A pilot program created by Providence Health Care that treats wounds of Downtown Eastside residents, right where they live, has already cared for 255 people since it opened last fall.
Mend & Tend provides nursing care to patients who drop in to the Evelyne Saller Centre in the DTES. No appointment is needed. It also gives patients supplies and works to source primary-care professionals for them.
That last point is a critical service, since many who come by have been without primary care for years, even decades, such as a woman in her 80s who visited in need of a leg wound.
Preventing emergency visits and building trust
“We’re filling a gap,” says Lisa Maks, a diabetes clinical nurse specialist and one of a team of Providence nurses that pitched the Mend & Tend idea at a research brainstorming event in Vancouver a year ago. “This service can help prevent emergency department visits by treating wounds earlier in the process.”
Maks adds that by having the service in the DTES, trust between its nursing team and patients “may help break down some past hesitation to seeking medical care.”
“We meet the person where they live and use other community services.”
Mend & Tend is available to people two days a week and staffed by Clinical Nurse Leader Anna Mathen, Licensed Practical Nurse Lauren Mockford, and several casual nurses from Providence. The non-profit service Raincity Housing provides peer support workers who may have had experiences similar to those of the patients.
Patients “worn down and beaten by life“
“People with a drug-use disorder are struggling and worn down, and beaten by life,” says peer worker Thomas Jenkins of the patients he sees. “Here we give them a smile, and encourage some with serious wounds to go to the Emergency,” which can be tough if the person has faced stigma at an ED in the past.
“Some people’s lives in the Downtown Eastside are chaotic and they find it hard to get acute care at a hospital for fear of being judged,” agrees Mathen.
She joined the program after Maks and colleague Aggie Black, a leader in Knowledge Translation at Providence, led the creation of Mend & Tend.
“There’s something about the program being located in the patients’ neighbourhood that makes it more welcoming,” says Black. They feel that the centre is their space, unlike perhaps a hospital, she adds.
Wounds reflect harsh life in the Downtown Eastside
The needs of the people who drop by, many of them homeless, are varied. Some have skin infections. Others have burns from butane lighters. Still others have wounds from assaults or dog bites. One person arrived with just a scrap of toilet paper covering their open wound.
The wounds that need the mending, and the tending, reflect the harsh conditions of life in this community, where poverty, substance use, and mental illness are common.
One patient had a large and growing ulcer on his leg that was so severe he was at risk of losing the limb without antibiotic treatment. Staff worked with him on a plan to get him to an urgent-care clinic for those drugs and treated his leg till it healed completely.
Connecting patients to follow-up care
Another woman, who was unhoused, needed care for painful second-degree neck burns she suffered after her tent burned down. She had been referred to a complex wound care clinic at Vancouver General Hospital, but because of the instability in her life, could not make the appointment.
“We were able to navigate a very difficult dressing change for her and then try to attach her to IHOT (Vancouver Coastal Health’s Integrated Housing Outreach Team) for follow up. I felt very grateful that day that we were able to offer a low-barrier service that’s easier for people to access,” says Mathen.
She adds: “With the lack of housing, safe drug supply and primary care in Vancouver, low-barrier nursing services like this are vital to try and address health care needs.”
The idea for Mend & Tend was sparked at Skunkworks: Hacking Wounds, in which participants from clinical, research and other health-related disciplines in the Vancouver-area community brainstormed ways to bring wound care to underserved populations. The Mend & Tend team won an award for its idea.
The annual Skunkworks is the flagship event of Providence Health Innovation, Research + Engagement (PHIR+E), which falls under Providence’s Innovarium umbrella. Innovarium offers resources and support to accelerate health-care innovation.
Each year, Skunkworks takes on a different element of health care to “hack,” or come up with ways to improve care. This year’s event on October 24 and 25 is Hacking Chronic Disease. If you are interested, email skunkworks@providencehealth.bc.ca or visit here.
Story by Ann Gibbon, Providence Health Care
