Telus and UHN deliver services to the marginalized

Telus’s Health for Good program has launched the latest of its specially equipped vans to provide medical services to the homeless and underserved, this time to the population of Toronto’s west end. The project relies not only on the hardware and software – the vans and technology – but on the care delivered by trained and socially sensitive medical professionals.

For the Toronto project, those professionals are working at the University Health Network’s Social Medicine program and the Parkdale Queen West Community Health Centre. The city’s Parkdale community, in the west end, has a high concentration of homeless and marginalized people.

First launched in 2014, Telus’s Health for Good program has delivered mobile clinics to 13 Canadian cities, from Victoria to Halifax. Originally designed to deliver primary care, the program pivoted to meet the needs of patients in the COVID-19 pandemic, said Nimtaz Kanji, Calgary-based director of Telus Social Purpose Programs.

Angela Robertson of the Parkdale Queen West Community Health Centre (CHC) asserted that marginalized people are particularly susceptible to the spread of COVID-19, as they don’t have access to the basic precautions that prevent its spread.

The clinic is located near a Pizza Pizza franchise; homeless people shelter under its overhang on the weekends, she said. Some have encampments under nearby bridges.

“The public health guidelines and requirements call for things that individuals who are homeless don’t have,” Robertson said. “If the response calls for isolation, that suggests people have places to isolate in.”

And in the shelter system, pre-COVID, the environment was very congregate, with many people in the same physical space, said Robertson. Some homeless persons, in order to keep themselves safe, have created encampments, and the city has opened up some hotel rooms across the city to create spaces for physical distancing.

Even proper hand-washing and hygiene becomes a challenge for the homeless.

“COVID calls for individuals to practice constant hand-washing. Oftentimes, individuals who are homeless use public washroom facilities that may be in restaurants or coffee shops, and many of those spaces are now closed. So there are limitations to accessing those facilities. It’s not like they’re in a community where there are public hand-washing facilities for people who are homeless.”

The mobile health clinic allows the CHC to take “pop-up testing” into communities where there is high positivity and where additional COVID testing is needed. The CHC can take testing into congregate sites and congregate housing to provide more testing, Robertson said.

“The other piece that we will use the van to do is, when the vaccine supply gets back online, and when the health system gets to doing community vaccinations … we hope that we can be part of that effort.”

COVID has contributed to a spike in cases of Toronto’s other pandemic: opioid overdoses. Some community members are reluctant to seek care because of the stigma attached to substance abuse; and COVID has a one-two punch for users.

The first rule of substance abuse is, don’t use alone; always be with someone who can respond to a potential overdose, ideally someone who can administer Nalaxone to reverse the effects of the overdose, Robertson said. “It’s substance abuse 101,” and the need for social distancing makes this impossible.

Secondly, COVID has affected the supply chain of street drugs. As a result, they’re being mixed increasingly with “toxic” impurities like Fentanyl that can be deadly.

The van itself is a Mercedes Sprinter, modified by architectural firm éKM architecture et aménagement and builder Zone Technologie, both based in Montréal. According to Car and Driver magazine, the Sprinter line – with 21 cargo models and 10 passenger versions – is “considered by many to be the king of cargo and passenger vans.”

Kanji said the platform was chosen for its reputation for reliability and robustness.

While the configuration is customized for each mobile clinic, it generally consists of two sections: A practitioner’s workstation and a more spacious and private examination room, so patients can receive treatment with privacy and dignity, Kanji said. The Parkdale clinic is 92 square feet.

“While the layouts vary across regions, they typically include an examination table and health practitioners’ workstation, including equipment necessary to provide primary healthcare,” the Telus vice-president of provider solutions wrote in an e-mail interview. The Parkdale Queen West mobile clinic is designed for primary medical services, including wound care, mobile COVID-19 testing and vaccination efforts, harm reduction services, mental healthcare and counseling.

The clinic equipped with an electronic medical record (EMR) from TELUS Health and TELUS LTE Wi-Fi network technology.

Practitioners will be able to collect and store patient data, examine a patient’s results over time, and provide better continuity of care to those marginalized citizens who often would have had undocumented medical histories.

The EMR system is Telus Health’s PS Suite (formerly Practice Solutions). It is an easy-to-use, customizable solution for general and specialty practices that captures, organizes, and displays patient information in a user-friendly way. The solution allows for the electronic management of patient charts and scheduling, receipt of labs and hospital reports directly into the EMR, and personalization of workflows with customizable templates, toolbars, and encounter assistants.

But like others tested for COVID, it’s a 24-48 hour wait for results. Pop-up or not, how does the mobile team get results to patients who have no fixed address?

The CHC set up a centre for testing in a tent at the Waterfront Community Centre. Swabs are sent to the lab. “We are responsible for connecting back with community members and their results,” Robertson said.

“This is the value of having Parkdale Queen West being in front of the testing, because many of the community members who are homeless we know through our other services, and there is some trust in folks either coming to us to make arrangements to collect their results, or we know where they are.”

This is a key element of the program, said Kanji – leveraging community trust. In Vancouver downtown east side, for example, where there is a high concentration of marginalized members of the indigenous community, nurse practitioners are accompanied by native elders in a partnership with the Kilala Lelum Health Centre.