Where the clinic hits the road

At home and in her job, Jodi Spence has to deal with other people’s health problems—major and minor—on a nearly daily basis. She’s the mother of four kids, all under eight, one of whom has a heart rhythm disorder. She’s also director of a daycare centre located inside a Saskatoon high school that watches over the babies of adolescent moms while they’re in class. So, whether it’s a baby’s rash, a teen who needs birth control, or her daughter requiring a medication refill for her heart condition, “I probably [go for medical attention] once a week,” says Spence, 32. Instead of visiting an overcrowded emergency room or her family doctor, who’s often booked solid for the day, Spence goes to the Health Bus—Saskatoon’s walk-in clinic on wheels.

A retrofitted 1976 RV that launched in 2008, the Saskatoon Health Bus parks at different spots around Saskatoon’s inner-city neighbourhoods—outside a Giant Tiger store, the Safeway or a Shell station, for example—seven days a week, year round, seeing an average of 12 to 14 clients a day. A nurse practitioner and paramedic are on the bus, offering medical attention to anyone who stops by, whether they have a health card with them or not. Known as the “Magic Bus,” it’s been so successful that, on Nov. 24, the rickety old RV will be replaced with a new model.

The Health Bus was created as a way to reach out to Saskatoon’s Aboriginal population, newcomers, children, the elderly and others who might not have regular access to a doctor, says Sheila Achilles, director of primary health and chronic disease management at Saskatoon Regional Health, which oversees the program. “There are family physicians in the area, but people aren’t going to see them,” Achilles says. And unlike patients who visit a series of walk-in clinics and emergency rooms, those who come back to the Health Bus get some continuity of care. “People who visit feel very safe,” Achilles says, and because it’s mobile, it can reach different people in different parts of the city.

Ramona Grolla, a nurse practitioner who works on the bus, says that a typical day might involve everything from treating a child’s ear infection to performing an STD test, helping a patient manage their diabetes, or draining and dressing an abscess, which is a common affliction for injection drug users. As a walk-in clinic that doesn’t require appointments, “it can be a challenge, because we never know what the day will look like,” Grolla says. Some are relatively quiet; other days, “people start knocking on the door as soon as we get there.” At times, even the police bring patients to the Health Bus, finding it’s quicker if somebody needs stitches than taking them to the emergency room.

There are other mobile health clinic programs in the country, often manned by nurses and volunteers, but Achilles says that the Saskatoon Health Bus is unique in that it pairs a paramedic with a nurse practitioner, who’s qualified to diagnose common illnesses, prescribe some medications, order lab tests and refer patients to specialists. As the numbers show, the program is clearly meeting its mandate. In 2009-10, 5,936 clients visited, according to the most recent report; 43 per cent came back more than once. Visitors were 48 per cent Aboriginal, 25 per cent kids under 16, and nine per cent newcomers. During the swine flu scare of 2009, the Health Bus was even set up to provide immunizations.

But the now-ancient bus is finally on its last legs. “It’s been really troublesome,” Achilles says. The air conditioner conks out in the summer, and on some especially frigid days in winter, it’s hard to keep the interior warm enough to work in. The current bus isn’t wheelchair accessible, so if a patient shows up in one, Grolla will find herself treating them in the parking lot. Despite the need, there also isn’t a lot of extra money. The Health Bus program (which is partnered with MD Ambulance, a private company) gets $350,000 from the provincial government each year, Achilles says, but operations cost $487,000. To keep the bus going seven days a week, “I skim the extra from other programs where I can.”

Aware of the need for a new vehicle, Community group Synergy 8 raised $180,000 for a replacement, and Potash Corp. matched its funds. With additional money from the Ministry of Health and Saskatoon Health Region, a total of $360,000 was scraped together. The new bus “is a beautiful piece of equipment,” Achilles says, bigger than the current RV, “with two areas to see patients, rather than one exam room.” And there’s a second door that’s wheelchair accessible. Front-line staff were involved in planning the interior, right down to the colours of the new counters—a rose colour called “Rhinestone Cowboy,” Grolla says.

Spence is thrilled at the prospect of a new bus. “I am always worried it’s going to close,” she says. As for the old one, once it retires, “we’re not sure what to do with it,” Achilles says. “We don’t want to throw it away. It’s too dear to our heart.”