Every day in Toronto, a team of nurses, administrative assistants and a social worker board an RV with one goal: to reach as many communities with large populations of Indigenous people as possible, bringing with them primary care, COVID-19 testing and traditional medicine.
The mobile health unit launched by Anishnawbe Health Toronto in June is an effort to bring support directly to Indigenous people across the Greater Toronto Area.
Jane Harrison, the organization’s mobile health unit coordinator, says the team saw a need for on-the-spot care for parts of the population that might not otherwise receive the medical attention and healing they need.
Harrison, who is also a nurse, says after witnessing the toll that COVID-19 had taken on many with precarious housing situations, the team saw the need for an accessible service that would not only provide testing for COVID-19 but also medical care for those unable to come to the centre.
“Ninety per cent of our Indigenous populations are living below the poverty line, and we have multiple complex health issues,” said Harrison.
The mobile health unit, initially created to address the community’s changing needs during the pandemic, has seen over 4,000 patients since it first opened its doors.
But even when the time comes when COVID-19 testing is no longer required, Harrison says the unit will be sticking around, adding it’s helped tackle the issue of access to services to the widespread Indigenous population.
“We have a cultural understanding and respect and we’ve had an incredible response,” said Harrison.
“We just have a lot of fun too, lots of laughter and lots of relationships — that’s what’s missing a lot of times where [people] don’t have anyone to reach out to for their medical needs or for testing or just understanding what happened to their leg,” Harrison said. “That’s why we’re there. We go where they are.”
“A lot of people in these communities and in this population, they aren’t so eager to actually go into hospitals to get the services or to get tested,” Bobby Soos, a nurse practitioner with AHT’s mobile health unit told CBC Toronto.
“We’re coming to them. They don’t have to come in to find any services. They don’t have to wait in long line-ups. They don’t have to register,” Soos said.
Soos says each day the unit is at a different location but they will regularly revisit many areas, allowing them to build trust and relationships with those hesitant to get tested.
The unit, which usually sees about 30 people each hour, is able to get COVID-19 test results within 24 hours and reaches out to patients by phone — as not all patients have access to the internet, Soos said.
“Everyone’s really grateful and really appreciative that we’re out here and that we’re taking the time to test and be able to turn around the test results so quickly.”
AHT wasn’t alone in its need to quickly pivot to provide accessible services to Indigenous people in Toronto amid the spread of the novel coronavirus — the agency 2-Spirited People of the 1st Nations had to do the same.
Keith McCrady, executive director with the 2-Spirited People of the 1st Nations, told CBC Toronto that after seeing an increase in people struggling to get access to healthy food, he knew they needed to serve the demand.
The 14-person team delivers around 40 food hampers each Wednesday to the doorsteps of community members.
“Many of our community members relied on us for meals that we would incorporate with our workshops,” said McCrady. “But the moment our offices closed down, there goes breakfast, lunch and dinner.”
“What we knew was that if we deliver the food to them, people will be more likely to stay home,” he said.
Along with food and medicine, over 300 tablets and 160 phones were distributed to members by the agency, which also helps pay for phone and Internet bills.
Julia Howell, vice president of community engagement of the Toronto Foundation, says the pandemic has revealed how vulnerable emergency food supplies really are.
She believes the system needs to change from the ground up in order for there not to be a massive demand for emergency food.
“This pandemic, this public health crisis has, in a way, given fuel to the needs and desires from communities that have been struggling the most. It’s given fuel to their efforts,” said Howell.
Dietary restrictions in the community
McCrady’s agency initially focused on providing prevention education and support for 2-Spirit, including First Nations, Métis and Inuit people living with or at risk for HIV and related co-infections. But while the organization is aimed at serving two-spirit individuals, McCrady says, it serves all Indigenous people.
“We’re all at risk, especially that we score so poorly on social determinants of health including HIV,” McCrady said. “We have a lot of bad habits and a lot of that comes from how accessible poor quality food is for us.”
Sugar, flour, lard and milk are often avoided, McCrady says, as Indigenous people can have trouble digesting those foods.
Instead, the agency focuses on incorporating and pushing healthy alternatives like whole wheat bread, milk alternatives, chicken breast, wild rice and fresh vegetables and fruit.
McCrady and Harrison both say their outreach efforts during the pandemic have allowed them to reach far more people than they might have otherwise.
“COVID wasn’t necessarily [just] a negative experience to us because we found out that we weren’t really servicing everybody that needed servicing,” McCrady said.
“There were people that didn’t want to come through our doors and since we started mailing out or going to people’s doors, we were able to access and meet more people.”