezing as night falls on inner-city Toronto. A group of men sink deep into their tattered fleeces as they struggle to stay warm. An icy January wind cuts into their faces. Some are seriously ill or addicts. Others have fallen on hard times and are simply homeless. Welcome to the heartland of St Michael’s Hospital, a remarkable Canadian institution that is part social worker, part doctor and part research scientist. Whether it is offering a hot meal, a shower and a clean, safe bed or long-term research into kidney disease, the Urban Angel, as it is known throughout the city, is part of Toronto’s human safety net.

“We go into parts of the city and provide health care services where other people do not want to go,” said Jeffrey Lozon, the hospital’s President and CEO. “And we have been doing it for nearly 120 years and have never turned anyone away. People know us. They trust us. We are a haven for people whose home is the street or the park bench. People who are outside the system with no medical insurance and no money can come to us. We deal with both human and health problems without judging the circumstances people find themselves in. We are unique. We combine the compassion of a valuebased organisation with the science of the teaching hospital.”

St Michael’s is a teaching hospital affiliated with the University of Toronto. It has more than 5,000 staff, with 600 doctors teaching 1,600 students. Impressive numbers but what makes the hospital so special is its work with the city’s most vulnerable citizens, the victims of homelessness, poverty, disease, drug abuse, mental illness and violence. The hospital, founded in 1892 during a diptheria epidemic, is recognised globally as a research leader in inner-city health.

This makes it a worthy recipient of a CAD25 million (USD21.7 million) donation from the Li Ka-shing (Canada) Foundation. The gift will be used to establish the Li Ka-shing Knowledge Institute, which will bring together the worlds of research, education and patient care. The institute will be the first of its kind to bridge the gulf of understanding separating education from research and research from front line health care. The gift is the largest single donation ever received by the teaching hospital and construction of the institute is scheduled for completion in 2009.

The Knowledge Institute will take the scientists out of the lab and put them in the front line

“The Knowledge Institute is a new idea,” said Mr Lozon. “It will allow us to create an incubator of knowledge. It will take the scientists out of the lab and put them in the front line so they see, feel and touch the people who are afflicted by a range of diseases. We will be able to attract the best and brightest in a wide range of disciplines. We are creating a living laboratory that can be both a molecular lab and a lab in the street. This will allow us to get the science to the patient faster. Think how many lives you might save. It’s a very exciting project. We are deeply grateful for the confidence being placed in us.”

The existing Centre for Research on Inner City Health, founded by St Michael’s Hospital in 1998, will be housed in the Keenan Research Centre of the Knowledge Institute. Here, in a rough downtown neighbourhood, more than 50 research staff, including doctors, biostatisticians, a geographer and a health economist, look beyond the health issues of individuals and search for factors that might lie behind them – everything from housing, transport, domestic violence and fast-food outlets. The director, social epidemiologist Dr Patricia Campo, said she was attracted to the institute because “there seems to be a collective responsibility for the plight of the poor, and a collective willingness to do something about it.”

The work of the centre includes everything from homelessness and HIV to immigrant health and gender equality in treatment. An ambitious project is underway that will map and track 3,500 families in Toronto over 10 years. The research at the unit helps to change medical practice and public health in Canada and internationally.

The Li Ka-shing Knowledge Institute will provide the Centre for Research on Inner City Health with more space and improved facilities, which will help to attract the best talent. The President of the University of Toronto, Dr David Naylor, said the Knowledge Institute would make a real impact on the world. “Now for the first time ever, we will be building on the education that researchers, educators and clinicians receive from the university and we will be building on the knowledge and accelerating their findings to the front lines of care, thus setting a new standard in health care,” he said. By combining groundbreaking research and education with practical training in a hospital facility, he said the Li Ka-shing Knowledge Institute would serve as a new model for other hospitals in Canada and for other institutions in the world.

Mr Li is, of course no stranger to Canada. Until recently, he was the largest individual investor in the Canadian Imperial Bank of Commerce (CIBC). He sold his stake in CIBC early last year and donated all the proceeds from the sale, approximately CAD1.2 billion, to private charitable foundations, including the Li Ka-shing Foundation and the Li Ka-shing (Canada) Foundation. St Michael’s joins Cambridge University in the United Kingdom, the University of California at Berkeley in the United States, Institut Pasteur in France, the University of Hong Kong and the Chinese University of Hong Kong and Shantou University in Mainland China in receiving a major grant under the Li Ka-shing Foundation’s biomedical programme.

Mr Li expressed his great admiration for the dedicated service the hospital was providing. “It is refreshing and touching to know that an institution has stayed true to its commitment to progress and care throughout the years,” he said. “I believe an equitable society can only be achieved if each and every individual is ready and willing to do his or her part in capacity empowerment through education and the building of a caring society, particularly through medical and healthcare related projects. These are two important pillars of hope for any society.”

THE $49 SYMBOL OF HOPE

THE STORY OF how St Michael’s came to be known as the “Urban Angel” reaches right back into the hospital’s history. Shortly after the Sisters of St Joseph founded the hospital in 1892, they found a dirty and blackened statue of St Michael the Archangel in a local pawnshop. They agreed to pay $49 for the statue, money they had saved from selling old newspapers, and it soon became a symbol of the hospital’s spirit and commitment.

In 1997, the statue was moved to a new wing from the hospital’s lobby where it had stood for many years. As it was lifted away from the wall, the word “Pietasantra” could be seen chiselled on the back of the statue. The marble had come from the same quarry in Italy as Michaelangelo used for his famous Pieta (c1498-99) that can be found in the Basilica of St Peter in the Vatican. The artist and the date of creation for the statue are not known, nor are the details of how it made its way to Canada. What is certain is that for more than a century, the statue of St Michael has been an inspirational symbol of hope and healing for patients and their families as well as for those who work and volunteer at Toronto’s “Urban Angel”.

The hospital itself originates from an old Baptist church, where a boarding house for working women was operated by the Sisters of St Joseph. A diphtheria epidemic was sweeping Toronto in 1892 and the sisters answered the call to service and St Michael’s Hospital was born. The hospital began with 26 beds and a staff of six doctors and four nurses. Within a year, accommodation was increased to include two large wards and an emergency department. By 1912, bed capacity reached 300 and a five-room operating suite was added.

As early as 1894, St Michael’s received medical students and in 1920 negotiated a formal agreement with the Faculty of Medicine at the University of Toronto that continues to this day. Between 1892 and 1974, St Michael’s School of Nursing graduated 81 classes of nurses, a total of 5,177 graduates! The school was closed in 1974 when nursing education was moved into the community college system.