Meet Hannah. “In high school, I was the kid who had condoms in her locker to give out to her friends.”
She didn’t stop there. After years as a public health nurse and sexual assault nurse examiner, Hannah is now settling into her role as a Nurse Practitioner at Fraser Health’s Embrace Clinic. Embrace Clinic is a new mobile outreach clinic for recent survivors of domestic violence, sexual assault and other forms of violence.
“Follow-up care is critical.” Hannah explains, “The medical care that a woman receives after an assault can affect her long-term health and prevent chronic medical conditions. When a woman is sexually assaulted and goes to the emergency room for a forensic exam, it’s often too early to test for certain sexually transmitted infections. Medical attention is needed in the following days and weeks to care for resulting injuries.”
Yet for many women and girls, their medical care ends when they leave the hospital.
Many patients were going to regular healthcare providers who weren’t used to working with survivors of violence. “The sensitivity wasn’t really there,” Hannah explains, “patients felt forced to have an exam, or felt forced to have tests they didn’t want, or forced to re-tell their story when they didn’t feel comfortable doing so.” The result was that women left feeling judged, and weren’t getting the care they needed.
At Embrace Clinic, Hannah does what she’s been doing for years: making health accessible to those who need it the most. “We know that it’s not always easy to get to a location,” Hannah explains, “so we connect with our patients in a location that’s safe for them.” The clinic’s first location is at Surrey Women’s Centre, and the program will soon expand throughout the community so that women can get help in spaces that are safe and convenient for them.
Hannah recognizes that access to healthcare is about much more than location:
“As a Nurse Practitioner, I really focus on a holistic approach to working with patients. So integrating what we call the social determinants of health, which are things like housing. Do they have access to food? Education? Clean water? Are they living in poverty? Do they have safe housing? All of these things really affect the ability to be healthy and to make healthy choices.” Hannah says. “if somebody doesn’t have access to food and I recommend an antibiotic that has to be taken with food, then we have to consider another option and connect her with the appropriate community resources.”
For patients who have experienced violence, these added barriers are more complex. Hannah explains that it’s not just about her immediate health, it is also about her safety. This might mean finding her a new pharmacist so that her partner can’t find her or withhold her medication.
Hannah empowers her patients by using a trauma-informed approach:
“It’s about choice. Approaching a patient from a place of understanding and non-judgment. One thing that I personally do is, I pay a lot of attention to my language. So, for example, if she allows me to do a pelvic exam…the language that I use can be so powerful, positively or negatively. So first of all, I ask permission to touch…I tell every patient before a pelvic exam that if she wants me to stop, I will stop. There is nothing so serious that if she wants me to stop, I wouldn’t stop. Otherwise I’m assaulting her all over again. This is true of every patient I see, whether I know of a history of violence or not.”
Following her patient’s lead, Hannah says, “we give the power back. Anyone can learn the skill, it is the approach that matters.”