Delivering compassionate care when and where it’s needed
Raymond Macaraeg, a primary health care nurse practitioner at the Parkdale Queen West Community Health Centre (CHC), is on the front lines of delivering essential primary health care and harm-reduction services to Parkdale-Queen West’s marginalised residents, many of whom feel excluded from the mainstream health care system. NICK MENZIES PHOTOGRAPHY
Queen West in Parkdale has been dubbed one of the hippest streets in Toronto, lined with fashionable cafes and shops, and, in pre-pandemic times, buzzing with smartly turned out people.
In the midst of this, however, is another reality. An estimated 8,700 Torontonians experience homelessness each day. In Parkdale, near Dufferin Street, that statistic is brought to life in the form of a large encampment of tents erected by homeless residents impacted by poverty, substance use, and mental health issues.
The encampment is serendipitously directly opposite the Parkdale Queen West Community Health Centre (CHC), a life-saving support to the area’s marginalised residents, providing an array of free medical care services and harm-reduction services administered by the centre’s podiatrists, community health works, psychiatrist, dietician, physiotherapist, nurses and physicians.
Today, Janis, a Parkdale resident in her early 50s who has spent much of the last decade living on the streets, waits patiently in the lobby. She’s there to receive her weekly dose of morphine, a clinically approved substitute to heroin and fentanyl, a dependency stoked by a childhood spent in acute poverty and trauma.
“You can get fentanyl as quick as a cup of tea here,” says Janis of the neighbourhood. Now, the deadly drug, responsible for numerous overdose deaths in the area, is being made even more lethal by the onset of coronavirus and physical-distancing measures taken to slow its spread.
Angela Robertson, Executive Director of the CHC, calls the new Parkdale Queen West Mobile Health Clinic, powered by TELUS Health, a “game-changer,” allowing the organization to treat clients when and where they need help. NICK MENZIES PHOTOGRAPHY
“The number-one rule in harm reduction is ‘don’t use alone.’ But COVID requires isolation. So when, and if, there is a crisis, no one is there,” says Angela Robertson, Executive Director of the CHC.
Dr. Andrew Boozary, a physician and Executive Director of Population Health and Social Medicine at Toronto’s University Health Network (UHN), has a decades-long vantage point to observe the workings of the country’s health system. He says that there is a pervasive image of its universality -- “but it’s just a mirage.
“Yes, it is a really powerful health system, but when you look at the actual system and its delivery, look at the empirical data over decades, it is clear that the system discriminates against people living in poverty, racialized and Indigenous people, and immigrants,” says Boozary.
In return, marginalized people often feel excluded from mainstream health care service models, such as a walk-in clinic or hospital. Those experiencing homelessness, in particular, face a variety of barriers to accessing health care, including lack of transport, not having a valid health card, undocumented medical histories, trauma, and untreated mental illness. As a result, their access to primary health care, mental health support, and harm reduction is further eroded.
“I hate going to hospitals. Everyone looks down on us. They think our addiction is a ‘lifestyle choice.’ Even if we were on the verge of dying, they wouldn’t listen to us.”
Support with humility
In addition to primary health care, the new clinic-on-wheels will enable mobile COVID-19 testing and vaccination efforts at homeless sheltering sites, congregate housing for marginalised people, and in areas with high positivity rates.
Delivering quality care to people like Janis is the reason TELUS has expanded its innovative Health for Good program to Toronto. In partnership with Parkdale Queen West CHC and UHN’s Social Medicine Program, a specially equipped clinic-on-wheels will hit neighbourhood streets throughout the city’s mid-west region, providing essential primary health care and harm-reduction services directly to marginalised populations. The clinic will also enable mobile COVID-19 testing and vaccination efforts at homeless sheltering sites, congregate housing for marginalized residents and in areas with high positivity rates.
Backed by a five year, $10-million commitment from TELUS, similar mobile clinics are already active in Victoria, Vancouver, Surrey, Calgary, Edmonton, Ottawa, Mississauga-Peel Region, Waterloo Region, Montreal, and Halifax. Each van is equipped with TELUS Health electronic medical records (EMR) technology and TELUS LTE Wi-Fi service, enabling skilled practitioners to collect and store health data, examine results over time, and provide better continuity of care to patients who may have undocumented medical histories.
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In Parkdale, it means, almost overnight, the CHC will be able to treat clients when and where they need help.
“I think it will be a game changer,” says Robertson of the clinic, formally known as the Parkdale Queen West Mobile Health Clinic powered by TELUS Health. “We know that if you are living in poverty, and if you are living with mental health and related traumas, and you cannot make a referral to go get your services at a certain hospital at a certain time because of a whole host of reasons related to your situation, you will just miss your appointment and access to care.
“Now, we can take that service to the client.”
In addition, Robertson says the mobile clinic will be a much-needed boon to battling the pandemic, as well as getting vital health services that go beyond primary care to clients, such diabetes education and overdose prevention supports.
Janis, too, is excited by the possibilities the clinic delivers. She recently secured a room in a rooming house for herself, but still acutely feels what it means to be on the streets and in need of medical help, but afraid to ask for it.
“Now, the mobile health van will simply erase that stigma since it will bring that medical help to you,” she says.
That’s the true strength of the program.
“I am incredibly excited about this partnership with Parkdale,” says Dr. Boozary. “This is how to do it — using community expertise that has already earned the trust of their clients to lead, and to support them with humility.”
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