Langs1

This transcription is a conversation about the services provided by MAP (Mobile Access Project) and the challenges they face in connecting individuals to healthcare resources. MAP offers primary care, wound care, case management, and support for addiction and mental health treatment. They work with various partners in the medical community to bridge communication gaps and ensure patients receive the care they need. Service disruptions, such as homelessness or lack of access to phones, make it difficult to maintain continuity of care. The goal is to help individuals access treatment and improve their overall well-being. MAP also aims to reduce emergency room visits and provide low-barrier care for sexually transmitted diseases. Foot care and frostbite risk are particular concerns for individuals experiencing homelessness. Inadequate access to care can lead to delayed treatment and more severe medical issues. We start with recording on just a brief summary of what went on at the event. Sure. I can start at this point? Sure. There you go. Okay. You want to start? Sure, go for it. So, just one neat little thing, too, when we're, like, recording. If there's that, we're going to cut that out. Okay, good. So, just a little pause, and then... Okay. Compose it. Compose it. Perfect. So, we've been involved with MAP since the beginning. It originally started back in 2015 as a response to COVID and everything shut down. So, we provide primary care, and we do that in a very wraparound way. So, we do have a social worker, a self-help and outreach worker. So, we have a nurse here, here, three days a week on the standard. That doesn't mean that we have somebody for various things. There are a few things I mentioned before. Kind of a very basic, we provide primary care in all ways that that works. In terms of the questions themselves, we'll just dive into those. So, for starters, what are the things you're seeing right now? Lots of wound care. I would say this is probably a... Not even just the wound, but... Biotics. And I would say also case management is a huge part of our role. Quite often we see a lot of the folks that we see here struggle with connecting with their primary care or with, let's say, if they're seeing a specialist or someone else for their health. Oftentimes those things can get missed, or if they don't have a phone, they miss appointments, the hospital's not able to get a hold of them, those kinds of issues. So, then we're there to try to figure out where things kind of got missed and how to reconnect them back. So, Phil's listening along and talking about case managing. It's very much about trying to manage the communications between the different silos. Yes, absolutely. The different things that are happening. Can you speak to what that looks like? If we're thinking about the silos, so there's different silos. We have the hospital, we have primary care, we have specialists, we have different organizations. And we all do our best to try to connect with each other. Unfortunately, there's not always a thread connecting them, which is really so badly needed for people who either struggle with connecting. So, unfortunately, then people get missed, they get dropped, because they're not able to advocate for themselves, to follow up on appointments, reschedule things. As far as the silos in health go, sharing information also becomes a challenge. So, because we work in primary care, we're better able to collect some of that information. But between different partners, I think one of the big struggles is, who can I share this information with in a safe manner to keep things confidential without jeopardizing someone's safety? And I think we've spent probably the last six years, building relationships and leveraging those relationships with the hospitals. So, social work and eMERGE and hospitals. And that's just, you know, when I say to somebody, let me message so-and-so in eMERGE. Let them know you're comfortable with that, because that feels better and that they can check in. So, leveraging those relationships built across, not just within our community partners that are, you know, here at MACS, but also leveraging our partnerships that we've established within the medical community. One or the other, you're asking about silos. And so, we try to support people who are interested in seeking treatment for addiction. And so, one of the challenges is trying to get somebody ready to go to treatment. And that can be a challenging thing. So, trying to support them. So, part of our role is providing some of that primary care to help get people to the places that they need to go. Mental health is another one as well. But unfortunately, people who struggle with their mental health are often more isolated or don't necessarily access the services as easily as other people would. And so, that's part of our role is to help kind of facilitate that. I've heard from some of our partners like AHWA in terms of struggle around what happens. Service disruption. Folks who are living rough. Sometimes that's very, very tough. You need to speak to the complexity of trying to work and get folks into treatment, if they're ready for treatment. What does that look like for service disruption? I would say that probably the biggest challenge there is, and we work often with outreach workers at AHWA to try to track people down. But often what happens is that we'll get somewhere with somebody. They're starting to follow through on things. And have to move along. Don't have. So, it's funny because we have systems to be able to track healthcare staff. But we don't have the same systems that the outreach workers have. Like, HIFIS. That's what people are. And so, trying to work with our partners to be able to provide the best care. And sharing information. Figuring out how we can best work together to help an individual. So, if somebody has been sent up to a shelter, they have that information. So, we do often try to encourage that our patients are accessing all resources. Because it does help us be able to find them better. Yeah. From what I'm hearing, you could literally have someone who is on the road to getting connected to treatment. And then suddenly a disruption in where they're living throws all of that work right out the window. Yeah. And that applies to pretty much any medical report that they can receive. So, whether it's treatment or it's, you know, seeing a psychiatrist, for example. Or medical follow-up. Suddenly, those things are all missed. And it's a big challenge to reconnect them again. Because there's missed appointments. They get put to the back of the list again. And so, these things that were high priority suddenly get pushed back further. We're still recording? Okay. I was just going to add HISIS. I don't remember exactly what HISIS stands for. Oh, me neither. What is this information? Something, something, something. Something system. You got it. Something. So, speaking a bit about the broader community, how would you describe how your services and what you do with other partners are providing a benefit? Well, you know, in order to have success with somebody who has either been living less, living in the shelter system, couch surfing. I mean, these are folks who have been, when we're talking about addiction, that have been ostracized from society. And reconnecting them to services. I mean, ultimately, we have some really great success stories of people that we have followed from, you know, they maybe started coming here. And then from here, they started accessing housing services. They started accessing our medical services. And then by building that trust, you know, then we have conversations with people and connecting them to those services. And then a magical thing happens. They go to treatment. While they're there, they are able to get housing. And then they're finally contributing to the way they want to and the way they deserve to be, contributing to society. And so it's this kind of interesting thing of, like, everyone's like, we don't want these kids. We don't want shelters. But those are how people connect. And it's how they're getting the services. When we have people that are moving along, I mean, there are people that we haven't seen for access to medical services. There they are. And it's quiet, and quiet isn't always a good thing. No, no. From a medical, like, specifically to our primary care clinic, I think one of the benefits, or we hope one of the benefits is that we can help to lessen ER visits, for example, for people who have used the ER frequently in the past. They may see this as an alternative for some concerns. So that's one hope. The other one is to try to improve. We also do provide some support for, like, sexually transmitted diseases and screening for them. And hopefully we can catch some of them more in a low-barrier approach and be able to provide care if that's needed, or, sorry, treatment. So those would be some other things just specific to us. And then hopefully, actually, we talked about case management. And just the improvement in the case management, I think, is one of our goals, is that people are able to get to those appointments. They are able to get their tests done. They are able to get their blood work, their imaging, and then hopefully from that they're able to get whatever, like, if it's surgery, like a knee replacement, or if it's treatment or whatever it is, hopefully those things can actually happen. That case management... Right. Yep. Yep. That's the hope. One item I want to capture... No, no. I'm right here. We're going to get to that. So with respect to coming back to very specific... I understood from conversations... Cameron's concerns around... Mm-hmm. Right. Could you touch on that? Because I know for some community members that'll be like, how does that... It's hard to wrap your head around that. Yeah. So when you're living rough, right, you don't have a foot care is an issue, or like footwear, I should just start with footwear. Poor footwear does not help with the risk for frostbite. And then also if you are living rough, oftentimes it's harder for wounds to heal if there is some frostbite there, which can happen. We do see that quite often in the wintertime, sadly. These wounds are not treated adequately, and so they don't access primary care until it has gotten significantly bad to a point where they need quite considerable medical treatment in order to help treat it. And so because there's that challenge to accessing care, they let things go too far, and that can increase their risk. And is that something... Yes, we've seen that. Well, I wouldn't say it's just even a winter issue. True. We have seen amputations from just infections that get way out of control. We've even seen people, I mean, one of the big challenges that we have, and we're talking about folks that are not able to remember appointments, but we have a huge struggle with wound care. So accessing wound care beyond us is almost impossible because a health card, a valid health card, in order to be able to access health care for ministry-funded wound care, again, appointments, they don't know if it's $350, they don't have a watch, they don't have a phone. And so wound care is a huge component of why we see wounds getting out of control. We do the best that we can to, as our nurses, we pull hot over some of the wounds we see, and trying to track people down to follow up and to do wound care for self with the limited supplies that we do have. Amputations are a constant, unfortunately. And again, people are afraid to go to the hospital because they fear judgment, they fear going into withdrawal, they fear sitting for hours and hours and going into withdrawal. There's so many reasons why people avoid the hospital, and unfortunately, by the time they are coming to us,