Province Must Treat Health Centre Staff Fairly
Miriam Garfinkle, Sharon Gazeley
Most Ontarians are aware that our health–care system eats up an enormous percentage of the provincial budget. What fewer people know about is perhaps one of the best kept secrets of Ontario’s health–care system: the network of 54 Community Health Centres (CHCs) spread out across the province.
For more than 30 years, CHCs have been delivering health care and social services to diverse communities in the province.
Funded by the ministry of health, CHCs provide a comprehensive model of multidisciplinary primary–care services intended to serve both urban and rural communities.
CHCs are managed by community boards of directors who are made up of people from the local community including those who use the health centres’ services.
The budgets of every CHC in Ontario added together comprise a mere 0.0056 per cent of Ontario’s health–care budget.
Yet, despite providing a shining example of a primary health–care model that really works, recent actions by the health ministry threaten to undermine the ability of CHCs to provide comprehensive health care.
Historically, CHCs have been set up to serve people more susceptible to health problems than the general population, such as refugees, new immigrants, seniors and people with low incomes, including the homeless and those living in rural poverty.
Many of our patients have no money left for food, let alone healthy food, after they pay their rent. Many live in crowded shelters or outdoors without shelter.
Although it is challenging to provide good care to people who lack many of the social determinants of health, CHCs have shown that it is possible to do just that with a solid team approach.
We have palliative patients attempting to die with dignity in apartments infested with thousands of bedbugs.
Because they cannot afford the services of pest control companies, essential homemaking and home health–care services pull out.
We often look after pregnant refugees who come to us late in their third trimester, having received no prenatal care — in which case we must cram nine months of prenatal care into a few short weeks. We care for many newcomers who have experienced war and torture and who come to us with profound symptoms of depression and post–traumatic stress. A larger than average number of children in our community have speech and language delays and developmental problems that require prompt and decisive interventions.
Our patients have complex health and social problems. While we can prescribe medication to lower their high blood pressure or help them manage their diabetes, who is going to obtain prescription drug coverage for them? Who is going to help them obtain a health card so they can see a specialist?
Who is going to help them stave off ever–imminent evictions? Who will intervene to correct mindless bureaucratic errors that result in lost income cheques? Who will help those with disabling anxiety learn coping strategies to function in the world?
Who will run prenatal classes, teach parenting skills, grow community gardens in impoverished communities, and develop innovative outreach programs so that the most vulnerable are not excluded from the health–care system?
The answer is, the amazing multidisciplinary teams we work with every day: nurses, social workers, community workers, dietitians, ethnocultural outreach workers and administrative staff who maintain the flow of patient care and programs.
Without them, we cannot provide good care to our patients. Without them, our patients’ health is seriously at risk. Without them the future costs to the health–care system will be greater than ever.
While physicians have powerful professional organizations to fight for decent salaries, our colleagues unfortunately do not.
Currently, CHC workers are negotiating for salary increases with the ministry of health, without much success. For all the reasons outlined above, we would like to see the government deal fairly with these highly skilled health and social service staff, who work with some of the most challenging patients in the province.
If no just settlement is reached, the government will ultimately jeopardize our ability to properly care for patients.
Miriam Garfinkle and Sharon Gazeley are both family physicians working in a downtown Toronto Community Health Centre.