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.

Share

Community Health Stars: Hollie Blanchette

Northern Health believes that health happens in the community and launched the Community Health Stars program to shine a light on amazing individuals who are promoting health where they live. The Community Health Stars program grew out of a desire to keep the spirit of the Canada Winter Games burning bright long after the closing ceremonies. This spirit has seen communities come together, volunteers contribute thousands of hours, celebration events taking place across our region, and residents living healthier, more active lives. When it comes to this legacy, this month’s nominee has it all: community spirit, volunteerism, active living, and more!

Our Community Health Star for the month of February has an infectious belief in the power of community connections to create healthy change. Whether she’s meeting a group to continue their “Walk Around the World”, connecting with others on one of 17 committees that she contributes to, or simply smiling and laughing with friends at the library, everything that Hollie Blanchette does seems to make Valemount a little happier and a little healthier.

Northern Health is pleased to name Hollie Blanchette as our Community Health Star for the month of February! I was very fortunate to be able to chat with Hollie about her contributions in Valemount.

Woman on a hiking trail with a mountain in the background.

“I don’t know about you but I want to live somewhere exciting, vibrant, and fun filled with happy and healthy people.” Northern Health is pleased to recognize Hollie Blanchette from Valemount as our Community Health Star for the month of February. Hollie’s commitment to community and to creating healthy change are inspiring!

Why is a healthy community important to you?

For me, it boils down to the fact that this is where we live! I don’t know about you but I want to live somewhere exciting, vibrant, and fun filled with happy and healthy people!

Another important consideration for me is that we are all aging. I think that we need to be asking ourselves how we want to age, both mentally and physically. I’m a very happy person – I think that mental wellness is such an important component of overall health – and I want to stay happy and age happily. I would like for my mind and body to stay as healthy as possible as I age and living in a healthy community is key to that.

What does a healthy Valemount look like to you?

For me, a healthy Valemount is full of diverse, unique people! Health isn’t about being a size zero and having tight skin. It is about eating healthy foods, being active, and managing stress to the best of our abilities. Each one of us is unique and there is no “perfect” – only the best you that you can be! The first step to a healthy community is ensuring that it is filled with people who are happy with themselves.

The second component of a healthy Valemount is that people are connected with one another. Our connections make our town healthier. They help us to know what is going on, who can help with what, and how each one of us can make a difference.

How are you involved in creating a healthy Valemount?

My involvement started with simply observing. When you live in a place that you love and when you want that place to be as healthy as possible, you start to notice things and then decide that you have to do something about it. For me, “doing something about it” meant connecting with projects and people in the community so I joined a few committees. I then wanted to make an even bigger impact so I ran for Council and was elected in 2011. There, I discovered the Northern Health liaison position, expressed an interest, met with local medical staff, and then took on that role. I’ve been able to learn so much from community members and partners in this role and I really enjoy it!

I currently serve on 17 different committees in town so I really see my role as knowing what’s going on, knowing who is doing what, and connecting those people in order to see projects take off. Some of the projects that I’ve contributed to and am currently working on include Valemount Walks Around the World, the building of the Bigfoot community trail system, working towards a dementia-friendly community designation, looking into projects to keep seniors happy and healthy at home, coordinating a visiting hearing clinic, installing indoor/outdoor chess, and more!

This involvement comes from a love for my town and I must say that living in Valemount is fantastic! I had moved 13 times in 18 years so when I first moved to Valemount, I didn’t hang up pictures. Now, I can assure you that there are pictures on the wall! I feel rooted here and it is that feeling that led me to get involved. This is one of the first places where I’ve really involved myself in local activities, which I believe says a lot about the wonderful place that I call home! I’ve got a great job and a great way to serve community members.

What is the Valemount Walks Around the World initiative?

Valemount Walks Around the World is a five year project that aims to get residents of Valemount moving! The project asks participants to input the time that they spend being physically active into a computer program which then converts that time to steps and tracks both individual steps and community steps on a walk around the world. Whether you swim, bike, in-line skate, walk, or run, your total helps move Valemount across the world!

The project has been a huge success in all sorts of ways! We just started year three and we’ve got about 10 per cent of our population signed up to the program. We just recently made it across the Atlantic Ocean together! We’ve also connected with local doctors who have noticed some patients walking as part of this project who are showing lower risks of chronic diseases and experiencing reduced morbidity.

What is your message for other northern B.C. residents?

For me, healthy communities start with the citizens. It is the citizens who see gaps and opportunities and it is the citizens who need to take these ideas for healthy change to the community.

If you have a project that you want to take on, look around for the liaisons, groups, and partners who might be able to help with this idea. And get involved with local non-profit organizations. These are the groups that can make it all happen and they keep you involved and busy! This is how communities can become healthier – citizens see a need, they ask for change, and then they connect with one another to create that healthy change.

Lastly, I think that a lot of health comes from being a happy person. Everything else fills itself in from there!


 

The Northern Health Community Health Stars program shines a light on community members across northern B.C. who, like Hollie, are doing exceptional work, on their own time, to promote health and wellness in their community. To nominate a Community Health Star in your community, visit the Northern Health website.

Vince Terstappen

About Vince Terstappen

Vince Terstappen is a Project Assistant with the health promotions team at Northern Health. He has an undergraduate and graduate degree in the area of community health and is passionate about upstream population health issues. Born and raised in Calgary, Vince lived, studied, and worked in Saskatoon, Victoria, and Vancouver before moving to Vanderhoof in 2012. When not cooking or baking, he enjoys speedskating, gardening, playing soccer, attending local community events, and Skyping with his old community health classmates who are scattered across the world. Vince works with Northern Health program areas to share healthy living stories and tips through the blog and moderates all comments for the Northern Health Matters blog. (Vince no longer works with Northern Health, we wish him all the best.)

Share

Tales from the man cave: Wonderful communities in action

Jim in Valemount

Jim at the community health fair in Valemount.

I was recently in Valemount at a health fair put on by the community, which was funded by a Healthy Communities grant.

Every move counts

For a small village community of about 1,200 or so, Valemount is punching well above its weight by walking the world. I believe they want to clock about 50,000km. This community is really engaged in increasing wellness by active living and this is a beautiful place on the planet in which to do so.

At the Poker walk, we had a small crowd take off and start the trail of five stations. I was on station number five and the sun was shining down on me gently. I had been starved of this sun from a long winter but I did my healthy living bit by wearing a hat to protect my aging and balding head from its rays.

I met some lovely people there who are really engaged in the well-being of their community and under the tent, a stone’s throw away, there is much laughing and comedy.

On the trail of Bigfoot

These things are, in my opinion, great measures of health. Life is serious but we can have fun with it nonetheless. Speaking of which, Bigfoot was reportedly seen in many areas of the walk and locals are calling to have him registered as a highly protected species. Reportedly, Bigfoot was photographed in 1957 and is Valemount’s equivalent of the Loch Ness Monster. I am sure its presence made some of the locals break the record for the round trip on the trail.

Keeping healthy is very important and these folks are showing me that it can be a lot of fun as well. There is a real community effort and it feels good to be here among them. My gut tells me that building a healthy community has to begin with social gatherings of this nature that aim to invigorate and support each individual to be the best they can be. It feels as if Valemount is doing this really well.

For more information on what Valemount is doing, visit their Facebook group page.

For more information on building healthy communities, visit the community health information portal.

Jim Coyle

About Jim Coyle

Jim is a tobacco reduction coordinator with the men’s health program, and has a background in psychiatry and care of the elderly. In former times, Jim was director of care at Simon Fraser Lodge and clinical coordinator at the Brain Injury Group. He came to Canada from Glasgow, Scotland 20 years ago and, when not at work, Jim plays in the band Out of Alba and spends time with his family.

Share

A focus on our people: Robson Valley health care upgrades

In this edition of my CEO video blog, I explore the recent changes to health services offered in the Robson Valley. I speak with Debbie Strang, Robson Valley health service administrator, and Toni Cinnamon, Valemount X-ray technician, about the new and improved services.

Cathy Ulrich

About Cathy Ulrich

Cathy became NH president and chief executive officer in 2007, following five years as vice president, clinical services and chief nursing officer for Northern Health. Before the formation of Northern Health, she worked in a variety of nursing and management positions in Northern B.C., Manitoba, and Alberta. Most of her career has been in rural and northern communities where she has gained a solid understanding of the unique health needs of rural communities. Cathy has a nursing degree from the University of Alberta, a master’s degree in community health sciences from the University of Northern BC, and is still actively engaged in health services research, teaching and graduate student support.

Share