I’m surprised at my own awkwardness at the Sexual Health Centre. It feels like a tongue twister to say what I’m there for: STI testing. I get a clipboard, a form and turn around and walk into the branches of a potted plant.
Whoops. I must be more anxious than I realize. I feel like I’ve managed my sexual health risks well in the past, but that doesn’t mean I’m not freaked out.
The average age in the clinic waiting room appears to be about 18. They’re mostly women, many teens, reflecting the fact that the clinic also administers birth control without seeing a family doctor. Nearly everyone waiting has brought a friend or a lover — another hint that this is a stressful experience.
The anxiety caused by STI testing creates a barrier to accessing sexual health services. It highlights a simple fact: if ever there was a health service that should be administered quickly in a comfortable environment, it should be this one. I’ve brought a coffee and some light reading, sunglasses, a snack; I’m prepared for the wait.
Others seem not so prepared to hang around the Clarence St clinic. A tall woman, 18ish, fumbles through the pockets of her knit sweater for a tissue. I overhear her ask the receptionist how much longer it’ll be, explaining she’s scheduled to work, explaining that she didn’t know it would take so long. She’s nervous, not demanding, and she follows the receptionist’s advice to wait a little longer.
A second woman, more assertive, complains that she has to move her car every hour to avoid getting ticketed and asks if she will lose her place in the queue. It’s already been two hours, have they called her while she was out? She asks if she should come back when it’s quieter, but the receptionist tells her that this is as quiet as the clinic gets — a Wednesday afternoon.
Eventually, after a lot of hand wringing in both cases, the women leave without seeing a doctor. One of them promises to come back when she’s got more time. I end up spending over four hours at the clinic that afternoon.
“There’s a capacity issue, there’s definitely a staffing issue,” admits the clinic’s manager Orhan Hassan. “That’s a fair comment.”
There’s no doubt that the clinic is in crisis mode. The city website has posted a public notice to would-be clients:
“We regret to inform visitors to the Sexual Health Centre that they may experience difficulty in accessing our walk-in services on certain days, due to high service demands. Some visitors may be asked to access services on an alternate day or book an appointment,” it reads.
“We’ve had to introduce a capacity [protocol] when we reach a certain point in the number of persons coming through our door, based on how many people we can see. We have to triage anyone coming in afterwards,” Hassan says.
By triage, he means nurses apply a crude litmus test — a slightly more sophisticated version of Is there discharge? No? Come back later or book an appointment — which puts the community at risk of new infections.
Research coming out of McGill university suggests that half of new infections of HIV are caused by people who don’t yet know they are carrying the virus. And now, with syphilis on the rise among gay men, the city and the province have to face facts: It’s time for the public health system to build more clinics.
“I think the city can handle it. I think they can handle three more clinics,” says Hassan.
Hassan points out that 70 percent of those who use the service live within 10 kilometres of the Clarence Street site. They handle 13,000 visits a year.
“It does sort of beg the question: where do people in the rest of the city go?” he says.
I tried to book an appointment before taking the drop-in route. There were no available spots in the next month, which is typical. The receptionist asked me if I was “symptomatic”; if I were, I should use the drop-in. If not, I should consider booking an appointment or using my family doctor or walk-in clinic unless I’m worried about an appointment.
A month-long wait before an appointment plus three weeks waiting for results: who has the willpower to wait almost eight weeks when the urge strikes?
But the clinic is the only place in the city that offers key services like anonymous HIV testing. In fact, the clinic doesn’t ask for your health card, making it a crucial resource for both illegal immigrants and those who don’t want their sexual histories to appear in their family doctor’s database. Anonymous testing is a service that the harried staff haven’t always been upfront about offering because it’s a little more paperwork, but there’s no check on whether you’ve given your real name at any point in the process.
That’s not the only advantage. While walk-in clinics (like the one attached to the University Of Ottawa) offer STI testing, doctors elsewhere are more likely to use bloodwork and urine samples. The Sexual Health Clinic uses the more thorough — if less comfortable — method of swabbing the mouth, urethra and anus in addition to blood and urine testing.
There may be ways to streamline service — by reducing the length of the one-on-one interview with the nurse, for instance; at 25 minutes, it takes more than twice the time required at similar clinics in Toronto and Vancouver.
But gathering the political willpower to install more clinics in Ottawa is likely to be tougher work.
That’s because Eastern Ontario is the most under-funded part of the province when it comes to public health. Ottawa is also suffering from a doctor shortage — a problem in itself — which puts additional pressures on walk-in clinics in general and the Sexual Health Centre in particular. Public health is funded by a combination of city and provincial dollars; so scoring a new centre isn’t as simple as lobbying the province.
For now, Hassan and his staff are making do with the resources they have. They run rotating sexual health clinics in Ottawa high schools, giving teens access to services that might be too far away for them otherwise. Hassan, in cooperation with the University Of Ottawa and gay men’s health groups, has vamped up satellite sites.
The latest initiative is a self-serve urine drop off at Ottawa’s bathhouses. It’s something Hassan hopes to do more of in the future.