In this Connecting with care film, we go behind the scenes at the Cool Aid Community Health Centre in Victoria, British Columbia, Canada. Cool Aid’s approach to health care and hepatitis C treatment is built on the organisation’s broader commitment to providing support and care to people who are impacted by poverty, substance use, homelessness, and mental health.
Just off Canada’s mainland lies Vancouver Island, home to a truly spectacular city. Victoria is the capital of British Columbia (BC) and was originally named after Queen Victoria in 1843. Modern Victoria remains one of the most British cities in North America, but there is more to Victoria than tea rooms, antique shops and galleries.
Victoria also deeply feels the effects of the toxic drug supply and overdose crises, which surpassed 10,000 victims by late 2022 in British Columbia alone. Today, fentanyl, carfentanil and benzo dope are responsible for the overdoses of hundreds of people in the city every year.
Victoria is considered a wealthy city with an outdoor lifestyle and some of the best weather in Canada. For these reasons, Victoria has long been the destination of choice for Canadians looking for a gentler climate and the opportunity for employment.
But it also has as a long history of heroin consumption, which extends back to when the city had indentured labourers brought it from China through its thriving port in the 1880s. Since this time, Victoria has attracted people looking to use opioids. And today, this is no different.
The sheer lack of affordable housing and a large internal population of drug users have contributed significantly to the city’s extensive street-based drug-user community.
How Cool Aid transformed from helpline to medical clinic and social support
In 1968, the Cool Aid hotline was started, and the first hostel opened its doors to provide life-changing services to adults impacted by poverty, colonisation, stigma and homelessness. From the outset, Cool Aid’s mission was to provide short-term, emergency shelter to the transient youth population travelling the country.
Quickly realising the increasing local need for further shelter and holistic services, the ‘Cool Aid Free Medical Clinic’ was established in 1970. Since then, the Cool Aid Society has expanded its offering of services to include permanent housing, emergency shelter, health and dental care, employment assistance, and social and recreational opportunities.
A few decades after its establishment, a young physician named Dr. Chris Fraser began to realise the significant medical needs of the city’s vulnerable communities and decided to join Cool Aid. More than 20 years later, Dr. Fraser is Cool Aid’s medical lead and has been instrumental in driving the organisation’s commitment to cure hepatitis C on the island.
Cool Aid client David remembers meeting Dr. Fraser, 20 years ago, like it was yesterday.
The first time I met Chris Fraser, my doctor, I was on the street, and I’d gotten cellulitis in my ankle from missing (when injecting), and it was painful. He said, ’okay man, you know what, I’m going to be your doctor from now on. If you want to have a good relationship, you have to be honest with me. That was in 2002 and we’ve developed a really good working relationship and friends. He’s a good man.
Focussing on hepatitis C treatment
In the interferon-based treatment era, hepatitis C treatment was tough, with significant side effects and low cure rates. The level of care provided to clients during this time required regular visits to the clinics, which limited the ability to provide care in a non-clinical setting.
The introduction of Direct-Acting Antiviral (DAA) hepatitis C medications was a game changer in British Columbia. In many ways, the DAA medications forced healthcare practitioners to consider how care could work best for the community in this new era.
The immediate reaction was, oh my gosh, we have a tool now that we can really run within the clinic. One thing that’s been really gratifying for the team is we’ve since seen virtually the end of decompensated liver disease from hepatitis C. And that’s been wonderful to see. We ‘re not seeing people at F4 (fibrosis stage) and really in a very serious medical state. We’re encountering most people – around 70% – much earlier in the course of their illness.
Combining social housing with a nurse-led model of care
Historically, Cool Aid has always had a strong nursing team within its walk-in clinic. Since the introduction of DAAs, the organisation has strengthened its nurse-led outreach model of care. Cool Aid has consistently been striking up new partnerships with local housing sites and other service providers around Victoria.
Cool Aid was also able to undertake a series of highly successful micro-elimination projects where the nurses would test everybody within a housing site and ask them to bring their family, friends, or their social sharing networks.
The Tally Ho is one of Cool Aid’s 13 supported housing sites that has become a regular stop for Cool Aid’s outreach van. Joey is a Tally Ho resident who had largely disengaged with the health care system before moving into the Cool Aid-run supported housing site.
Over time, Joey formed connections with the staff at Tally Ho, including site director Jenny Temple and slowly, that expanded to the Cool Aid nurses who would arrive a few days a week in the van. Joey had known for quite some time he was living with hepatitis C, but his previous negative health experiences had contributed significantly to him avoiding accessing care. In time Joey decided to trust Cool Aid nurse Tamara Barnett, and in 2022, he completed hepatitis C treatment and was successfully cured.
To be Hep C free, it is a real bonus. Everybody needs your liver because your liver’s important to you. It’s almost like you can almost feel a smile in there now. It’s kind of nice.
Nurse Tamara Barnett coordinates the hepatitis C care for all Cool Aid patients. Care coordination is no easy feat and often requires a lot of communication with various stakeholders engaged in the patient’s care.
If we can’t get a hold of the patient, then we’re speaking to the pharmacist in the pharmacy, and then it’s our nurse’s job to locate the patient. Maybe that patient is now in the hospital, and we need to coordinate their hepatitis C treatment through the hospital providers and transfer their medication from the pharmacy up to the hospital. Or, maybe somebody is incarcerated, and the nurses and staff need to sort out how we get the meds to the patient. So it’s, it’s very intensive, and it requires lots of hours each week for about 45 patients we’re treating at any given time.
Nurse Tamara Barnett
Cool Aid is synonymous with a safe space to access healthcare
Since Cool Aid client David first met Dr. Fraser back in the 2000’s he has continued to develop long-term relationships with many of the Cool Aid staff, including Tamara.
David can recall the many times he has felt supported by the team, including being treated twice for hepatitis C, being visited by Dr. Fraser when in hospital and asking advice from the team before commencing medications for HIV. David has also gone on to have a successful career as a harm reduction worker and is employed by harm reduction service AVI.
Cool Aid’s medical program has grown exponentially, and for many in the community, the Cool Aid Society is synonymous with a safe space to access health care in a range of settings and provided by a range of practitioners.
It now has approximately 6,000 patients registered on its database, runs a large medical clinic and has 12 nurses and a smaller number of physicians managing mobile health services in an outreach van. Cool Aid also offers in-reach in more than 20 services, including housing sites and social services. This expanded footprint has been key to Cool Aid Society Health Centre’s successful treatment of approximately 500 clients.
Strong teamwork has been central to Cool Aid’s success in treating hepatitis C; however, according to Dr. Fraser, there is plenty more still to be done in Victoria.
I view it as a kind of an iterative process with a lot of quality improvement we can always do. And so, I would say we’re maybe halfway along the journey towards really meeting people where they’re at and doing a good job.