Host: If you're in Toronto, you may start seeing something new outside your local library branch, a mobile health clinic aimed at connecting more people with primary care. Doctor Andrew Boozary is the executive director of the Gattuso Centre for Social Medicine. Aly Velji senior manager, adult services at Toronto Public Library, and they both join us in our studios. Great to have you both. How are you doing? Thank you.

Aly Velji: Good. Thanks for having us.

Host: Andrew. Let's talk about how did the idea of a mobile health unit come about?

Andrew Boozary: So I think there's been terrific work for many decades from community health centres and various community organizations that have been able to try to advance mobile health options to get health care to where people are. And so Sherbourne Health, Parkdale, Queen West Community Health Centre, Anishinaabe Health have had mobile vans or mobile clinics for some time, and we've been able earlier to partner with some of the organizations to evaluate, is this something that can work? What we found in the last few years is that the mobile health clinics are incredibly effective at providing the sort of care that can keep people out of resorting to the emergency department. For 37% of the folks who are able to be seen, they said that actually averted an emergency department visit. So there's a long standing history and evidence base for mobile options, which is really pushing back against the mantra we've had in health care is that if you build it, people will come. The reality is, for folks who've been marginalized from the system, who have obstacles and barriers to reach the system, you have to go out to where people are. And so to me, what's really unique about this work and this initiative is the partnership with Toronto Public Library, who I'm the longest standing fan and public fan of public libraries, and I believe they've been the original social medicine hubs. And so to me, it's a really long overdue marriage to try to ensure that we are continuing to build a relationship and a connective tissue between hospital and community that will prevent more people from falling through the cracks.

Host: All right. We do have some photos of the van that I want to pull up. So this is the exterior of it. You wouldn't know what's inside of it. And we do have a photo inside just a little bit, a little sneak peek. You can see a bit of a chair set up, a little sort of what you would see in a regular clinic, but there's a little bit more in there. Tell me, what are the services that are provided. Tell me what it looks like inside.

Andrew Boozary: So it's rather comprehensive from the outside. You look at it sort of as a usual sort of van, but there was a lot of work in designing the space. So as you can see at the front, there's a sitting area. Again, we're trying to rebuild trust with people who can sit, have conversations that are private again, whether that's around access to various mental health and addiction supports, or really being able to have a reassessment of where they are in terms of their health care journey. And then in the back of the van, there's a full clinical space, just like where I was working this morning. You've got a bed, the blood pressure cuffs, all of the screening tools that you would need to ensure that you can provide high quality primary care. And so I think that was a lot of the co-design with people with lived experience of what kind of experience would they want and what kind of setting can be as dignified, given that you've got some limitations with a mobile clinic, but the importance of it having the ability to, to provide high quality primary care, and that's basically all the things that you can access in a clinic office.

Host: All right, Ali, the first one, this this mobile clinic here is outside the Sanderson Library branch near Bathurst and Dundas in the city's downtown core. Why this location?

Aly Velji: Yeah. So I think, you know, as libraries overall are open and accessible spaces. And we serve a lot of individuals, especially those that are looking for social supports and other health supports as well. And this library specifically serves a wide range of a wide range of individuals, including newcomers, including individuals who are under housed and who are looking for those kind of supports. So the Sanderson Library made perfect sense because it was also right next to just across. And I know Andrew and his team did a lot of research as well to identify spaces that that needed that extra support.

Host: Now, talk to me a little bit about sort of the wraparound services as well that the library provides that people, once they've, you know, gotten in the van, done their check-up. What else are we providing?

Aly Velji: Yeah, for sure. So it's as soon as they visit the clinic, they're able to come by to the library, they're able to meet our staff where we can find out a little bit more about what they need. Of course, we're going to want to make sure that they get a library card. After that, we'll have a conversation with them to find out what else they need support in. So you might have a newcomer family that is looking for some support. So we'll link them up with the library partnerships that we have or settlement agency in the area. They might be an individual who's looking for work so we can help them build their resume. We can also help them with the necessary digital literacy skills that they need. Or you might get an individual who is lonely and isolated and really need some support. So we might be able to allow them, sorry, might be able to help them find out ways to get online so they can get connected or even join one of our many programs that we.

Host: Have in terms of the, the staffing of the van and sort of the role of the library, but also the health workers there. What's what's the crossover? How many people are actually in the in the van? And then what's the crossover with staff?

Aly Velji: So so I'll let Andrew speak about who's in the van.

Andrew Boozary: Yeah. I think you've nailed it. It's about trying to build one team with the library workers that I think Alise mentioned have done incredible work to try to stitch together different options, whether it's from loneliness to accessing income supports, but they also have a good idea of what some of those needs are of the clients and folks who are in the library. And so the Sanderson branch is less than a block away from Toronto Western Hospital. So you could literally throw a football from the door of Sanderson Branch to the emergency department. And so the reality is that there has not been that kind of connection and relationship between these two institutions that serve many shared patient populations. And so with the mobile health clinic, it's about having a community health worker, an RN, a nurse practitioner from a primary care piece, but also from the mental health and addiction support that can be there. And so that's how the teams are starting to integrate. And beyond whoever's on the mobile health clinic service, it's also about being able to call a community health worker as part of the centre for Social Medicine and say, you know, I'm a little bit worried about so and so. They've seemed to deteriorate over the last few weeks. It may be worth for a check in. And then also vice versa. That might be clinical staff or folks who are working at the hospital or at the centre say, what kind of supports could be there from tax support to housing support to, again, loneliness and isolation, which can't be effectively or fully addressed in the clinical setting or inside the hospital walls.

Host: Why is this needed? Now? I know this is not something that just you guys put together in a couple of months, those couple of years in in terms of the process here. But just knowing that, you know, what Andrew talked about, the libraries being this hub, I'm sure you guys have noticed that this is a great idea. This is something that we need now. But why now?

Aly Velji: Yeah for sure. I mean, I think we are always facing, you know, individuals who are looking for those kind of supports and we're always doing our best to be able to refer them to other agencies. So I think the the timing was perfect where we were finally able to bring those services into our spaces, allow them to meet supports in a safe and welcoming environment, and then being able to support them in whatever else other way we can.

Host: I was gonna say, Andrew, I think a lot of people will see this clinic and also see the timing of, you know, funding being pulled from safe injection sites, a safe consumption sites. And I think a lot of people make those connections. But as you mentioned, this has been in the works for a couple of years. But why why now? Or is that timing kind of a good thing?

Andrew Boozary: Look, I think the timing is urgent. Wherever you look across the system, we know that there are millions of people who can't access primary care in Ontario. And again, across the country. That's been a real challenge. And fundamentally, I would say if we believe in a universal health system, you need strong primary care is the bedrock of a high performing system, and we believe in universal healthcare. I think that's what we continue to hear from people across the country, from people in the city. And there have not been enough options that have been able to go out and, again, really partner with community and be able to ensure that there's access. So, one, I think that is fundamentally important in delivering on our promise of universal health care. Two, I think the other realities are that we are facing a toxic drug overdose crisis, that there have been far too many lives lost. And we look at some of the most recent data from Toronto Paramedic Services. There's been a doubling in the amount of non-fatal overdoses, the amount of calls to EMS. And as Ali mentioned earlier, I mean, this is an intersection at Bathurst and Dundas that has seen increasing poverty. We've seen a doubling in homelessness in the last four years in our city, probably a tripling just around the Toronto Western. And so we need a real concerted approach. We need different responses. Mobile health clinics, by themselves alone, are not going to solve the primary care crisis or the toxic drug overdose crisis. But I think it's finally starting to learn both from community, from our partners, from the needs of patients, about trying to mobilize options that have been denied for far too many people.

Host: Ali. From what I understand, success so far in the initial, you know, rollout of this, their plans for expansion, what does that look like?

Aly Velji: You know, I think this has been the start of a really great partnership. I know we've been speaking about this for many. Yeah, it's definitely been a long time. You know, I think, you know, it's really wonderful to see the success that we've had so far. And the interest in this as well. And I know that we'd love to be able to kind of expand and look at different options, to be able to bring primary card sports and other supports into our spaces.

Host: Andrew is something that we can see outside of this city and across the province.

Andrew Boozary: You know, there have been, again, lots of pilot projects and examples that again, where public libraries have been real leaders across the country, and again, where there's been community health centers and various organizations trying, to push, mobile health options. I think seeing more of these partnerships across the country is only welcome. I mean, I think in, in, in line with Ali's points, I mean, one of the things that we're doing is always wanting to ensure we're data driven about where those needs and the response needs to be. And one of the things that we've been seeing and working with Toronto Community Housing and some other partners is that there are certain addresses and locations that have really high volumes of EMS calls, ostensibly for things that can be treated where people are at. So I think there's many ways that this is to evolve. I think, again, we know that there are many other branches and neighborhoods that have really serious needs. And we also know that we have a health system that's under a lot of duress. So how can we help our own, you know, terrific colleagues in emergency department and hospital wards by being able to provide the kind of care that can keep people at home. But also, I think fundamentally keep people alive. I mean, this is far too frequent in Canada where people are getting a cancer diagnosis in the emergency department. It's far too frequent that people are seeing a limb amputation for something that could have been prevented, or at least managed through chronic disease, methods. And so this is, to me, really the thrust of this work is that it is about reaching more people, but keeping people alive. And I think building the synergy between public institutions that, you know, have a real commitment to the population that's right around our buildings and right around our footprint.

Host: I think it's a fantastic idea. I wish we did it sooner, but I want to thank you, gentlemen, I would agree. Yeah, exactly. Gentlemen, I want to thank you so much. Keep doing the great work. I really appreciate your time. Thank you.

Andrew Boozary & Aly Velji: We appreciate it.