Rebuilding Primary Care with Janet Dang and Asher Frydman
When the Thames Valley Family Health Team realized early in the pandemic there was a shortage of PPE in the London-Middlesex region, they put out the call. Students, local businesses and the community stepped up with incredible results.
Welcome to Rebuilding Primary Care, special podcast series dedicated to Primary Health Teams. For this special series we’re partnering with the Association of Family Health Teams of Ontario (AFHTO) to highlight the work of several amazing primary healthcare teams.
Family health teams provide comprehensive primary care and are based on a collaborative model where physicians, nurse practitioners, nurses, dieticians, social workers and many more disciplines work together.
In this episode we speak with Janet Dang, Transformation Lead for Primary Care at the Thames Valley Family Health Team, part of the London Middlesex Primary Care Alliance, and Asher Frydman, a 2nd year medical student at the Schulich School of Medicine & Dentistry at Western University. Asher was one of the early volunteers to join Janet’s Covid project.
In the early stages of Covid-19, Janet and her team realized the area was experiencing a severe shortage of PPE. With the help of student volunteers and donations from businesses and the community, this grassroots effort grew to become the primary PPE distribution hub for the provincial supply within the region.
Mentioned in this Episode
- AFHTO Association of Family Health Teams of Ontario
- Thames Valley Family Health Team
- Schulich School of Medicine & Dentistry
- Fanshawe College
Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers. A podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest healthcare system.
Ellen Gardner: Welcome to HIROC's podcast, Healthcare Change Makers. I'm Ellen Gardner with Phillip De Souza. We're delighted to partner with the Association of Family Health Teams of Ontario, or AFHTO, to highlight the work of several amazing primary healthcare teams. These teams recently presented at AFHTO's virtual conference. Family health teams are a unique group because they provide comprehensive primary care and are based in a collaborative model where physicians, nurse practitioners, nurses, dieticians, social workers, and many more disciplines work together. HIROC chose to highlight these teams because they have improved primary care through their hard work and innovative solutions to problems. Those solutions became even more essential during COVID-19.
Ellen Gardner: Today, we're talking with Janet Dang, transformation lead for primary care at the Thames Valley Family Health Team, part of the London-Middlesex Primary Care Alliance. Asher Frydman is a second year medical student at the Schulich School of Medicine and Dentistry at Western University in London, Ontario. Asher was one of the early volunteers to join Janet's COVID project.
Ellen Gardner: In the early stages of COVID-19, Janet and her team realized the area was experiencing a severe shortage of PPE. With the help of student volunteers and donations from businesses in the community, this grassroots effort grew to become the primary PPE distribution hub for the provincial supply within the region.
Ellen Gardner: What motivated you and your team to create a PPE distribution hub in London-Middlesex?
Janet Dang: Earlier on in the pandemic in March, many of us weren't sure how long COVID was going to last for, what it was going to be like, and whether it was going to wrap up by summertime. And unfortunately that's not the case. At that time there was a grassroots effort started by family physicians themselves through the London-Middlesex Primary Care Alliance, which is a group of family physicians, nurse practitioners, administrators in primary care. They realized that PPE was an issue. There was a shortage and we weren't getting many supplies coming in. So they wanted to be able to help support our colleagues. And then that's where the folks like Asher stepped in, and the family physicians and I asked anyone in healthcare may have had their offices shut down, such as dentists, or foot care clinics, or vet offices, to look at their supplies of personal protective equipment to see what they can share. We had donations of surgical or procedural masks, face shields, gloves, and gowns. It was all collected within the London-Middlesex area with the help of our volunteers like Asher.
Asher Frydman: It was just announced that school was being cancelled in terms of in-person. So I realized I had some time, I had my March break where I was just getting caught up with everything, and I realized this was the real deal. I wasn't going back to school and I wanted to get involved in something. I started searching around then I saw that there was a small project that was kind of at its grassroots stage collecting PPE from the community. I said, "This is absolutely what I want to do." I saw that they were had a whole community effort working together in order to make sure that we could actually maintain the primary care sector and make sure that they could still operate during this time. And I realized that I wanted to do something that could have an impact like the one that they were hopefully going to have.
Ellen Gardner: One of the things that really jumped out during your presentation to the AFTHO conference was that there were several elements that contributed to your success. And one of them was acting early, that you got out there really quickly. And then the second thing was reaching out to local businesses and organizations who really did step up and help. What was that like?
Janet Dang: It was really, really cool Ellen. It was in a time of need, our community, everyone in our community stepped up and help support in so many ways. One of the things that we talk a lot about was the PPE. There were a number of other areas that had a great support as well. For example, all the students who were volunteering had meals delivered from different community members, different physicians and their families would bring treats and lunches for the students so they can work around the clock to prepare PPE packages and organize it. We had wellness kits as well. And wellness kits were little snack kits included with unique thank you notes from all the kids who were off school. So some of the physicians went around to some of their grandkids and asked for some drawings and little thank you notes. It was a huge collective effort.
Janet Dang: It included, as well, business owners that were well-connected within our city and our community that reached out through their networks and associations as well. And so groups that we traditionally didn't work with in the same way, we're definitely stepping up. I'm not sure, Asher, if you want to add based on some of your experiences as well?
Asher Frydman: It just so fascinating for me to see how quickly the community was able to step up to help support primary care. I was actually telling Janet yesterday how I remember on my first day when I toured, I remember walking into a room just full of PPE and asking one of the students who had started working just before me where all of this came from. Because I honestly thought it was either from the hospital, maybe to help out, or maybe some other health care clinics. But it was just from everywhere in anywhere. These were from small businesses, they were from car dealerships. Anybody who had something to provide was providing. And so it was just absolutely incredible to see how you had students who were working actually on the PPE side, but then just the entire community there to help support us right from the get-go. I think that was really what helped bridge that gap, especially at the beginning, when there was an extreme deficit of PPE for what we needed. It was incredible to see the community step up and make sure that we met all of those needs.
Janet Dang: Yeah. And I guess also add to that onset, like when this was starting up, there are a lot of other administrative folks who were working from home and weren't working in the same way. And we had some amazing individuals volunteer their time. So staff from Soul Science and staff from Fanshawe College, who had some project management skills that they could lend us to help us keep us organized, and work with me to put together schedules, and a way of organizing all of our PPE. There were amazing folks at help support our organization of all the students who did a lot of the leg work as well, Ellen. So it was truly a collective effort from beginning to end.
Ellen Gardner: It does seem incredible to how big a role the students played in all the gathering of the materials and the distribution. Where did the students come from and how did you get so many students involved?
Janet Dang: The first day, I still remember, was around March 16. It was just me coming into the office and there were some donations rolling in and I was thinking, "Oh no, it's just me. I need some help." And at that point, I was talking to some of the physicians and they said, "Oh, well the med school just announced that they're going to pause for a little while until they have a better picture of what COVID is going to look like." So I was able to put a little call-out to some medical students to see if they would be willing to volunteer with me.
Janet Dang: As Asher mentioned, at that time there were some other initiatives going on to support healthcare workers, such as babysitting or doing grocery runs or walking a healthcare worker's dog, for example, because they're at a shift at the hospital, or extra shifts. I had two volunteers, and we started to call a couple places and more PPE came in and things were being picked up and it started to snowball. And we thought, "Oh no, there's only the three of us. We can't really do this for the entire city." And there's so many different providers. There are a couple hundred primary care physicians in our community. We won't be able to keep up and meet this demand.
Janet Dang: And so the students and I advertised to the medical students who were still trying to figure out what they were going to do, and a couple more volunteered. At that point in the springtime, we probably had about a dozen volunteers, and we had shifts and it was a well planned and organized volunteer mission that we had. It was through word of mouth. And I think that's around the time when Asher, you came along and joined us and it had a tour.
Asher Frydman: Yeah, exactly. So I ended up joining, I think you guys were about a week and a half, two weeks in. Had just started collecting and I realized was this was definitely the right thing for me, I wanted to make sure that I could help out the entire community. And I got to work with a great group of ... I think the students that were working with you were all clerks at that point. So they were all finishing third year of medical school, whereas I was still finishing first year. I joined them for a little while and for them, correct me if I'm wrong, Janet, but they were entirely stopped. Their schooling was totally cut off for the foreseeable future at that point. So they really wanted to fill up their time.
Asher Frydman: For me, I still had some school going on. So we didn't really look towards many students at first that were in my year, just cause we all still had our exams, we were still keeping really busy. And a lot of people were working with the babysitting, the walking dogs, grocery delivery. So people were busy, but then once the clerks, we realized that they were going to be starting back up early summer. We had to start replacing some of them, because otherwise it was just going to be me and Janet now operating a massive hub, with a lot of stuff and that wouldn't be possible. So I ended up sending out some announcements to my class and the year older to see if there were people who were willing, and then we ended up gaining another like 10 or 12 volunteers on top of the clerks that we had so that we made sure that we were all covered, and that worked out really great because that helped us continue on throughout the summer until the end of August.
Janet Dang: The medical students are fantastic. They're so resourceful and we had a couple of students work on going through the directory, actually like a phone book, literally, of all of the businesses in town that were spas or construction companies, anything that would potentially have PPE, any sort. Opened, unopened, whatever it may be. They put together a strategy to call, and they divvied up. I think you've called, as a collective med students volunteer group, probably a few hundred businesses in town and in the county to see if they would be willing to donate. And if they did, there would be a separate team of students, Ellen, that would go out and pick up the PPE. So business owners didn't have to do too much, only saying yes to that they have PPE and setting up a time for these students to come up pick up, and then bring all that PPE back to our hub, which was located at the Thames Valley Family Health Team. The family health team was very gracious in providing support with space and the infrastructure to get that organized.
Ellen Gardner: Here you were creating something from scratch, a total grassroots effort and really a solely donation driven operation. So how did you get such an efficient supply chain and distribution system going so quickly?
Asher Frydman: I would say it came through a team effort, but through multiple cycles. So it definitely did not look like that back in the beginning of March when everything was kind of just, "Oh my gosh, we got to get all this PPE. We need to make sure it's getting to the right people." As time progressed, we started realizing, okay, we need to come up with an ethical framework. How are we going to distribute this? How do we know how much to give? And so we figured out over time making spreadsheets. We actually had a big whiteboard, where that would tell you exactly who's like PPE was currently packaged, who's needed to be packaged, who's had been picked up and we can erase it. And then we had a spreadsheet to keep track of all of that over longer periods of time.
Asher Frydman: You can imagine, the basic components don't change all that much. Package up the PPE and have someone pick it up, but the actual cycle of making sure that you're tracking all of it, to make sure that they're getting the exact amounts that they need, no more, no less. That really took a lot of cycles discussing with each other, discussing with some of the individuals who work higher up like Janet, as well as some other doctors that we were talking with to really make sure that we were working efficiently as well as ethically.
Janet Dang: Absolutely. And I think I would add to that, this is where having that primary care support and having the London-Middlesex Primary Care Alliance and the physician leadership and the administrative leadership there that would help assist make some of these decisions and as well here, what's going on out there with primary care colleagues. Where are people struggling, and how do we get that word out there? So that's where I think in a different slide we had when we were presenting at AFTHO, we talked about how the OMA worked really closely with us and other associations and organizations to get the word out there to colleagues to say, "Hey, if you're struggling, contact this email. Let us know how we can help you and we'll do our best." And that was critical, Ellen, I think, as we were getting organized as a province.
Janet Dang: And so later on in that process we fed nicely into the provincial and/or regional framework of how organizations can get PPE, and obviously that process still runs on today.
Ellen Gardner: There was an interesting transition that happened partway through the program where you moved from PPE distribution to PPE stewardship, which was really communication and education to the people requesting PPE. Why did that need to happen?
Asher Frydman: The biggest issue that I think we noticed was, especially early on, March April-ish and even going into May, there were definitely individuals who were requesting a lot more than anyone else in their exact same situation with the same number of patients. And we noticed that they were requesting a lot more and that they were requesting a lot more often. That's one of the great things about our hub was that we were actually able to have direct line of communication with the individuals who we were serving. So we kind of help figure these things out.
Asher Frydman: A great example was we found out that some people were using gowns for very small tasks that did not require gowns, and although maybe it was expected to wear a big gown pre COVID, it wasn't really the expectation now during the pandemic. And so we realized that every time you used a new gown, for example, to quickly change a patient's tray, if you're in a long-term care home, that's not necessary anymore. You can use the same gown to go in there and give them a new tray, take out a tray. We shouldn't be using a different one each time. And so that's really what motivated us to move towards stewardship and kind of explain we don't have an infinite supply. It is very much finite and we are still in a deficit of supplies, and we need to make sure that they're all that we're all using this as efficiently as possible while still maintaining safety. So that's kind of how that all started.
Ellen Gardner: How is it going now? Where are you at? Is the hub still going?
Janet Dang: So unfortunately, as the students received word that they were going back to school on September, we knew that around August area we had to come up with a transition plan. Because there were a lot of people that have this operation running. As other parts of the province were having the provincial groups that take over the work there, and integrate it together, we took this opportunity to transition over to Ontario Health West and the HMMS, which is the group that distributes and organized the process. So we took this opportunity to transition over, and we still have a great supply of donated items. That stockpile of donated supplies continue to be added to any orders or any physicians or primary care providers that need a top up of that amount.
Janet Dang: The work through the province, Ellen, really looks at a formula to decide how much PPE they will provide. It's on how many patients you're seeing and what you're doing. Donated supplies definitely helped offset any discrepancies there, and continue to be there to provide support for any primary care or primary care organizations there. So that's where we're at with the hub. It was winding down and it's definitely transitioned over now.
Ellen Gardner: How did it go at the AFTHO conference? Did you get great response? What were any interesting questions that came up as a result of your presentation?
Asher Frydman: Having the opportunity to present was absolutely fantastic. I think we were able to get our goal across, which was to explain to people that there are hubs systems that can really work, and not can actually make a difference in your communities, that can help actually maintain close relationships with physicians and other primary care providers to ensure that they can continue their operations during a pandemic such as COVID. And to potentially give maybe even smaller communities that may be having trouble dealing with the overall provincial supply, how they can get started and make sure that they can help their own primary care organizations while they're still waiting for the province to help support.
Ellen Gardner: What I really took away from what Janet and Asher have to talk about was how the initiative itself revolved around three things that I took away. Doing things efficiently, ethically, and with an abundance of communication. So my question would be, thinking of people in healthcare listening to this podcast today, and want to have some takeaways, what's one thing you felt, that magic sauce that made those three things happen for the initiative, or for you personally?
Janet Dang: I think there's so many things that people can take away. What's the secret sauce? What's the thing that we can take with us as we enter into the second wave, into another pandemic in the future? I think the feeling of being able to express gratitude. We didn't go into detail in our presentation about the wellness kits that came in. The wellness kids had different business owners that didn't have PPE donate. They wanted to help, and they wanted to do what they can. And so different businesses had different things that they were selling, or services that they were providing. There were some businesses that provided juice boxes and chocolate bars and everything.
All of those kids and physicians that took time out to write individualized thank you notes and there were thousands of them in our office, packaged individually. It just showed the importance of knowing that we're in this together. I know that many people have talked about how we are in this together, but when you see these different businesses, physicians, nurses, students like Asher coming together for the benefit of our community.
Ellen Gardner: Was this a transformative experience for you Asher?
Asher Frydman: Absolutely. I remember even that first day when I walked in, and when I saw the PPE in that one room and thinking that it had come from the hospital or come from other primary care providers to help each other out. When it was explained to me that this was from the community, it was absolutely incredible to see how both the community can step up to help healthcare workers, and how future healthcare workers are really willing to step up as well, and make sure that we can have that continuity of care. I think that is definitely something that I cannot forget. I've never really had the opportunity like this before to step up like this and help out an entire sector. I have so much gratitude to all the people that I worked with and hopefully they all enjoyed working with us as well to make sure that we could provide the best services we could to our area.
Janet Dang: I think Asher said it really well. It was just an amazing experience to see our primary care physicians and our primary care sector lead this work with our community members. It just really shows the opportunities that we have in the future as well, as the system continues to transform as COVID continues on. It just shows that when we communicate and work together in a way to provide support at a time of need, it just was really genuine, truly grassroots and so organic Ellen. It was something very special to be a part of.
Ellen Gardner: You have been listening to Rebuilding Primary Care. A special series about family healthcare teams, produced by HIROC and the Association of Family Health Teams of Ontario. Today our guests were Janet Dang, transformation lead for primary care at the Thames Valley family health team, and Asher Frydman, a second year medical student in the Schulich School of Medicine and Dentistry at Western university. Please stay tuned for more episodes of Rebuilding Primary Care.
Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website HIROC.com and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at firstname.lastname@example.org. We'd love to hear from you.