Rebuilding Primary Care with the Delhi Family Health Team
The Delhi Family Health Team goes mobile during COVID, providing compassionate care to Seasonal Agricultural Workers.
For this special series HIROC is partnering with the Association of Family Health Teams of Ontario (AFHTO) to highlight the work of several amazing primary healthcare teams.
In this episode we speak with Robin Mackie, Executive Director, Delhi Family Health Team; Roxanne Pierssens-Silva, Clinical Services Manager/RPN, Delhi Family Health Team; and Rebecca Spencer-Knight, Nurse Practitioner, Delhi Family Health Team.
Migrant workers constitute a large portion of the workforce in rural Haldimand, Norfolk and Brant Counties. In Haldimand-Norfolk, there are 204 farms that hire and house over 3,300 Seasonal Agricultural Workers (SAW). The Delhi Family Health Team has traditionally provided primary care services to the workers and were the first people called when a case of COVID was reported. Within hours they transitioned to a fully-functional mobile care team. And they never looked back.
Using their cars, cell phones, and as much equipment and supplies as they could carry, Robin, Roxanne and Rebecca attended to the physical, mental and emotional needs of the workers who were isolated, spoke a different language, and were far from home.
The experience of providing low-tech care in an unpredictable environment reminded the team of why they became nurses in the first place and the importance of looking out for each other.
Mentioned in this Episode
- AFHTO Association of Family Health Teams of Ontario
- Delhi Family Health Team
- Migrant workers from Trinidad and Tobago stuck in Haldimand-Norfolk
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Ellen Gardner: Welcome to rebuilding primary care, a special series from HIROC. I'm Ellen Gardner with Philip De Souza. We're delighted to partner with the Association of Family Health Teams of Ontario, AFHTO, to highlight the work of several amazing primary health teams. Today, we're speaking with Robin Mackie, executive director of the Delhi Family Health Team; Roxanne Pierssens-Silva, clinical services manager, and RPN on the Delhi Family Health Team; and Rebecca Spencer-Knight, nurse practitioner on the Delhi Family Health Team.
Migrant workers constitute a large portion of the workforce in rural Haldimand Norfolk and Brant counties. In Haldimand-Norfolk, there are 204 farms that hire and house over 3,300 seasonal agricultural workers. The Delhi Family Health Team has traditionally provided primary care services to the workers and were the first people called when a case of COVID was reported.
Within hours, they transitioned to a fully functional mobile team, and they never looked back. Using their cars, cell phones and as much equipment and supplies as they could carry, Robin, Roxanne and Rebecca attended to the physical, mental, and emotional needs of the workers who were isolated, spoke a different language and were far from home.
The experience of providing low tech care in an unpredictable environment reminded the team of why they became nurses in the first place and the importance of looking out for each other.
Ellen Gardner: Migrant workers constitute a large portion of the workforce in Haldimand Norfolk and Brant counties. Can you just talk a little bit about that population, what they do, where they live, where they come from?
Robin Mackie: So this is Robin. I will start by stating that the seasonal agricultural worker program here in Norfolk is one of the largest programs in rural communities. I believe it's over 3,300 seasonal workers that come in from roughly May through until October each year. We've been running a seasonal agricultural worker program for primary care since approximately 2007, where we offer two evenings and maybe one afternoon or morning a week. So we have been working with the workers for a number of years, providing their primary care in our community.
Ellen Gardner: Did things change dramatically with the arrival of COVID? What started to happen as COVID arrived in Ontario and maybe if it did start to move towards the agricultural sector?
Robin Mackie: I'm going to introduce Roxanne, she can speak to a little bit about this.
Roxanne Pierssens-Silva: There was some difficulties of workers being able to get into Canada. There also was for us seeing our patients that we serve, that we had to go more virtual, which had its difficulties on itself. This is something that we'll talk about in our lessons learned. We also had to go to pre-booked appointments rather than them just walking in. A lot of the individuals don't have cell phones and so on. So there was a lot of barriers that we did see this year for those being able to access primary care.
Ellen Gardner: Why did you feel like you needed to create the clinic?
Robin Mackie: So the Grand River Community Health Centre is one of the programs that's funded by the ministry to serve this community for this specific vulnerable sector. And when the workers come to Canada, there is a challenge for access to primary care. So they do have their drug benefit card. They get their OHIP card, but there is no family physician for them. So there needed to be some access to primary care. And the government had provided some funding to the Grand River CHC for this program, for this community and the Grand River then reached out to us back in 2007 to start expanding these services in our area. So Grand River provides the services in the Brant County and part of Norfolk and the Brant community and we provide it for the Norfolk community.
Ellen Gardner: What is the primary care response team and why was it set up?
Robin Mackie: So our primary care response team was based out of a necessity when we started meeting with our community partners, when we realized that we went into the pandemic with COVID-19. So we had been meeting on a regular basis and on one specific date, we found out through our regular meetings, that there had been some workers in the fields that had become positive. And when we started looking at that, we got the request to go out and try and flatten this curve and stop the spread or to provide that medical assessments with our community partners.
Ellen Gardner: You seem to transition very well from being a response meet team, to moving to mobile. What was that like for the team?
Robin Mackie: We had known that the pandemic was here. We had already started to prepare for congregate settings in other areas. So our team had their fit test and we had the PPE supplies, we had education. We were all ready to provide that service in-house and when it came out that there was a concern about how we were going to provide these services to the workers on site. We really had to sit there and say, "Okay, how can we mobilize? How quickly can we get out there?"
And literally, on a Saturday morning when we got the call, we were asked if there was any way that we could start seeing these workers. And we said, "Yes, for sure." And originally we thought they were going to come here to our clinic. Then we recognized very quickly that because of a lot of things that we can talk about later regarding their culture and the ability to have the primary care services, we recognized with public health to be able to go out and provide those healthcare services on-site was going to be the best option.
Robin Mackie: So within, I would say 20 minutes, I was on the phone calling my team. We all have each other's personal cell phone numbers. And when I started calling them and saying, "Hey, what is your availability? Can we start going out to these farms within the next couple hours?" I had no doubt that the team was going to respond in a positive way. They have such dedication to not only patient care, but to this community. And they were ready to go within two hours. We knew at that point that our primary care response team became a primary care mobile response team within two hours. Once we started becoming mobile, we never really looked back because we realized that was the best care for the seasonal agricultural workers, and probably some other groups in the future. It just became such a good avenue for providing this primary care that we just stayed with it.
Ellen Gardner: When you talk about becoming a mobile team, I imagine this van outfitted with all your equipment and devices and medications that you need and just getting on the road, but was it that coordinated or was it really everybody in their own cars convening somewhere?
Robin Mackie: Yeah, I'm going to let Rebecca speak to that one because remember in rural community, it's pickup trucks out here. So I'm going to let Rebecca speak to that.
Rebecca Spencer-Knight: Hi, it's Rebecca here. So the idea of having a beautiful van outfitted for mobile service is a wonderful thought and not the reality for us at this time. We did very much use our own vehicles. Our trunks were full or trucks were full of PPE and the equipment, medications, medical supplies that we needed for these workers. We did try to designate the clean truck and the dirty truck, for lack of a better term, in order to keep our supplies clean. Any contaminated PPE we'd removed had gone into separate locations and keeping everything separate and safe for all of us and the workers as well.
Ellen Gardner: This I'm sure is something you're thinking, yes, we are going to continue to do this in the future.
Robin Mackie: We definitely did learn a lot and we really needed to lean on each other to make sure that nobody really burnt out. I think the best thing about this is that not one of our workers became ill during this time. There was a lot of self-monitoring, a lot of safety that was put in, and I'm going to refer back almost to when you put your oxygen mask on first to be able to make sure that you can still provide to others. And certainly my role as the Executive Director was to make sure that this team felt safe and that they were well before anything else so that they could provide the great service that they did to these workers.
Ellen Gardner: Have you dealt with a crisis like this before Robin? And what were some of the key things in terms of the team being resilient when you were really called to respond to a crisis like that?
Robin Mackie: Yes. So I can say, I've been a nurse for over 25, I'm going to say coming up to 30 years. I have never seen anything like this. Even when SARS hit back years ago, we've seen nothing like this in this community. And it's funny because I really didn't have any doubt about the team. I think when I got here years ago, I recognized the strengths within this team and the dedication that they have, and they just needed that support to know that no matter what, that their leader was going to have their back. And I know a couple of times in the field, some of the staff would give me a call at night and say, "Hey, did I do something wrong here? Or maybe I should be doing this." And I would support them 100%.
Robin Mackie: So I think the resiliency of our team was knowing that no matter what happened, I was going to have their back and we were going to have each other's back too. So if Rebecca was out there at 9:30 at night, if she wanted to call after hours, she knew that I was going to pick up the call. She knew that Roxanne was going to pick up the call during those times. And this happened before too. We had some really significant team building events prior to the event happening and I think that relationship issue and that trust and respect for one another was there, but I'm going to pass it over to Rebecca or Roxanne.
Rebecca Spencer-Knight: Absolutely. Rebecca here. As one of the nurse practitioners who is in the field with these workers, I would say just about every day for the course of our time out there, I absolutely agree wholeheartedly with Robin. The resiliency component came from knowing that we had our team support and that we were appreciated for doing what we were doing. We were out there knowing that at any point in time, if I needed supplies, if I needed support, if I needed just a phone call that I had people available to me at any time of day. We also very much shared a common goal with our focus on being the priority of the health of these workers.
And we also ensured within the field, whether it be myself, working with our translator or whoever else happened to be with us that day, that we ensured that our own team's physical and emotional needs were met as well. That it was important that if we needed a break or we needed a timeout, or we just needed to chat that we had that available to us.
Rebecca Spencer-Knight: And really we celebrated our small successes together as a team. We would if needed in a field somewhere, if we had a picnic lunch and we just celebrated the successes of that day, no matter how small, and it kept us going, it kept us motivated for the next day that we were going to be out there for potentially 12 hours, again.
Roxanne Pierssens-Silva: Like Robin and Rebecca both said, communication at any time of the day. The phone call would come like, "Hey, we only have one N-95 left and we have to go to another site. Okay. Let's hop in the car and get them out to them." So it was amazing when you're in something as big as this, how things just seem to fall into place.
Ellen Gardner: This is just a logistical question, but did you always have enough equipment?
Roxanne Pierssens-Silva: We did. Yes.
Robin Mackie: That also, I tie that back into our community as well. So when there were shortages, our community pulled together. We had local businesses that showed up here with supplies. We had local businesses showing up here with cabbage rolls to feed us. I have to tell you when you talk about rural community, we couldn't have done this also without the support of the community and the receptiveness of the farming community. Right? So again, we did not meet resistance. We were very much welcomed. And again, we weren't perfect. Nobody's perfect in any of this.
Robin Mackie: And sure there were opportunities where there could have been frustration and communication concerns, but it was really interesting because like Rebecca said, we had the same goal. We were paddling in the same direction. So despite the turbulent waters, we knew where to go and we knew that our team and everybody in our community was behind us. And it was really to make sure that we could get the seasonal agriculture workers, the best care they could and early intervention to allow them not to get to a point where, like I said, where this COVID-19 really does wreak havoc on vulnerable sectors.
Ellen Gardner: In your presentation at the AFHTO conference, you said that what started as a professional and moral obligation to attend to the needs of our community and its members became a lesson in culture, quality care in an unpredictable environment, organization in the face of chaos and collaboration between our community members. So you were coping with things changing all the time and a very chaotic and challenging situation. And then there was the cultural component as well. So can you tell me about that? Why was the cultural factor so important here?
Rebecca Spencer-Knight: For the seasonal agricultural workers that we were dealing with and working with closely, they were away from their families in another country with a significant language barrier, as well as a cultural barrier. And it was so important for us to recognize that their emotional and mental health needs were just as important during this time as their physical needs. In my opinion, it would be so easy to forget the human component behind these gentlemen and not address that. And by not addressing their emotional needs, I think we would have been doing them a disservice. We very much were a third party health provider for them, meaning that we weren't working with public health. We weren't working directly with the farmers, but we were there for the gentlemen themselves. And by doing that, we were able to over time, build their trust.
Rebecca Spencer-Knight: They were able to share with us some of their own personal experiences, not just from the pandemic, but from their experiences at home and kind of regroup for what their family life was at home and meet with them more on a personal level. I think by being able to do that by offering them accurate information, by reassuring them about their care and being there for them on an emotional basis as well, we were really able to enhance their ability to heal, their ability to cope with the isolation that they were going through at that time. At the end on some of our last days, we were invited back for dinner and dancing. I feel like we were really able to make a positive impact with these gentlemen, not just for their physical health, but their emotional as well.
Ellen Gardner: One of the things that really comes through in your whole experience is everything you say that the emotional component was so important, but also adapting quickly and responding to what was needed. So I wonder if you all could share any lessons learned that other family health teams can take for their own experience of how to react during a crisis.
Robin Mackie: I'm going to ask Roxanne if she wants to speak first to this.
Roxanne Pierssens-Silva: We were able to help our community and this seasonal agriculture workers where it needed to be and how the situation just fit at that time. So a lesson learned is that in healthcare, and especially now going forward, that we need to be thinking outside of the box, I guess is the best way to put it. As Robin has said that we're all very tests and admin-orientated and you'll hear from most people in healthcare, the admin side that we have to do now is taking away from that emotional hands-on nursing that most of us got into healthcare for. Whether it's computer, things that need to go to the Ministry, all that kind of stuff. A lot of our time is taken up from what we love to do. So I think being on-site and in the field, we didn't have computers which would have been helpful because we're used to it, but we really got to take that time with each individual.
Rebecca Spencer-Knight: It's Rebecca here. I'll just touch on some of the things that I learned by being out in the fields for the majority of this time. And that really, as we've previously mentioned, that communication and mutual respect, not just amongst our team, but amongst the other community members, including public health and the workers that we were caring for was of utmost importance. And it really showed that over time of how well we were able to work together and including in that is the adaptability that we had to have. As we've all mentioned, things change. We were dealing with a situation that none of us had direct experience dealing with before.
Rebecca Spencer-Knight: So we were able to be adaptable. We were able to go back to our paper charting when we didn't have the technology, we were able to make do on the fly when things changed when we were in the field and we were able to do so in a way that enhanced the health of the workers that we were working with, as well as with our communication as a team. So I think the things that really were important that we learned over time was that adaptability is important and that in order to do so and do it well, we all had to communicate and support each other unconditionally.
Robin Mackie: I think that sometimes in leadership roles, we do get focused on the rigidity of the rules and the payment models. And we get kind of focused on those things. I think that for leaders that have these dynamic teams, you got to really trust in your teams and figure out the other piece later, especially in a pandemic. I mean, I know we have heard a lot where it's like, "Well, let's make a plan. Let's figure this out then." And everything seems to have to be T's crossed and I's dotted before you make a move.
Robin Mackie: And I'm not saying, that you shouldn't have a really good plan in place, but at sometimes you just have to have trust in the abilities and the skills. And if you've got a well-prepared team get prepared in advance, lessons learned, be prepared in advance. Our team has already gone through training again. So even though we just came out of this, it's like, "Okay, we're all going to go through donning and doffing again, we're going to get fit tested again. We're going to go through infection control practices, again." Be prepared so that when something happens, as the leader I can say, "Yep, we're ready to go!"
Robin Mackie: Maybe we don't know what it's going to turn out like. Maybe we're going to hit some bumps along the way, but we didn't even know if we were going to have any money coming in from all of this, to be honest. We were just like, "Okay, can we do it?" Sure. We'll figure out the rest of it later. But we put safety first. We put our workers first. Then we put our patients first and then we moved forward.
Philip De Souza: Hearing the three of you, Robin, Rebecca, and Roxanne you guys can write your own leadership book because you talk about psychological safety, communication, respect, adaptability, and leadership, and ensuring your people are heard. And I think all those winning ingredients that really made your story shine which is why we want to feature you. And like Robin said, you put safety first, like the safety of your team, the people you serve. And I think that's just commendable. So congratulations.
Robin Mackie: I've got such dedicated people here that love this community and care for each other that I have the best working foundation I could have ever worked with. And they just needed to me to say, "Okay. Yeah, open the barn now. Let's go." Right? Let's go. We're ready. We're going to use that rural analogy!
Rebecca Spencer-Knight: But it's not just us that were out in the field. It's Robin and Roxanne and everybody that were working behind the scenes here, just because they weren't out in the field with the workers doing the assessments, they were doing just as much, if in my opinion, more work here, being in office, doing the communication with public health, doing communication with the farm community and being readily available 24/7 was just as demanding on time and energy and that exhaustion that comes with it. You don't have to be out in the field. Every component of that is important.
Robin Mackie: This team laughs a lot. We laugh at ourselves a lot. We do a lot of silly things. And I remember during this time too, we'd have a couple of funny little pictures or texts like one of the baby memes. Some of the things that we sent to each other late at night, I would be dying laughing, We’re exhausted, but we did keep our sense of humour up. And I think that's also part of it is that we do know how to have some fun. And I laugh. The timing is great. We have our team-building this afternoon and our team is going out and doing some team-building. And we're doing an escape room in the bush. And we're maintaining social distancing and I had pretty funny things going on that this team... They have a sense of humour. They're going to have a sense of humour to get through this afternoon!
Ellen Gardner: You have just been listening to rebuilding primary care. A special series about family health teams produced by HIROC and the Association of Family Health Teams of Ontario. Today, our guests were Robin Mackie, Executive Director of the Delhi Family Health Team, Roxanne Pierssens-Silva, Clinical Services' Manager and RPN on the Delhi Family Health Team, and Rebecca Spencer-Knight, Nurse Practitioner on the Delhi Family Health Team. Stay tuned for more episodes of Rebuilding Primary Care. Thank you for listening.
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