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Who We Are: Delhi Family Health Team, Dr. Bill Thorogood

Our department’s faculty work tirelessly to offer learners the experiences and opportunities to become highly-skilled clinicians and leaders in tomorrow’s health care systems. That mentorship comes embedded as part of an interprofessional team — a true strength of primary care. DFM greatly appreciates the work done by all staff at our teaching sites and the skillful and caring contributions they are making to the health of our communities. So, it is from that perspective that we’d like to highlight a single example among many: work led by the Delhi Family Health Team, a team our learners benefit from greatly, in both clinical and academic experiences.

The power of many: How a Delhi family practice curbed a massive COVID-19 outbreak

by Elizabeth Meen

On May 29, 2020, Registered Nurse Robin Mackie and her team found themselves on the front line of a battle nobody would want. COVID-19 had infected at least one seasonal worker at a local farm, threatening hundreds more.

The regional Medical Officer of Health, Shanker Nesathurai, was asking if Mackie’s family practice could provide on-site assessment and treatment for hundreds of symptomatic and asymptomatic Mexican workers living at Scotlynn Group farm in Vittoria, most of whom would ultimately test positive.

It made sense that Public Health in Haldimand-Norfolk would turn to Mackie. She is executive director of the Delhi Family Health Team, which provides a COVID-19 assessment centre as well as evening medical clinics for the region’s 3,300 seasonal farm workers. The family practice is also known for its affiliation with McMaster University. It is a teaching site for the Department of Family Medicine.

However, Mackie knew of no local precedent for an expansive and open-ended mobile crisis response like this one.

She phoned four nurses. “I said I don’t know how – or even if – I can pay you. They said ‘Robin, what do you need?’”

Within hours the nurses were in full PPE in the back of a pick-up, bound for the bunkhouses at Scotlynn farm.

Early detection

Mackie didn’t blink at the challenge because she’d had COVID-19 herself 10 weeks earlier.

“In my experience, if you don’t treat this virus before it damages your lungs, it will kill you,” she says bluntly.

Ultimately, the Grand River Community Health Centre paid for overtime hours through the Seasonal Agricultural Workers Program, while Ministry of Health covered regular hours. But those details were settled long after the team got to work, providing 673 assessments, daily site visits, and compassionate care that Public Health officer Nesathurai described as, “over and above their mandate.”

Of 216 seasonal agricultural workers from Mexico, 199 would test positive, more than 25 days after observing the 14-day quarantine required upon arriving in Canada. One of them, Juan Lopez Chaparro, 55, died in a London, Ontario hospital on June 20.

Many were hospitalized. The others hunkered down for weeks of isolation, spaced and divided into houses according to the severity of the symptoms.

Fear

“You could see in their eyes they were terrified,” recalls Dr. William Thorogood, assistant professor and Simcoe site lead for McMaster University’s Department of Family Medicine and preceptor with the Delhi Family Health Team.

Thorogood and the Delhi team regularly assessed the men at the farm until the outbreak was declared over July 10.

“They were away from home, away from their families, unable to speak our language and watching their colleagues get seriously ill.”

The nurses “were the heroes here,” says Thorogood, “and this is a story of their collaboration with Emergency Medical Services and Public Health in a broad community effort. It’s the story of nurses who gave much more than medicine.”

Insidious

Desperate to support families back in Mexico, many of the men believed they could still work.

“It’s insidious, this virus,” says Mackie, who was infected with COVID-19 at a wedding in Cambridge on March 13 and showed no symptoms until March 26.

She quickly learned she was exposed and self-isolated.

“I went from feeling fine, although tired, to completely bed-ridden in 24 hours. I had a 102 degree fever for 10 days. My husband finally put me in an ambulance and sent me to hospital,” she says.

“So, you see? I did exactly what these men did. I’m a nurse, and I still thought I could beat it at home.”

Given the language barriers, the co-morbidities and close proximity when working and living together, “these men were vulnerable to COVID the minute they arrived,” she adds.

Building trust

Back at the farm, nurses relied on interpreters and translation apps on their cell phones. Overtime hours attest that they put their hearts into the work.

Nurse Practitioner Rebecca Spencer-Knight was already finished her shift when she texted Mackie for permission to stay longer. “A gentleman was crying, he was so home sick. She didn’t think he should be alone,” Mackie says.

Another evening, learning that many of the men were hungry, the same nurse contacted a friend at a pizzeria in Vittoria. The Catherwood and The Kiln donated nine pizzas and pop to the cause.

Nurses also filled prescriptions after work. The men often left hospital with prescriptions they couldn’t understand or fill by themselves. The team began asking if they “received any pieces of paper,” filling the scripts temporarily with samples from the pharmacy at the practice an hour away.

Patients increasingly turned to the nurses over the month of June, sharing stories of home, the wives and children they were missing, and finally, sharing their fears: health, money, family and future employment.

When it veered from the medical, the team turned to Nesathurai and found a reliable ally in his Public Health department, which coordinated various public responses with Haldimand-Norfolk.

For their part, the farm workers came to see the visiting nurses as advocates, learning their names and, in the end, thanking them personally.

Lessons learned

One death is too many, “but we had 199 positives. So many were saved because we jumped on it, and we never turned our backs,” Mackie says:

“These men were kind, respectful and courteous in a time of chaos and fear, and their kind words about the positive impact we had on their lives in this time will stay with me forever.

“It was terrible – but it was beautiful. It made me a better manager. It made us better nurses. It made us better people.”

Ready to roll

 The emergency COVID-19 response team for McMaster University’s Department of Family Medicine teaching site, Delhi Family Health Team: (l-r) Sara Redecop NP, Maureen Harrison, Interpreter, Julie Martin-Jacob RPN and Rebecca Spencer-Knight NP; Absent team members include: Cassandra Dobias NP, Roxanne Pierssens-Silva RPN, Cheryl Oliver RN, Dr. Bill Thorogood and Dr. Ryan Coelho, Robin Mackie ED.

 

Nurse Robin Mackie, COVID-19 survivor and executive director Delhi, FHT
“We could have waited for approvals and directives but, if you wait, this virus will kill you.”

 

 

 

 

 

 Dr. Bill Thorogood, Assistant Clinical Professor
“Doctors are steering the emergency response, but we’re really just one spoke in a big wheel.”

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