Healthy Living in the North

Robson Valley communities opt for virtual health care to improve rural emergency services

(Editor’s note: This article first appeared in our staff publication, The Northern Way, Fall 2018 edition. Read the full issue here.)

Health care providers posing with telehealth system.
Health care providers in Robson Valley launched a pilot project in November 2016 to evaluate the benefits of using telehealth to improve Northern Health’s rural emergency services. Here they are testing the system. Back row (L-R): Dr. Stefan Du Toit, family practitioner, Dr. Jatinder Baidwan, Northern Health locum (on the monitor), and Kimberly Duncan, RN; front row (L-R): Raymond Tabeshi, medical student, Brendan Lilgert, nurse practitioner student, and Sussana Gasser, RN. Photo: UBC Digital Emergency Medicine Evaluation Team.

Telemedicine technologies such as real-time videoconference consultations are enabling rural health practitioners to deliver improved emergency health care in the Robson Valley.   

Dr. Ray Markham, a general practitioner based in Valemount, BC, and Chief of Staff for Robson Valley, is one of the physicians spearheading the Robson Valley Virtual Medicine project. He says the “virtual care approach” works like this:

  • Rural family physicians in Robson Valley community clinics/emergency rooms use videoconferencing or secure text messaging to link with emergency physicians in Prince George;
  • Nurses-patients at clinics/emergency rooms in Valemount and McBride use video links to connect with local, on-call family physicians at home; and
  • General practitioners connect virtually with patients at their homes.

“Virtual support of clinicians providing emergency care in the Robson Valley has resulted in a number of patients not having to travel for their care,” says Markham. “And it’s improved the confidence and comfort of nurses and physicians in low volume settings. You realize you’re not alone – someone else has their eyes on the patient and can be supportive.”

Pilot Project Launched

Valemount and McBride are served by a total of five physicians, but on weekends or after hours, only one nurse and one physician provide emergency services to clinics in both areas. That means some patients may have to travel 90 kilometres between McBride and Valemount to actually see the on-call physician. In addition, some patients may have to be transferred to Prince George for care, over 200 kilometres away. Depending on the season, that means ambulance crews can run into inclement winter road conditions like snow and ice, or wildlife on highways. Remote locations also mean that ambulance crews are often out of cell phone range.

Markham credits Dr. John Pawlovich as the person who initially saw the need for virtual emergency health care support in northern rural areas. As the video lead for the Rural Coordination Centre of BC, Pawlovich has been providing telehealth support to First Nations communities for several years, working with the Carrier Sekani Family Services (CSFS) group across northern BC.

Following Pawlovich’s lead, the Robson Valley Virtual Medicine initiative began as a pilot project in November 2016, led by Northern Health and the Northern Interior Rural Division of Family Practice (NIRD). Over the ensuing 18 months, the telehealth approach was used and evaluated in 26 consultations. An evaluation report of the pilot, conducted by the UBC Digital Emergency Medicine Evaluation Team, was released in April 2018. Its findings showed that virtual care improves rural patient care and safety, reduces patient transfer costs, and builds relationships between rural and emergency physicians. Another benefit? It reduces stress for rural physicians, especially in acute situations.

Patients support the telemedicine approach, as well.

“The more hands involved, the better,” says a patient interviewed for the evaluation report. “The experts were right there on hand. It gives great assurance for the patient that they were in good care with two doctors on hand and two doctors on video.”

Building Rural Capacity

Dr. Stefan Du Toit, who co-led the initial testing and use of the Robson Valley virtual medicine system, is also based in Valemount, but also handles emergency calls from McBride. He says with rural doctors consulting with emergency physicians using hand-held cameras or videoconferencing stations, the physicians acquire information directly, then decide if a patient needs to be sutured, for example, or undergo a more complex procedure.

Du Toit says during the pilot, for example, Robson Valley physicians had to do three electrical cardioversions in one week. In that procedure, atrial fibrillation is corrected with an electrical impulse to the heart which resets the heart’s rhythm. Thanks to support from Prince George emergency physicians, the procedures were done locally with no complications, and patients did not have to be transferred to Prince George.

“We usually get trained as students to deal with these types of cases but very few of us have to deal with them commonly as physicians,” says Du Toit. “And when you have someone who can guide you through the case, it helps with education and teaching.”

Adds Du Toit: “Where virtual care helps me significantly is when we’re on call on the weekend – just a doctor and a nurse. We have to keep our hands on the patient. So, if you have a video call linked, you can keep your hands on the patient, and have a conversation in the room. It’s that extra support that you need sometimes. Patients and physicians benefit.”

Embedding Virtual Support

With the pilot project completed, there is still work to do to ensure the virtual medicine project continues to thrive. Among some of the recommendations made by the evaluation team:

  • Roll out stable, easy-to-use technologies slowly, provide training, and ensure IT support;
  • Involve all members of a team-based care model in the virtual care process, including regional and provincial partners such as BC Ambulance Service;
  • Address physician compensation, workload, and time factors to encourage virtual care buy-in;
  • Conduct a cost analysis to verify the cost savings resulting from virtual care.

Markham says the new system has already resulted in improved communication, learning, and understanding between rural and emergency physicians and specialists. Virtual care has also led to improved collaboration between rural family physicians and nurses in Robson Valley communities.

Telemedicine in the North

The pilot project’s success has also resulted in NIRD receiving further funding from the General Practice Services Committee (GPSC) to advance the virtual care work. The GPSC is a partnership of the Government of BC and Doctors of BC.

“It’s evolving all the time and other pieces are being added on to it. For example, a link can be sent to a patient to access videoconferencing by phone, laptop, iPhone or Android device, which enables clinicians to do virtual home visits not only with local patients, but also those in outlying areas,” says Markham.

He adds that communities including Vanderhoof, Fraser Lake, Mackenzie, Burns Lake, and Quesnel have all expressed interest in the virtual medicine project, noting that CSFS communities such as Takla Landing and Tachet have been leading remote telehealth work for years. Du Toit is the co-lead, through NIRD, to get videoconferencing up and running across the north.

“It’s really centred around providing better care for our patients, and support for clinicians,” says Markham. “It’s providing appropriate care with confidence.”

Collaboration has been key to the implementation and success of the pilot project. In addition to co-leads Northern Health and the Northern Interior Rural Division of Family Practice (NIRD), other collaborators involved with the Robson Valley Virtual Medicine project are local physicians, several specialists, and the following organizations:

  • BC Emergency Medicine Network
  • Telus (assisting with telecommunications needs)
  • Northern Partners in Care
  • Rural Education Action Plan
  • Rural Coordination Centre of BC 
  • BC SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit
  • UBC Digital Emergency Medicine Evaluation Team
  • St. Paul’s Hospital Redesign
  • Project Manager Georgia Betkus
Joanne MacDonald

About Joanne MacDonald

Joanne MacDonald is a communications consultant for Northern Health. Prior to joining Northern Health, Joanne worked in the journalism and communications fields in the lower mainland, Whitehorse and Ottawa. She keeps active by taking Zumba and spinning classes.

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Youth urged to use common sense and practise safe sex

Coasters with HIV awareness messages

Anyone can become infected with HIV or other sexually transmitted infections. Know your status, take precautions, and get the information you need before having sexual relations.

Anyone can become infected with HIV or other sexually transmitted infections (STIs), including young people. That’s why it’s so important to take precautions before having sex, advises Shannon Froehlich, manager of support services at Positive Living North (PLN) in Prince George.

Froehlich said there are many tips young people can follow if they’re considering having sexual relations, which includes both oral sex and intercourse (vaginal and anal).

“Abstinence is the safest approach. But if that’s not an option, young people should use a condom and lubrication every time they have sex,” said Froehlich. “And young people seem to consider oral sex to be safe sex — but they should be advised that it’s not.”

Just as important, she said, is having a conversation with your partner before having sex. “And don’t drink or do drugs beforehand to prevent careless actions,” said Froehlich.

Young people in northern B.C. are encouraged to visit their local health unit if they have questions about sex or are considering having sexual intercourse. Youth who want to be tested for STIs can visit their family doctor, or they can visit the local Opt clinic, which offers sexual health services including STI testing, birth control counselling, and low cost contraceptives and supplies.

Froehlich said PLN staff can supply youths with condoms and have conversations with them about sex — which will be kept anonymous.

“We can also share information about different STIs, and give them brochures that they can take to their partner to have a discussion about sex,” she said.

PLN, a not-for-profit HIV/AIDS/HCV organization, is a Northern Health community partner, and was a key participant in Northern Health’s award-winning STOP HIV/AIDS education and awareness project. PLN can be reached at three locations in northern B.C.: Prince George at 250-562-1172; Smithers at 250-877-0042; and Dawson Creek at 250-782-5202.

Visit hiv101.ca for more information and to learn about online youth educational options.

More information:

This article was first published in A Healthier You, a joint publication of Northern Health and the Prince George Citizen.

Joanne MacDonald

About Joanne MacDonald

Joanne MacDonald is a communications consultant for Northern Health. Prior to joining Northern Health, Joanne worked in the journalism and communications fields in the lower mainland, Whitehorse and Ottawa. She keeps active by taking Zumba and spinning classes.

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Attention all donors! The 2013 Scotiabank AIDS Walk for Life needs your help!

Dr. Abu Hamour

Dr. Abu Hamour, this year’s Scotiabank AIDS Walk Champion.

I’ll be blunt: the organizers for Saturday’s annual Scotiabank AIDS Walk for Life in Prince George are in dire straits. Although almost $19,000 were raised in 2012 for this signature fundraising event, donations this year are nowhere near that as tomorrow’s walk approaches.

Positive Living North (PLN), one of Northern Health’s community partners, is hosting the Prince George walk this Saturday, as well as walks in Smithers, Moricetown and Hazelton through next week. Vanessa West, PLN’s executive director in Prince George, says all of the funds raised through the AIDS Walk events stay in the host communities and go directly to the services and programs to support Canadians living with HIV/AIDS and Hepatitis C.

So West has a message for you: PLN is asking northerners to support their annual AIDS walk events or the programs and services they offer to some of our most vulnerable citizens could be at risk.

Her plea comes as Northern Health is reporting an increase in the number of HIV tests being conducted throughout the region in 2012. Not only that, Dr. Abu Hamour, Infectious Diseases Specialist in northern BC — and the 2013 AIDS Walk Champion — reports that 88 per cent of the 233 HIV-positive patients in his care are on HIV medications.

What does this mean? Simply that while Northern Health and its community partners have made great progress in our collective efforts to bring awareness about HIV and AIDS to northern BC, and encourage northerners to get tested and treated early for HIV, there is still much work to be done to ensure that progress continues.

Don’t forget that at least 25 per cent of people with HIV don’t even know they have it. And although there’s no cure for HIV, it’s now considered a chronic disease that can be managed with antiretroviral medications. But for persons living with HIV/AIDS, life can be a challenge. And the support they receive from AIDS service organizations like PLN can be invaluable.

That’s where the rest of us come in. We need to remember that HIV does not discriminate and can affect anyone — all ages, all genders, all sexual preferences.

So if you can’t make it to this weekend’s Prince George AIDS Walk, you can opt to donate online or download a pledge form by visiting www.hiv101.ca. Or you can check out the times and locations of the AIDS Walk events listed below. Choose the one that’s closest to you and help fundraise for this most worthy cause.

Help us spread the word about HIV — not the disease:

  • Prince George, Saturday, September 14 • Masich Place Stadium • Registration: 11:30a.m. • Opening Ceremonies/Walk: 12p.m.
  • Moricetown, Wednesday, September 18 • Moricetown Multiplex • Registration: 11:30a.m. • Walk: 12p.m.
  • Smithers, Thursday, September 19 • Dze L K’ant Friendship Centre • Registration: 11:30a.m. • Walk: 1p.m.
  • Hazelton, Friday, September 20 • Hagwilget Bridge Pullout • Registration: 11:30a.m.• Walk begins: 12p.m.

Also, view highlights from Monday’s news conference promoting the 2013 AIDS Walk for Life on CKPG TV.

Joanne MacDonald

About Joanne MacDonald

Joanne MacDonald is a communications consultant for Northern Health. Prior to joining Northern Health, Joanne worked in the journalism and communications fields in the lower mainland, Whitehorse and Ottawa. She keeps active by taking Zumba and spinning classes.

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Combating the fear, shock and stigma around HIV/AIDS

Be a warrior against HIV

Playing cards developed by the STOP HIV/AIDS program for the hiv101.ca campaign.

I first learned about AIDS when I worked as a newspaper reporter in Vancouver in the mid-1980s. AIDS Vancouver, one of the first AIDS support organizations in Canada, was in its infancy, and little was known about this mystery disease other than it only seemed to affect gay men who were dying of a strange form of pneumonia in various North American cities.

When it became known that AIDS was actually a global epidemic that also affected heterosexual men and women, people everywhere reacted with fear, shock and stigma.

Fast forward to October 2011, when I was hired by Northern Health to work as a communications officer on the provincially-funded STOP HIV/AIDS pilot project. Things haven’t changed much since the 1980s. Mention HIV/AIDS now and many people still react with fear, shock and stigma — mainly because they’re woefully uneducated on all things related to HIV/AIDS.

What has changed is that HIV is now considered a manageable chronic disease — it’s no longer an automatic death sentence. That’s where Northern Health’s STOP HIV/AIDS pilot project comes in. The project has been operating since 2010 and on May 29, 2012, we launched the education/awareness component of the project. As communications lead, I’ve had the opportunity to work with talented consultants, dedicated community partners and Northern Health staff on this education/awareness campaign. We’re giving northerners the facts about HIV. We’re telling them that HIV affects everyone: all genders, all ages, all races. We’re encouraging people to take an HIV test and, if necessary, seek treatment to control the disease which will allow them to lead longer, healthier lives.

Our aggressive campaign, running in communities across northern B.C., features newspaper, radio, TV and billboard ads; a new website, hiv101.ca; and catchy drink coasters, posters and other promo items all encouraging people to take an HIV test. We also created the very powerful video posted below.

It’s been a real team effort — and a very emotional one. It’s been heartbreaking to hear people living with HIV describe how they were diagnosed with the virus and, in some cases, shunned by their families and friends.

On the flip side, it’s been truly inspiring to work with people who’ve bravely allowed their photos and words to be used in our very public campaign. Their courage has enabled us to begin breaking down barriers about HIV in the north, and getting people talking about how to combat its spread. As the Canadian HIV/AIDS Legal Network points out, “Reducing the stigma and discrimination surrounding HIV/AIDS is key to both stopping the spread of the epidemic and improving the quality of life of people living with the disease.”

I’m not sure how many people we’ll actually reach with our STOP HIV/AIDS campaign. Some people say that our year-long education/awareness campaign will reach a saturation point, with our HIV/AIDS messages eventually ignored. I respond that behaviour change can take years to occur. The fact that we’re still fighting stigma about HIV more than 25 years after AIDS first appeared tells me that we still have much work to do. But I’m optimistic that if we and others persist with our education efforts that, perhaps one day, the stigma around HIV can be eliminated — along with the disease itself. For more information, visit hiv101.ca.

Joanne MacDonald

About Joanne MacDonald

Joanne MacDonald is a communications consultant for Northern Health. Prior to joining Northern Health, Joanne worked in the journalism and communications fields in the lower mainland, Whitehorse and Ottawa. She keeps active by taking Zumba and spinning classes.

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