Elder-led mobile health program brings healing to Downtown Eastside

Ruth Alfred is a member of the Namgis Nation, and was raised in Alert Bay. As Elder-in-Residence at the Kílala Lelum Health Centre, she offers one-on-one cultural and spiritual support to members in need: “I am basically their surrogate auntie, grandmother, whatever they want to call me.”RICH LAM PHOTOGRAPHY

Transformation. Unconditional love and acceptance. Healing and good health. These values-in-action are transforming lives through a trail-blazing community organization at work in Vancouver’s Downtown Eastside.

Two years ago, the Kílala Lelum Health Centre opened its doors as an Indigenous, Elder-led primary care centre serving residents of a tight-knit, but troubled neighbourhood at the heart of British Columbia’s overdose and homeless crisis. To honour the Host First Nations of the region now referred to as Vancouver, the name Kílala Lelum (Kee-LAH-LAH Lee-LUM) was chosen in consultation with the Musqueam people.

The name, which means “butterfly house”, makes clear the centre’s purpose.

“We were looking at how to bring our members in from the Downtown Eastside, trying to get them to go into a good place, a place of transformation. That’s what Kílala Lelum is for -- the transformation for our members, that they go into a good way, a healthy way,” says Bruce Robinson, a founding member, board member and one of the Elders-in-residence.  

The health centre exists to fill a much-needed gap in the medical system. Approximately 2,223 citizens experience homelessness in the City of Vancouver on any given night, and Indigenous people represent 39 per cent of that population. Systemic racism, discrimination, poverty, trauma, violence, and addiction add to the barriers to quality care experienced by many in the neighbourhood -- a critical situation further magnified by the COVID-19 pandemic, which disproportionately affects Indigenous people.

“Simultaneously, these same people often have the greatest healthcare needs and typically only present to care when there is an extreme health crisis,” says Dr. David Tu, a Vancouver physician, and founder and board member of Kílala Lelum.

Kílala Lelum, by contrast, has crafted a model that partners Western medicine and Indigenous healing practices to deliver timely, culturally safe and trauma-informed care, and promote greater health, wellness, and social stability.

Dignity and respect are deeply rooted in the organization’s mission, and steeped in the invaluable guidance and wisdom of the Elders.

“Our role is to provide one-on-one support for the members who need it. They come in and visit me in the Elder’s room where it’s nice and quiet and we can hear each other and listen to each other without interruption,” says Ruth Alfred, another founding member and Elder-in-residence.

“Many of them who come to me are without family. They’ve been either locked out of a family relationship or have lost family members so I am basically their surrogate auntie, grandmother, whatever they want to call me. We have conversations about how they came to be where they are at and how much they want to be released from that addiction or whatever it is that is keeping them down. We have quite some conversations,” she says. 

“I always offer them that spiritual part of it, too -- a brushing with cedar or an eagle fan, or a smudge,” says Elder Bruce. “They are just offers, it is their choice. It’s with the understanding that they’re living the life they want to live, but they’re here because they want to change something for themselves.”

We are all on the same path

Helping Kílala Lelum succeed is the reason TELUS has expanded its innovative Health for Good program in Vancouver. Via a specially equipped clinic-on-wheels, the organization can now bring its culturally appropriate primary medical treatments, Elder-led cultural care, mental health services, and addiction support directly to the underserved citizens of the Downtown Eastside. 

Backed by a five year, $10-million commitment from TELUS, similar mobile clinics are already active in Vancouver, Victoria, Surrey, Calgary, Edmonton, Ottawa, Mississauga-Peel Region, Waterloo Region, Montreal, Halifax, and Toronto. Each van is equipped with TELUS Health electronic medical records (EMR) technology and TELUS LTE Wi-Fi service, enabling 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.

The clinics are specifically designed to operate in communities where frontline care is urgently needed and to act as a vital link between the community and local health authority. Critically, they offer primary health care services in a far less intimidating manner to people who feel excluded from the healthcare system.

For Dr. Tu, the mobile clinic is a means to build on relationships Kílala Lelum has formed with members/patients, and, ultimately, bring specialized care to more people.

“It’s a bit of a discovery process. We are going to learn over the next months and years how this program is going to impact people’s lives,” he says of the new service. “I'm hoping that people can recognize that this mobile team is trying to bring the best services they can to situations where people are not otherwise able to engage in healthcare. I'm hoping it is going to be appreciated as a valuable gesture that might overcome some of the inherent distrust of systems and health providers.

“By bringing their humanity forward, that helps to create a relationship. That’s the foundational piece. Once a relationship is in place, then we can work to address people’s basic needs,” says Dr. Tu.

The timing of the Health for Good expansion could not be more critical. COVID-19 and physical-distancing measures enacted to slow the spread of the virus have only increased feelings of isolation experienced by many in the community -- putting lives at risk. 

“Now we have the mobile coordinator, an outreach worker and a nurse practitioner on board the mobile clinic. They can go through the community and clients can just come and see them to get their meds or whatever treatment they need,” says Elder Ruth. “We can make sure everyone is taken care of.”

“What we do is an essential service,” says Elder Bruce. “I have family down here. I call them all my loved ones. But we call everyone members. They are all members. We have to look at everybody as equal.”

Elder Ruth echoes the message of providing members with dignity through their interactions with staff and Elders. 

“No one is different than the other. No one is above another person, that is how I feel about my relationship with the Kílala Lelum members. I’m not above them and they’re not above me. We are on the same path, looking for the same thing.”