Safely ensconced in a state-of-the-art medical school, we cannot easily imagine the structural barriers to health that some members of our communities face.
All four of us are medical learners who immigrated to Canada with our families. Volunteering with Abode Community Centre reminded us of the barriers our parents faced when arriving to this land and finding their footing. It also offered us an opportunity to reflect on the stories and values that drew us to medicine.
For instance, loneliness aches.
“What are we doing next week?” asked one of the participants in FaajiTime, a virtual community created by Abode to help combat senior isolation during the COVID-19 pandemic that devastated health outcomes for the elderly, both through direct infection as well as through profound social isolation.
Data from the 2020 Canadian Longitudinal Study on Aging revealed that loneliness increased by 87 per cent for women ages 65 to 74 and 37 per cent for those 75 to 84. Smaller but significant increases were seen for men in the same age groups. The general lack of familiarity with technology in these age groups made pivoting to a new way of communicating more difficult. Seniors from ethnic minorities and immigrants were particularly vulnerable to social isolation, which has been shown to be associated with a 26 per cent increased risk of mortality.
Isolation is a universal struggle, yet lack of access to money and media in familiar languages adds further layers of vulnerability. In Toronto, many seniors are immigrants with limited English proficiency and health literacy, a population that was the most vulnerable to the psychological and physical ravages of the pandemic.
Hunger also aches.
COVID-19 broke down global food-supply chains, resulting in rising costs and lack of access for many communities. Food banks also struggled to provide food, partially due to in-person restrictions.
COVID-19 broke down global food-supply chains, resulting in rising costs and lack of access for many communities.
Abode is one organization trying to fill the gaps. Thelma Adelekun, Abode’s founder, had worked in city administration and understood the bureaucratic policies that reinforce social inequalities. She says that for years, community members have lived through these inequalities in Toronto’s Jane and Finch and North Etobicoke neighbourhood, where 77 per cent belong to a racial minority. That the community’s median income was a third less than the City of Toronto’s was not a theoretical concept; it was one of the barriers preventing purchases of those extra plantains or tomatoes for dinner.
Adelekun decided to act.
Founded in 2017, Abode is a grassroots, non-profit organization that aims to build culturally sensitive community support for seniors, families, single parents and children and youth. Its mission and vision: To ensure all vulnerable members of the community have equitable access to food and health promotion, feel socially connected, and are empowered with essential services, resources and community partnerships. Abode’s primary services include food drives and deliveries, social activities for seniors such as FaajiTime and health- and mental-health promotion events. It also provides referrals for housing support and employment services.
Beyond this, Abode also develops and delivers awareness campaigns on Gender-Based Violence, which further heightened during the pandemic. It further created a targeted approach to Anti-Racism and Hate, offering workshops on trauma-informed therapy, an approach to support communities impacted by racial and colonial trauma.
We met Thelma through the Integrated Clinical Experience: Health in Community course at the University of Toronto’s Temerty Faculty of Medicine. This course matched learners with a year-long internship at a local community partner. Our involvement at Abode included teaching health promotions workshops during FaajiTime on subjects such as Back Pain and Shoulder Pain; Healthy Aging: Preventative Care with a Culturally Sensitive lens; and Health and Diet: A Culturally Sensitive Lens for a Predominantly Black Community. We also helped write a Second Harvest Emergency Food Security Fund grant that raised $49,000. This grant provides culturally inclusive cooked meals for 98 seniors weekly, supports weekly food bank days, and provides 350 $50 food vouchers to each Abode food-bank recipient.
Our experience with Abode provided a practical example of working with an asset-based, community-building model. As medical students, our roles were not to “save” the community, but rather to learn from Abode and community members and to identify how we can contribute.
This invaluable exposure should be afforded to all medical students and professionals early in their training. Toronto is a highly heterogeneous city, and one of the tremendous privileges of learning and practicing medicine in this city is the exposure to such a richness of narratives and patient stories. However, there often is a rift between the ivory tower of our medical institutions and the realities of living in the city. Abode is a mere 45-minute commute from the University of Toronto downtown campus, yet traveling there feels like traversing a great distance.
Our experience has proven to us that there needs to be a stronger connection between medical education and the social determinants of health that shape the communities we will serve as practicing physicians. This is crucial in shifting our focus toward bridging gaps in care.
As future clinicians, we must not be oblivious to the needs of our communities. However, we must not pretend to be “saviours” of vulnerable communities, propagating unsustainable dependence on medical institutions and disrupting the ecosystem of communities. Instead, we should foster partnerships and bolster assets already existing with the intent of learning from them rather than shaping them.
We continue our training knowing that when patients ask for food or housing, we can connect them with local grassroots organizations like Abode. We are also now more aware of our role in supporting such local initiatives.
We would like to acknowledge and express our deepest gratitude to Thelma Adelekun, the Abode Board of Directors, team and volunteers. We would also especially like to thank Thelma for supporting the writing of this article. Our Abode experience has been invaluable and has provided a level of understanding and appreciation for the communities we will be serving as future physicians. Thank you, Thelma, thank you, Abode!