Taking it to the Streets
Dr. Andrea Sereda is providing care for at-risk people through two street-level programs and is advocating for change on how to combat the country's opioid crisis
By Jennifer Parraga, BA'93
"Housing, food and warmth are medicine,” said Dr. Andrea Sereda, HBSc’03, MD’07.
Sitting at a local restaurant just a short walk from her office at the London InterCommunity Health Centre (LIHC), Dr. Sereda is taking a few minutes away from her patients. Her passion for the people she cares for is inspiring. Her concern about the current health care system, and how it is not serving the country’s most vulnerable populations, is a rallying cry.
Dr. Sereda is a physician focused on street-level, at-risk programs. At the LIHC, she works with the hydromorphone Emergency Safer Supply substitution program. Additionally, she also works with Street Level Women at Risk (SLWAR), a program in the community that uses a housing stability approach to assist women who are experiencing homelessness and involved in street-level sex work.
Illuminating her concerns about at-risk people, Dr. Sereda describes the plight of one of her patients.
“Imagine a young girl sold into sex before the age of 10,” she said, pausing. “That young girl lives on the street as a teen, starts selling sex and doing drugs and is at a point of desperation by the time she is 22 years old. Then the system asks that young woman – what’s wrong with you? We abandon so many people in these situations as children, and we don’t take care of them as adults, and through no fault of their own, they have been set up for failure.”
“These are my patients,” she added. “And the current health care system in Canada isn’t serving them.”
Dr. Sereda believes that the structures and processes of the Canadian health care system create barriers and exclude marginalized populations.
“Not only do we not have anything to give them, we actively block them from receiving health care,” she said.
In London, the rise in use of Fentanyl as a street drug in the past three years has exacerbated the negative conditions for many street-involved populations, creating an even bigger challenge and obstacle to providing care.
“We have seen people get really sick and overdose and then get even sicker because of what they have to do to get the drugs,” she said.
Dr. Sereda and the team at LIHC approach care by addressing the patient’s concerns rather than their own. For some, this means providing food, warmth and even legal navigation as a foundation for building trust. Patients can drop into the Centre with no appointments and Dr. Sereda regularly goes out into the street and shelters so she can provide care where her patients are.
Born and raised in Aylmer, Dr. Sereda, the eldest of three children, says that her family was very social justice oriented, which has had a lasting influence on her. Completing her undergraduate and medical education studies at Schulich Medicine & Dentistry kept her focused on the local community and provided continuity to her engagement with the Withdrawal Management Centre.
She’s forever grateful to her brother who made a connection to the Withdrawal Management Centre for her during her fourth year when she was looking for a part-time job. It was her first exposure to the experiences of those people in London who were living with substance abuse and it sparked an interest in her.
Soon after, Dr. Sereda found herself seeking out mentors who were social justice advocates and they, in turn, inspired her to look at social and health issues with less of a medical lens and more of a patient-focused lens.
Dr. Anne Bodkin was one of those mentors. Dr. Bodkin was a family physician working at the LIHC who partnered with London police sergeant Lorna Bruce to provide care to women in the street-level sex trade. It complemented a program to support persons at risk that Bruce had established years before in response to the Robert Picton murder case in British Columbia.
“We are seeing people come back into themselves and enjoying their humanity.” — Dr. Andrea Sereda
When Dr. Bodkin retired from her position at the LIHC, she recommended Dr. Sereda. That was three-and-a-half years ago. Since that time, Dr. Sereda has continued to advance Dr. Bodkin’s work and is beginning to see results.
SLWAR has been in operation for three-and-a-half years, and in that time, the group has been able to house 50 of the 150 women who are part of the program – a profound accomplishment in addressing chronic homelessness.
“We have women who were living on the street injecting drugs, now housed and taking care of their children,” said Dr. Sereda.
The Safer Supply Program through the LIHC is where Dr. Sereda feels she is really making a major medical difference. Through the Program, she works with about 100 patients receiving oral opiates. According to Dr. Sereda, the changes have been profound. The Program has seen women give up sex work and men give up crimes; they’ve housed about 50 per cent of the people who were chronically homeless and have patients who had never been to a doctor before now coming to the LIHC weekly.
“We are seeing people come back into themselves and enjoying their humanity,” she said.
In 2018, Dr. Sereda was named one of Canada’s Top 40 Under 40, as well as one of London, Ontario’s Top 20 Under 40 for her work in the community.
Humble about the awards, Dr. Sereda is most touched that the national award came as a result of a nomination from a medical student who she had worked with at the LIHC.
She’s also grateful that the awards were able to provide her with provincial and national connections with harm-reduction networks so that she can advance the work she is doing, influence policy and hopefully bring change to the health care system.
Recently, Dr. Sereda joined forces with three other Canadian advocates to raise awareness about safer supply programs. They collaborated on an opinion piece in Healthy Debate and engaged with national media to appeal to their physician colleagues to consider prescribing alternatives for people.
Turning her attention to her medical colleagues, Dr. Sereda hopes physicians begin to truly appreciate that substance use is not a moral failing or a choice; it usually is a completely reasonable adaptation to certain circumstances.
“We have an entire group of patients who aren’t meeting their potential but could if we are willing to do things differently. The responsibility for those changes can’t be on the individuals who are marginalized and stigmatized. The responsibility has to be on people of privilege who are doctors and have them respond to the issues differently so that it can help patients,” she said.
Despite feeling overwhelmed and tired at times, Dr. Sereda only has to see one of her patients looking healthy and feeling secure to stay motivated.
“I love what I do, and I’m proud of what we have accomplished in a short period of time,” she said.