To hear Bonny Johnson tell it, you wouldn’t think to call Whitewater Bromley Community Health Centre (CHC) Satellite “the House that Bonny Built.”
But for all those who witnessed or assisted the development of this rural CHC first-hand, Johnson was the one who stepped up to provide leadership and vision when the community was losing its primary care physician in the mid-1990s, and wondering what health services would survive. After gathering around her table so many years ago, those same witnesses came together to nominate Johnson for the 2016 Joe Leonard Award, the highest honour given out by the Association of Ontario Health Centres (AOHC), which is reserved only for individuals who have made outstanding contributions to improving the health and wellbeing of people and communities facing barriers to health (for more background on the award, see the end of this article).
“Bonny exemplifies the work of Joe Leonard towards a holistic approach to community health,” wrote John Jordan, Executive Director of Lanark Renfrew Health and Community Services, in his letter of nomination.
A Registered Nurse with experience in primary and long-term care turned Nurse Practitioner, Johnson’s advocacy on behalf of her community over more than three decades of work in her fields and beyond culminated in the creation of a hub for community health care and wellbeing services on two sites in Beachburg and Cobden, satellite CHCs of Lanark Renfrew Health and Community Services (LRHCS). But the journey to getting there had started about eight years before, when Johnson invited the physician who was retiring in the area, along with other community leaders, to a conversation around her kitchen table. Out of those conversations came the road that would lead to the creation of the CHCs, but along the way, it was Johnson’s stewardship and willingness to lead by example that would make all the difference.
“Bonny never had a ‘glass half empty’ approach, in fact her glass was always overflowing,” wrote Wanda MacDonald, CEO, Pinecrest-Queensway CHC, in a letter supporting Johnson’s nomination. MacDonald, who had been Executive Director at Lanark-Renfrew HCS at the time, detailed how Johnson had moved from securing funding for the Nurse Practitioner initiative, to working with municipal governments to ensure space was secured for her practice, to then working with physicians and other providers to build up a level of primary care and wellbeing services out of which she could then present her vision – and population needs-based case – for a CHC. “Bonny’s positive energy, her dedication to people, her allegiance to the CHC model of care, her leadership, and her commitment to teamwork have all contributed to the success of Cobden/Beachburg’s CHC sites,” MacDonald added.
Johnson is being awarded the Joe Leonard award at a gala presentation in Richmond Hill on June 8, 2016, after she was nominated by community members and professionals across the Whitewater-Bromley area and beyond, and chosen by the AOHC’s Board as this year’s recipient. Nomination letters highlighted Johnson’s commitment to educating people about the community health centre (CHC) model, and her work mobilizing other citizen and healthcare leaders to lobby for the creation of a centre that might better serve their large and challenging rural population with services and programs specific to their needs. Equal parts visionary, pragmatist, and roll-up-her-sleeves advocate, Johnson faced down unsuccessful applications, Ministry refusals for funding, political hurdles, personality conflicts, and other roadblocks with abundant creative problem-solving skills, and a joyful sense of how to bring people to consensus while keeping the bigger picture goal in view.
Of course, that bigger picture goal was always to promote better health and wellbeing for everyone in her community, where Johnson had lived and worked most of her adult life. Doing so meant promoting innovative health strategies, such as pioneering a service to help isolated seniors with a partnership that saw local paramedic services visiting people during idle times, or by developing a falls prevention program, a seniors fitness program, and services ranging from cardiac rehab to Alzheimer’s outreach. Johnson’s energetic lobbying eventually led to the creation of a CHC for her area, but her drive to create one began with a focus on delivering health care and wellbeing services where people needed them, when they needed them, and in creative enough ways to make use of limited resources.
“From that initial coffee table meeting in her home until the present, Bonny has continued to recruit and guide volunteers and professionals and to network with political bodies, community organizations, and others to embody the philosophy developed in the early days of the Whitewater-Bromley CHC initiative,” wrote Marie Zettler, a community journalist in the area in the 1980s and ’90s who was also involved in the CHC push. “This philosophy believes in promoting a healthy community, and recognizes that health is a social, physical and personal resource, and that community spirit, social activities, education, and employment are important to maintaining it.”
Here then, in her own words, talking about the history of Whitewater-Bromley, the strength of the CHC model, and overcoming barriers to health system transformation, is the 2016 Joe Leonard Award winner, Bonny Johnson:
Q: How, when and why did you get your start in nursing and community health?
A: My beginning in nursing was locally, at the Lorrain School of Nursing, back in the day when it was not connected to community colleges. I graduated in 1974. I worked in long-term care, and I worked in hospitals, and then I began working in primary care in 1980. In hindsight, I was attracted to nursing because I’m of a care-giving nature. I think that’s probably the best explanation. Nursing was a profession that I admired, and it seemed a noble profession.
Q: Can you tell us about the motivating factors for seeking support for a community health centre in your area?
A: In the mid-1990s, the physician I was working with and myself, we realized there were changes happening in health care, and over those years we began to realize that we lived in an under-serviced area. As the doctor was getting older, he realized that what usually happened – a younger physician moving in to take over the practice, so it would continue on and everyone would be looked after – was not likely to happen, and that the 1,500 or so people who we cared for would be left to their own devices. So what prompted the development of the CHC model in our community was that we first connected with the North Lanark Community Health Centre, which was the closest CHC serving people in the area. We did a visit, and they were just starting, out of a little house, and beginning to grow. Wanda MacDonald was the executive director at the time, and she offered whatever support that we might need. But it was only when there was a crisis point, and the physician got sick and things were shutting down, that we started to do the work with the community to lobby for a community health centre.
Q: Can you talk about this doctor for a moment, and what he’d meant to your career and the CHC?
A: I started working with Dr. E.C. “Mick” Pye in 1980. He was a visionary who believed in nurse practitioners and supported that role in the healthcare system, and so he supported me in becoming a nurse practitioner and working in the primary care practice. In that role, I was doing everything from helping to deliver babies to helping out at the other end of life. We both thought that the CHC model would be great for our community. After the doctor’s death, the thread continued with Dr. Pye’s family: For instance, when we were doing the lobbying, his son, who’s a graphic artist, did our logo. It’s the “Care to Be Aware” logo, it’s quite beautiful, and the logo we still use. He volunteered his time, along with many others. We had no money when we were doing all of this lobbying. It was all definitely grassroots.
Q: Can you talk about some of the people who were on board with you from the beginning, and some of the early hurdles you had to cross to promote the idea of a CHC?
A: At very beginning, it was people in the community who were concerned that there would be less health care around the table. We met with the MPP, Sean Conway, who represented the area at the time. He was very supportive, and he helped us get to Queen’s Park in order to lobby. We had the editor of the local paper, Marie Zettler. We had someone from the District Health Council (which would later morph into the LHIN).
The biggest hurdle we faced was explaining the model of care to people. Because people hold a status quo concept: “I go to the doctor, and I get whatever is wrong fixed, and then I go home.” So working to promote a model of wellness – explaining that the primary care component is important, but that it’s part of the whole interdisciplinary team – that was challenging. They understood my part of it – the nurse practitioner element, they didn’t question that – but when it came to the rest of it, the response was often, “Well, I want a doctor.” Our message was that it wasn’t just about “getting a doctor.”
Q: So it was initially about changing minds in your own community. How did lobbying efforts get underway?
A: We did a road show. We started off with Public Health, and did a presentation, and then the Federation of Agriculture. And they gave us our first cheque, for $100, and that’s when we first started to believe we were on to something and that, “Hey, we can do this.”
We also visited the local hospitals. We went to the Renfrew Victoria Hospital, and Randy Penney was the CEO there and he was very, very supportive. We visited with seniors groups. We did a couple of town hall meetings, so that we could get the people who might not understand what this was all about. At this time, it was also pre-amalgamation of municipalities in Ontario, so we approached each one, and they all very kindly donated a small amount as well, so that we could actually put together a proposal and do a needs assessment.
Q: Can you talk about support you received from the AOHC?
A: We had support from the AOHC from the very beginning. And I remember being sort of surprised at the amount of support that there was. I thought, “Well, this is a rather large organization and they’re not going to be concerned with a small community up in the Ottawa Valley,” but they were. So they provided us with lots of contacts with like minds, and people at CHCs who had already done proposals, like Woolwich Community Health Centre, in St. Jacob’s, who provided us with lots of support. But whatever we needed, they said, “Just tell us and we’ll send it to you.” And so that was really helpful at the beginning. Rishia Burke, at the AOHC, she was very helpful, sending us things that helped us with our cause.
Q: How did things develop on the political front? How were you able to navigate the standard line of “there’s no more money for that”?
A: Sean Conway, our MPP, agreed to do whatever might be required to gain political support. So he took myself, members of the steering committee and municipal representatives to Queen’s Park, where we would eventually meet with Tony Clement, who was the Minister of Health at the time. We got a lot of, “Hm, yes” at the beginning, at our first meeting was with the Deputy Minister. “There’s definitely no funding, but there’s going to be,” they said. So they told us to apply for Nurse Practitioner in Under-serviced Area, since there was a request for proposal going out for that. And they told us that doing so would put us in a good spot in six months to apply for funding for the health centre.
So we did submit for Nurse Practitioner in Under-serviced Area, and we were fortunate in that because there were a couple of physicians from Quebec who were working doing primary work in Beachburg, and they agreed to support that project. So in March 2000, I started in that role, in collaboration with these two physicians, and then, five years later, we got satellite CHC funding.
Q: So was that period challenging because you didn’t yet feel properly resourced to offer the care you wanted to deliver?
A: Growing in that way had its own rewards. We learned a lot, because we were supported all the way along by North Lanark CHC. They agreed to support the NP in Under-Serviced Area project, and then supported what was required to expand, such as a second nurse practitioner for another site. So the need was there all along, but things did progress slowly. The catchment area included the Whitewater region, and what’s now known as Admaston-Bromley. That’s a total population of just over 16,000 people, and covering an area of approximately 2,000 square kilometres!
Q: Can you speak to your involvement with the Madawaska Communities Circle of Health (MCCH), and what that work meant to you?
A: The tremendous involvement of the community and all the organizations supporting the MCCH project, with volunteer board members of the organizations, was a great learning experience for me and helped to inform work locally. My involvement was to help transition care into a new setting, and help maintain the model of care and its focus on the social determinants of health even once the point of access had shifted. It was a precursor to the work of the Health Links, so it was important to learn about how other organizations work and how they fit together for clients.
Q: What do you think makes the community-governed primary care and wellbeing model so compelling? What do you hope policy-makers can learn from the model?
A: Everyone matters. It’s as simple as that. Because it’s truly an interdisciplinary team, CHCs develop programs and services that are very specific to the needs of the community, which is a wonderful thing. The model also allows the community itself to take ownership of their CHC. Over the period of time that Whitewater-Bromley has evolved – and it’s not always easy because not everyone agrees on direction – everyone from board members to volunteers in the community who run exercise programs and other activities have contributed because they believe in the health centre, because they feel safe there. That, to me, is much different from health care being dispensed to someone. The community is an equal partner in the centre and their own care.
The community health centre can also help to support doctors’ offices that stand alone, as well, and other wellness and health organizations. It’s not a competition. It’s more, “We’ve got this service over here at the CHC. Can we help the clients that you have access this, since they wouldn’t be able to otherwise?” The CHC helps give health care a depth, I think, and helps make organizations aware of each other, and what they do.
Q: Any words of wisdom for people working towards a more collaborative and community-driven health system?
A: Sometimes, the system catches up when people see things in action. Certainly now, with the moves the Ministry is making, working on its Patients First plan, it’s adopting the same kind of approach that CHCs have been taking for decades.
I am hopeful. There’s a lot more discussion and awareness amongst the silos of health care. And there’s some really excellent work being done. It may take some time – and they’ll never be a perfect system – but there’s a wider interest in interdisciplinary care, and people striving towards providing the best possible care that they can.
Background: The Joe Leonard award is named after LAMP Community Health Centre’s first Executive Director, Joseph Patrick Leonard. For over 25 years, Joe Leonard touched many lives through his support to others, his leadership, his vision, and his commitment to the community and social justice. He believed passionately in a non-profit, public health care system in which everyone, regardless of their ability to pay, would receive the highest quality of care available. His work significantly contributed to ensuring the public health system was strong and accessible to all. The purpose of this award is to recognize individuals like Joe Leonard who have demonstrated extraordinary leadership, commitment and support for creative solutions for accessible, high quality and affordable health care.