Kilala Lelum’s mobile clinic visits to WISH showcase critical need for co-location of services

It’s been nearly eight months since Kilala Lelum launched its mobile clinic to provide primary care and cultural wellness outreach to the Downtown Eastside (DTES) community.

The mobile clinic helped fill a critical gap at WISH, where the Drop-In Centre clinic remains unused due to a lack of medical staff.

WISH is one of many community partners working with Kilala Lelum’s Mobile Outreach Program. The mobile clinic focuses on primary care outreach drop-in clinics three times a week. At WISH, the mobile clinic visits twice a month — once with a physician, and once with the support of a nurse and an Indigenous Knowledge Keeper. Despite this, there is still a critical need for more physician sessions at WISH. Additional funding and/or onsite deployment from the health authorities is needed so that participants can have regular access to the drop-in clinic.

The mobile clinic was established as a means of responding to gaps within the current healthcare system, recognizing that many individuals benefit from care in an outreach setting that is trauma-informed, culturally safe, and low barrier.

At WISH, at least half of the participants the mobile clinic sees reside in our new temporary emergency shelter. Being able to contact residents at the shelter for follow-ups, specialist appointments, or prescription delivery, has been instrumental in mitigating some of the systemic barriers WISH participants often face.

The mobile clinic has highlighted the critical need for the co-location of services. Bringing services to the locations where people feel safe and are already accessing multiple services, as well as adapting to the context that people are already in, is a crucial step that is often missed by the health care system.

“People need to be met where they are at. There are so many intersecting barriers to accessing culturally safe primary care for the community served by WISH,” said Dr. Emma Preston. “Kilala Lelum is committed to providing low barrier access to culturally safe, healing centred primary care for folks engaged in sex trade work by co-locating services during the dual crises of the COVID 19 pandemic and the opioid overdose epidemic as part of decolonizing medicine.”

For communities and people who face systemic barriers, stigma and discrimination — such as street-based sex workers — accessing mainstream hospitals or clinics can present multiple barriers and result in avoidance. People should be able to receive care in a setting in which they feel safe and with practitioners they feel they can trust.

Although the mobile clinic was launched late last year, the fixed location clinic (Kilala Lelum Health Centre) has been around for almost three years. The clinic was created in part as a response to the TRC’s calls to action around the Health of Indigenous people, using a lens of cultural safety and working to decolonize a very colonized space — healthcare.

The team at Kilala Lelum Health Centre is made up of over 70 individuals – including family physicians, a nurse practitioner, nurses, counselors, social workers, outreach workers, nutritionists, peer community health workers, Indigenous Elders and cultural wellness workers.

The current health system has failed — and continues to fail — those who have been made vulnerable due to poverty, homelessness, trauma, gender-based violence, stigma, and a lack of access to support and opportunities.

The Mobile Outreach Program is currently funded by the Telus Health for Good initiative until March 2023. Funding and support for the continuation, and expansion, of the Kilala Lelum mobile clinic program is vital, as well as the creation of more outreach programs modelled after it.

The system has failed WISH participants, and others in the community, for too long. Enough is enough. It is time to act.