When the Medical Officer of Health for Haldimand and Norfolk called her on a Saturday morning last spring as COVID-19 outbreaks were overtaking many Ontario farms, Robin Mackie, a registered nurse and executive director of Delhi Family Health Team, didn't hesitate for a moment.
"I said, 'OK, what do you need?' and Dr. [Shanker] Nesathurai said, 'We need you guys in the field, can you go out and do this?' I thought he meant Monday, but then he asked, "Can you get out there today? We need to flatten the curve as much as we can."
Mackie, who herself had battled a serious COVID-19 infection that resulted in a transfer to hospital in March, said it clicked in her head in a split second, given the barriers that seasonal agricultural workers face in terms of language, access, housing and co-morbidities.
"Even though we have a seasonal agricultural program (to serve workers in need of primary care, the FHT operates a clinic serving 3,300 workers), it’s very dependent on the workers getting to us. With this virus, and its ability to spread so quickly, how were the farm workers going to get to us safely?" Mackie explained in a recent interview with the Alliance. "When Dr. Nesathurai suggested going to the farms, the first thing I thought was, 'That’s a fantastic idea. Bring health care to them.' I didn’t even think of the logistics of how we were going to do it. I just knew that we were going to do it. Honestly, there was no option."
In the next few hours, Mackie called her team and assembled a plan. One thing there was never any doubt about was the dedication of the Delhi Family Health Team doctors, nurses and other staff.
"I knew that my team was that good, that they were that prepared, and I knew that they were that dedicated," Mackie said. "So I put out a call saying, 'I have no idea how we’re going to do this, but this community needs us. This vulnerable population needs us.' And my team just said, 'Where do you want us, and when?' "
Within hours, Mackie had gathered a team of two doctors and four nurses with PPE and they headed to the farm’s bunkhouses. Later, efficiencies were created by utilizing medical directives, onsite Nurse Practitioners, translators and nurses who often traveled to multiple bunkhouses by way of their own a pickup truck. In the coming weeks, staff relied on interpreters and translation apps to assess the needs of the farm workers. Their work encompassed physical screening, testing, assessment, and treatment of workers -- but also went beyond those public health imperatives.
The Delhi team would conduct 673 "in the field" visits on the farm in 30 days, with Mackie noting that she remained on call for her team, which often spanned 12-14 hours with some evenings in June until 10 p.m. Together with strong, trusted community partners from the Canadian Mental Health Association, Grand River CHC, and community parademics, along with public health, the core Primary Care Mobile Response Team led by Delhi FHT was able to put in place supports and interventions to help prevent outbreaks, serious illness and hospitalizations. Over time, the workers opened up to staff about more than just medical concerns -- also speaking of missing families and children, their fears about money and health. One evening, 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 said.
The nurses “were the heroes here,” said 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., “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.”
Earlier this month, the Association of Family Health Teams of Ontario recognized and honoured this amazing group and their partners with its highest honour, a Bright Lights Award. The recognition means a lot to Mackie, not just as a health leader, but also for her team and team-based health care in general.
"Team-based care has always been behind the scenes doing work and we don’t seem to be noticed, and we’re kind of a humble group. We know what the right thing to do is, and we do it," Mackie said. "This award isn’t about ourselves, it’s about our community. And it’s about recognizing how well team-based care can work."
Mackie also credits the community governance at the Delhi Family Health Team for their trust and support of her leadership and staff, and being an important enabler of the nimble response for farm workers.
"For our board, their gut response is always to support community. They trust me to do what’s right for the people we serve and our broader community."