By: Christina Torrealba (she/her), Graduate Student in Community Health and Epidemiology

The Dalhousie Medicine Service Learning Program helps first year medical students prepare for community-engaged experiences through content in the Professional Competencies class. The program also provides medical students with an optional opportunity to participate in collaborative community-engaged experiences in their second year. I sat down with Qëndresa Sahiti, a second year medical student, Service Learning Program participant, and dear friend of mine, to learn more about her project.

Qëndresa Sahiti (she/her), Doctor of Medicine candidate and Service Learning student.

Qëndresa is working with the SeaStar Child and Youth Advocacy Centre, an interdisciplinary support service for children and youth who may have experienced violence or abuse, based out of the IWK Health Centre. SeaStar works in collaboration with Halifax Regional Police/RCMP, Nova Scotia Department of Community Services, Nova Scotia Department of Justice, Nova Scotia Department of Education, Mi’kmaq Family and Children’s Services, and Avalon Sexual Assault Centre, bringing together a variety of different professionals. “SeaStar offers an integrated approach to these supports and services that aims to reduce the trauma associated with these investigations,” says Qëndresa.

For her Service Learning project, Qëndresa is creating a child-friendly animated video that explains what to expect during a visit to SeaStar. “We know that these visits can be anxiety-provoking for families,” Qëndresa says, “we hope that this video will help children and youth feel more comfortable and prepared attending their visit.”

The Service Learning Program is important for medical students because it allows us to truly become integrated into our communities, beyond the health care institutions in which we train. It provides valuable perspective for students regarding the impacts of the social determinants of health and gives us insight into the work that community organizations are doing to address these gaps. By being more aware of this, medical students and physicians can use their positions of privilege to advocate for these organizations and the populations which they serve. Being exposed to the network of community supports available in Halifax is also helpful in the medical care that we provide, because we can better connect our patients to the services and supports that may benefit them.”

-Qëndresa Sahiti

Qëndresa says that the Service Learning Program has helped her integrate her passions for both science and art, allowing her to improve the patient experience for a vulnerable population in a creative way. “It allows me to use some of my artistic skills to truly learn about the ‘art’ of practicing medicine,” she says, “it has enriched the scientific and clinical information that I have learned in my lectures and tutorials by teaching me more about the context in which we provide this care. The context includes the various social determinants of health and the ways in which these determinants intersect.”

Learn more about The Dalhousie Medicine Service Learning Program here, and about the SeaStar Child and Youth Advocacy Centre here.

[Read more…]

By Taylor Jordan (she/her), Dalhousie Medical Student (Class of 2023), Service Learning program participant 

MainLine Needle Exchange is a North-End Halifax organization well known for their needle exchange service, but they also provide many additional services and supports that serve their goal of harm reduction. As participants in the Service Learning Program, my classmate Brianne Cruickshank and I designed 5 minute education/resource “huddles” on harm reduction in acute care delivery. These were to be delivered to acute care providers to increase awareness of community resources for hospitalized patients who inject drugs. Unfortunately, due to Covid-19 restrictions in 2021, we could not deliver the final product. The plans for our project were passed along in hopes that future Service Learning students will be able to deliver this type of efficient, concise, and accessible education within the acute care setting. The importance of this type of project was highlighted when we were working to identify hospital units that would allow us to deliver our huddles to their staff; hospital administrators informed us that only specific floors would benefit from education on harm reduction for patients who are hospitalized and who inject drugs. This highlighted the pervasive bias within the formal health care system that members of the People who inject drugs (PWID) community only experience health problems related to their drug use behaviors. 

  Through the medical school curriculum and Service Learning program material, I have been introduced to the theory of intersectionality. Intersectionality has provided me with a framework to better understand the experiences of the community MainLine serves. People who inject drugs (PWID) may not only experience discrimination related to their health behaviors, but many individuals belong to more than one minority social group, including groups related to gender, sexuality, class, economic status, and mental health status. Additionally, PWID are unique amongst social groups that are treated inequitably because they experience criminalization of their lifestyle, an additional intersectional axis shaping their lives and experiences. In some circumstances, informal and formal groups that should represent social support networks for PWID may consciously or unconsciously perpetuate stigma and inequitable access to resources for PWID. Intersectionality attempts to illustrate that there can be layers of discrimination felt by one individual due to multiple aspects of their identify which overlap and intensify one another. This is important information for me to be aware of as I move forward into my career as a physician, interacting with the health care system and diverse community members daily. I believe the art of medicine requires recognizing the unique location of each person within various intersectional axes of identity which influence their life and experiences. 

MainLine front door. Source: MainLine Facebook page

By: Michelle George, MSc. Candidate Community Health and Epidemiology

At Dalhousie University, first- and second-year medical students have the option to take part in the Service Learning Program offered by the Global Health Office. This program allows medical students to gain valuable community engagement experience and have opportunities to practice their skills and test their knowledge in a community environment. It is while she was participating in this program that Rumana Rafiq, a 3rd-year medical student, was able to bring the Gateway Project to Nova Scotia. While in her first year of medical school, Rumana noticed that there were some knowledge gaps in the current curriculum that didn’t address working with newcomer populations. For example, working with an interpreter or understanding cross-cultural medicine. Adapting the Gateway Project to Nova Scotia from Memorial University, where it was initially established, was a way for Rumana to address these knowledge gaps. Now, Rumana and another medical student, Christopher O’Grady, continue to spearhead this program with support and guidance from Dr. Tim Holland, an assistant professor at Dalhousie in the Department of Family Medicine.

Rumana Rafiq – from cbc.ca

The Gateway Project at Dalhousie University is a program that connects medical students to the Newcomer Clinic in Halifax. This allows students to engage with the newcomer and refugee population in Halifax to improve student skills in cross-cultural medicine. Students who participate in this program have the opportunity to conduct a Post Arrival Health Assessment (PAHA) under the supervision of a physician and usually with the help of an interpreter. Participating in this program allows students to gain more familiarity with newcomer health patient needs. For Rumana and Christopher, participating in this program opened their eyes to the barriers that newcomers face in receiving healthcare and the inequities that these populations face. Rumana, Christopher, and Dr. Holland agree that students who engage with the newcomer population gain a better understanding of cross-cultural competency within a clinical context which helps them to continue to be advocates for these communities in medicine.

Christopher O’Grady

Like most programs, the Gateway Project was impacted by the Covid-19 pandemic. There was a major slow-down of immigration of newcomers and as such there was a limited number of opportunities for the large number of students interested in the program. Also due to the pandemic, some of the assessments took place online which, although still a successful and rewarding experience for students, doesn’t always translate to an in-person experience. Despite these struggles, the Gateway Project has received nothing but positive feedback from participating students which has been rewarding for Rumana, Christopher, and Dr. Holland as they coordinate this program.

Rumana, Christopher, and Dr. Holland hope that the program continues and that they can integrate the lessons learned from this program more permanently into the medical school curriculum. They also express that the success of the program was only possible by the physicians working at the Newcomer Clinic who were willing to go above and beyond to make themselves available to teach students and the admin staff who were crucial during the pandemic in helping adapt the program as necessary.

By: Clarissa Brisseau, Dalhousie Medical student

In the span of just under two months, COVID-19 has touched every part of our lives. From how we learn to how we interact with our communities, most of us have found our new “normal”. However, taking a look outside our community spheres can reveal that our ability to cope with a pandemic and our social determinants of health are more closely linked than ever. Halifax, like many cities, has had its struggles in helping people who use drugs (PWUD) even before the pandemic was on anybody’s mind. It is important to reflect on the intersection of the pandemic and PWUD and to close the inequality gaps so everyone can remain safe. 

Harm reduction is a pragmatic and patient/client centred approach to reducing the harms and adverse events of drug use (Beirness et al., 2008). These include, but certainly are not limited to, needle exchanges, methadone services, and overdose prevention sites. Like many aspects of health care, COVID-19 has suddenly and dramatically changed how health care is provided. There have been closures and cancellations across all areas of health care. Harm reduction is not immune, as seen with the limitation of the Mobile Outreach Street Health’s in person services and a reduction in Direction180’s dispensary hours. Distancing requirements interfere with optimal care including empathy and connection which are cornerstones to harm reduction. Physical distancing requirements are essential for flattening the curve, however a harm reduction lens determines that more nuance is necessary.  

Addiction is a complex process that interacts with other domains of a person’s life (Galea and Vlahov, 2002).  Housing is a major issue, especially in Halifax where there was low vacancy rate even before the pandemic (Canadian Mortgage and Housing Corporation, 2020). Being able to “stay the blazes home”  is impossible when you don’t have a home to call your own.  Access to critical social assistance programs, such as Pharmacare and Income Assistance, also become vastly more difficult without a permanent address. Furthermore, even if shelters expand capacity it is challenging at best for everyone to adhere to 2 m distancing rules, putting the lives of an already high risk group at even more risk. Finding a solution to the housing crisis, both right now and in the future, is needed not only to protect lives in this moment but to provide the basis for future improvements of health in a meaningful way. 

The key question that remains is: What can we do? Apart from our personal acts to stop the spread of COVID-19, we can support the groups that keep harm reduction going in all aspects.  We can work to unburden shelters and provide urgent housing to those who don’t have it. We can make sure that the emergency benefits that the government is rolling out are equitably accessed by those with unsecure housing and work to make our other social safety net programs more accessible now and in the future. We can also make sure that vital community services (e.g. food banks and soup kitchens) remain open.  Finally, we need to make sure that harm reduction remains accessible, practical, and efficacious for PWUD and that public health guidelines account for the needs of PWUD.  Without thinking about the health of others in a time of pandemic, we risk letting the gains made in the opioid crisis slip from our hands. We must not let one crisis jeopardize the progress of another. 

As always, we thank our Service Learning partner Organizations. For more information on the Service Learning Program please visit our website. 

 References: 

BC Centre for Disease Control. (2020, April 23). COVID-19: Harm Reduction and Overdose Response. http://www.bccdc.ca/Health-Info-Site/Documents/COVID19-harm-reduction.pdf 

Bierness, D.J., Jesseman, R., Notarandrea, R., Perron, M. (2008, May 20). Harm Reduction: What’s in a Name? Canadian Centre on Substance Abuse. https://www.ccsa.ca/sites/default/files/2019-05/ccsa0115302008e.pdf 

Canadian Mortgage and Housing Corporation. (2020). Rental Market Report Data Tables – Nova Scotia [Data set]. Canadian Mortgage and Housing Corporation. https://www.cmhc-schl.gc.ca/en/data-and-research/data-tables/rental-market-report-data-tables 

CBC News. (2020, April 2). Without resources, Nova Scotia’s homeless are more at risk for COVID-19. CBC News. https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-s-homeless-are-more-at-risk-for-covid-19-1.5520017?fbclid=IwAR1ISNtFw8UkdpSNkW4oN6kJS_AoxowLKG6UfXI6nDCNhUl7lbh9cnIfBys 

Galea, S., Vlahov, D. (2002). Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Reports, 117 (Suppl 1), S135-S145. 

Government of Canada. (2019, July 27). Social Determinants of Health and Health Inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html 

Jeffords, S. (2020, April 30). ‘Two crises’: Ontario’s opioid problem worsens during COVID-19 as services for drug users scale back. CBC News. https://www.cbc.ca/news/canada/toronto/ontario-opioid-covid19-1.5551368 

Tait, C. , Gee, M., Woo, M. (2020, April 13). Pandemic restrictions reshape opioid treatment as doctors sound alarm. The Globe and Mail. https://www.theglobeandmail.com/canada/alberta/article-pandemic-restrictions-reshape-opioid-treatment-as-doctors-sound-alarm/?fbclid=IwAR0nm0r7tnLY1Z9gHNPNGiOYqTZb-ocrlBnjQHyUzK9zehW_R01Ruqd9niI 

By: Sarah Peddle, Service Learning Program Manager, Dalhousie Medical School 

The global community is in unprecedented times.  As the Program Manager for the Service Learning Program, I mindfully consider the impacts on our students and the communities they are involved in as part of this program. We are navigating new ways of engaging and identifying plans with students to complete their community-based experiences.  

The Service Learning Program matches second year medical students with not-for-profit community-based organizations. The program requires students to spend time in the community from September to December and deliver a small project with the organization from January to April.  Many students were able to complete their service learning experience off-site with the support of their community partner.  

This pandemic, while full of challenges, has provided time to pause and consider how we work and how we engage with each other. I reached out to our community partners and asked them to share how COVID-19 has impacted their organization and the clients that they serve. Here are some of their insights. 

NaviCare/SoinsNavi

Summary provided by Dr. Shelley Doucet, Co-Director 

NaviCare/SoinsNavi is a research-based navigation centre for children/youth aged 25 years or younger with complex care needs and their families in New Brunswick.  Our nurse patient navigator has continued to offer support by coordinating patient care, connecting clients to resources that are still available, directing clients to virtual services where possible, being a resource for the team, and informing families about COVID-19 related services and other services available to meet their needs. The need for resources and education in the community has increased during the pandemic.  We moved all in-person outreach activities and meetings to online settings.  We encourage children/youth, families and care providers to reach out for support during this difficult time. 

Arthritis Society

Summary provided by Nik Harris, Community Engagement Coordinator, Maritimes: 

Arthritis Society employees are temporarily working-from-home across the country during this time, actively continuing to support the 6-million Canadians living with arthritis. Our focus shifted to highlighting new and existing online-based supports to the arthritis community. 

• Developed a COVID-19 website hub www.arthritis.ca/covid19 
• Two online webinars regarding COVID-19 and Arthritis, providing evidence-based answers to the many questions we receive from community members. www.arthritis.ca/arthritistalks 
• Tools available on our website including Self-Management Learning Modules (www.arthritis.ca/education), our wellness blog Flourish (www.arthritis.ca/flourish), and additional resources on our content hub (www.arthritis.ca/resources) 

Brigadoon Village 

Summary provided by Jenn Ross, Director of Operations: 

At Brigadoon Village, we are offering virtual programming to our campers and families 

• BrigaBroadcast – twice a week virtual session on Zoom for our campers 
• Brigadoon Leadership – Campers sign up for a 4 week program to participate on weekly leadership sessions (to replace our cancelled March Break Leadership Camp)
• Briga At Home – Activities posted on our social media and website for people to participate in on their own time – https://brigadoonvillage.org/camps/brigaathome/  

Fresh Start Services  

Summary provided by Melanie Vautour, Executive Director: 

Fresh Start Services provides support for women and children in crisis situations.  The biggest impact for our agency and our clients has been social distancing for our homeless and sex workers.  We closed our office because we could not guarantee distancing and cleaning methods with walk-in traffic. We are providing more mental health support and re-assurances that we still care and are trying to protect THEM from US as we are more apt to introduce the virus to them. We are also advocating with landlords and tenants to advocate for flexible policies to support our clients. 

Moving Forward

Imagine this pandemic experience without your cell phone, computer and internet to connect with people and services. Imagine being unstably housed and all services and community access points are closed. There is growing research that is exploring the impact of the determinants of health throughout the pandemic.   

For more information, follow the important work of the  National Collaborating Centre for the Determinants of Health with weekly panel discussions on equity related issues.   http://nccdh.ca/blog/entry/stigma-discrimination-health-impacts-and-covid-19 

The National Collaborating Centre for Public Health also has a recourse repository for  Public Health Ethics pertaining to COVID-19: http://www.ncchpp.ca/823/COVID-19.ccnpps 

Stay safe and take care of each other. 

By: Tina Kim and Talia Bond, Dalhousie Medical School, Class of 2021

Student Experience

When it comes to migrant populations and healthcare, discussions of barriers, challenges to access and system flaws is a common narrative. Medical education focuses on teaching future doctors the inequities of healthcare and barriers to its access. While it is important to appreciate and understand the numerous unique challenges faced by newcomers to Canada, it is equally as important to share the successes in overcoming these challenges, in order to build on positive experiences and create new opportunities. During the past few months, we had the opportunity to do just this, through the Service Learning Program at Dalhousie University. This past year, we partnered with Immigrant Services Association of Nova Scotia (ISANS), a community organization that works to settle newcomers to Nova Scotia, to not only learn about the challenges newcomers face, but also to learn about the supports and services that are currently in place.

Talia Bond and Tina Kim

One of our most valuable experiences with ISANS was the opportunity to work with the Youth Life Skills Workers. The Youth Life Skills Program provides newly arrived government-assisted refugee youth, aged 15 to 25, with guidance and support as they adjust to life in Canada. It is offered within the first three months of arrivals and matches each refugee youth with a Life Skills Worker who speaks their language. Many of the Youth Life Skills Workers at ISANS are previous refugee youth who have also participated in the program, and through it, have gained confidence and independence in a new country. In collaboration with the Youth Life Skills Workers, we facilitated a “Welcome to Canada Orientation” session for 15 refugee youth from El Salvador, Somalia and the Democratic Republic of the Congo. While the workshop focused on Canadian geography, currency, multiculturalism, sports and hobbies, and healthcare delivery, we were pleasantly surprised to receive questions from the youth on Canada’s history, tax system, Indigenous peoples, and political structure.

Afterwards, we collected feedback on how the orientation was presented and comments on the youths’ experiences since coming to Canada. The evaluations from the youth were overwhelmingly positive and the orientation was well-received. Many of their positive experiences since coming to Canada shared similar themes around the Life Skills Program and settlement support, friendliness of Canadians, and opportunities for education.

“I have learnt that here there is good education system.”

“I have liked the people in Canada because they are friendly.”

“I am going to learn computing and I like it!”

“I have enjoy the life skill support from other people.”

The week following the orientation, we organized a field trip to Bowlarama, which was a blast! It was an opportunity for all of us to get to know each other and have fun. This was the first time many of the youth got to experience bowling and was the perfect way to wrap up our time together.

Bowlarama Halifax

Bowlarama Halifax

Our experience with the Youth Life Skills Workers has highlighted for us the truly amazing work done by ISANS in our community. The Youth Life Skills Program has evolved into a self-sustaining program, creating connections for past refugee youth to support new refugee youth. It is an example of the resilience and strength that has emerged within our community and is an example of the response of organizations like ISANS to address some of the barriers and challenges that newcomers face when settling to Canada. It is our hope that sharing our experience with ISANS will provide insight for healthcare professionals on the programs available for their patients and be a reminder to continue to work on creating welcoming and supportive spaces for newcomers to access healthcare.

Dalhousie’s Service Learning Program

By: Peri Fenwick, 2^nd year Medical Student and Service Learning Program Participant

Located in an office on Cunard Street in Halifax, NS, the Schizophrenia Society of Nova Scotia (SSNS) helps a community that is often under-served. Since its establishment, the Schizophrenia Society has been a resource for those living with mental illness, including friends and family members.

As a second-year medical student with an interest in psychiatry, working with the SSNS through the Dalhousie Medicine Service Leaning Program has provided a unique opportunity to learn about mental health resources outside of the hospital. After seeing patients discharged from an inpatient setting to re-integrate into the community, I have found myself wondering “what happens next?”

To answer this question and gain a first-hand perspective on the work the SSNS does, I interviewed Ian Burton. Ian took the time to sit down with me and tell his story, including the role that the SSNS has played in his recovery journey. Sitting across from Ian now, one would not think that this is a man who has lived through difficult times in which he did not know where he would be able to find shelter for the night. His happy demeanour, friendly smile, and positive attitude towards life serve as a testament to his resilience.

Ian’s journey began in the early 2000s when he was first hospitalized for psychosis. After a number of hospitalizations, Ian found himself living on the streets of Halifax. Eventually, he spent a year at Simpson Landing transitional living facility in Dartmouth before being discharged to live independently in the community.

Early on in the course of his illness, Ian’s family encouraged him to utilize the SSNS services in his hometown of Wolfville. Ian was reluctant to do so at the time, which he attributes to his young age and frustration with the healthcare system. Little did he know at the time that the SSNS’s Supportive Housing Program would be the means by which he would transition to independent living. The Supportive Housing Program offers support to people with lived experience in recovery. Ian lives with roommates who are also in recovery, which allows residents to support one another through weekly house meetings, training opportunities, and access to other SSNS programs. For example, the SSNS hosts a weekly peer led education and support group, a family education support group, and one to one peer support to assist individuals upon discharge from the hospital.

Over the past five years in the supportive housing program, Ian has spent his time volunteering, obtaining employment, and working with his healthcare team to optimize his medication regimen. When he is not at work, Ian spends his time playing guitar, watching Netflix, and participating in outings organized through the SSNS.

Looking into the future, Ian’s primary goal is to live independently and graduate from the Supportive Housing Program. He said he would not have been able to reach this point in his recovery without the help of the SSNS: “After my last hospitalization in 2014, there was a long journey back to living independently, SSNS and Caldy Grange were there to assist as a stepping stone towards developing an independence that lasts. It was the perfect balance of help and support to stay on the right track and have a great relationship with roommates, and I am happy to say I am in the process of getting my own place!”

Unfortunately, obtaining funding as a non-for-profit organization is challenging. This challenge is augmented by the societal stigma surrounding mental illness, in addition to the lack of services available in rural regions throughout the province. The SSNS has a network of education and support groups for those affected by schizophrenia, psychosis, bipolar and related mental health disorders. These groups are led by dedicated volunteers, and the Schizophrenia Society hopes to make their services more readily available in other regions.

The SSNS has yearly fundraising initiatives, such as the annual Road to Recovery Walk, which directly supports their programs and services. Their annual “Living and Learning” conference hosts inspiring speakers working in the field and engages mental healthcare clinicians, community organizations, and people with lived experience. Through these fundraising and education initiatives, the SSNS is able to support more people like Ian in their progression to independent living and integration within the community. Moreover, serving as a testament that with the support of services like the SSNS, the community, and healthcare professionals, recovery is possible.

Annual Road to Recovery Walk

For more information on the Schizophrenia Society of Nova Scotia, go to: www.ssns.ca

For more information on the Service Learning Program, click here.

Written by: Mike Myette, Masters of Public Administration, Dalhousie University, Class of ‘08

Our community organization, 211 Nova Scotia was involved with Service Learning participants from Dalhousie’s Med 2 class in 2016 and 2017. 211 Nova Scotia exists to connect people in need with the human and social services that can help them. Supported with funding from the Province of Nova Scotia and the United Way, we maintain a province-wide database of thousands of services delivered by community groups, non-profits and government departments.  We invite inquiries by phone (just dial 2-1-1), by email (help@ns.211.ca) through webchat (www.ns.211.ca) and by text (21167).

The novel thing about our database is that everything is organized by need, not by who offers the service. This makes it much easier to search and to find services. For those who prefer self-service, we offer a search portal on our website. During 2017, more than 200,000 Nova Scotians reached out to 211 for help through our various channels.

Our introduction to the Service Learning program took a somewhat circuitous route. In 2014 we worked with the college of family physicians in Nova Scotia to create an awareness program for practicing family doctors.  The college recognized the fact that medical outcomes are improved when patients have access to social supports dealing with issues like poverty, housing, affordable medications etc. 211 helps both patients and their doctors access a broad range of support services with a single phone call or a few clicks of a mouse.

The college agreed to an outreach program to educate family physicians about the benefits of 211. Recognizing however that practicing physicians are a challenging group to educate simply because of how busy they are, it occurred to us that it might be more effective for us to reach out to medical students during their training. In early 2015, in my role as 211’s Executive Director, I contacted the Dean of Medicine at Dalhousie to pitch the idea of integrating awareness of 211 into the medical school curriculum and “voila” I was introduced to Sarah Peddle and the Service Learning class at Dalhousie Medical School.

The first Service Learning project in the fall of 2016 involved the creation of a 211 “webinar” that students could access through their e-learning platform. At the end of the term, students presented their projects and it was at this point that another twist of fate entered to assist us in our ultimate goal of integrating 211 into the medical school curriculum. The Service Learning student was unable to do his presentation so I was asked to present.  By way of background to the   presentation, I mentioned my initial pitch to the dean to get 211 awareness into the curriculum. Fortunately, faculty in attendance realized the benefits of 211 to medical training and they approached me afterwards to discuss this and this conversation put some wheels in motion.

The second Service Learning project, commenced in the fall of 2017, sought to extend awareness of 211 further into the medical community as the student eventually published an article in the Doctor’s Nova Scotia Magazine titled “ Is 211 included in your Prescription Regimen?”

For me, the true “icing on the cake” from service learning occurred prior to the article being published when in mid-2017; the student notified me that 211 awareness was now included in a Med2 lecture in a class titled “Professional Competencies”.

Our partnership with Dalhousie Medical School has truly generated significant returns by way of increased awareness of 211 service. It is our hope that in some small way, we will have contributed to enhancing both the lives of future physicians and their patients through the Service Learning experience.