White Coat, Black Art

Hard-to-reach Vancouver patients find compassion, care in mobile clinic

The Kilala Lelum mobile health-care unit in Vancouver that offers everything from stitches to prescribing treatment for opioid addiction is providing a way to reach patients who may otherwise avoid doctors and hospitals.

Van-based clinic offers everything from wound care to prescribing treatments for opioid drug addiction

Dollie sits with one of her dogs outside the Kilala Lelum mobile health clinic van that often parks near the Terminal Avenue shelter in Vancouver. (Rachel Sanders)

Originally published on February 12, 2022.

Dollie was shocked and surprised when she first saw the mobile health clinic van in her neighbourhood on Vancouver's Downtown Eastside last year.

"It was so casual and I felt comfortable right away," Dollie, whose last name was not shared for medical privacy reasons, told Dr. Brian Goldman of CBC Radio's White Coat, Black Art. "We did all the same things that I would in a regular doctor's office."

Now Dollie shows up regularly to get help from the Kilala Lelum outreach staff when they park their van near the Terminal Avenue shelter, where she lives with her two dogs, Little and Hazel.

Dollie has mobility problems, along with back, kidney and bladder issues. For her, the draw to a clinic on wheels is simple. There's no rush. Staff are welcoming. It was the opposite of her past hospital experiences.

"They accused me of drug seeking and it wasn't like that at all. Like I was passing a kidney stone and it was quite serious. They told me to basically take some Tylenol and go home. I'm like, I'm peeing blood, I'm passing a stone," Dollie told Goldman in November. 

By then, the mobile unit had been on the road more than a year.

Dr. Andrew Kostyniuk provides health care to a patient in the mobile health clinic in Vancouver on Nov. 3, 2021. (Ben Nelms/CBC)

So far, the Kilala Lelum mobile unit has treated more than 330 patients, offering everything from stitches and wound care to prescribing treatments for opioid drug addiction. This after record-breaking toxic drug deaths in B.C., with more than 2,200 people dead in 2021.

For the patients, it all comes with none of the judgment or racism that some say they've experienced when they sought care in hospitals.

Through its work, the mobile unit offers a way to reach patients who may avoid doctors and hospitals, and experts are urging governments across Canada to fund more of these initiatives longer-term.

The van-based Kilala Lelum outreach clinic is one of 26 mobile health units in Canada – but the only one with an Indigenous focus, according to researchers. Staff estimate about half the clinic's patients are Indigenous.

It's part of a growing North American trend of mobile health-care delivery, according to research done by the school of population and global health at McGill University in Montreal.

McGill medical student Anne Xuan-Lan Nguyen was surprised how few mobile health units operate in Canada, compared to the U.S.

She said mobile outreach is an effective tool to reach hard-to-serve patient populations.

Dollie waits outside the Kilala Lelum mobile medical clinic with her dogs Little and Hazel. (Rachel Sanders)

"These [patients] don't necessarily have access to the health-care system or they mistrust it." 

But a lack of stable funding is a common hurdle for clinics on wheels. A three-year grant through a partnership agreement that the Kilala Lelum outreach clinic relies on will end on March 31, 2023.

It is part of a $10-million commitment from telecommunications company Telus to fund specially equipped mobile health units or clinics on wheels in under-served communities across the country since 2014.

Dr. David Tu, a founding board member of the Kilala Lelum Health Centre, saw a need for the mobile outreach. 

"We are trying to create another choice," said Tu, a Downtown Eastside doctor who specializes in inner-city and Indigenous health issues and worked as a doctor in East Africa with Médecins Sans Frontières.

"There's usually a shopping bag list of why [a] person isn't making a meaningful connection [to health care] and isn't returning to a physical brick and mortar place. Experiences of racism and discrimination are one of those."

Dr. David Tu speaks with his patient Stan Tessman in a clinic room at the Kilala Lelum health centre in Vancouver on Nov. 3, 2021. (Ben Nelms/CBC)

Tu said he's had to "unlearn" a lot of his "like it or lump it" medical training. He also tries to make his Vancouver clinic more welcoming to Indigenous patients by having an elder on site and being mindful of trauma-informed care.

The mobile van-based clinic launched in late 2020, not long after Canadians saw the video of Joyce Echequan, an Atikamekw woman who recorded her care at a Quebec hospital as she lay dying. 

Health-care staff made racist remarks to the mother of seven who had heart issues. The video sparked outrage, and Tu hopes, change.

"We've evolved a way of practising medicine here that is certainly different from how I was originally trained." 

Tu said just because he's a doctor, he does not get automatic respect: that is something that needs to be earned with the patients he sees in his clinic and can take years to develop.

Elder Bruce Robinson at the Kilala Lelum health centre in Vancouver on Nov. 3, 2021. (Ben Nelms/CBC)

In addition to the Telus grant, the van is also funded by money from Vancouver Coastal Health Authority. That financial support covers the salary of the nurse practitioner, who is part of what's usually a three-person team, along with an outreach worker and team lead.

The team hopes the van isn't parked when funding runs out because it's helped to get patients into the office-based Kilala Lelum clinic on Powell Street.

"When you connect with [patients] where they are already feeling safe, there is a transfer that can happen and then people from that relationship can show up [in the clinic]. You can do a lot in a van. You can't do everything in a van," said Tu.

He knows trust building can take time.

No 'dinosaur' doctor

Stan Tessman first saw Tu more than a decade ago. Tu knows about Tessman's past, his adoption and his struggles with his Indigenous identity. He keeps a photo of Tessman's 18-year companion, Sugar Bear, a blind dog, on his office wall.

Tu has helped Tessman with complex addiction issues, grief and loss and chronic pain from bone and soft tissue infections. He's also helped him deal with substance abuse issues.

Tu knew Tessman's mother as a patient and said that he saw the "groove" her death left in him.

"His life is not just this person that's been hollowed out by a lot of circumstance over the last five years. I know the person that's underneath there," said Tu.

Tessman said Tu is not like other doctors.

"He's got a heart. He's got compassion. He believes in our traditions," said Tessman, who is part of the NaK'Azdli Nation.

"He's a new age doctor compared to dinosaur doctors."

Robinson says he offers spiritual guidance, 'something that's not available in most mainstream medical care.' (Ben Nelms/CBC)

When Tessman shows up at the clinic, he's treated like a celebrity by staff, who see about 100 patients per day.

For Tu, one turning point came while he was treating a residential school survivor who asked to speak to an elder.

Now the clinic on Powell Street has an elder who also sometimes heads out in the van

Patients often see Nisga'a Elder Bruce Robinson, or Owii`lo`ly`eyum`gaudlth`ni`Ki`insque — Grizzly Bear with a Big Heart.

Robinson said he has had personal experiences with racism in health-care, and a male relative was once mistaken as drunk by doctors when suffering a heart attack.

When asked about his role with patients, Robinson's chuckle is almost inaudible. He discourages self-criticism and offers spiritual guidance, something that's not available in most mainstream medical care.

"The most powerful thing they can do for themselves is to feel better about themselves. What I'm talking about is their spirit."


Written by Yvette Brend. Produced by Rachel Sanders.

Clarifications

  • The story has been updated to remove the amount of the grant the clinic receives, which was mistakenly released to CBC without approval of the grantor.
    Feb 14, 2022 7:23 PM ET

Corrections

  • An earlier version of this story stated that Telus committed $5 million to mobile health units countrywide. In fact, it is $10 million since 2014.
    Feb 14, 2022 12:06 PM ET

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