Bridging the Gap

A Q&A with OneBridge founder Sonia Martin 

 Brita Frost, Primary Times writer 

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Sonia Martin is a fervent advocate for health care that listens, championing a health care model that prioritises the complex social needs of the people she cares for. She established the street outreach health service OneBridge in 2023. The organisation provides much needed health care to people experiencing vulnerability in her local community in Queensland. The organisation now operates nationally, providing nurse-led care to priority populations unable or unwilling to access conventional health care.  

 

How did you come to establish OneBridge?  

In 2017, I was working in the public hospital system as a nurse unit manager and running a complex discharge coordination service across five hospitals. There were around 30 clinical nurses that I worked with. Across the hospitals, there were almost 700 people in 6 months who were discharged to unknown destinations or were experiencing homelessness. After a while, I started to notice that some of these people were re-presenting without an acute or emergency reason to attend an emergency department. Some people just wanted someone to talk to. Some enjoyed the bustle around them because they felt a little bit more connected. Some people wanted somewhere to sleep. 

One evening, I went to a palliative care fundraiser for the Queensland Hospital and Health Services. They showed a movie about a doctor in India who was supporting homeless people. He was working in a normal clinic but on his way to work he kept stepping over people dying in the streets. Eventually he decided to care for them. It was an incredible movie. It ended with that Martin Luther King Jr quote, ‘Life’s most persistent and urgent question is, “What are you doing for others?”’ At the end of the movie I thought, ‘I'm going to have to resign.’ 

I've worked in the public and private sector. I've worked in aged care and community. I've been a relationship-based nurse my whole life. I thought, ‘I can do this.’ I gave five weeks’ notice and then I went out on the streets. I made a nursing kit and started working out the back of a car boot. 

Can you describe a typical day in your role as founder and executive director of OneBridge?  

I have a mix of responsibilities, but I always attend a clinic on Monday mornings in the local area. It’s very grounding for me. I didn't want to be in the position where I moved up in the organisation and lost touch with the human voice and experience. On Mondays, I'm at a local clinic by 7:00am.  

It’s often very cold, especially through winter. Foot equity and foot health is a significant issue, so I might turn up with a load of socks. We carry a backpack with our diagnostic equipment and a lot of wound care products.  

We often come across wound infections. Typically, people get infected wounds because they can't access GP clinics. In the town where I live, there are no bulk-billing GPs. But people also need to trust the person they're going to see. Sometimes they haven't showered for months, so it’s a dignity issue and people feel embarrassed and shame about the infected wound.  

At OneBridge, we are a justice-based health service that takes into consideration people’s needs. We look at the barriers. We can hand out a prescription, but we also ask, ‘Can you afford it? Can you make it to the pharmacy?’ The pharmacy might be 200 metres down the road, but people prioritise their day differently.  

We sit with people who feel invisible and who don't have access. We go into parks, under bridges and we have street outreach teams that are walking in the community. We're in social housing spaces where people have had years, sometimes decades, of living on the streets and consequently carry poverty-based trauma in their minds and bodies. It can take a long time to work through that. And we work with families living in motels and specialist homeless services.  

How do you collaborate with other healthcare professionals to provide comprehensive team-based care for your patients?  

OneBridge is nurse-founded and we have front-facing registered nurses and enrolled nurses. If we reach the limit of our scope and specialised skills, we have access to nurse practitioners who provide support around skin cancer and diabetes, and we access local bulk-billing GPs, Medicare mental health centres, and urgent care centres. 

Whenever we start in a new region, we set up a process called Community Mapping. We look at equity-based services in the community. For example, we look for GPs who bulk bill, have a level of compassion and are willing to take some time with another human. We look at other nurse practitioners in the region, as well as psychologists who don’t require referrals and who are willing to support OneBridge. We also look for sexual health clinics and for clinics who will remove skin cancers. 

What are the most challenging aspects of your role?  

From an organisational perspective, the lack of grassroots funding. I don't think the government has invested enough in nurse-led services for priority populations. There are services doing incredible work that are volunteer led, but priority populations and people experiencing vulnerability should not have to rely on volunteers for their health care. The government needs to invest in these spaces. Nurses need to be paid in these roles. Asking health professionals to have a part-time or full-time role and then volunteer their time in complex spaces leads to burnout. It's not a sustainable solution.  

We are trying to get people access to health care that doesn't cost them anything and isn't too intrusive. Currently there are too many assessments. We're asking people all these questions and they’re exhausted and they just need help. So that's challenging for me. I find the system challenging. It’s why I created OneBridge. I wanted to create a sustainable service where nurses are paid above award rates with strong clinical and operational governance.  

What are the most rewarding aspects of your role?  

It’s simple. It’s seeing people come out of cycles of vulnerability. There’s one woman who’s been sleeping under a bridge for a long time and who has recently started working. Sometimes she gets sick and we don't see her for a while so we link in with her. People just need to know that someone's looking out for them. The other day she turned up to her work shift a little bit late and we were anxious that she may not attend, but when she arrived, she said, ‘I'm so sorry I'm late.’ And then, joking, ‘I slept through my alarm.’ She's living under a bridge; she's doing the best she can with what she has. And she turns up in a uniform and starts serving coffee and tea to people.  

And it’s the simple things that OneBridge nurses do. Quite often it’s as simple as holding space and letting someone know that they matter and they're valued. It’s letting someone take up space in the world, hearing that they feel better because of that and that they feel like they have value. 

Is there any specific training that is essential for your role as a street health nurse?  

I've been a registered nurse for 30 years. I have primarily worked in aged care and community care. I've run private enterprises before. And I've worked in the public health sector as a registered nurse, a clinical nurse, a nurse educator, a nurse facilitator and a nurse unit manager. When I began this, I didn't have street health skills in Australia. It's not even known as a street health sector in Australia. It's not even known as a sector.  

I was counting on my community nursing skills and that I was a relationship-based nurse. But when I started, I was naive. I thought people would like the biomedical model. As nurses, we love to clinically assess and provide interventions and evaluations and we're awesome at it. But that’s not what the community wants. What they want is to be heard. They want to take up space. They want to tell their story and they want to try and make sense of the trauma in their life. So, the model had to shift quickly from a health service to a health and social service.  

We upskill because it's what community needs. We started the Hep C program because we had so many people walk in and ask us if we do Hep C testing. The questions for me then, as organisation director, are: ‘What's the scope? What's the legal scope with the nurses? What's the scope for nurse practitioners?’  

What advice would you give to nurses who are considering a career change? 

If you are interested in working with people experiencing vulnerability, I suggest you start doing research. Look at what's happening in your local region. At OneBridge, we are looking for nurses with a desire to learn or with skills in mental health and drug and alcohol support. We also look for nurses who have previous experience working with vulnerable populations, the capacity to problem solve and navigate equity-based health pathways in community, as well as a strong understanding of the social determinants of health and the impact that these have on a person's life and health outcomes. Ultimately, it's all about best practice. If you are looking to move into this and seeking out groups and organisations that hold the values of the people they care for at the core of what they do, find a tribe that's doing it well and link in with them. Also make sure you know what the peak nursing bodies are doing in this space as well so you're in alignment. 

To learn more about OneBridge, go to www.onebridge.com.au. 

More about Sonia Martin 

As a recipient of the Dr Dorothea Sandars and Irene Lee Churchill Fellowship in 2022, Sonia's global travels to India, France, Italy, the UK, the USA, and Canada in 2023 furthered her commitment to improving access to primary health care and palliative care for people facing homelessness and poverty. Sonia's ground-breaking work has earned her the 2022 Outstanding Leadership Award in Entrepreneurship, the 2021 Australian Health Minister's Nursing Trailblazer Award and Sonia was nominated for Australian of the Year in 2020 and 2022.  

Taking observations in a driveway