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home / 世界杯决赛2022

surrey mobile unit brings health care to 'unseen' homeless people affected by overdose crisis

homeless people who are more comfortable speaking a language other than english are often missed by government aid

by joanne lee-young

sep 10 2022
read time 7 minute read
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upkar tatlay and anky kumar greet each other heartily on the sidewalk next to a strip mall parking lot in newton. they dive into a conversation that switches from a few words in english to an animated mix of hindi and punjabi.
tatlay heads engaged communities, a small non-profit group that runs mobile health units aimed at providing vulnerable and homeless people in surrey with basic care as a way of building trust with them so it can learn what other supports they might find helpful.
it comes as there are signs that some communities are struggling more with the overdose crisis than others. and there are indications there may be a growing population of homeless people who don’t live in shelters and can’t easily access support services because they express themselves better in languages other than english, face cultural barriers to asking for attention or simply live too far away from where help is being offered.
upkar tatlay holds a collage containing photos of various family members in white rock on feb. 10, 2022.
upkar tatlay holds a collage containing photos of various family members in white rock on feb. 10, 2022. mike bell / png
kumar, who is homeless, has visited one of the mobile health units before and is accompanied today by a friend who has cuts on his elbow. a volunteer cleans the scrapes, applies antiseptic cream and covers them with bandages.
“i am sleeping on the road, on the roadside, but these kinds of people are helping us,” says kumar, 48, who moved to newton after growing up in delhi, india. “my situation is that i am trying to survive here.”
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he talks about feeling helpless after his wife left him, and how he is comforted by the way tatlay always listens to him talk about his struggles.
tatlay later explains that kumar started using drugs — “for whatever reason, that sparked it, and it got out of hand and he was on the streets and it’s just gotten worse. he has a child and his heart is broken.”
the engaged communities mobile operation is nimble and incorporates fraser health staff who provide primary care and connect people to mental health or substance use support.
tatlay and engaged communities volunteers regularly set up a tent at several locations, including this one in newton and a spot near a bus stop in white rock.
the volunteers drive around in a minivan and pull out a portable washroom and hand out supplies such as bottled water, snacks, clean syringes, naloxone kits and other harm-reduction supplies. on hot days, they might set up a misting station.
the goal is to open a door and start simple conversations to get to know people.
tatlay said kumar is the perfect example of someone who might otherwise have gone unnoticed.
“i met him here on the street. that’s the benefit of being mobile.”
engaged communities workers giving away water and food to people who are in need in surrey.
engaged communities workers giving away water and food to people who are in need in surrey. francis georgian / png
setting up in parks, church basements or parking lots is important, said ranjit dhari, an assistant professor at the university of b.c.’s school of nursing.
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“the challenge is that where community health centres are set up, sometimes it’s very far from where the actual community in need is. the mobile units fill a gap by bringing care to the community where the community is, especially when it’s a community that maybe is marginalized more by society and is unable to trek in to where the services are.”
because there can be a fear of seeking help, being present in the community is a way to engage in simple health care, build relationships and then move to offering clinical care, she said. she teaches nursing students that taking the time to give foot soaks and not wearing medical scrubs when meeting people at these mobile units are ways of connecting and reducing barriers.
registered nurses and outreach workers from fraser health’s integrated homelessness action response team have been working with the engaged communities mobile unit in recent months. some of them speak several languages. they offer wound care. in some cases, they tend to dressings that haven’t been changed in weeks or talk to people who haven’t sought medical help for years. the goal is to encourage people who need support to come again and perhaps receive more regular care.

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tatlay points to a report released in 2020 by fraser health’s chief medical health officer that found a dramatic increase in overdose deaths in the south asian population in the fraser health region.
the number of drug toxicity deaths among ethnic south asians in fraser health increased to 78 in 2018 from 22 in 2015. that was an increase of 255 per cent. meanwhile, the number of drug toxicity deaths among non-south asians in the health region increased to 442 in 2018 from 186 in 2015. that was an increase of 138 per cent
the authors of the report highlighted how the risks of substance use were going unacknowledged in fraser health’s south asian community, which accounts for three-quarters of the province’s south asian population.

the report found that between 2015 and 2018 more south asian people who died from overdoses in fraser health were men, at 97 per cent compared to 81 per cent of non-south asian people who died being male.

about two-thirds of deaths from overdoses among south asians in fraser health during this period were of people under the age of 40, compared to 50 per cent among people who weren’t south asian.
the report found that half of the deaths among south asians were of fathers and that two-thirds were living with a partner when they died. half of the community’s deaths were of people who were working and half of those workers were in the trades and transportation sectors, including construction and trucking.
left to right is upkar singh tatlay executive director,engaged communities canada society; isha brar, program coordinator; mandave dhadda program coordinator.
left to right is upkar singh tatlay executive director,engaged communities canada society; isha brar, program coordinator; mandave dhadda program coordinator. francis georgian / png

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tatlay, who participated in compiling the report, said that as policymakers make longer-term plans for how to tackle the opioid crisis, his group is trying more immediate solutions such as running the mobile health units and offering constant feedback.
“knowing that these are my community members who are dying, i just can’t sit and wait for action on the report and this information,” he said.
“the downtown eastside advocates reach out to me and say, ‘we feel bad for what’s happening here and we complain about not being seen, but you’re dealing with communities that are not even on the register.’
“how many times do we hear people talking about south asian, chinese, black homeless people? they aren’t even part of (homeless) counts. there’s homelessness and then there’s hidden homeless. these people are the ones who just can’t express themselves, or when they do, the communication isn’t right.”
he said official campaigns to increase awareness about overdoses, such as holding educational sessions at gurdwaras, are well-intended but sometimes miss the mark.
“many south asian people are hindu, muslim, buddhist, christian, non-denominational and some sikhs who do not even venture anywhere near a gurdwara. the gurdwara has been a central focus for these efforts, but it needs to be one of many, not the sole response.”

producing more pamphlets, handouts or web content in punjabi will help, but tatlay says his group has created an app with translations also in tagalog, hindi, urdu, spanish, simplified chinese and other languages.

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andy yan, director of the city program at simon fraser university, said that in 2006, 28 per cent of census respondents in the city of surrey said the language most often spoken at home was neither english nor french. by 2020, that increased to 35 per cent.

it’s important to get ahead of changing trends instead of reacting to them, he said, pointing out that in places like california — where a different measurement is used, but more than 40 per cent of the population speaks a language other than english — it’s state law that hospitals must provide qualified medical translators.

fraser health also provides some administrative support to another organization, umbrella multicultural health co-operative, which runs a centre for newcomers, refugees, immigrants and migrants and a mobile health clinic that specifically reaches out to spanish-speaking migrant farm workers. 

even though many have health insurance and work permits that entitle them to health care, most workers still find it challenging to navigate the system and sort out issues such as transportation and schedules, said shaina schafers, a coordinator at umbrella. aside from straight translation, sometimes other support is needed.

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“we have volunteers who are cultural brokers, someone who is able to bridge between the patient and the canadian health-care system, and also views on health, a person who is able to guide the patient and the clinician in coming to an understanding about health and how to meet needs.”
farina khondaker, a simon fraser health science student and volunteer at engaged communities, said there are two sides of learning for someone such as herself who has the language skills and background to reach people in need as well as play a part in talking frankly about homelessness, drug use and the opioid crisis as something that is happening in her community.
“it’s about having the conversation about drug use and being educated about it and saying it doesn’t mean you are promoting it. there isn’t really a word in punjabi for drug use or overdose. (many) say they’re bad people or their parents weren’t there for them,” she mused.
“i can be a bridge between the two. as an academic, i have so much privilege and will be taken seriously later on in life, but academics need to know what’s on the ground. a lot of people don’t want to see it, but this is something i want to learn about.”
jlee-young@postmedia.com

for more 世界杯决赛2022 and content around diseases, conditions, wellness, 2022年世界杯名单猜测, drugs, treatments and more, head to healthing.ca – a member of the postmedia network.

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