INSIDE
PALLIATIVE PLANNING:
BEYOND THE BEDS Pg. 17
HEALTH EATING F Y O SENIORS R
Pg. 8
Healthier You Fall
OVERDOSE EMERGENCY
Working together to save lives
SURGICAL EXPANSION
More surgeries planned at Kamloops hospital
The more we know
2016
SENIORS CARE
Information for seniors including healthy eating, palliative planning and more research studies at Interior Health – p. 10
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Volume 2, Issue 1
featurestory
Fall
Working together to save lives
2016
Responding to B.C.’s overdose emergency takes a multi-pronged approach – and a lot of team work.
22
p.
INSIDE HEALTHY EATING ������������������������������������������� PAGE 6 Giving your body the nutrients and energy it needs is important at any age... THE MORE WE KNOW ���������������������������������� PAGE 10 Interior Health’s research team loves asking questions and finding answers... FAMILY MEDICINE TRAINING EXPANDS ���� PAGE 13 Doctors in the South Okanagan are on a path to rural family practice... By Kerry Blackadar, UBC. Photos by Warren Brock, UBC
Gillian Frosst is leading the surveillance response.
PALLIATIVE PLANNING ����������������������������� PAGE 17 Patients and loved ones deserve the best in palliative and end-of-life care... OPERATION EXPANSION �������������������������� PAGE 20 Patients waiting longest expected to benefit from surgical expansion at Kamloops hospital...
Tasty recipes to keep seniors healthy
p.8 FALL 2016
Healthier You
3
WELCOMEmessage
Welcome from Interior Health It’s hard to believe a year has passed since I was interviewed and offered the position of Interior Health President & CEO. Time f lies! And a lot has happened in that year. What still resonates most for me, though, is our “every person matters” focus. I continue to be amazed and inspired by the work being done, as well as the commitment to provide quality care to all. This is reflected in the many patient thank-you letters we receive. At the end of August, I joined my Chris Mazurkewich, RURAL AND President & CEO Interior Health ABORIGINAL wife for a seven-day canoe trip through HEALTH MENTAL HEALTH AND SUBSTANCE Bowron Lake Provincial Park. It was an incredible USE opportunity to immerse ourselves in the beauty PRIMARY SURGICAL HEALTH of whereSENIORS we have the good fortune to live. CARE ACCESS CARE But it was also a timely reminder of the PRIMARY HEALTH CARE importance of planning and navigating in SENIORS CARE PRIMARY order to achieve a goal. (Incidentally, she SENIORS CARE HEALTH CARE gets all the credit for that!) RURAL AND ABORIGINAL HEALTH MENTAL HEALTH AND To succeed, we need to be clear about RURAL AND SUBSTANCE SURGICAL ACCESS ABORIGINAL USE HEALTH where we are headed and how we are MENTAL HEALTH AND SUBSTANCE USE getting there; this applies to our work here at Interior Health, and it also applies to each SURGICAL ACCESS of us in our efforts to live a healthy life. Speaking of direction and goals, we’ve been using the Healthier You magazine to introduce our Five Key Strategies, sharing our goals for Primary Care, Frail Elderly/Complex Medical, Mental Health and Substance Use, Surgical Access, and Rural and Aboriginal Health through related patient and provider stories. This issue features more stories about the good work occurring in these priority areas. It’s great to see our partnership with UBC’s Southern Medical Program continue to expand, as it supports rural health and primary care. Implementation of our palliative care strategy will make a difference to many seniors. More recently several other initiatives have come to light as priorities for Interior Health – a good example is overdose prevention work in response to the tragic number of overdoses now occurring across B.C. You’ll read about work that’s happening to respond to this public health emergency. In this issue we’ve also featured tips for healthy eating for seniors; a story about the important role of research within Interior Health; and how we are enhancing surgical access thanks to the expansion of our surgical service at Royal Inland Hospital in Kamloops and other areas of Interior Health. I hope you enjoy the read. We welcome your feedback at IHACommunications@interiorhealth.ca.
4 Healthier You
FALL 2016
Healthier You Volume 2, Issue 1 – Fall 2016
Published by:
www.glaciermedia.ca
PUBLISHED BY INTERIOR HEALTH & GLACIER MEDIA
Copyright ©2016. All rights reserved. Reproduction of articles permitted with credit. Interior Health
Contributors / Healthier You is produced by the Interior Health communications team with contributions from public health staff, in partnership with Glacier Media. Interior Health Corporate Office #220 - 1815 Kirschner Road Kelowna, BC V1Y 4N7 Glacier Media Group
Sales & Marketing Kevin Dergez Director of Special Projects kdergez@glaciermedia.ca Ellyn Schriber Newsmedia Features Manager BC eschriber@glaciermedia.ca Keshav Sharma Manager Specialty Publications ksharma@glaciermedia.ca
Advertising Sales The Daily Courier – Kelowna Kamloops This Week
Creative Director / Eric Pinfold eric@phitted.com | www.phitted.com
Advertisements in this magazine are coordinated by Glacier Media. Interior Health does not endorse products or services. Any errors, omissions or opinions found in this magazine should not be attributed to the publisher. The authors, the publisher and the collaborating organizations will not assume any responsibility for commercial loss due to business decisions made based on the information contained in this magazine. Speak with your doctor before acting on any health information contained in this magazine. No part of this publication may be reproduced or transmitted without crediting Interior Health and Glacier Media. Printed in Canada. Please recycle.
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Healthy eating for seniors
W
HEALTHY EATING IS IMPORTANT AT ANY AGE.
hen you eat healthy, you give your body the nutrients and energy it needs.
Healthy eating means:
• A way of eating that meets your energy and nutrient needs and supports your physical, mental and emotional health. • Being able to shop for, buy and prepare a variety of healthy and affordable foods. • Being able to enjoy the food that you eat. • Getting pleasure from sharing meals with family and friends. As you get older, your body’s ability to use or absorb some nutrients may change. Changes in home life can also impact how we eat as we age. We may no longer be preparing meals for a family – instead, we may now be shopping and cooking for one. Our budget may be more restricted than in the past. And we may have a chronic disease, such as heart disease and diabetes. You can meet your nutritional needs by following Eating Well with Canada’s Food Guide, available from Health Canada (www.hc-sc.gc.ca).
If you are over 50 years of age, aim for: • 7 servings of vegetables and fruit; • 6 to 7 servings of grain products; • 3 servings of milk and alternatives; and • 2 to 3 servings of meat and alternatives 6 Healthier You
FALL 2016
As you get older, you may find it harder to get to a grocery store to buy your groceries. Look for services in your community such as: • Home delivery from grocery stores • Fruit and vegetable delivery from local farms • Meal delivery services • Or ask a neighbour to pick you up a few items on their next trip to the grocery store
You may find yourself only cooking for one or two and this can be challenging! You can try to: • Cook larger portions and freeze leftovers for later • Cook a few meals each week with friends and families • Join a community kitchen program • Have a recipe exchange with friends and family If you have any questions about healthy eating, food, or nutrition, call 8-1-1 toll-free in B.C. to talk to a Registered Dietitian. The Dietitian is available 9 a.m. to 5 p.m. Monday to Friday. You can also leave a message after hours and a dietitian will return your call. Visit www.healthlinkbc.ca/healthyeating/ for more information. continued on page 8
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Healthy Eating for Seniors
Spinach Frittata This spinach frittata uses simple ingredients, and it is easy to prepare. It includes a serving of vegetables, along with protein and fibre. It can also be modified based on the ingredients in your fridge or your personal preferences. For example, try adding mushrooms, peppers or other vegetables. Serve with a slice of whole wheat toast, a glass of milk and fruit for dessert. Serves: 1 Preparation and cooking time: 20 minutes Per serving: Calories: Protein: Fat: Carbohydrate: Fibre: Sodium: Calcium:
362 23 g 14 g 19 g 3.8 g 562 mgs 316 mgs
Ingredients • 2 eggs • 11/2 tsp (7 mL) water • 1/2 tsp (2 mL) olive oil • 2 tbsp (25 mL) chopped onion • 1/4 tsp (1 mL) minced garlic • 1 cup (250 mL) chopped spinach or Swiss chard, packed • 1/4 tsp (1 mL) dried basil • 2 tbsp (25 mL) grated parmesan cheese Instructions 1. In a small bowl, whisk eggs and water together. Set aside. 2. In a small non-stick skillet (fry pan), heat oil over medium heat. Add onion and garlic, cook for one to two minutes. 3. Stir in chopped spinach or Swiss chard and basil, and cook for three to four minutes or until wilted. 4. Add the egg mixture and cook for three to five minutes or until browned on the bottom but still not completely set on top. 5. Sprinkle with cheese. 6. Flip frittata over and cook for one to two minutes until browned and completely set. 7. Remove from pan and cut in half.
Reprinted with permission from the Healthy Eating for Seniors handbook. To order a print copy of Healthy Eating for Seniors, call HealthLinkBC at 8-1-1. Find it online at www.gov.bc.ca.
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The more we know:
Research at Interior Health
LISTENING TO RESEARCH DEPARTMENT DIRECTOR DEANNE TAYLOR TALK ABOUT RESEARCH WITHIN INTERIOR HEALTH, SHE SOUNDS LIKE A KID IN A CANDY SHOP.
T
o say that she is passionate about research would be an understatement and there is a lot to be excited about these days. There are more than 150 active research studies underway within Interior Health. These studies focus on a variety of health-care topics, including how to improve treatment, prevention, addressing challenges within the health-care system, supporting aging patients, engaging staff, and pharmaceutical trials. “The research currently underway covers babies to seniors and everything in between,” says Deanne. “Research is the knowledge that guides how we improve care. It helps keep us moving forward. The closer to home research occurs, the more the findings will reflect the realities of those studied, and the more effective it can be.” She believes the best research comes from lived experiences. One of the first things Deanne did when she started in her role with Interior Health earlier this year was make site visits to different parts of the health authority. “I was introduced to the concept of how rural life affects care and the interesting and innovative ways to look at rurality from the academic, health, and lived perspective.” People in rural sites provide a continuum of care from birth to aging and, despite obstacles that occur because of their distance from urban centres, they have come up 10 Healthier You
FALL 2016
ABOVE: Research
Department Director, Deanne Taylor.
Research study SALTY looks at quality of life in later years Interior Health researchers are among a team recently awarded $2 million for a new national study.
Interior Health has an enthusiastic team of researchers who are avid about both asking and answering questions.
with innovative solutions to fill those gaps,” she says. “I want to learn from them. A research department’s role is to learn from these areas and support research, which is not just doing research, but to form research questions. We look at a piece of knowledge that may work in one area and not another and ask why.” For Deanne, everything starts with a question. It doesn’t matter whether she is reading an autobiography or visiting rural health-care sites, research questions form in her brain. Deanne says she is so fascinated by research and how it plays into everything from leadership to front-line work that it pretty much consumes her whole world. Important questions arise out of books and conversations, she finds, and most often those questions are related to health care and the interrelationship with social issues, specifically marginalized and vulnerable populations like the frail elderly. Interior Health’s Research Department was established in 2005. In 2008, a grant from the Michael Smith Foundation for Health Research to look at improving health outcomes, allowed the department to further develop and it has been growing ever since. “Research in health-care settings results in better health care. That is the driver of all of our efforts to increase research capacity at Interior Health,” says Scientific Research Director Yvonne Lefebvre. “The research department has attracted funds to support research capacity building across all regions of Interior Health. We need to engage in research individuals in the urban centres and in more remote and rural settings, include those of all ages, and from all populations including the vulnerable. Our goals are challenging but the payoffs promise to be significant to the health and well-being of those we serve.” The recent recruitment of research practice leads along with others who are trained to develop and support research activities bodes well for the future of research at Interior Health, Yvonne says. The team recently developed an interactive online map that shows where studies are located as well as the area or type of research occurring. The map currently identifies 112 studies associated with a specific location; other studies are Interior Health-wide. To view the online map and to learn more about current research within Interior Health, visit the Research Department web page at www.interiorhealth.ca.
Seniors – Adding Life To Years (SALTY) is a fouryear research project that will evaluate programs, practices, and policies used in residential care facilities across Canada. The team aims to better understand how to add quality to the years in the last phase of life for people in residential care and their caregivers. The project, which involves decision-makers, clinicians, care providers, and family/friend caregivers, is being conducted in B.C., Alberta, Ontario, and Nova Scotia under the direction of Dr. Janice Keefe, Professor at Mount Saint Vincent University and Director of the Nova Scotia Centre on Aging. Project partners include Heather Cook and Dr. Deanne (Dee) Taylor from Interior Health, along with: Dr. Carole Estabrooks, University of Alberta; Dr. Tamara Daly, York University; Dr. Ivy Bourgeault, University of Ottawa; Dr. Kelli Stajduhar, University of Victoria; and Dr. Leah MacDonald , Vancouver Island Health. This project is funded by the Canadian Institutes of Health Research (CIHR), the Nova Scotia Health Research Foundation, the Michael Smith Foundation for Health Research, Alberta Innovates–Health Solutions, and the Alzheimer Society of Canada.
Rural community “pumped” about research The Community Research Lead recently participated - as a co-investigator within a UBCO & TRU research team - in a series of focus groups with representatives from six rural communities. There were four Citizen-Led Health Service Coalitions and two non-citizen led groups that were engaged across Interior Health. A CIHR planning grant enabled the research team to travel to these six rural communities to listen and learn about the motivations and ‘entrepreneurial approaches’ used by citizens to advocate and secure health-care services that they deem necessary to allow residents in their community to stay in their community as they age (called ‘aging in place’). Residents from these towns and villages with populations ranging from 270 to over 3,000 were engaged in this collaborative process. The research team will analyze the data and use it to shape an upcoming day-long planning event when the research team, community group Coalition representatives and Interior Health staff will come together to determine next steps. Community based research processes like this one enable community partners and researchers to co-create solutions to local challenges. One representative had this to say about their experience… “Just wanted to tell you how much we enjoyed our encounter with your research team. Everybody was pretty pumped afterwards.”
FALL 2016
Healthier You
11
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Forever Grateful. KGH Foundation helps grateful patients give back in a meaningful way. Since 1978 the Kelowna General hoSpital Foundation haS been the bridGe between a GenerouS community and the reGionS rapidly GrowinG healthcare needS.
Over the past 38 years, the organization has also provided a conduit for grateful patients to give back to the people who have provided ‘above and beyond’ care to them or a loved one. Many patients and family members report feeling a deep sense of gratitude for their care-givers in the face of a life-changing illness or injury, and philanthropy can be a powerful mechanism for healing and hope. For the first 69 years of his life, Kelowna resident Don Sugimoto didn’t need anything extraordinary to keep him in good health. A vital 69-year-old, Don was running ten kilometres a day, watching his diet, in essence, doing everything right. When a nagging cough suddenly took a turn for the worse though, suddenly Don found himself fighting for his life. As Don struggled to breath, he became completely unaware of his situation or surroundings. His wife, Dorothy, rushed him to Kelowna General Hospital’s Emergency Department where Dr. Jeff Eppler and his team were able to identify Don’s condition. They quickly intervened with every resource available. Intubated, put into a medical coma and hooked up to an IV with an array of antibiotics, Don was fighting a rare and serious bacterial infection. Under the watchful care of Dr. Eppler and his team, Don survived. Ron with his doctor, Dr. Keith Prestage This life changing experience left the Sugimotos feeling profoundly grateful. Their desire to give back to the team that saved his life led Don and Dorothy to the KGH Foundation where they were able to give a donation in direct support of the incredible work of the doctors and nurses in KGH’s emergency department. The KGH Foundation is an independent, volunteer driven charitable organization committed to working with donors who wish to make a difference and provide excellence in health care. Donor gifts of any amount can directly support the immediate needs of Kelowna General Hospital or the residential care facilities of Brookhaven, Cottonwoods, David Lloyd-Jones and Three Links Manor, or the Central Okanagan Hospice House. Gifts can be directed in honour of a special caregiver, towards a specific piece of approved medical equipment or to provide overall support in area of greatest need. Don remembers very little of his time at KGH, while Dorothy has vivid memories. Remarkably, they’re mostly good ones. Dorothy recalls the professionalism, the care, the compassion and the expertise that saved her husband’s life. She recalls how comforting it was to feel as though her husband was getting the best care possible, and how these people, strangers before this event, had become so important to her and her family.
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UBC family medicine residency training expands to the South Okanagan
SURGICAL ACCESS RURAL CARE
FROM A YOUNG AGE, TRAVIS THOMPSON TOOK AN ACUTE INTEREST IN MEDICINE — BUT IT WASN’T JUST AN AFFINITY FOR ANATOMY AND PHYSIOLOGY THAT DREW HIM TO THE FIELD, RATHER THE PROSPECT OF HELPING OTHERS, PARTICULARLY THOSE LIVING IN UNDERSERVICED AREAS OF THE PROVINCE. By Kerry Blackadar, UBC. Photos by Warren Brock, UBC
“When you come from a small town, you have a unique understanding of the needs felt by a community,” says Dr. Thompson, who grew up in Oliver, B.C., nestled near the south end of the Okanagan Valley. “I remember when my grandmother was sick many years ago, the entire medical community rallied around her — it was in that moment I decided I wanted to be part of a tight-knit medical community and provide quality health care to others down the road,” he recalls. This year, Dr. Thompson — a recent graduate of UBC’s Southern Medical Program in Kelowna — will continue his path to becoming a licensed family physician in the place he calls home: B.C.’s South Okanagan, the newest training ground for family medicine residents. Dr. Thompson joins three other residents — Jacqueline Bourdeaux, JoyAnne Krupa, and Rebecca Psutka — in becoming the first cohort to join UBC’s South Okanagan Family Medicine residency site, which will see up to eight residents in training by July 2017. According to the site directors Margie Krabbe and Cathy Rooke, the arrival of these new trainees will bring about many benefits for the communities of Penticton and Summerland, as well as surrounding towns, like Oliver and Osoyoos.
ABOVE (top): UBC residents ready for their work in the South Okanagan. (bottom) Drs. Krabbe and Rooke are looking forward to working alongside local family doctors and other health-care practitioners in the South Okanagan.
continued on next page FALL 2016
Healthier You
13
Dr. Travis Thompson who grew up in Oliver B.C. is now back in the south Okanagan to complete a family medicine residency.
“We’re very excited to welcome these resident physicians to the South Okanagan, a region that offers an exceptional training ground for new doctors,” says Dr. Krabbe, who has worked as a family physician in Summerland for the past eight years. Over the course of the two-year residency program, Drs. Thompson, Bourdeaux, Krupa, and Psutka will work alongside local family physicians and other health-care practitioners in Penticton and Summerland, gaining exposure to family medicine, as well as a wide range of specialties, like pediatrics, internal medicine, emergency
medicine, surgery, and psychiatry. They will train in local clinics and regional hospitals, including Penticton Regional Hospital, which is set to become home to a new patient care tower, with an expanded space for UBC medical students and residents. Drs. Krabbe and Rooke hope that the wide breadth of clinical experiences will help shape the residents’ understanding of what practicing in smaller communities is all about. “Family physicians, particularly those in smaller centres, like Penticton and Summerland, engage in a broad scope of practice and are heavily involved in inpatient and outpatient care,” says Dr. Krabbe. “Our residents will benefit from small, group learning experiences with family physicians and specialists.” Drs. Krabbe and Rooke also expect the arrival of the new trainees to have a positive impact on the medical community at large, helping to bolster the teaching environment. “The new learners are very enthusiastic and are eager to experience as much as they can, and this drive really helps to reinvigorate everyone’s passion for medicine,” says Dr. Krabbe, who is excited by the opportunity to dedicate more time in her career to training the next generation of physicians.
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Distributing training opportunities across B.C. The opening of the new training site is part of a combined effort by UBC’s Faculty of Medicine, the provincial government, and health authorities, to support the recruitment and retention of physicians to serve the health-care needs of families throughout B.C. “Residents play a very critical role in our health-care system, helping to enhance service capacity across the province. The launch of this new training site in the South Okanagan will bring about increased access to physician services and help meet the needs of communities in B.C.’s Interior,” says Roger Wong, Executive Associate Dean of Education, UBC Faculty of Medicine. Willa Henry, director of UBC’s Family Practice Residency Program — now the largest in Canada, with 19 unique training sites across the province — agrees. “Training residents throughout B.C. is important, as it not only helps increase service capacity to meet the primary care needs of British Columbians, but exposes doctors to the wide range of practice possibilities in more rural and remote regions.” The launch of the South Okanagan family medicine residency site represents a continued expansion of medical education opportunities in the Interior, which is already
home to UBC family practice residencies in Kamloops and Kelowna, an emergency medicine residency in Kelowna, and UBC’s Southern Medical Program, one of four unique MD training sites. Allan Jones, the Regional Associate Dean, Interior, says the continued growth of medical education and training opportunities in the Interior will bring benefits to the region over the long-term. “With the addition of this new site, we’ve opened up more opportunities for doctors to complete their medical journey in the Interior, and it’s our hope that this distributed approach to medical education will encourage more physicians to stay in the region to practice after their training wraps up,” says Dr. Jones.
Rural roots Over the past decade, UBC’s residency programs have witnessed steady growth. Today, nearly 1,400 medical residents are engaged in 72 different residency programs offered at clinical training sites across the province. This year, UBC welcomed 345 entry-level residents — the largest number of entry-level postgraduate trainees in the history of B.C.
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tired of being tired? Liquid Iron and Vitamin Formula helps reduce exhaustion and fatigue Iron deficiency symptom checklist Do you suffer from any of the following? Are you continually tired and lack appetite? Pale skin & dark circles under eyes? Often have difficulty concentrating? Feel chilly or catch colds easily? Have brittle hair or fingernails that chip easily? The more questions you answered “yes” to, the higher your risk of being iron deficient. Iron deficiency often goes undetected, so you may want to ask your doctor for a serum ferritin test.
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Palliative planning: Beyond the beds WHEN KEVIN DUNK’S MOTHER DIED TWO YEARS AGO, HE FELT FORTUNATE THAT HE COULD BE BY HER SIDE. HE STAYED WITH HER IN HER ROOM IN CRANBROOK’S JOSEPH CREEK CARE VILLAGE. FOR THREE DAYS, HE HELD HER HAND AND SPOKE TO HER, UNTIL SHE PASSED AWAY. “Even though I lost her, it changed me in a good way.” Kevin is now an active volunteer supporting caregivers and participating in B.C.’s Patient Voices Network, where he is an advocate and adviser on issues such as residential care, family caregivers, and palliative care. “I couldn’t walk away. There is a need to share information,” he says. “Being a caregiver can feel like such a lonely task.” Kevin’s mother died just short of her ninetyfirst birthday. After living with Kevin in his home gradually her health deteriorated. Like many others with dementia, she had spent her final years in residential care. “She was always true to herself and true to her feelings – true to her soul right to the very end. I didn’t see her pass away. What I saw was her soul being released. I was so happy for her,” he says.
ABOVE (top): Kevin
Dunk was able to be by his mother’s side
until the end. (bottom) Kevin
with his brother and their beloved mother, on a holiday prior to losing her to illness.
continued on next page FALL 2016
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17
Many of us would rather not consider our inevitable dying day. Others have strong ideas about what we would like that death to look like. In 2013, the Ministry of Health committed to improving end-of-life care in B.C. by doubling the number of hospice beds by 2020. As part of this goal, Interior Health plans to designate 51 beds as palliative – in some cases, in partnership with hospice societies – in a phased approach over the next three years. The plans include 18 community hospice beds to be located in residential care facilities, and 33 within hospitals. While the bed planning is great news for patients and loved ones, it is only one part of the solution. Interior Health’s palliative strategy is an ambitious plan that includes broad system changes.
“It’s about creating a community of care through all the different layers of palliative and end-of-life care. – Dr. Alan Nixon
An important piece of the strategy was the creation of a regional Palliative Care Medical Director position. Dr. Alan Nixon joined Interior Health in this new role on May 2, 2016. “The plan here is very exciting. Education and coordination are the foundation for this work,” he says. “It’s about creating a community of care through all the different layers of palliative and end-of-life care. “Palliative care can extend deeply into the end stages of many chronic diseases – cancer, heart disease, diabetes, dementia. We will have the opportunity to follow these patients for some time during their illness and at the end of their lives. Patients and families will see clinicians working with them who have up-to-date education and training in palliative care; who know the principles and understand the practice of palliative and endof-life care.
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“Beds are not the whole answer. The whole answer includes education, having local champions of palliative care in each community, and coordination of care throughout the continuum. For example, having patients able to transfer easily from home, to a dedicated bed in a hospice or residential care, or to hospital and then home again – with a care team providing appropriate supports along the entire journey. “The ideal is for people to die at home, but often patients are so complex at end of life that is not possible. But we want them to be as close to home as possible.” Kevin reiterates the importance of teamwork and communication. “We had our family doctor who visited the home every month and would see mom. There was always good, open communication. Dr. Alan Nixon, Interior The staff were very engaged Health’s Medical Director for palliative care. with me. I always told them ‘we are a team – you are my eyes and ears when I am not able to be here,” he says. Education also plays a fundamental role in enhancing care, and has already begun across Interior Health. In April 2016 a number of staff and physicians received five full days of training in Castlegar, Kamloops, and Kelowna. Others have taken the Learning Essentials Approach to Palliative Care (LEAP) course set by Pallium Canada. To learn more about palliative care in Interior Health, visit the Palliative and End-Of-Life pages under Your Care at www.interiorhealth.ca.
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OPERATION EXPANSION HARD WORK RESULTS IN SURGICAL SERVICE GROWTH ACROSS INTERIOR HEALTH
THE SIXTH OF SEPTEMBER BEGAN LIKE ANY OTHER FOR SURGEONS AND NURSES AT ROYAL INLAND HOSPITAL. UNDER THEIR SKILLED CARE, PATIENTS RECEIVE TREATMENT THAT WILL ENHANCE THEIR QUALITY OF LIFE, AND MIGHT EVEN SAVE IT.
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o those on the fourth floor of the Kamloops hospital, this is everyday stuff. To the rest of us, the work they do is simply extraordinary. What makes it even more special for Interior Health is that Sept. 6 marked the day that RIH expanded its surgical service by adding a planned 495 procedures to its slates before fiscal year end on March 31, 2017. It’s part of Interior Health’s plan to improve timely access to scheduled elective surgery by increasing surgical capacity across the region – particularly for those patients who have been waiting longest for their procedures. “Everyone is excited,” says Sue Gardner-Clark, the RIH Health Service Director who oversees perioperative services. “It’s going to be busy and challenging for them, but exciting as well. It’s brilliant for patients. And it’s a long time coming.” The journey to surgical service expansion actually began in 2014, with the planning of an extensive renovation that saw some existing storage space combined and transformed to create a ninth elective operating room at RIH. The project was complete the following spring, and the new theatre went into 20 Healthier You
FALL 2016
ABOVE: Members
of the surgical team in RIH’s newest OR.
operation April 15, 2015. The cost of the project was $2.5 million and was shared by Interior Health, the Thompson Regional Hospital District, and the RIH Foundation. RIH’s intention was to expand its surgical service when the ninth OR was completed. However, the stars didn’t align as originally planned. A challenge with consistent anesthesiology coverage due to unforeseen circumstances and retirements put expansion on hold. Flash forward more than a year, and RIH’s anesthesiology department has worked hard to get the Kamloops hospital through that difficult time. A lot of effort has gone into recruiting a full complement of anesthesiologists, says Dr. David Hanks, RIH’s perioperative medical director, and expansion is now ready to proceed – which is great news. At the same time, he is keenly aware that with expansion will bring new challenges for a hospital that is regularly faced with high patient volumes. He and his colleagues are ready to face that challenge. “It is good. It’s a start. A lot of hard work has already been done that needs to be recognized, but there is still work to be done to grow the program,” he says.
“RIH’s administration, the medical staff, and the physicians have done a tremendous job. Our ORs are probably the most efficiently run in the region. I can’t say enough about RIH Health Service Administrator Carol Laberge, Sue Gardner-Clark, and RIH OR manager Lesley McLeod, who have advocated for us. People do appreciate it. Everyone at RIH is doing a great job and has worked hard to get here.” RIH’s surgical expansion will focus on addressing those patients waiting longest for surgery – primarily in orthopedics such as hip and knee replacements, but also ear, nose and throat, neurology, vascular, urology, plastics, and daycare procedures. The RIH volumes are just one piece of the larger Interior Health puzzle. Improving timely access to appropriately scheduled elective surgery is a key priority for Interior Health. Thus, in addition to the 495 cases being planned for RIH this year, another 1,152 procedures have been planned across the region by the end of March, benefiting patients in the Okanagan through Interior Health’s regional operating room (based at Kelowna General Hospital), as well as at Vernon Jubilee Hospital, Kootenay Boundary Regional Hospital in Trail, and Pleasant Valley Health Centre in Armstrong. The completion of these additional procedures this year will help Interior Health meet its ultimate goal of having 95 per cent of scheduled elective surgeries completed within 26 weeks,” says Ben Rhebergen, lead for Interior Health’s surgical strategy. Ben adds that Interior Health is already showing progress. An additional 1,000 procedures were completed at KGH’s regional operating room, which provides service to patients from Penticton to Vernon, in 2015/16, thanks to extra funding provided by the Ministry of Health. This helped result in a 26 per cent reduction in those waiting longer than 40 weeks – to just 6.8 per cent at July 31, 2016, down from 9.2 per cent. Sue is excited to think about having more patients benefit from increased capacity this year. But she’s equally pleased for her staff and the surgeons at RIH, because they have worked together a long time to see the Kamloops hospital’s surgical service grow and improve – just a pocket of the work the hospital was already doing to enhance the patient experience at RIH. “It’s something that staff feels invested in, so it’s very exciting to see it finally coming to fruition,” she says.
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Working together
Harm Reduction Coordinator Jeff Walsh displays a Take Home Naloxone kit, used to treat drug overdoses.
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to save lives
O
n April 14, Dr. Perry Kendall, B.C’s Provincial Health Officer, declared a public health emergency in response to increasing overdoses and overdose deaths in our province. This is the first time these emergency powers have been exercised in B.C. The emergency declaration has sparked a flurry of activity across Interior Health with the purpose of working together to save lives. “Overdoses are occurring in our communities, our hospitals, on the street, in private homes and we all need to work together to stop this disturbing trend,” says Director Clinical Operations for Population Health Lori Hiscoe. “Responding to this emergency has required collaboration across numerous portfolios and with our community partners.” A health authority-wide emergency operations team has been formed in Interior Health. The team is focusing their work on three responses – enhancing overdose surveillance, expanding the Take Home Naloxone program, and exploring safe consumption services.
Enhanced Surveillance Gillian Frosst, public health epidemiologist is leading the surveillance response. “In public health, ‘surveillance’ is essentially about using data to inform action,” says Gillian. “Prior to the declaration of the public health emergency, we had limited data on overdoses. It was not available in real time and was difficult to turn into timely action.” The emergency declaration has resulted in an Order from the Provincial Health Officer, which has made reporting of overdose deaths and overdoses with recovery mandatory for all emergency departments. Because not all people who experience an overdose present at a hospital, surveillance tools have also been developed to track overdoses in the community. “The data we now collect is helping us better understand where overdoses are occurring and the circumstances related to those overdoses. When we know where risks are arising, we can take proactive and timely action to warn and protect people who are at risk,” adds Gillian. 22 Healthier You
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Expansion of Take Home Naloxone Naloxone is a drug that can reverse the effects of an opioid overdose. It has been used safely in emergency departments for decades. It is non-addictive, has no effects in the absence of opioids, and has no street value whatsoever. It can be administered by anyone who has completed a five- to 20-minute training session, including the users themselves. To reduce the risk of brain damage or death from an overdose, Naloxone must be administered promptly and that makes accessibility key. Take Home Naloxone (THN) is a program provided in collaboration with the BC Centre for Disease Control. The program provides training and naloxone kits free of charge to people who use opioids or have a past history of using opioids. Expanding this program will save more lives. “Before the emergency was declared, the THN program was offered in some of our emergency departments, public health centres, and through some community partners,” says Interior Health Harm Reduction Coordinator, Jessica Bridgeman. “We now have this life-saving program available in all emergency departments, all public health centres, all mental health and substance use offices, and in our primary care sites and community agencies that serve at-risk populations.” The Take Home Naloxone program is specifically for those at risk of an opioid overdose. A list of Take Home Naloxone sites is available at www.interiorhealth.ca. Friends, family members and others who wish to carry naloxone are encouraged to purchase a kit from local pharmacies – a prescription for naloxone is no longer required.
Safe consumption services
Every person matters - Chloe’s story
Safe consumption services are an evidence-based intervention proven to reduce mortality from overdoses. They provide safe and clean environments where people can use drugs under the supervision of trained staff. Dr. Silvina Mema, the Medical Health Officer who leads the safe consumption service response, points out that the model Interior Health is exploring would not be a stand-alone service like the Insite program in Vancouver. Instead, Interior Health is looking at a model that would embed the service into an existing program that already provides harm reduction and health-care services to the target population. Dr. Mema acknowledges that safe consumption services may be seen by some as controversial and that controversy is often because people do not understand how they work or the evidence behind them. “There is a great deal of evidence to demonstrate that safe consumption services benefit those at risk of overdose and the community by reducing the number of overdose deaths, connecting people who are using drugs with health-care and treatment services and also reducing the nuisance of public drug intake and discarded needles in the surrounding area.” Planning for a safe consumption service requires significant local stakeholder engagement and an application for an exemption under Section 56 of the federal Controlled Drugs and Substances Act prior to implementation. The process for seeking a Section 56 exemption is comprehensive. Feedback and consultation with stakeholders is essential for getting approval from the federal government. Kamloops and Kelowna, the two largest cities in the region and also the cities experiencing the highest rate of overdose deaths, are the communities where Interior Health has started engaging stakeholders about offering safe consumption services. More information on safe consumption services, including a list of Frequently Asked Questions, is available on Interior Health’s Overdose Public Health Emergency webpage. For a link to this page look for the yellow OD Public Health Emergency button on the right hand side of the home page at www.interiorhealth.ca.
Penticton teenager Chloe Highley was only 18 years old when she passed away from a heroin overdose on April 26, 2015. Her mother, Tricia, describes Chloe as a typical teenaged girl. “Chloe was a sweet and shy girl with a bubbly personality. She loved slushies, Harry Potter, Lady Gaga and the latest gossip about the Kardashians,” remembers Tricia. Chloe also struggled with debilitating social anxiety and depression which led her to self-medicate with street drugs like marijuana, crystal meth and eventually heroin. The Highleys are part of a growing number of families across B.C that have lost loved ones due to overdose. In the first six months of 2016 alone, 64 lives were lost across Interior Health. That’s 64 sons/ daughters/ friends/ loved ones who are now gone and 64 families grieving. Tricia says that the new measures in place could have made a difference for Chloe – especially having access to Naloxone. “Chloe was never offered a naloxone kit –even though her counsellors knew she was using heroin – the kits weren’t readily available at the time. I am glad to see they are now. “ Tricia believes that the harm reduction measures that Interior Health is implementing are important to keep people alive but she also feels that more needs to be done to make it easier for people to get the help they need when they need it and a big part of that is tackling the stigma that exists. “People tend to look at addiction as something that happens ‘outside of ourselves’ – it happens to ‘other people’ – to people who are less than ‘desirable’. You hear it when people make comments like ‘we don’t want a safe consumption site in our neighbourhood because we don’t want those people here. ‘Those people’ are sons and daughters; they are part of a family. We need to recognize the humanity in everyone and we have to stop judging. This can happen to anyone – to any family –and the shame and stigma that comes along with it can be real barriers to getting help.” Tricia acknowledges that tackling issues like stigma and improving the system are not easy but its work that needs to be done. Since Chloe’s passing she has been actively involved with the Child and Youth Mental Health Collaborative, F.O.R.C.E. Society for Kids’ Mental Health and Moms Stop the Harm. “Our family’s story does not end with the preventable death of our beloved daughter. We struggle everyday with the loss and pain. We share our tragedy in hopes that lives will be saved. The work that is happening now in both harm reduction and in the mental health system must make a difference today.”
LEFT: Gillian
Frosst is leading the surveillance response.
Chloe Highley – here with her mother Tricia – was one of many people who have tragically died too soon due to a drug overdose. FALL 2016 Healthier You 23
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