Demonstrations demand public funding to keep 'doctor-less' Quebec clinic from closing its doors

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On Sunday, May 8, approximately 150 people marched to the Assemblée Nationale in Quebec to save the the Cooperative de solidarité SABSA (service à bas seuil d'accessibilité). Sunday's demonstration forms part of an ongoing effort to save the clinic from closing its doors due to lack of funding.

The SABSA clinic is a not-for-profit, "doctor-less" clinic that serves over 1,500 people free of charge in the neighbourhood of St. Roch in Quebec City. In December 2011, five founding members opened the clinic to address the growing and unmet needs of vulnerable populations living with HIV and Hepatitis C.

Since 2011, the clinic has expanded its services to address the health care needs of the area. In 2014, the Fédération Interprofessionnelle de la Santé du Québec (FIQ) started funding the clinic as a pilot project to provide a clinic close to area residents. The FIQ's funding expanded SABSA's capabilities to include walk-in appointments with a nurse practitioner specializing in primary care.

Isabelle Têtu, the clinic's nurse practitioner, is able to receive patients with any condition and of all ages. A team of Université de Montréal researchers studied the clinic between October 2014 and June 2015. The researchers found that a total of 750 patients entered the clinic for 1,700 visits, and SABSA's nurse practitioners were able to deliver complete care in 80 per cent of the cases. Since 2014, a total of 1,500 patients visited the clinic for a total of 4,880 visits.

The clinic currently faces an uphill battle: the FIQ's funding ran out on May 1, and the provincial government has refused to step in.

"The FIQ cannot replace the health department," the FIQ spokesperson Manuel Dionne told the Montreal Gazette. Quebec's Health Minister Gaétan Barrette will not finance the clinic unless it is integrated into a regular family medicine group. The clinic cannot be integrated into the health care system because clinics and family medicine groups need to include doctors. Minister Barrette did not immediately respond to's request for comment.

Maureen Guthrie, a nurse who works at the SABSA clinic, told the Gazette that many of SABSA's patients do not have access to clinics and family doctors integrated into the health care system because they are IV drug users. Guthrie described how the clinic also serves an increasing number of patients who are not able to receive care from family doctors.

With an average cost per visit of around $68 (patients are not charged), the clinic saves the government around $120,000 per year. The Université de Montréal research concluded that the clinic is both innovative and efficient. The clinic combines quick consultation practices and walk-in appointments with an offer of a follow up appointment.

Geneviève Martel, one of the clinic's patients, moved to Quebec City two and a half years ago, and had trouble finding a doctor. "I couldn't find a doctor. I was on a waiting list. They told me that it could take up to five years," Martel told the CBC. In the meantime, she was taken as a patient at SABSA.

The Quebec government has committed to training 2,000 new speciality nurse practitioners. "I cannot see the interest in studying to become a SNP if the government is refusing to give them the chance to practice in complete autonomy in the public sector. Unless, of course, the objective is to push them towards private practice," wrote Régine Laurent, president of the FIQ, in a recent blog post.

SABSA is currently working to fundraise $250,000 so the clinic can continue to provide services to the neighbourhood, and is exploring ways in which the clinic's model can be integrated into the current system.

Sophia Reuss is a Montreal-based writer, editor, and is a recent graduate of McGill University. She's interested in how online media and journalism facilitate public accessibility and conversation. Sophia also writes and edits for the Alternatives International Journal. She is the news intern.

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