Primary Focus with Dr. Tara Kiran

In this episode, Dr. Tara Kiran travels to Durham, Ontario, to visit the Durham Community Health Centre, where CEO Francis Garwe leads a team rethinking what primary care can look like when it is truly rooted in community. Touring a repurposed public school that now houses a wide range of services—from mental health counseling and a regional diabetes team to food security programs, youth programming, and community gardens—Tara sees firsthand how Durham CHC addresses the social determinants of health alongside clinical care. She then sits down with Francis Garwe, Dr. Akeem Stewart, and Dr. Kirk Stewart to discuss how the centre is advancing Black health through initiatives like the Kliniki clinic and a community ambassador model designed to build trust and improve access. Together they explore what it takes to co-create programs with the communities they serve—and what other clinics in Canada might learn from Durham’s approach to equity-driven primary care.
Donate to Durham CHC
Durham CHC relies on private donations, grants, and other sources to fund some of the important services they offer that address social determinants of health. To support the Durham Community Health Centre’s innovative work, visit their website at www.durhamchc.ca.
Podcasthon
Primary Focus is proud to take part in Podcasthon, the world’s largest charity podcast event! We were tasked with creating an episode dedicated to supporting a charity or non-profit that truly matters to us, and we chose Durham CHC. Podcasthon brings together podcasters globally to raise awareness for important causes - without any money involved. It’s all about uniting voices to make an impact, with more than 1,000 podcasts highlighting a charity of their choice. Listen to more episodes as part of Podcasthon here. 
Research and programs mentioned in this episode
Get more information on the Durham Community Health Centre. 
Learn more about Ontario Health’s Black Health Plan, informed by the work done by Francis Garwe and the Durham CHC
Find out about the Black Health Committee, a committee for the Alliance for Healthier Communities
Visit the Black Physicians Association of Ontario website to learn more about their work on Black health
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.
Listen to other episodes of Primary Focus in our series on community-driven health equity clinics:
In Costa Rica: How a middle-income country built a world-class primary care systemIn Costa Rica: integrating public health and primary careIn Vancouver: A Clinic Accountable to the Community It Serves
More about Primary Focus:
Subscribe to our Substack newsletter
Have an idea for an episode? Email [email protected]
Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 
Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

For many newcomers to Canada, accessing healthcare isn’t just about finding a doctor. It’s about navigating an unfamiliar system, in a new language, often without the safety net of family or community. Appointments, referrals, and forms can become barriers rather than pathways.
Too often, people fall through the cracks not because they don’t need care – but because the system isn’t built with them in mind.
Today on Primary Focus, I take you on a tour of the Umbrella Multicultural Health Co-op Clinic in Vancouver, BC. At Umbrella, primary care didn’t start with a funding envelope or a policy directive… it started with community members (many of them newcomers to Canada) organizing around a simple truth: the system wasn’t meeting their needs.
They started with a mobile clinic for migrant farm workers, and eventually expanded into a community health centre that now provides longitudinal primary care, mental health support, and help with social needs — all grounded in a cooperative model where community members have real governance power.
In this episode, we are focusing on their use of a unique role: the cross-cultural health broker.
What is a cross-cultural health broker?
A cross-cultural health broker is a member of a primary care team at Umbrella who helps bridge the gap between patients and the healthcare system by combining language interpretation, cultural understanding, and system navigation.
Unlike an interpreter, a cross-cultural health broker:
🌐 Shares language and cultural background with the patient (currently Umbrella has brokers who speak Spanish, Arabic, Tigrinya and Farsi/Dari/Pashto)📋 Helps patients prepare for appointments, understand diagnoses and treatment plans, and follow through on next steps🧭 Supports navigation outside the clinic; labs, pharmacies, referrals, transportation, benefits, and paperwork⁉️ Flags cultural misunderstandings that could affect care and helps clinicians adjust how questions are asked or care is delivered
In short, a cross-cultural health broker doesn’t just translate words… they translate context, helping patients feel understood and helping care actually happen.
A conversation about equity — and trade-offs
In this episode, I sit down with Dr. Mei-ling Wiedmeyer, a family physician and Umbrella’s clinical lead.
We talk honestly about what it takes to make this model work — including the very real tension around resources. Here’s a sneak peak of Mei-ling’s powerful response to my question about whether this model they’ve created is scalable:
Why this episode matters
Umbrella is a powerful example of what can happen when primary care is built with community and truly accountable to meeting the community’s needs. It’s an inspiring model of how we can close gaps in health equity through high-quality health care for those too often left behind.
Here are some photos I took of the Umbrella clinic during my visit:
A small ask (that really helps)
If you are enjoying Primary Focus and think the ideas we discuss are worth sharing, here are 4 ways you can support the podcast:
* Forward this email to one person who cares about improving our primary care system
* Share your favourite episode with a friend or colleague
* Hit follow on your favourite podcast app so new episodes show up automatically
* Leave us a review on Apple Podcasts - it truly does help us get more exposure.
Thank you for listening.
With gratitude,Tara


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

In this episode, Tara speaks with Dr. Nicole Boutilier, Executive Vice President of Medicine and Clinical Operations at the Nova Scotia Health Authority —  a family doctor leading primary care transformation from within the government. Dr. Boutilier walks Tara through Nova Scotia’s multi-pronged plan to improve primary care access: transforming the province’s centralized waitlist into an active patient management tool, building and strengthening Health Homes (team-based primary care clinics), creating pathways for people without a family doctor to access care while they wait, and modernizing how data flows — so patients can access and share their own health information through the YourHealthNS app.
Research and programs mentioned in this episode
Read the OurCare reports from the Provincial Priorities Panels (including Nova Scotia’s).
Find out more about Nova Scotia’s Need a Family Practice Registry and Health Homes model.
Get more info on Nova Scotia’s Longitudinal Family Medicine (LFM) physician payment model.
Watch a video about how the YourHealthNS app gives patients access to their health data.
Learn more about Nova Scotia’s new pathways for integrating internationally-trained medical graduates and the new Cape Breton Medical Campus training rural family doctors.
Dive into the research on virtual care in Canada.
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:
Subscribe to our Substack newsletter
Visit our website at primaryfocus.ca
Learn about the OurCare Standard
Do you have an idea for an episode? Email [email protected]
Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 
Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

In Part Two of our Costa Rica series, Dr. Tara Kiran takes you inside an EBAIS (Equipos Básicos de Atención Integral de Salud) clinic on the Nicoya Peninsula in Costa Rica to see what it actually looks like to deliver primary care beyond clinic walls. Costa Rica organizes primary care around geography. Each clinic is accountable for a defined population — and community health workers play a central role in making sure no one is missed. They visit households, provide education on prevention and chronic condition management, deliver vaccines, identify risks early, and act as a bridge between public health and clinical care. It isn’t a perfect system. But it is an ambitious one. And it offers a powerful contrast to Canada’s often fragmented approach to primary care and public health — reminding us that building a system where everyone has care is not just a matter of funding, but of design.
Further reading:
Listen to Part 1 of our series on Costa Rica with Dr. Madeline Pesec
Take a look at the research article that first introduced me to Madeline (co-authored by Dr. Atul Gawande) 
Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs 
Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul Gawande
Read the BBC article Tara mentioned about how Nicoya Peninsula is home to a large number of centenarians
Learn more about rising violence in Costa Rica related to femicide and gang violence
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 
More about Primary Focus:
Subscribe to our Substack newsletter
Visit our website at primaryfocus.ca
Learn about the OurCare Standard
Do you have an idea for an episode? Email [email protected]
Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 
Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

This episode is the first in a two-part series on the primary care system in Costa Rica. Dr.Tara Kiran sits down with Dr. Madeline Pesec, an internal medicine physician and pediatrician, to explore Costa Rica’s ambitious primary health care system. They talk about how Costa Rica's commitment to health as a human right and its community-oriented primary care have led to significant improvements in health outcomes. From the concept of "Hospital Without Walls" to the role of community health workers, Madeline shares insights from her extensive research and personal experiences in Costa Rica. Then, join us in our next episode where Tara goes on a tour of a Costa Rican clinic and speaks to members of the EBAIS (Equipos Básicos de Atención Integral de Salud) about both how and why they do their work. 
Further reading:
Take a look at the research article that first introduced me to Madeline
Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs 
Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul Gawande
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 
More about Primary Focus:
Subscribe to our Substack newsletter
Visit our website at primaryfocus.ca
Learn about the OurCare Standard
Do you have an idea for an episode? Email [email protected]
Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 
Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com