November 4, 2010

Clinics ensure Winnipeg's vulnerable receive flu shot

Joe Nicholas receives his flu shot from Dan Lavelee.

Joe Nicholas fit the target group profile.

Before visiting Main Street Project, Joe's diet and living conditions were somewhat less than ideal.

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In other words, Joe was someone who could easily become infected with influenza this winter. And that could lead to a visit or two to Emergency, and possibly a stay in hospital.

Not anymore.

Thanks to the Winnipeg Health Region's influenza immunization outreach clinic, Joe was able to get a flu shot, one that will dramatically reduce his odds of becoming sick this year.

Not only is that good for Joe, it's also good for those who will come into contact with him in the months ahead. After all, if Joe does not get sick with influenza, he won't be able to pass it on to anyone else, either.

Containing the spread of influenza is an important public health goal. That's part of the reason why the Manitoba government decided to make flu shots available for free to anyone who wanted one this year. It's also why the Winnipeg Health Region staged a week of 12 public clinics in October.

More than 22,000 people turned out to the clinics to get a flu shot this year, and it is expected that even more will receive one from their family doctor.

But what about those who are not equipped to get a flu shot through the usual channels? What do you do if you aren't able to get your flu shot in a large group? What if you don't have transportation to get to a flu clinic? What if you're staying in a shelter? Or maybe it's just not a priority in your lifestyle.

That's where the outreach clinics come into play.

"Some people have mental health issues and can't do a crowd with fifty people or more. Some have no transportation to get to a mass flu clinic. The Winnipeg Health Region goes to some seniors' homes and we come here," says Wayne Inkster, Outreach Worker with the Winnipeg Health Region's Healthy Sexuality and Harm Reduction Team, of a seasonal flu clinic running out of the New West Hotel. "This is normal for them to have a day clinic here."

For residents who popped downstairs from their room to others who had seen the sign in the bar advertising the flu shot clinic, all appreciated the fact that they didn't have to go far and could get the shot quickly.

"My doctor recommended I get the flu shot," said Wayne Abrahamson moments after being immunized at the New West Hotel. "I don't go to the Health Sciences [Centre]. I don't need to. They put it here so I go here."

Figuring out how to reach Winnipeg's vulnerable population is much more complex than it looks. It involves looking at which clinics had high numbers last year. It includes looking at familiar area haunts and incorporating how people move in their communities. Some people, for example, wouldn't cross the street to attend the clinic at the New West Hotel. That's why another similar clinic was set up at the Sutherland Hotel - directly across the street - on the very same day.

"We've been doing this for several years - offering clinics out of bars, women's shelters and even the Street Connections van," says Inkster. "We've tried to figure out where the best traffic is to reach a high risk population."

Others opted to get their flu shot from the Street Connections van - a community outreach vehicle that doubles as a mobile flu clinic at certain times of the year. (Street Connections is a health-based harm reduction program which focuses on the needs of those who have addictions, are street involved or are involved with the sex trade.) For clients of Street Connections, this is a comfortable way to get their flu shot.

Comfort level is a big part of why these untraditional clinics have been set up. Wait times are minimal, often two or three people deep at most, which can help alleviate or minimize anxiety a person may have about getting a needle. Anxiety that may be compounded if you have a history of mental health concerns.

Whether people are rolling up their sleeves in a familiar place where they're surrounded by their buddies or at Salvation Army or Main Street Project, acceptance and the genuine commitment to ensure public health practices are available to all is very clear. A concerted effort was made by everyone working the flu clinics to communicate and educate the people who visited the clinics. And work in a way that worked for them.

From writing notes to ask screening questions of people with hearing impairments, to the offer "I'll be your glasses then" to someone who wasn't able to fill out the form to explaining the flu shot and its risk in ways that could be easily understood, it's no wonder these clinics had a comforting, calming vibe for people like Lorna Spence, James Vinette and Tamara Fontaine. Each had their own reasons for getting their flu shot through flu clinics offered right in their communities. But they agreed it was quick and relatively painless.

At the Main Street Project clinic, humour was a large part of most people's experiences. Whether a nurse asked someone to show him their pipes or a client asked if getting the shot would help her find a boyfriend, there was much laughter during the early morning hours the clinic offered flu shots.

Respect and openness were key elements. People visiting these unique clinics were able to speak frankly about being homeless, having addictions or planning to drink without being judged. People openly spoke about how they didn't expect a reaction to the flu shot because "I've taken everything and haven't had a reaction". In some cases, referrals were provided as options to consider. In others, they were encouraged to consider getting the pneumonia (pneumococcal) shot so that their bodies and immune systems would have a better chance of surviving a cold, Winnipeg winter that can be much colder and harsher if you call the streets home.

Inkster explains that it's a different mindset but that they've been able to win trust and respect with this community where public health issues are concerned.

"For you and me our health is a priority. For some people their priority is surviving day to day or for their addictions," says Inkster. "We'll put their health as a priority."

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