A.J. scratches his arm through several layers of clothes. Sleeves slide up. A reddened sore appears. There are more on his face.
A.J., who declined to provide his full name, insists he’s healthy. But he wasn’t a year ago when an abscess developed on his knee. He tried to drain it himself. That didn’t work, so he visited the community health van that provides nursing along with food, clothing, and harm-reduction supplies. But the ailment, which required a prescription to treat, was not within the scope of what nurses are legally allowed to handle, and so they sent him to a local community-health centre.
Since March, though, there's been a more comprehensive mobile health-care option in the Waterloo region for A.J. — a primary-care clinic in a specially designed bus that's dedicated to serving local, vulnerable populations. Four days a week, Sanguen Mobile Health Clinic stops at places where people are most likely to congregate, such as drop-in centres or encampments, to provide care. Inside, patients will find an examination room, seating where blood samples can be taken, a long, grey laminate-topped desk where clinic staff can work, and the staff themselves: a nurse, a nurse practitioner, and a social worker.
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Dr. Chris Steingart, founder and executive director of the Waterloo-based Sanguen Health Centre, which operates the mobile clinic, says that bringing the service to people helps address medical issues early so they don’t become serious or life-threatening and lead to emergency-room visits or hospital stays. “If you compare those costs to the benefits, you make up your costs pretty quickly,” Steingart says. “And we’re doing that on a daily basis.” By mid-November, the clinic had conducted 2,000 primary-care sessions, he says.
For people who are precariously housed or homeless, getting health care can be a huge challenge. Nearly 50 per cent of people who are homeless don’t have a family doctor or nurse practitioner. They lack access to transportation, health cards, or money to pay for prescriptions.
Emergency rooms instead become the default for care, although many are wary of how they’re going to be treated and put off the trip until they can’t anymore. “When you go to the hospital, when you're homeless, you're not treated right by some of the staff,” explains Udanapher (Nadine) Green, who manages and lives at Lot42 — a shelter that comprises 24 tiny, unheated cabins in rows behind a former steel mill in the city’s industrial outskirts.
A.J. is one of those people. “I won’t go to a hospital,” he explains, while circling the pool table in the kitchen lounge that serves the roughly 50 residents of Lot42. He says he often visits friends at the shelter, but at present lives with and cares for his mother, who is very ill.
The bus is one of four such clinics in operation in Ontario, with others in Ottawa, Toronto, and Oxford County. These clinics are part of a field known as street medicine, which emphasizes treating patients where they are likely to be rather than taking them to other medical settings. “The street medicine movement is all about literally going under the bridge, to the river bank, under the abandoned building,” says Dr. Jim Withers, who pioneered the concept in the early 1990s in Philadelphia.
Even within Canada’s universal healthcare system there’s a need for this kind of care because “there are always people that fall through the cracks,” Withers says. “There are really lots of people that we don't think too much about who are out there with very complicated problems: we've seen people on dialysis, people with cancers that aren't diagnosed, women with pregnancies.”
Often, people on the street deal with severe trauma and mental-health issues that make it difficult for them to seek help. “The imperative is to, first of all, gain trust and the connection with people, but then to somehow try to bring the services,” he says. Teams are interdisciplinary and often include peers that can help build trust.
An example of the mobile clinic’s effectiveness is the work it has been doing to test and monitor for COVID-19 in the region’s homeless population, Steingart says. So far, they’ve made 8,000 assessments (people can be assessed more than once). By mid-November, the virus hadn’t been seen within the area’s homeless population. “No one knew that COVID was coming, but we were able to fashion a really good response and support for people that wouldn't have otherwise had that kind of support,” Steingart says.
Yet the program is expensive to operate, he acknowledges. Funding comes from different sources, including Ontario Health, local community-health centres, and corporate sponsors. The organization is midway through a three-year, $500,000 donation from Telus; the Ontario Health funding “should be sustainable on a yearly basis,” he says.
Making the program sustainable is crucial, he says, and the potential to do so was assessed before the decision to launch. Taking away the service “would be [a] much greater [impact on the community] than if we never had the program in the first place,” he explains.
Kelly Anthony, who teaches about the social determinants of health at the University of Waterloo School of Public Health and Health Systems, and volunteers with Lot42, wonders, however, if these efforts need to be balanced by more investments into early intervention programs to help at-risk children and families to prevent homelessness. “There is definitely need right now — people are literally and figuratively bleeding,” she says. “But we also have children born today to at-risk families, and they will need help now to prevent the kind of tragedies that we see at Lot42.”
At Lot42, feelings are mixed. A.J. doubts that an enhanced mobile service with a nurse practitioner, who can order diagnostic tests and prescribe, would improve primary care over Sanguen’s community-health van: “They’ll take a quick glance at [an ailment] and then they go, ‘OK, well, we're just going to call you a cab and send you to the hospital or the clinic,’” he says.
On the other hand, Dennis Leger, who lives at the facility and manages the kitchen, is a fan. He moved to Ontario from British Columbia early in the fall and arrived at the facility in mid-October. If it wasn’t for the clinic, which visits the shelter every Tuesday, “I’d have no clue how I’d get help,” he says.
“It does help,” says Green, the shelter’s manager. Many residents at the shelter use needles; most needle users have inflammation.
“With the mobile truck, they know most of the guys personally, or, if they don't know them, they get to know them,” she says. As trust grows, “the guys go to the mobile truck, they'll tell them their issues and be more open.”
This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.