Indigenous health service hits the road in new medical outreach van

A brand new outreach van is now roaming the streets offering medical help to those in need in Vancouver’s Downtown Eastside, fully equipped with all the tools found at a regular doctor’s office.

Operated by Vancouver’s urban Indigenous healing co-operative — the Kilala Lelum Health Centre — the mobile van and its team hit the road in January.

Described by Kilala Lelum elder Wendall Williams as a “medicine house on wheels,” the outreach team offers a mix of western and traditional Indigenous healing practices to patients who are unable to access the agency’s clinic at 626 Powell St.

With one of the most sophisticated medical outreach vans in the city, the new van is helping the team to meet people where they are at, both literally and figuratively, operators say.

“When you think about barriers to [health] care, people don’t think about sitting in a clinic waiting room for an hour or two. That’s something that can be a real challenge for a number of reasons for some people,” says Rory Marck, manager of the Kilala Lelum mobile unit.

Fully loaded vans

The van is outfitted with all of the same medical resources that can be found at a traditional primary-care facility — including a private exam room. The vehicle is also fully loaded with electronic medical-record technology and lightning-fast WiFi connectivity.

It is one of 13 mobile clinics in Canada funded by Telus as part of its Health for Good program.

“We wanted to remove the barriers that many homeless and other precariously housed Canadians are facing as it pertains to medical care,” says Nimtaz Kanji, director of social-purpose programs at Telus.

It’s been a busy year for these mobile clinics, which have also been funded in Victoria, Halifax, and Toronto. Since the Health for Good program first launched in 2014, Kanji says the clinics have supported more than 50,000 patient meetings nationwide, with more than half of those logged in 2020.

The Health for Good program also administered 12,000 COVID-19 tests through its mobile clinics to people experiencing homelessness across the country.

Over the next five years, Kanji says Telus plans to contribute $10 million to fund the clinics throughout Canada.

Dr. David Tu, a staff physician and board member at Kilala Lelum, says it’s a much-needed service, explaining that even under normal circumstances, up to 20 per cent of patients may not be physically able to come to their Downtown Eastside location.

“There’s so much diversity in this neighbourhood and people find themselves in a lot of different situations with different pulls on their time and their resources,” Tu says.

“[The van] increases what we’re able to do on a practical level, but symbolically there’s also a degree of commitment … that we’re really trying to provide the highest level of care we can.”

The van has been running through a soft launch since November 2020 and staff say that they’ll need more time on the road to get more insight into how well the service is running. Erinn Taggart, Kilala Lelum’s medical office assistant and outreach worker, says over the next few months, staff will be focusing on showing up consistently and gaining the trust of the community.

“People have often had negative experiences working with service providers in the past,” Taggart says. “There’s something to be said for just us showing up at the same time every week. It’s going to take some time to build that trust and I think that’s fair.”

Taggart works in the van with Marck and nurse practitioner Drew Kostyniuk to provide medical care, distribute harm-reduction supplies, hand out snacks, and oversee case management to connect clients to other services.

The mobile outreach program runs Tuesday through Thursday and offers individual follow-ups, as well as making regular stops at three main locations in the Downtown Eastside: VANDU (Vancouver Area Network of Drug Users) at 380 East Hastings St., WISH Drop-In Centre at 344 Alexander St., and Strathcona Park.

The outreach team says the busiest place by far is at Strathcona Park, which is home to about 200 unhoused residents.

Cultural care is key

Telus, in collaboration with Vancouver Coastal Health, approached Kilala Lelum for the project in part due to the organization’s unique ability to meet the needs of Indigenous peoples in the Downtown Eastside.

The team provides care on a drop-in basis for anyone in need, but prioritizes Indigenous patients and people who are not connected or precariously connected to a health-care provider.

According to the 2020 city of Vancouver homeless count, Indigenous peoples account for represent 39 per cent of those experiencing homelessness and, by extension, poorer health, even though they are only 2.2 per cent of the city’s total population.

At Kilala Lelum’s regular primary-care clinic, patients are cared for using a team approach, integrating support from physicians, counsellors, and Indigenous elders.

As revealed in B.C.’s In Plain Sight report released last November, 84 per cent of Indigenous patients describe personal experiences of racism and discrimination when seeking medical care in B.C. The report underscored the need for improved cultural safety and Indigenous leadership in health services.

“Things like [traditional] ceremony are meaningful parts of people’s health and wellness, and can make a difference in someone’s life,” said Tu. “This service is filling a need.”

A soon as it’s safe to do so, the mobile health team at Kilala Lelum plans to go beyond providing basic care such as wound cleaning and physical examinations to include even more traditional medicinal practices and support from elders on the road.

“As an Indigenous person, there are moments when something feels wrong or off, and it can mess with the way that you’re living,” Taggart says. “Sometimes just having prayer or a smudge can bring you back and ground you again.”

The team members also say they are excited to see what the mobile outreach operations will look like in a post-COVID world.

“[The pandemic] has brought a lot of change and innovation, and much of it has been good,” says Tu. “But a lot of it has been aimed at decreasing social connection and I’m looking forward to turning that around. I think it’s a really important determinant for how healthy people are.”