In Crisis? 
When I think about our teen clinics at Klinic I think, this is how it started. It was changing youth culture and needs that drove the early days of Klinic, as you can read about in a previous guest post by Dr. Mike Dillon , and it is still a key component of Klinic services.
Every Monday evening is Teen Klinic from 4-8pm; in addition we offer a clinic at Tech Voc High School on Wednesdays. Last Monday I spent the evening shadowing in our Teen Klinic, and had the opportunity to see firsthand the work that is happening.
I start off with Kim, the primary care nurse assigned to Teen Klinic, to talk a little about what the average Monday looks like (average is maybe too generous), then we head up front to see how the night is lining up. What is immediately apparent at 3:55pm is that there is a lineup of young people checking in and the front desk is very busy. I chat for a bit with Kris, our floor medical assistant, as she starts assigning rooms to practitioners and quickly loading patients in. There are 4 possibilities for anyone attending the clinic, and they may see one, two or all of the possible options, depending on their needs. Though the vast majority of clients are here for sexual and reproductive health services, like birth control or STI testing, we also will address other primary health concerns.
The clinic is staffed by:
- A volunteer trained to talk about birth control options and offer pregnancy testing for anyone requiring it (tonight it is Mandy who is a newer volunteer). These volunteers are trained centrally to work at teen clinics throughout Winnipeg offered by many partners.
- A nurse (Kim) who can do a wide variety of things including birth control starts and refills, pregnancy and STI testing, and general assessment of issues.
- A physician (tonight is Dr. Chris Buchel) who will address any needs that would require physician support.
- A social worker (Jenny) who can address any life crisis or social issues occurring.
I start out my shadowing with Kim, our nurse, and a young woman who is looking for a refill on her birth control started last month by Dr. Buchel. Kim is efficient and accessible; she is able to get a wide variety of information from the young woman and establish that there are possible reasons to also talk to Dr. Buchel, so, off we go to Dr. Buchel. We take a quick stop by the med room to pick up some of the low-cost birth control we keep in stock. While Kim and Dr. Buchel have further discussions with the client, I join Mandy, the volunteer, in a meeting with another young woman who is here for a pregnancy test. I am impressed with the amount of information Mandy is able to share with this client- whom I am going to call Joan*, while she discusses the reasons she thinks she may be pregnant. This is her first visit to Klinic.
Joan* wraps up with Mandy and is armed with a whole host of birth control information, a sample cup for her pregnancy test, and some free condoms. After her sample is tested she will meet with Kim for the results. While Joan* is waiting, I follow Kris for a bit as we do rounds in the rooms. There is a constant need for room cleaning and change over; at Teen Klinic practitioners are usually working with two rooms at a time, one for the current patient and one for the next. As Kris finishes cleaning one of Dr. Buchel’s rooms, I join Dr. Buchel and her next patient who is concerned about a possible bacterial infection. In this visit I learn two valuable things about our clinic:
- Young women are able to take a swab and self-swab in the bathroom and return it if they do not feel like being examined- this is an incredibly trauma-informed way to practice.
- Klinic Lab techs are one of the few labs where the techs are certified to and have the equipment to examine swabs under microscopes to diagnose immediately things like bacterial vaginosis, yeast, and possibly trichomoniasis.
While swabs are being taken and examined I rejoin Joan* on her journey through Klinic, now seeing Kim, our nurse. Joan* is not pregnant. She has recently been released from her primary care physician who was a pediatrician, and she has several physical complaints that cause her stress and have not been diagnosed. It is evident after some discussion with Kim that Joan* will also be seeing Dr. Buchel tonight. I chat with Joan* as she waits to see the doctor and she shares that she never thought coming here for a pregnancy test would lead to such a comprehensive assessment, and she is very grateful.
Colleen Warkentin, Lab Technologist
Kris Froese, Medical Assistant
As Joan* moves on to see Dr. Buchel, I rejoin the front desk to get a status update and talk for a bit about what they encounter over the course of the evening. One of the biggest challenges is the amount of young people who do not have their Manitoba health card or know their number, a great deal of time can be spent trying to track them down in the E Chart system, though this is a vast improvement from before E Chart where this would be impossible. It is 7pm and there are about 4 people still in the waiting room, and another 4 in the back. A Monday clinic can average 20-30 patients; tonight we will be closer to 20, which is good considering some of the complexities we have seen.
As I do my rounds checking in and prepare to call it a night I note that Joan* is still in with the doc, and I feel an enormous sense of relief and gratitude that I know someone is making sure she feels heard and is getting the care that she needs. I have no doubt we will be seeing Joan* again.
*Names have been changed