Homeless people sleep on a building's steps in the Victoria, July 2007.Diana Nethercott For The Globe and Mail
Victoria's Access Health Centre is the model of efficiency. Gathering an array of medical services under one roof, the centre has treated 1,500 more patients in its first year of operation than the various agencies would have seen on their own - with the same amount of money.
Housed in a downtown heritage building - once a carriage repair shop - the modern clinic caters to Victoria's most marginalized population. The homeless, the drug-addicted, the mentally ill, people with HIV/AIDS - most clients walk in off the street with multiple issues.
Under a single roof, they can find primary health care, dentistry, counsellors and hot meals. While the structure resembles a typical walk-in clinic, little differences reflect the clientele's needs. The onsite pharmacy allows homeless people with HIV/AIDS to store their expensive medication. One wall displays a wide selection of condoms and other harm-reduction supplies.
The synergy comes with linking in other partners, including AIDS Vancouver Island and the Native Friendship Centre, to provide one-stop care. The average client will connect with three or more services in a single visit.
Clinic manager Irene Haigh-Gidora said the merger of services has been a success. In the first year, she said the centre logged almost 35,000 medical and dental appointments, an increase of almost 6,000 from when the services were spread out. In total, 1,500 more people came through the doors.
On Friday morning, the main waiting room was almost empty, but the medical clinic was running at capacity. Because it is not a walk-in clinic, clients will typically drop by in the morning - many have no access to a telephone - to get an appointment the same day. The spots are usually all booked by 10 a.m.
Chris Fraser specializes in inner-city medical issues. He came here from working in Vancouver's Downtown Eastside. The problems here are the same: people with chronic, complex health-care needs who are also struggling to find food, clothing and shelter.
Dr. Fraser is the medical director of the Cool Aid Community Health Centre, the backbone of Access Health. Cool Aid has been keeping electronic health files for a decade - long before E-health became a buzzword - allowing the physicians, psychiatrists, nutritionists and other practitioners to keep track of their patients.
A side benefit of keeping that data has allowed staff to track one byproduct of the new health centre. Patient visits to (far more costly) hospital emergency rooms have dropped significantly. "We're offering fast and efficient intervention," he said.
He has just come from a consultation with a patient who has been in his care for two years. The man first walked into the old Cool Aid clinic with full-blown AIDS. He was homeless and suicidal and had a heavy intravenous-drug habit.
Today he is "quite unrecognizable" from the patient Dr. Fraser first encountered. He has a place to live, he is getting support for his depression, his drug use is down, and he has gained 14 kilograms.
"If I had seen him in a traditional private practice, I could not have helped him as much," Dr. Fraser said. "You really need this team."
He'd like to see the centre expand its hours and open seven days a week. But first, the $5.3-million centre needs to retire the last of its debt. It is a little less than $1-million away.
Justine Hunter