Dr. Stu Skinner & Mobile Medicine: Halting Syphilis & HIV

Stuart Skinner (MD) knew something was wrong three years ago, when patients started coming to him with vision loss, fever, rashes, and meningitis.

Almost every case could be traced back to untreated syphilis — a sexually transmitted infection with caseloads exploding 1,200 per cent from 2017.  Saskatchewan saw this spike just as Covid-19 entered the picture.

“With the pandemic, testing dropped dramatically,” Skinner said, noting this wave of syphilis entered north-western Saskatchewan from Alberta, often travelling alongside HIV. Syphilis often spreads through sores, and can remain unnoticed for months or years on end, making early detection difficult.

“If you don’t see it, you won’t be seeking care for it."

 

When the infectious diseases physician and the Wellness Wheel team began treating mothers with severely ill newborns, stillbirths and birth defects, Skinner knew he had to act. Treating syphilis usually means a series of clinic and laboratory appointments, followed by intramuscular Bicillin injections, and intense contact tracing.

Instead, Skinner, Dr. Sean Rourke, Cara Spence and their teams pared that down to a one-hour stop.

They approached tribal councils and Indigenous-led health organizations, asking for help setting up mobile locations where anyone could be tested, diagnosed, and offered treatment. 

Nursing teams drove vans to powwows, festivals, even pharmacies, offering quick, confidential finger-prick tests and results.

“The whole concept was to be flexible and mobile and adaptable . . . . so that we weren't the barrier,” said Skinner. “It wasn't easy for the nurses to set up and read the results or draw the blood in a less comfortable environment, but they did an amazing job.”

 

In Saskatchewan, a total of 1,797 people agreed to be tested, uptake Skinner calls ‘phenomenal’. Roughly three per cent were infected with HIV; 16% had syphilis.

“The majority were willing to get treated right then and there,” Skinner said.

Those teams have now visited more than 50 locations across the prairies, through a $4M national partnership called the ‘Ayaangwaamiziwin’ Centre — which translates to ‘be careful, be prepared’ in Anishinaabe. Health officials and private donors recently extended those grants for an additional year.

Skinner's colleagues keep fielding requests for the point-of-care service, which in turn has created a network of trusted Indigenous health leaders. This web, he said, could create the backbone of targeted outreach and screening for other diseases, such as diabetes or cancer.

 

But it only works with mutual respect, he warned.

“This isn't going to First Nations just to help them,” Skinner said. “I've learned so much from the cultural values that are built on what happens in First Nations. We have a lot to learn."

Skinner said mutual respect also means predictable paycheques — not just the odd grant.

He said health budgets need to pay for health promotion workers employed at Indigenous-run organizations and non-profits, the ones who stick around after the testing van leaves. Patients are more likely to stay in touch with familiar faces and staff, he said.

“It’s about respect, kindness, and building trust,” he said. “That is really critical.”