Doctors hit Hamilton streets to deliver COVID vaccines

Equipped with a laptop, syringes and Pfizer doses, Dr. Joe Oliver is a walking vaccination clinic.

If Oliver spots you - maybe riding your bike, sitting on your porch, or lying outside a tent in a Hamilton park - he'll politely ask if you want a shot.

His non-pushy pitch goes exactly like this:

Excuse me, sir. I'm sorry to bug you. We're out doing COVID vaccines. Do you by chance want or know anyone that wants a COVID vaccine?"

Oliver repeats this a few times on a humid afternoon around Barton Street East in a part of Hamilton where vaccination rates are lagging despite a worrying fourth wave of the pandemic fuelled by the aggressive Delta variant.

The neighbourhood is in the L8L forward sortation area (the first three characters in a postal code), where only 51 per cent of roughly 30,000 residents have received two doses.

Oliver's outreach efforts through Hamilton's Shelter Health Network to deliver the vaccine to those who might not otherwise seek it out also coincide with an ongoing homelessness and opioid crisis.

In this particular case, the would-be recipient - a man crossing Sanford Avenue North - says thanks, but he's already dosed up.

But Oliver - towing his two small children behind him in a cart this August afternoon - is about to find a match.

He gives Jack, 7, and Norah, 4, a brief, age-appropriate explanation of homelessness before heading to a cluster of tents in Woodlands Park.

It doesn't take much to convince Roger Rochester.

I'll do it," he says, springing to his feet while noticing the children gazing at him from the cart.

Don't worry," Oliver jokes, referring to his kids. They don't do it."

He looks up Rochester on his laptop and verifies he's due for a second dose after a colleague administered the first one at a downtown health centre a few weeks ago.

The 38-year-old offers his right arm for the jab, and within a few short minutes of meeting the doctor, he's fully vaccinated.

His five-year-old son and wife's parents are foremost in his mind, says Rochester, who notes he has struggled with addiction but isn't homeless. He's at the encampment to help out.

Me, personally, I don't want to get anybody sick and have that on my conscience."

But if the doctors hadn't come to him, it's unlikely he'd be vaccinated, Rochester says.

I didn't want to do it, but the man upstairs made you guys come to me, so."

Familiar faces

Whatever the rationale, Oliver, who practises pediatrics most of the time, will take these small but significant victories.

He emphasizes the approach (gentle, patient and understanding) as well as finding people on their own turf are the keys to success.

More than personal hesitancy, it's systemic obstacles that seem to hinder vaccine uptake among marginalized populations, Oliver says.

We'll go until nightfall sometimes, or until we're just gassed in the heat, because you keep finding people."

Walking the neighbourhoods that surround vaccination clinics at local health centres, shelters and social-service hubs has become routine for Oliver and his colleagues.

In some cases, it's to find willing arms for surplus doses. But the ambulatory approach is also deliberate in its goal to reach those living in encampments or facing other barriers to access clinics.

On this muggy day, Oliver and his children have ventured out from Mission Services on Wentworth Street North, where Dr. Kerry Beal is overseeing a clinic.

Beal, the Shelter Health Network's lead physician, and her team have been on the front lines of the pandemic since it struck in March 2020.

They were in the trenches when shelters reached double-digit outbreaks after several months of remarkably few cases, thanks to routine surveillance testing and vaccinations by health practitioners.

There is hesitancy," Beal says about uptake among the homeless population.

I am totally amazed at the number of times, though, that we'll walk along the street with our baskets, with our vaccines in it, and a complete stranger, we'll put a needle in their arm," she adds.

So, having somebody show up and say, OK we'll do it right now,' it's amazing the number of people who jump."

Dr. Jill Wiwcharuk - who is with the Hamilton Social Medicine Response Team - echoes Beal's observations.

She visits encampments with a Keeping Six harm-reduction worker and paramedic Social Navigator - a partnership with police - to offer medical care and vaccines.

For sure, there's some people, like everywhere, that are just not interested."

But Wiwcharuk says she's pleasantly surprised" by how many pro-vaccine" people she encounters.

Being a familiar face helps.

Everywhere we go, we're meeting people that we already know who trust us, and that is a really privileged position to be in."

But with a fluid population of no fixed addresses, followup for second doses, contact tracing and isolating those with the virus can be challenging.

We do reasonably well at finding people," says Beal, who regularly receives calls from public health nurses trying to track down patients who have tested positive but fallen off the radar.

So far, the Shelter Health Network has given roughly 1,650 shots to people experiencing homelessness, Beal says.

But determining the rate of vaccine uptake among this fluctuating group is tricky.

Not all stay in shelters for a range of reasons, including security concerns, mental illness, drug use, fear of contracting the virus, reluctance to part with pets, or the chronic space crunch in the women's sector.

We know our numerator. We have no idea what our denominator is, so we have no clue," Beal says.

But doctors who do street outreach worry their pandemic-related tasks could soon become tougher with the end of a city policy that allowed tents to remain for 14-day stretches and made considerations for mental illness.

Earlier this month, during a hastily called emergency meeting, councillors - some citing complaints about trash, drug use and safety concerns - scrapped the protocol in place since last fall that resulted from a legal settlement with a coalition of doctors and advocates.

The possibility of more displacement from encampments during the Delta variant-driven fourth wave weighs heavily for Wiwcharuk, who was involved in last year's court challenge.

No question, it is a very real concern for finding people for second vaccines and also for finding people (in order) to quarantine them when they're sick."

In an emailed response, the city said it remains focused on supporting homeless individuals in securing safe and affordable housing, taking an individualized approach to connecting those experiencing homelessness with community resources and supports."

As well, it will continue to consider the safety and well-being of individuals living outdoors, and the broader community needs, including access to green space for safe outdoor recreation."

Focus on survival'

But bridging gaps, whether through doctors' visits to encampments or connections with staff at social-service agencies, will remain important as the pandemic wears on.

While Beal oversees the clinic at the Mission Services food bank with help of Good Shepherd and city staff, Wiwcharuk is around back at an outdoor women's health event hosted by various organizations.

Some are already here to find support at Willow's Place, a drop-in space Mission Services offers for women-identifying people who are homeless or precariously housed and may have complex health and addiction issues.

Encouraging some clients to be vaccinated has been tough," says Wendy Kennelly, associate executive director of administration and resource development at Mission Services.

Struggles with mental health and addiction can supplant ambitions to get shots, explains Jaclyn Smith, assistant director of outreach programs for women and children.

Because really the focus is on survival, eating and showering and sleeping," Smith says. And sometimes the mental-health paranoia piece, psychosis from drugs, makes people hesitate."

But having the shelter doctors and a Keeping Six worker around this day is helping, they say.

When they're asking us questions about the vaccine, they're hearing it from someone they already trust. It makes a huge difference in uptake," Wiwcharuk says.

In one day, the clinic vaccinated about 35 people, with 10 or so directed from the health event outside - a better outcome than Beal had expected. The next day, they achieved the same total.

In the haze of addiction and daily grind of homelessness, getting vaccinated just wasn't on Michelle Ward's radar.

It wasn't something I thought about," says Ward, after getting her first dose during Wednesday's walk-in clinic.

But her outlook - one that viewed the pandemic as fearmongering" - started to shift a few months ago when she fell ill with coronavirus.

It was terrible," says Ward, 51.

Patricia Read, her fiancee, also decided to get her first jab.

We're sober," says Read, who also attributes the delay in getting vaccinated to struggles with addiction.

Both also have a strong motivating factor: Seeing Read's extremely ill mother in Muskoka before she dies.

While homeless, they've stayed at Carole Anne's Place, an overnight drop-in service the YWCA operates for women who can't get into shelters. This month, it has experienced an outbreak reaching 12 cases.

During the day, Ward and Read go to Willow's at Mission Services.

It keeps us safe and away from all the drugs," Ward says.

The women hope to secure a room in an east-end hotel where Mission Services offers overflow spaces the city secured during the pandemic.

In the meantime, they're also counting the days to their second doses.

Definitely, we'll follow up," Read says.

Teviah Moro is a Hamilton-based reporter at The Spectator. Reach him via email: tmoro@thespec.com