From the outset of the pandemic, urban Indigenous organizations in Tkaronto recognized the need for culturally responsive programs to address the well-being of Indigenous people during the COVID-19 era. This focus emerged in part from the historical and ongoing experiences of mistreatment in the health care system. Furthermore, social inequalities like poverty and inadequate housing disproportionately affect Indigenous people in both urban and rural environments and can increase their risk of contracting COVID-19. Chronic health conditions such as diabetes and high blood pressure may also worsen the infection severity. In addition to the foregoing factors, the rights of Indigenous Peoples to self-determination create a framework for the development and implementation of novel responses to the pandemic designed and led by Indigenous communities.
As a mixed blood Anishinaabekwe physician working in Tkaronto, I have had the opportunity to work on a mobile healing unit started by our local Aboriginal Health Access Centre, Anishnawbe Health Toronto (AHT). The goal of the healing unit is to provide COVID-19 outreach testing to members of the urban Indigenous community. While testing through the mobile unit is open to everyone, the designated client groups are Indigenous people living in a variety of settings such as shelters, housing units, outdoor encampment sites as well as those who access services at specific Indigenous organizations or those who prefer to receive care from an Indigenous service provider. My work with the AHT mobile unit offers respite from the stress of practicing medicine during the COVID era. In fact, it has led to learnings which can enhance health care delivery for all people both during and beyond the pandemic.
One of the primary strengths of the AHT mobile unit is that it is a community-based initiative. Rather than being imagined and implemented by a tertiary care health center like a hospital, it evolved based on the needs of a community health center with a focus on the care of Indigenous clients. AHT is a trusted organization which has provided culturally safe care to Indigenous people in Tkaronto for decades. Clients who may be fearful of getting a test at a COVID-19 Assessment Center in a hospital may feel safer with AHT based on its mandate, history, Indigenous leadership and the presence of many Indigenous staff. AHT has strong relationships with community groups including both Indigenous organizations and non-Indigenous ones with a large number of Indigenous clients. These formal or informal partners often call upon AHT’s mobile healing unit for COVID-19 testing rather than rely upon hospitals which may be unwelcoming or have a history of taking control rather than respecting a community organization’s knowledge and expertise.
As an Indigenous health center, AHT enacts key principles to strengthen the health care of Indigenous people like trauma-informed care and cultural safety. Trauma-informed care embeds the knowledge that any client may have had a history of trauma or violence and recognizes how institutions may bring this trauma to the forefront of a person’s mind and impact their behaviours. The act of being swabbed for COVID-19, although not painful, is actually quite invasive; it involves inserting a long testing swab into a person’s nostril and may trigger fear or anxiety in someone with a previous trauma history. Within just a few hours of working on the mobile unit, I observed how team members clearly explained each step in the testing process and details about how the test results could be shared. This knowledge exchange ensures transparency and allows ample time for questions, both of which are paramount for a client to make an informed decision.
I quickly learned strategies to support a person who may be resistant to having a test because of its invasiveness: I allow them to hold the swab while I guide their hand to perform the test and explain each step of the process as it occurs. While there are many components of culturally safe care, some specific examples demonstrated by the mobile healing unit are the creation of a welcoming space through visual signifiers like the beautiful art painted on the RV, the opportunity for clients to ask questions before and after the test itself and the ability to smudge. As a mobile unit, the vehicle travels to sites around the city where Indigenous people are more likely to be living and hence increases client comfort through their familiarity with the physical surroundings.
Although the primary goal of the AHT mobile unit is to perform COVID-19 testing, it does not focus exclusively on COVID-19. The team consists of a physician or nurse practitioner who can provide wound care, counseling and even primary care in a private space with an examination table on the RV. Occasionally, a chiropodist attends to offer comprehensive foot care. Referrals or contact information for other services provided by AHT may also be shared. For those who are most structurally marginalized, the contact during a COVID-19 test is a critical moment of engagement with health care and an opportunity to provide primary care or build trust with a provider. In addition to health services, the mobile healing unit may include a drum circle, food truck or even informal conversations with children about careers in the health professions. It embodies a wraparound care model which is grounded in respectful relationships rather than clinical transactions.
Working with the mobile team brings me joy because I can serve our community as an Indigenous provider. But I also am deeply inspired by its innovative approach to high-quality, community-based care. Although the healing unit emerged to meet the specific needs of Indigenous people, the program can inform and guide initiatives for other communities, especially those who may be marginalized or excluded by health and other government institutions.
This article is a component of a collection that will be published by the Royal Society of Canada. The collection is available here: https://rsc-src.ca/en/covid-19