The RHSRNbc fund travel bursaries to be awarded to year 1, 2 and 4 FLEX students who are working in projects that involve rural and remote health activities. Year 1, 2, and 4 bursaries are funded up to a maximum of $1000 each. These bursaries are intended to subsidize the costs of travel and accommodation related to your FLEX Project. Allowable expenses include: transportation to rural communities and accommodation. Funds will be reimbursed after submission of original receipts and final report for RHSRNbc.
“FLEX (Flexible Enhanced Learning) is a series of courses that offer medical undergraduate students unique opportunities to pursue a variety of scholarly activities in Year 1, 2 and 4 of the renewed curriculum. In FLEX, students develop and pursue activities that allow them to explore individual learning interests in greater depth.
FLEX activities can take place in academic settings or communities anywhere in British Columbia, Canada or the world.”
MED 449 (Year 4 FLEX)
In collaboration with Kootenay Boundary Divisions of Family Practice and Interior Health, two community engagements in the region were held whereby which members of the Doukhobor public had open group discussions, brainstorming cultural needs they believed primary care providers should be aware of. Based on the content identified in these discussions, thematic objectives guided the development of a clear and concise curriculum for primary health care providers who interact with the Doukhobor culture. I completed a focused literature overview to describe the necessity for cultural competency in primary care. Using information garnered from traditional Doukhobor manuscripts, and guided by the aforementioned primary literature, I created a Doukhobor cultural competency curriculum with the focal audience being health care providers across the Kootenay Boundary region. I led an in-person community feedback/engagement session with members of the Doukhobor public. Completed project deliverables include (1) Focused literature overview, (2) Doukhobor Cultural Competence Curriculum in three forms: script, pamphlet, and PowerPoint presentation, (3) Direct community engagement with members of the Doukhobor public, and (4) Article that I authored to be published in local Doukhobor publication disseminating project outcomes/next steps
MED 429 (Year 2 FLEX)
High School Educational Sessions on Health (H-SESH) is a community based project designed to provide educational sessions around health topics of interest for high school students in Terrace, BC. This project began in May 2018 and has expanded over the past two years to include middle school students. I also had the pleasure of welcoming another medical student, Nicholas Brochez, to the project in December 2018. Together, we have created and delivered more than 75 sessions on health topics including puberty, sexual health, mental health, substance use and careers in health care. As Nicholas and I continue our medical education in Terrace, BC for a year as a part of the Integrated Community Clerkship (ICC) program, we look forward to continue engaging with the community. In addition, we are working in collaboration with the UNBC Terrace Nursing Program to explore the potential option to integrate community outreach and education as a part of the nursing curricula to provide longitudinal delivery of health education to the community of Terrace.
I would also like to take this moment to thank our FLEX Project Supervisors (Dr. Denise Jaworsky and Dr. Ariane Mundhenk), RHSRNbc, administrative and staff members at School District 82, local health care team members in Terrace, and the nursing coordinators at UNBC. Without their continued support, this project would not be possible. I have gained so much knowledge and experience in the past two years, which will greatly contribute to my personal and professional development as a physician.
MED 419 (Year 1 FLEX)
Previous research has identified poor health outcomes in the Bella Coola Valley with a specific community identified concern for youth issues including lack of opportunities for social
and recreational activity (Health Profile - Bella Coola Valley and Bella Bella British Columbia, Thomassen, 2003). We hypothesize that there are barriers (educational, environmental, and resource based) that youth in this region face that prevent them from engaging in physical activity and that low physical activity is a contributor to poor health outcomes. To address this hypothesis, we will complete the following aims:
Aim 1: Connect with the community and build relationships via classroom and outdoorbased
educational sessions about physical activity in collaboration with the local Bella Coola
Valley elementary and secondary schools.
Aim 2: Determine youth identified barriers to physical activity by administering a survey
to youth through the local Bella Coola Valley elementary and secondary schools.
Aim 3: Work with community champions to overcome youth identified barriers to
physical activity by creating a community action plan to address them.
During the MEDD419 FLEX cycle we completed Aim 1 and began working on Aim 2. To complete Aim 1 on May 13, 2019, we travelled to the Bella Coola Valley. While we were there we delivered: three presentations on physical activity at Nusatsum Elementary School to grade 5, 6, and 7 classes; four presentations at Acwsalcta School to the grade 6 - 9 students on physical activity and grade 10 - 12 students on healthcare careers; and one presentation at Sir Alexander Mackenzie Secondary School to the grade 12 biology students on healthcare careers. We also completed two full days, with different morning and afternoon groups, of trail maintenance and hiking (outdoor educational sessions) with the Acwsalcta grade 6-12 students. This allowed us to build relationships with the youth, principals, and teachers in the Bella Coola Valley.
Some other activities we also had the opportunity to engage in allowing us to learn about the valley community were: attending the Acwsalcta potlatch; hiking with the Nusatsum grade 5-7 students; eating at the Legion community burger night; participating in drop-in ultimate frisbee; participating in the Bella Coola Elementary School bike home from school week events; meeting for conversation and dinner with two local retired physicians; and having dinner with a current local physician. Together all of these activities allowed us to make many connections in the Bella Coola Valley with teachers, healthcare professionals, and other local community members and to learn about the Bella Coola Valley and its opportunities and limitations. To follow through with our time in the Bella Coola Valley and present what we accomplished with the schools to the community we wrote a newspaper article that is awaiting publication in the
local newspaper, Coast Mountain News. Before, during, and after our time in the Bella Coola Valley, we completed a literature review to answer the following four questions:
1. General barriers to physical activity in rural/remote communities in Canada
2.General barriers to physical activity in youth in rural/remote communities in Canada
3.Health status of the Bella Coola Valley and the youth population within.
4.Barriers to physical activity in the Bella Coola Valley.
We completed literature searches of Medline OVID, PubMed, ERIC, and CINAHL databases to find our 23 papers for the body of the literature review with several other articles/sources used in
the introduction to define our terms and for health and population data. The information gathered will be used to help develop a survey in the future. What we learned about the Bella Coola Valley and from our literature review will be extremely helpful in moving forward with the development of a youth survey (Aim 2) in the Fall during MEDD 429 and the connections we made in the community our absolutely essential to keep moving forward with our project and ensuring that this research is something based on community needs and values.
In Canada, rural community members receive less access to health care, leading to a disadvantage in some health outcomes. There are, however, some regions of rural Canada such as the East Kootenays that have higher indices of health. Studies on rural health outcomes typically focus on what makes rural communities less likely to be healthy, rather than examining what makes rural communities healthy. Our study aimed to identify factors leading to increased health within communities in the East Kootenays, and to identify ways that health could be improved. Previously, this work has been undertaken in Kimberley, BC. For my project, we chose Sparwood, BC as a focus community of a resource extraction based town. We conducted 10 key informant interviews with community leaders to identify factors that influence health within the community. We found that Sparwood has some features of a traditional industry based town that do not support healthy living, but that there are ample recreation opportunities and an emerging culture that supports a more active and healthy lifestyle.
I have been invited and introduced to the Indigenous community of Sea Bird Island. Seabird Island is a self-governing Indigenous community that is situated in Stó:lō. Territory. One of the community missions is quoted to be that “The Seabird Island Band exists to promote a healthier, self-sufficient, self-governing, unified and educated community. We believe that a healthy community is one that has achieved physical, emotional, mental, spiritual and cultural balance.”. To achieve this aim, they developed a health promotion team consisting a nutritionist and her assistant, two licensed practical nurses, and a mental health professional. Health promotion is often defined as empowerment of people by increasing control of their own health through awareness and prevention techniques. However, it is important to acknowledge that the Indigenous view of health promotion incorporates the individual’s environment, culture, community, and self as a holistic interconnection of health.
The Seabird Island health promotion team gave me the role of researching effective nurse led health promotion strategies that can be utilized in an Indigenous community. I gathered information about current Indigenous focused health promotion strategies through peer-reviewed literature and by reaching out to other Indigenous organizations and First Nations communities. With this information I created a literature review and a resource table that the health promotion team could reference when developing a health promotion strategy for the upcoming year. Within this table I gave suggestions on how the team could use the resources to employ for the health promotion plan for the upcoming year.
Additionally, I engaged with the community via shadowing local physicians, attending the Seabird Island festival, and working with the nutrition team for their community kitchens (community event where people gather to make food together and learn about healthy cooking). I wrote regular reflections about this experience. These reflections helped me be mindful of my experience with the community. My goal is to become a physician that practices in Indigenous communities and I feel confident that these reflections helped me grow towards this goal.
Elk Valley Hospital (EVH) is a rural community hospital in Fernie with a 24/7 Emergency Department (ED) and 20 inpatient beds that services a catchment area of approximately 14,700 people. In addition to its residents, the town of Fernie has a large seasonal population increase over the winter months and sees over 300,000 visitors annually, many partaking in mountain sports. Currently computed tomography scanning (CT) is not available at EVH, which requires patients needing CT to travel (either by private car or BC Ambulance transfer) to the regional hospital 97 km away. This results in significant delays in imaging, potential delays in diagnosis and management, costly inter-facility transfers, and potentially decreased access to care for residents and visitors. The aim of this project is to determine the number of ED patients who required inter-facility transfer for CT imaging in a one-year period, evaluate reasons for required imaging and quantify resulting time delay due to transfer needs. Through these measures the initial steps of Quality Improvement will be completed, establishing if patients’ needs are being met through the current system or if new solutions need to be explored. Future phases of this project could include determining the cost of acquiring, maintaining and staffing local or mobile CT to improve access to healthcare for residents.
The aim of this project was to identify the needs of the autism community in Northwest BC. This project was important to inform the types of changes that we would advocate for and to create programs that can be tailored to the needs of the community. We conducted 30 interviews in Terrace, Kitimat, and Prince Rupert with caregivers, individuals, organizations that work with people living with autism, physicians, educational staff, behavioural analysts, behavioural interventionists, a music therapist and art therapist. The questions helped to identify health, education, social, transportation, employment, housing, caregiver and Indigenous needs that were relevant to these communities. The research was part of Autism BC’s larger venture of program development and delivery, prioritizing the region of Northwest BC. The findings from our needs assessment will inform future services provided to this community.
"We are two second year medical students working on a project for the Centre for Rural Health Research (CRHR), under the supervision of Dr. Jude Kornelsen. The overarching project is called: Building Blocks to Sustainable Rural Maternity Care – The North Island Project, and it is an initiative aimed at improving rural maternity services on northern Vancouver Island. There is a clear disparity between the system goals of supplying maternity care within rural communities and the reality of providing these services on the North Island. Because of the geographic isolation and lack of availability of local services in these communities, the necessity travelling long distances for their baby’s due dates has been realized by most mothers. This poses social and financial challenges associated with leaving a familiar environment and community supports. Additionally, compared to BC averages, a relatively large proportion of women on the north island experience heightened social vulnerability, including teen, substance using, single, and indigenous mothers. Providing culturally and socially responsible care for these women is of particular importance. Understanding the experiences of these high-risk mothers has been identified as a clear gap in current literature.Our project, Voices of the North Island, is a participatory health research study, focused on hearing birth and pregnancy stories from mothers and families, facilitating the data feedback loop with communities, and we plan to document our findings into literature. We have been on two trips so far; the first introducing ourselves to the community, and the second for data collection. We have conducted interviews in many communities in the North Island region, including Port Hardy, Alert Bay/’Namgis First Nation, Gwa’sala ‘Nakxwada’xw First Nation, and Kwakiutl First Nation. We are now analyzing our data back at UBC. Our goal is to provide evidence to act as an instigator for change in community policy on maternal healthcare."
Virtual Healthcare Roadshow – Taking the Traveling Healthcare Roadshow Online – Zhao Xuan
“The Virtual Healthcare Roadshow is a video showcase of healthcare careers targeted towards rural high school students, ranging from medicine and nursing to midwifery and medical radiography. It is part of the Healthcare Travelling Roadshow run out of UNBC and UBCO, which features week-long road trips to various rural high schools across northern and central BC where students from various healthcare fields present about their respective professions. I was the videographer for the Cassiar Roadshow which travelled to Smithers, Dease Lake, Watson Lake, and Fort Nelson from April 29th to May 5th. It was eye-opening to see the northern communities and to interact with students from other professions such as lab tech, OT, respiratory therapy, and pharmacy and gain an appreciation for how they might work together. Additionally, by speaking to community members, I was able to better understand the current state of rural and remote healthcare and what improvements need to be made.”
Experiencing Indigenous Well-being: Researching and Assessing the Impacts on Medical Students of Cultural Learnings Gained by Being Immersed in Northern First Nations Communities – Gabby Levesque
“This project was open to medical students to learn more about what life is like living in a remote First Nations community. This experience exposes medical students early on in their careers to remote communities and how they may differ from larger more accessible centers. The communities involved in this project are very welcoming and eager to share their stories, history and homes with medical students. I was very fortunate to spend 5 days in Hartley Bay, a community of 150 people just south of Prince Rupert, BC. During my stay, we heard stories from elders, went on a whale survey with the Guardians, visited the health clinic and talked with nurses, a mental health worker and mobile diabetes team that was there for a couple of days. We attended an archeology presentation about the Gitga’at land and history which was very informative, and got to explore the land through hikes and kayaking. We also learned how basic everyday tasks, such as grocery shopping, are much more challenging for isolated communities such as Hartley Bay, as there are no local stores and it is only accessible by ferry or float plane. It is a truly humbling experience being welcomed into someone’s home and life the way we were welcomed into Hartley Bay.”
The First Nations Community Education Program (FNCEP)
The First Nations Community Education Program (FNCEP) was established several years ago as a unique partnership between the Northern Medical Program and the First Nations Health
Authority, the Health Arts Research Centre at UNBC, and the Northern Heath Authority.
Through FNCEP, we (4 medical students from 1st and 2nd year UBC medical school) visited the Gitga’at First Nations community in Hartley Bay, BC for one week this April. The experience was unparalleled as we soared through mountains on float plane to get to our rural destination. The four of us took a dive head first and were warmly welcomed by the Gitga’at nation. Throughout the week, we learnt from the elders, the children, explored nature and its offerings, and most importantly, connected and learnt from the Gitga’at people about their way of life and their rich history that is closely linked to their health and health outcomes. The lessons learnt in our short week about the rural and indigenous way of life, especially in a community as isolated as Hartley Bay, will be carried with us throughout our medical training and careers.
Participation in the 2018 Northwest Food Security Forum – Claire Deboer
Provide a brief description of your activity and the role you played working with your supervisor (and peers if a group project) in the planning and implementation of the activity.
“First: I assisted with the organization and production of the 2018 Food Security Forum in Smithers, BC. The goal of this two day event was to promote increased food security and resilience by supporting initiatives as prioritized by communities, and encouraging networking of key players. My role was in contributing to the logistical arrangements, communicating with various speakers, participants, and sponsors, and researching certain projects (e.g. root cellars). This role also included note-taking throughout the event, and compiling these and other forms of recordings into a final report, which has been edited by my supervisor and posted to their website. I also wrote a personal reflection to better understand my experience.
Second: I completed a policy scan of food security related policies along Hwy 16 from Prince George to Smithers. A brief review of literature was used to inform my conception of “food security,” its different facets, and what it means at a community/local level. I primarily examined the OCPs of the communities and rural areas along this stretch of highway, but also looked at Northern Health policy, First Nations Health Authority policy, and Public Health policy along this corridor. The purpose of this scan was to identify themes in the policy as well as ascertain where gaps occur; the scan includes a summary table in the hopes it can contribute awareness of this issue. A more extensive scan in an overlapping subject area is being performed by a Masters student from SFU.”