It began as a breezy, hot Sunday afternoon in Halifax teasing the promise of summer ahead. But by the end of the day, the wind and heat that lifted spirits would turn against the community, fanning an insatiable wildfire. Thousands of people were forced to evacuate their homes and run for their lives.
There wasn’t much question how Nurse Practitioner Deb Blois would spend the next few days. The evacuees would need medical care, prescriptions and support as they faced the trauma of potentially losing everything, or the uncertainty of what they left behind. Nova Scotia Health was setting up a Mobile Primary Health Care Clinic to support evacuees and Blois would be a key part of the team.
“I think people were traumatized because they had to leave so quickly,” said Blois. “Mostly people needed refills or help for respiratory illnesses or sick kids. One man lost his home. He had burns on his face and arms. We were providing access to health care as best we could.”
Eight months ago, Blois got a similar call after another disaster. Doctors’ offices in Cape Breton were closed after Hurricane Fiona, and people needed health care. Her phone rang with an urgent request – could she drive up to Cape Breton at 5 a.m. and help staff a makeshift mobile clinic? She said yes, adding, “You’re lucky I have a great sense of adventure.”
Blois didn’t know it at the time, but she was in on the ground floor of something big. The urgency in the wake of Hurricane Fiona catapulted an idea under development at the Nova Scotia Health Innovation Hub into reality.
“When Fiona happened, we were in the planning phase, engaging partners, talking about the idea for mobile clinics, trying to identify the needs and choosing communities for test and try,” said Tara Sampalli, Senior Director, Implementation Science and Evaluation, and Global Health Systems Planning with the Nova Scotia Health Innovation Hub. “Our CEO, Karen Oldfield, said are we ready to go, can we do this? Before we knew it the Emergency Health Services (EHS) events trailer was already in Sydney, and I was searching for nurse practitioners who could be part of it.”
From its humble beginnings as an ad hoc clinic operating out of a trailer, Mobile Primary Health Care Clinics are now a key part of delivering health care to Nova Scotians when and where they need it. Since Hurricane Fiona, there have been close to 100 clinics throughout the province with an average of 81 patients per day.
Sampalli credits the Health Innovation Hub for making the mobile clinics possible. It brings together entrepreneurs, clinicians, innovators and health partners to test and try solutions to improve health care in Nova Scotia.
“It creates an opportunity for partners to come together and collaborate. It’s beyond a physical space or a vision. It’s really all grounded in partnerships. The Health Innovation Hub is critical because it is always identifying new models, new technology, and new innovations so when there is an opportunity or a need you are able to quickly set up in a way that would not be possible given the challenging staffing within the health care system,” said Sampalli.
That first 10-day clinic post Fiona was a perfect testing ground for those partnerships.
“When we did the first mobile, we brought capacity in different ways. We got retired nurse practitioners, we got EHS staff, and partners from Public Health. If I had to stand this up as a primary health care solution in a short time, it would not have been possible because primary health care is already stretched to capacity. So, the mobile idea was always about who are the external partners who can bring capacity.”
It's just one example of the work of the Health Innovation Hub, according to Dr. Gail Tomblin Murphy, Vice President, Research, Innovation & Discovery, and Chief Nurse Executive of Nova Scotia Health. “We are pleased to see “test and try” initiatives such as mobile clinics launched through the Health Innovation Hub with key partners in Nova Scotia Health and IWK Health working closely with Primary Health Care, Public Health, EHS and more recently with Mental Health & Addictions during the wildfires in Nova Scotia go from a “proof of concept” to fully integrated solutions as one more point of access for primary care across the province. Mobile clinics continue to help us address the needs in communities as they arise and inform the planning for other innovative models of care and for primary care services.”
Back in Halifax the morning after the wildfires began, calls went out at 9 a.m. to staff a mobile clinic at the Canada Games Centre where evacuees were being supported. It was operating by 1 p.m.
“The biggest thing that stood out to me was the amount of teamwork that it took to make this happen,” said Katie Meisner, Health Services Lead for Primary Health Care with Nova Scotia Health in Halifax. “It was remarkable how each partner came together to provide a piece of the puzzle to offer a service to folks who were really in need. There was a lot of planning happening in the background each day, but the service to patients was pretty seamless.”
Registered Nurse Joanne Sanford was part of that team, alongside Blois. She describes it as a highlight of her 38-year career in nursing. One of her patients had just gotten off a bus which took evacuees to the wildfire zone to see their homes. He suffers from long Covid and was having trouble breathing after escaping the fires.
“He needed to talk, and he showed me pictures of his place that was no more. He also had tears, and it was one of those things that just hits you,” said Sanford. “Nursing is all about holistic care. That’s very important to me. They accepted hugs or they wanted hugs. We allowed them to cry. They were thankful.”
Meanwhile, two hours down the road another wildfire that would become the largest in Nova Scotia’s history forced the evacuation of the Roseway Hospital and the closure of the Shelburne Community Health Centre. Heading into a weekend, yet another team quickly pulled together a mobile clinic at the Shelburne Fire Hall. Nurse practitioner Maria Ceschiutti stepped in to help.
“The most memorable aspect would be people coming in with a lot of emotional distress that was then showing up in their blood pressure,” said Ceschiutti. “That was really significant because that’s driven by stress, driven by such an extreme situation. They could feel it and they were really worried because our hospital was evacuated, our clinic was closed down so there was no one to ask and there was a real sense of worry that their blood pressure was too high.”
Ceschiutti also saw an elderly man who originally approached the mobile team for help signing up for emergency aid. That conversation led to an important finding. “He had this chronic wound on his leg that was really quite terrible, and he doesn’t have a health care provider.” The clinic was able to set him up with supplies and connect him with ongoing wound care. “It was just so good that we were there to assist with that,” said Ceschiutti.
All of this was happening while Ceschiutti herself was an evacuee. Fire came within metres of her Gunning Cove home. She knows water bombers were called in to save it and that it’s still standing, but as of June 9 she still hasn’t been able to return home to see the damage. Still, she signed up to work her first mobile clinic. “I really do think it’s tremendously important to the community. It provides access where it’s most needed."
Mobile clinics continue to evolve as needs are identified. There are now specialized clinics for respiratory issues and coming soon, clinics for patients with COPD. And of course, the mobile clinics will be ready to go when the next emergency happens. So will Deb Blois. “I feel proud that I was able to contribute a little bit. It feels good that I am able to help and work with a great team to do everything we can to make sure patients are well cared for.”
For more information on Mobile Primary Care Clinics, visit nshealth.ca/MobilePrimaryCareClinics
