For more than 20 years, the white and pink Winnebago has brought sexual-health services to immigrant women where they live and work.
The 10-metre-long mobile home delivers a doctor, an examination room and translation services to women who are often poor, lack health coverage and for reasons of work, transportation or cultural restrictions within the family have trouble getting medical care. Other cities have looked to the sexual-health bus as a model. But the budget crunch imposed by Mayor Rob Ford at Toronto’s City Hall has prompted the city’s public health agency to propose a $200,000 cut to the agency that runs the bus, putting the service at risk. The proposed cut amounts to roughly 25 per cent of the Immigrant Women’s Health Centre’s city funding.
Ayesha Adhami, the centre’s administrative co-ordinator, said demand is so high that the bus is booked solid until April. But if the budget cuts pass at city council later this month, the service will have to be reduced. Ms. Adhami said her agency, which also runs a traditional clinic office on College Street, was told by Toronto Public Health that it works less efficiently than other Toronto clinics. It has 5,000 patient visits a year, roughly 15 per cent on the bus, compared with 7,000 at comparable clinics. The reason, Ms. Adhami says, is that clients get 20-minute appointments, twice the usual 10-minute appointment at a clinic or family doctor, because recent immigrants are complex patients who often require a translator.
Ms. Adhami said they were also told by the public health agency that they should see more clients under the age of 25. But she counters that their mandate is to treat newcomers. The average age of an immigrant to Canada is closer to 35 than 25.
A spokeswoman for the health agency was unable to either confirm the extent of the cut or explain its rationale Tuesday. The mayor has asked all city departments to reduce their budgets by 10 per cent for the coming year.
Ms. Adhami said the proposed cuts will present uncomfortable choices.
“Do we cut staffing for Farsi speaking women or for the Afro-Caribbean women? Those are the kinds of choices we face,” she said.
Politicians such as city councillor Mike Layton are rallying support in an effort to spare the Immigrant Women’s Health Centre from the axe.
“These are services people depend on. This is not gravy,” Mr. Layton said. “This is one of those preventative things that’s supposed to save us money down the line. So I’m hoping it will be on the top of the list of things to save.”
Although the cut is significant, under the shared funding model with the province, only $40,000 of the $200,000 actually comes from city coffers, Ms. Adhami said. The rest is provincial money controlled and distributed by the city.
The agency currently provides outreach, counselling and translation in Mandarin, Cantonese, Spanish, Portuguese, Farsi, Urdu, Hindi, Italian and Vietnamese. In a multicultural city such as Toronto, those services are increasingly valuable for public health, particularly in the city’s outer suburbs where immigrants have recently tended to concentrate and medical care can be harder to reach. The bus arranges with local agencies to visit a site, often a community centre or workplace, where at least 12 to 15 women can be seen.
The bus also provides care for free to those who don’t have public health coverage. That includes people who are in the three-month waiting period after immigration as well as undocumented immigrants.
Sheila Wijayasinghe, a physician at the centre who also writes the Ask the Doctor column for The Globe and Mail, said 30 to 40 per cent of the patients she sees don’t have medical coverage. Many of her patients have never been to a physician for such care as a pap test, breast exam or STI testing that are crucial to practising preventative medicine.
“It’s the most fulfilling work that I do. They’re coming to our clinic because there’s nowhere else to go,” Dr. Wijayasinghe said.
“We see a lot of women who have faced abuse, who come from countries where rape is not uncommon. To be able to provide culturally sensitive care in that situation, it’s a vital service for that reason.”
