This interview is part of a series that highlights the work of Community Health Centres (CHCs) across Canada through the Community Vaccination Promotion (CVP)-National project and discusses the realities of COVID-19. Visit CACHC’s Addressing COVID-19 webpage and listen to CVP-National related episodes of our Community Matters podcast to learn more about the frontline response of CHCs across Canada to COVID-19.

Briefly tell us about your organization, where it is located, the services and programs provided, and the communities/population you serve?

The North End Community Health Centre (NECHC) is a non-profit, registered charitable organization that unites over one hundred staff members and healthcare providers in the vision of providing innovative, respectful and compassionate health and wellness services to our unique and culturally diverse community. Services provided include a primary care clinic, a dental clinic, Mobile Outreach Street Health (MOSH), Managed Alcohol Program (MAP), Housing First, and most recently, a Supported Housing component. We provide collaborative, multi-disciplinary services to meet the needs of those who often face barriers to access. Our mission is to support health and well-being in our community through quality primary health care, education and advocacy in an environment in which people are treated with respect and dignity and there is equitable access to services and programs.

Over the last 3 years the COVID-19 pandemic presented unforeseen challenges in all sectors, and the vulnerable population has been one of the hardest hit groups. What has been the impact of the COVID-19 pandemic in your community, how have you been able to address it and how is your organization navigating providing care and services to your clients during this time?

The COVID-19 Pandemic profoundly impacted the folks we serve and partner organizations who serve them in 2020 for the first year, and still significant impacts for another, with milder impacts presently:

• Shelter bed capacity dropped by more than half to allow for physical distancing and a push to decarceralize people to the community, in the context of high intolerance for street-homelessness for public safety, led to the establishment of “pop-up” shelters and hotel-models, staffed by individuals who were new to the field and needed additional support.
• Public Health Information and recommendations evolved daily and were often not nuanced enough to address the needs of those we served. In Nova Scotia we were told to “stay the blazes home,” which left a huge vacuum regarding how to proceed when it came to those without one.
• Front-line staff were uncertain and at times fearful, without access to PPE in early days and in 24-7 congregate settings with large numbers of people, so it became challenging for partners to staff services.

Nova Scotia’s approach to Covid was conservative relative to other provinces in terms of Public Health guidelines for gathering limits and school closures, access to testing and vaccination, which kept our COVID-19 numbers down for quite some time, with a cost of directing a lot of health resource to COVID-19 at some expense to other health issues.

The NECHC stepped forward to offer leadership and mobilize many new services to address changing needs that diverse members of our community faced during the pandemic:

• The NECHC established a meal program to support individuals in hotel-model shelters and became on-call support to new shelters’ staff.
• MOSH’s program shifted to 7-day per week to offer, in early months, daily contact with existing and newly-established shelters’ leadership and front-line staff to help interpret public health recommendations for the sector and support the daily complexities that arose in trying to help people with addictions, mental and physical health challenges isolate in congregate settings.  When we could not enter establishments, we set up outdoor mobile clinics near partner agencies to provide access to primary care.
• Until Dec 2021, MOSH was able to keep pace with Covid-positives in the community, mobilizing same-day COVID-testing teams and using harm reduction prescribing to support hotel isolation to reduce spread among this high-risk group. Then, after a large wave of positives, partner agencies began to take responsibility for much of their own testing, in partnership with the MOSH team and Public Health support.
• MOSH established an emergency managed alcohol program (MAP) to prescribe and delivery alcohol to folks given the possibility that liquor stores could close and result in life-threatening withdrawal for dozens we served with severe alcohol use disorder.
• MOSH persistently catalyzed support from Public Health in terms of attention to recommendations for this population, infrastructure to support isolation for those who could not isolate in home, access to testing and results, and finally, access to vaccines.
• • • •  

Your CHC is one of the recipients of the CVP National (PHAC funded) Project. Could you tell us about your project and its goal? Include any activities and programs carried out and resources created.

The goal of our project was to improve health equity by reducing barriers to vaccine access among people who are homeless and street-involved and the community sector that supports them. Based on our long-standing positive relationship with community partners and service users, we were in a unique position to provide education and vaccine to some of the hardest to reach individuals in our community through assertive outreach campaigns and careful dose tracking (and assertive follow-up to locate individuals for second dose and boosters). Our project was very successful and led us to apply for and undertake a similar project for Phase II.

What milestones or achievements (including uptake of the vaccine) have you achieved, and lessons learned during the project so far? 

The total amount of vaccines administered during phase 1 and 2 combined was 1260 doses. Covid-19 helped reinforce the importance of community health centers, trusting client-teams relationships, client centered and barrier free service delivery, provincial health care turned to us to vaccinate marginalized populations. Overall our biggest milestone we achieved was that we were successful in providing education and vaccine doses to some of the hardest to reach individuals in our community.

Have you and your team experienced any challenges or barriers to vaccine promotion and uptake in your community? How have you managed these challenges?

After successfully administrating initial doses we ran into a communication problem, trying to track clients down for their second or third dose. The clinic responded  by keeping up-dated, in-house records, creating a list of clients who needed additional doses, their primary contact, location of first vaccination and addresses. Another challenged that emerged was the changing information about the vaccine. Hesitant patients took the changing of guidelines to fit new research and best practices as evidence that they were being toyed with – and the lengthening stretch of time between doses.

Did your project involve any partnerships or collaborations? If yes, please describe. What relationships if any did you leverage to ensure the delivery of your project.

We collaborated with over a dozen partners to help administrate vaccinations to our hard to reach community. Partnering organization collaborated with us in many ways to run clinics at their agencies, provided staff with lived experience to conduct incentivized surveys. The NECHC is a true collaborative practice.

With new variants and the approval of booster doses, what effect have these had on the work your centre carries out as well as the CVP National Project, in other words how are you adapting to this ongoing public health issue?

When new variants surfaced, booster doses were introduced which created another layer of uncertainty and hesitancy with our vulnerable population. In a short period of time we mobilized a team and re-employed a targeted strategy of engaging long-standing community partner to re-establish referral and collaboration pathways (similar to in Phase I), this time adding a day per week of in-clinic walk ins to our outreach. As previously described, this outreach relationship-based care model mitigated many of the barriers surrounding vaccination education and procurement for people experiencing homelessness and those at risk due to poverty or street-involvement.

How has the funding through the CVP National Project helped your centre and the community it serves?

Although faced with a sense of “vaccine fatigue” this funding did allow us to engage in the valuable work of vaccinating hundreds of often-high-risk individuals (in terms of health status, living in congregate settings) and heard gratitude from a number of our community partners in mitigating some COVID-19 related risk.

What are the next steps for your centre after the CVP project with regards to COVID-19 and your hope for the future?

We will continue to be available to provide health leadership in our community, anticipating and responding to challenges related to COVID-19 in the context of priorities of those who use our services.

What do you think your experiences throughout the pandemic say about the ability of Community Health Centres to adapt to emerging social and public health issues, and the importance of CHCs within our health and social service systems?

The pandemic has brought attention to many issues that our organization has long seen as systemic failures. COVID-19 shined a light on the NECHC as it allowed us to demonstrate what innovative, harm reduction social-determinants-of-health, community-informed health care looks like. The result – exponential growth within our organization. We have grown from a staff of 30, with a clinic space, and one van to a staff of over 130, with 150 housing units, four locations, and three vehicles.