The Power of Partnerships

March 2020 has an ominous place in history. Following Canada’s first presumptive COVID-19 cases, schools, borders and businesses closed, travel ground to a halt, and people stayed home to help slow the spread of the virus. As hospitals and public health officials sprinted to identify new cases, and contact trace, and care for those who had fallen ill, it became clear that the pandemic response needed to extend beyond the walls of traditional institutions in order to reach those most affected. And doing this effectively would require a network of close partnerships embedded within the community.

Early in the first wave, COVID-19 exacerbated existing inequities and disproportionately affected marginalized and underserved communities. Michelle Joseph, CEO of Unison Health & Community Services, and her teams saw this as cases climbed in the northwest corner of Toronto.

“The thing about northwest Toronto is there is not lot of community services and the geography is really big,” described Joseph. “Pretty early on, we wanted to do some community testing in a really localized and low barrier way because we were recognizing that the communities we serve were having symptoms but not seeking out testing for many reasons – fear, wait times, work, accessibility. This is when Women’s College Hospital reached out to us and said they would be happy to support that.” 

At around this time, Women’s College Hospital had begun deploying mobile teams to provide testing in long-term care homes, shelters and congregate living facilities. However, while the hospital had built expertise in testing and best practices for infection prevention, it lacked established relationships and the trust required to get buy-in from community members. By partnering with Unison, the hospital hoped to bridge this gap.

“One of the important things we acknowledged was that other people are out there on the frontline too,” said Dr. Suvendrini Lena, Senior Medical Advisor Pandemic Programs & Medical Lead for Schools Women’s College Hospital. “We knew we had special expertise – we understood the science, the infection prevention and control – but we needed to find a way to share it and to make it useful to people in a way they could use and implement.”

Together with Unison, the hospital’s COVID-19 response team identified more partners working within some of the hardest hit communities and opportunities to support with testing in places where people live and work. This paved the way for a unique relationship with schools that would come to span the pandemic.

Many schools had become community hubs, often acting as food banks, providing healthcare referrals to their families, among other services. They served as a lifeline for a much larger community with deep roots extending beyond their classrooms.

“The role that principals and teachers have played, and are going to continue to play, throughout the pandemic is often underestimated,” described Dr. Lena. “They have demonstrated flexibility in the continuous pivoting they’ve had to do – almost becoming nurses, triage clerks, IPAC specialists, vaccine clinic logisticians. And they didn’t stop teaching to do all those things.”

At Charles E. Webster Public School, principal Gord Young and vice-principal Alisha Mohammed exemplify this. As they watched new cases climb within their community, they were concerned by the barriers to testing and care.

“We were doing everything we could, but COVID-19 was so widespread in our community and there were so many inequities that we were concerned with all the different challenges out there,” recollects Young. “We saw barriers preventing some of our families from doing things like regular testing.” 

Mohammed adds, “We asked ourselves, ‘How do we make testing easier for our families because so many parents are working multiple jobs and even without sick days?’ The answer was to bring it into the school.”

Throughout the fall of 2020, Women’s and Unison partnered with 20 schools located in areas with high positivity rates and often used the sites as testing hubs to reach local factories, apartment and housing complexes, and shelters. When it came time for the vaccine rollout in April 2021, the inroads made through these partnerships proved invaluable.

“I always saw testing as a way of creating relationships. If you can get people to trust you to test, which is often invasive and means that you’re waiting for results that could turn your life upside down – that can serve as a basis for a relationship to vaccinate,” said Dr. Lena. “The key was to form a relationship that people feel will be sustainable and feel you are going to be accountable to them. In our approach, we emphasize wrap around care together with Unison because people have to know that if you test, you’ll be there to help them with the consequences.”

The Unison team was also able to use their extensive network and relationships within the community to provide both outreach and wraparound support. Unison teams engaged in door-to-door talks, spoke with those coming into their centre and distributed flyers with the goal of identifying additional approaches to augment the province’s overarching testing and vaccination strategy.

“The difference in a lot of our communities is that we have to think a lot about language and a lot about accessibility. And you really need to have a trusting relationship,” explained Joseph. “You need to send people out that the community members will identify with, will feel that the information they are being given is trusted information – and usually that means that they’ve had some prior relationship with the person or organization.” 

For the vaccination clinics to be successful and reach as many people as possible, mutual trust and respect was at the heart of all of the community partnerships formed by Women’s College Hospital. Each partner had an equal voice and brought a unique set of expertise to the table, from outreach to understanding the needs of the community and how to best meet them.

As Mohammed points out, “We didn’t see it as Women’s College coming in to run the vaccination clinic – we knew we were servicing our community and our families, so we really wanted to be a part of the process in terms how do we get our families in first so that we can build up the buy-in for vaccination, and then open it up to the greater community. We’re not here just to teach the students but to help the families in the wider community as well.”

“Women’s College really gave us ownership in how we wanted the clinic to operate, and they respect what we were trying to do for our school,” added Young. 

Looking ahead, the partners agree that the collaboration, flexibility and process of relationship building are valuable lessons that can be carried forward to continue providing equitable access to healthcare services beyond the pandemic. 

“That culture of understanding that community organizations have certain expertise and knowledge to make the partnership work – that understanding is pretty unique to Women’s,” summed up Joseph. “I really think it speaks to all the wonderful individuals but also that there’s something about the culture at Women’s that really makes it special.”